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)
Hands to midline
4 mths (3-5)
Unilateral reaching while prone on elbow
5 mths (4-6)
pivot prone position
5 mths
Begin intra axial rotation
5 mths (4-6)
Rolling prone to supine (segmentally)
5 mths (4-6)
supine, hands to knees and feet
5 mths (4-6)
supine bridging
5 mths (4-6)
Ring sitting, unsupported with full trunk extension and high guard
6 mths (7-9)
Transferring objects hands to hand
6 mths (5-7)
Beginning quadruped
8 mths (7-9)
Begins pull to stand
8 mths (7-9)
Creeping
10 mths (9-11)
Walking independently
12 mths (10-15)
Creeps up stairs
15 mths (14-18)
What do you see at 1 mth of “normal” development
• Decreased flexion
• Momentary head elevation with minimal forearm support
• Tracks a moving object with head rotation
• Head usually to side
• Reciprocal and symmetrical kicking
• Positive support and primary walking reflexes in supported standing
• Hands fisted with indwelling thumb most of the time
• Neonatal reaching
• Alert, brightening expression
What do you see at 2 mth of “normal” development
• Head elevation to 45° in prone, prone on elbows with elbows behind shoulders
• Head bobs in supported sitting
• Does not accept weight on lower extremities (astasia-abasia)
• Responds to friendly handling
What do you see at 3 mth of “normal” development
• Prone on elbows, weight-bearing on forearms
• Elbows in line with shoulders, head elevated to 90°
• Head in midline in supine, hands on chest
• Increased back extension with scapular adduction in supported sitting
• Takes some weight with toes curled in supported standing
• Coos, chuckles
• Optical and labyrinthine head-righting present
What do you see at 4 mth of “normal” development
• Rolls prone to side, supine to side
° Sits with support
• No head lag in pull-to-sit
• Ulnar-palmar grasp
• Bilateral reaching with forearm pronated when trunk supported
• Laughs out loud
What do you see at 5 mth of “normal” development
• Rolls from prone to supine
• Weight shifting from one forearm to the other in prone
• Head control in supported sitting
What do you see at 6 mth of “normal” development
• Prone on hands with elbows extended, weight shifting from hand to hand
• Rolls supine to prone
• Independent sitting
• Pulls-to-stand with hands held, bounces
What do you see at 7 mth of “normal” development
• Can maintain quadruped
• Pivots on belly; moves body in circle while prone
• Assumes sitting from quadruped
• Trunk rotation in sitting
• Recognizes tone of voice
• May show fear of strangers
• Belly crawls
What do you see at 8-9 mth of “normal” development
• Quadruped creeping
• Side-sitting
• Pulls-to-stand through kneeling at furniture
• May stand independently for 1-2 seconds
• Reaches with closest arm, radial digital grasp, radial palmar, three-jaw chuck grasp, and inferior pincer grasp with thumb and forefinger
• Can transfer objects from one hand to the other
What do you see at 10-11 mth of “normal” development
Standing
- Stands without support
- Pulls to stand using half-knee to intermediate position
- picks up object from floor from standing (with support)
Mobility
- walks with both hands held
- walks with 1 hand held
- creeps on hands and feet (bear walk)
- Fine pincer grasp
- puts object in container
What do you see at 12-15 mth of “normal” development
- Walks without support
- Fast walking
- Walks sideways
- Bends over to looks between legs
- creeps or hitches upstairs
- Throws ball in sitting
- Marks paper with crayon
- Builds tower with 2 cubes
- Turns over small container to get contents
What do you see at 16-24 mth of “normal” development
- squats in play
- walks backward
- walk upstairs and downstaris with 1 hand held using both feet on step
- propel ride-on toys
- kicks ball
- throws ball
- throws ball forward
- picks up toy from floor without falling
What do you see at 2 yrs of “normal” development
• Immature running with increased speed
• Can go upstairs foot-over-foot (reciprocal stair climbing)
• Active, restless, tantrums
• Catches large ball
What do you see at 3 yr of “normal” development
• Jumps with two feet
• Rides tricycle
• Stands on one foot briefly
• Jumps off step
• Hops on one foot
• Gallops
• Kicks ball
• Understands sharing
• Climbs on playground equipment
• Mature/true run
What do you see at 4 yr of “normal” development
• Hops on one foot several times
• Stands on tiptoes
• Relates to friends
What do you see at 5 yr of “normal” development
• Skips
• Kicks ball well
• Dresses self
• Swings self on playground swing (pumps legs independently)
Asymmetrical Tonic Neck Reflex (ATNR)
- Stimulus: Head position, turned to one side
- Response: Arm and leg on face side are extended, arm and leg on scalp side are flexed, spine curved with convexity toward face side
- Normal age of response: 0-6 months
Interferes with:
* Feeding
* Visual tracking
* Midline use of hands
* Bilateral hand use
* Rolling
* Development of crawling
* Can lead to skeletal deformities (e.g., scoliosis, hip
subluxation, hip dislocation)
Symmetrical Tonic Neck Reflex (STNR)
- Stimulus: Head position, flexion or extension
- Response:
Head is in flexion = arms flexed, legs extended.
