Peds Flashcards
Congenital Heart Disorder
- Malformation of the interior walls, valves, or major arteries or veins of the heart.
- Blood flow through the heart may be slowed, blocked or misdirected
- most common type of birth defect
Atrial septal defect
- hole in the wall of the heart separating the R and L atria.
- In fetal circulation there is normally a foramen ovale that allows for the blood flow between the atriums but it is supposed to close at birth.
- Etiology- typically genetics and environmental factors
- S&S - small to moderate may show no symptoms or may gradually show after the person ages (after ~30 yrs).
Large or long standing ASD causes:
- Heart murmur
- SOB (especially wen exercising)
- Fatigue
- Swelling of legs, feet or abdomen
- Heart palpitations
- frequent lung infection
- stroke
- cyanosis of the skin
- Treatment - surgical closure if larger
Coaractation of the aorta
- Aorta is narrow near the ductus arteriosus.
- Usually occurs with other congenital defects
- Etiology - genetics and environmental factors. May also occur latera in life due to atherosclerosis.
- S&S
Infants - (from severe narrowing), pale skin, sweating, and SOB
Older children and adults - HBP in arms and LBP in the arms. SOB, intermittent claudication, weakness, and HA.
- Treatment - surgical repair (if large or severe enough), (resection, patch, bypass), or balloon angioplasty
Patent ductus arteriosus (PDA)
- ductus arteriosus (normally shunts blood from the pulmonary artery directly to the descending aorta in utero) does close after birth.
- Etiology - genetics and environmental factors may play a role.
Risk factors: premature, other heart defects, family hx, rubella infection, DM during pregnancy, exposure to alcohol, drugs, chemicals, or radiation during pregnancy. - S&S -
Small : may be asymptomatic
Large: tachycardia, respiratory distress, poor eating, weight loss, CHF - Treatment -
Non-surgical: diuretics and indomethacin to reduce size
Surgical
Ventricular Septal Defect (VSD)
- hole in the septum separating the R and L ventricles
- if hole is large too much blood will pump into the lungs which leads to the heart failure
- Etiology - genetics and environmental factors
Risk factors: premature, other heart defects, family hx, rubella infection, DM during pregnancy, exposure to alcohol, drugs, chemicals, or radiation during pregnancy. - S&S -
Small: may eventually close the intraventricular wall grows after birth.
Large: cyanosis (skin, lips, fingernails), poor eating, failure to thrive, fast breathing/breathlessness, fatigue, swelling (legs, feet or abdomen), rapid heart rate (tachy) - Treatment - surgical patching or stitching to close the hole
Tetralogy of Fallot
4 defects:
- VSD - ventricular septal defect
- pulmonary stenosis
- R ventricular hypertrophy
- Aorta overriding the ventricular septal defect
Etiology - Risk factors: poor maternal nutrition, viral illness or genetic disorders
S&S -
- cyanosis
- SOB and rapid breathing, especially during feeding
- fainting
- clubbing of fingers and toes
- poor weight gain
- tiring easily during play
- irritability and prolonged crying
- heart murmur
- Treatment - surgery only effective treatment. If not treated can get infect endocarditis.
WeeFim what is it used to determine?
- Functional Independence Measure for Children, better known as the WeeFIM,
- Measurement tool that is administered to determine the level of caregiver assistance needed to perform functional activities
- Assessment through observation and subsequent rating in established motor and cognitive categories. The higher the score, the greater the independence of the patient.
AIMS what is it and what is it used to determine?
Alberta Infant Motor Scale
- Assesses gross motor skills in order to identify gross motor delays.
PDMS what is it used to determine?
Peabody Developmental Motor Scale
- Used to determine small changes in motor development and assist with programming for children with disabilities.
What is the primary purpose of assistive devices for a child with CP?
- Used to assist children with cerebral palsy to participate in activities and gain independence.
- Although adaptive equipment does not normalize tone, strengthen or improve postural control, it is an effective compensatory strategy to assist children to participate in activities.
- not primarily intended for normalization of tone
A physical therapist works with a seven-year-old child diagnosed with spina bifida. The therapist has noticed that over the last two months the child has become less participatory with physical therapy and has experienced more frequent behavioral issues. What is the MOST appropriate strategy to promote long-term improvement in the patient’s level of participation?
1.Continue to encourage the child to participate during each session
2.Allow the child to select treatment activities from a list of available options
3.Develop a reward system for the child based on their level of participation
4.Inform the child about the consequences associated with not participating in physical therapy
Develop a reward system for the child based on their level of participation
- Allowing the child to select treatment activities from a list of available options can serve as an effective strategy to improve the child’s participation, however, this strategy is more likely to promote short term improvement.
- reward system to improve the child’s level of participation can be an effective long-term strategy. This approach is an example of positive reinforcement (operant conditioning). This type of approach attempts to promote desirable behaviors while attempting to extinguish less desirable behaviors.
Basics of comparison of adult to newborn vitals
- temp stays about the same as an adult
- HR values will be much higher than an adults
- Respiratory rates will be higher than adults
- BP will be lower than an adults BP
Beginning midline head control
3 m (2-3)
prone on elbows, head to 90, chin tuck
4 mth (4-6)
Prone on extended arms
5 mths (4-6)
head lift in supine
5 mths (5-6)
propped sitting
5 mths (5-6)
Rolling supine to prone (segmentally)
6 mths (5-7)
Independent sitting with secondary curves
8 mths (7-9)
Plantigrade position
10 mths (10-12)
Plantigrade creeping
10 mths (10-12)
Pulls to stand and lower self
10 mths (9-12)
Cruising
10 mths (9-12)
Pulls to stand through half kneeling
12 mths (10-13)
Walks up stairs with help or handrail
18 mths(16-20)
Rolling supine to side-lying nonsegmentally
3 mths (2-4)