Head in extension = arms extended, legs flexed - Normal age of response: 6 to 12 months
Interferes with:
* Ability to prop on arms in prone position
* Attaining and maintaining hands-and-knees position
* Crawling reciprocally
* Sitting balance when looking around
* Use of hands when looking at object in hands in sitting position
Tonic Labyrinthine Reflex (TLR)
- Stimulus: Position of labyrinth in inner ear - reflected in head position
- Response:
Supine = body and extremities in extension
Prone = body and extremities in flexion - Normal age of response: 0-6 months
Interferes with:
* Ability to initiate rolling
* Ability to prop on elbows with extended hips when prone
* Ability to flex trunk and hips to come to sitting position from supine position
* Often causes full body extension, which interferes with balance in sitting or standing
Galant Reflex
- Stimulus: Touch to skin along spine from shoulder to hip
- Response: Lateral flexion of trunk to side of stimulus
- Normal age of response: 30 weeks of gestation - 2 mths
- Interferes with:
- Development of sitting balance
- Can lead to scoliosis
Palmar Grasp Reflex
- Stimulus: Pressure in palm on ulnar side of hand
- Response: Flexion of fingers causing strong grip
- Normal age of response: 0-4 months
Interferes with:
*Ability to grasp and release objects voluntarily
* Weight bearing on open hand for propping, crawling, protective responses
Plantar Grasp Reflex
- Stimulus: Pressure to base of toes
- Response: Toe flexion
- Normal age of response: 28 wks gestation-9 mths
Interferes with:
* Ability to stand with feet flat on surface
* Balance reactions and weight shifting in standing
Rooting Reflex
- Stimulus: Touch on cheek
- Response: Turning head to same side with mouth open
- Normal age of response: 28 wks gestation to 3 mths
Interferes with:
* Oral-motor development
* Development of midline control of head
* Optical righting, visual tracking, and social interaction
Moro Reflex
- Stimulus: Head dropping into extension suddenly for a few inches
- Response: Arms abduct with fingers open, then cross trunk into adduction; cry
- Normal age of response: 28 wks gestation-5 mths
Interferes with:
* Balance reactions in sitting
* Protective responses in sitting
* Eye-hand coordination, visual tracking
Startle Reflex
- Stimulus: Loud, sudden noise
- Response: Similar to Moro response, but elbows remain flexed and hands closed
- Normal age of response: 28 wks gestation-5 mths
Interferes with:
* Sitting balance
* Protective responses in sitting
* Eye-hand coordination, visual tracking
* Social interaction, attention
Positive Support Reflex
- Stimulus: Weight placed on balls of feet when upright
- Response: Stiffening of legs and trunk into extension
- Normal age of response: 35 wks gestation-2 mths
Interferes with:
* Standing and walking
* Balance reactions and weight shift in standing
* Can lead to contractures of ankles into plantar flexion
Walking (stepping) Reflex
- Stimulus: Supported upright position with soles of feet on firm surface
- Response: Reciprocal flexion/extension of legs
- Normal age of response: 38 wks of gestation-2 mths
Interferes with:
* Standing and walking
* Balance reactions and weight shifting in standing
* Development of smooth, coordinated reciprocal movements of lower extremities
