Peds Conditions Flashcards
What is the first functioning organ within the growing fetus?
Heart
At what gestational age can fetal heart sounds be detected?
8-10 weeks
At what gestational age can heart contractions begin?
17 days
Fetal blood is oxygenated by what?
Placenta
Maternal circulation
What percent of blood flow of the fetus follow the pathway of adult circulation?
12%
Why does fetal circulation have an alternative pathway?
b/c of the fluid-filled lungs
Where is blood circulated to effectively bypass the lungs?
Foramen Ovale
Ductus arteriosus
Foramen Ovale
One way door in atrial septum
RA –> LA –> LV –> Aorta –> systemic circulation
When does the foramen ovale close?
First few HOURS of life
What is the Ductus Arteriosus?
Vascular link outside heart b/t pulmonary artery and aorta
Allows blood to exit pulmonary artery directly in aorta for systemic circulation
When does the ductus arteriosus close?
First few WEEKS of life
When does the ductus arteriosus close?
First few WEEKS of life
At what gestational age does the respiratory system begin?
22-26 days
At what gestational age is when surfactant is produced?
20 weeks
What is surfactant?
Lipid like substances that allows for adequate alveolar expansion by limiting surface tension across the alveolar membrane
When does ventilation occur and why?
Right after birth
First few breaths to inflate lungs and force fluid into lymphatic system
[Infants/Adults] have higher larynx
Infants
A newborn’s chest wall is mostly made of?
Cartilage, for increased compliance of ribcage
What muscles are the primary stabilizers of the thorax in newborns?
Chest wall muscles
Infants have…(read)
Smaller airway diameter
Increased resistance of airflow
Increased work of breathing
Increased ribcage compliance –> leads to decreased thoracic stability
What anatomical position helps with development of ribcage structure and function?
Upright antigravity head, neck, and trunk control
TUMMY TIME
Conditions that impair ventilation
- Asthma
- Cystic Fibrosis
- Infant Respiratory Distress Syndrome (RDS)
- Bronchopulmonary Dysplasia (BPD)
Asthma is what type of pulmonary disease?
Obstructive
Asthma is caused by?
Airway inflammation that causes increased secretions and smooth muscle bronchoconstriction
Etiology of asthma
Unknown but thought to be genetics, environment, infections
How common is asthma?
Most common chronic childhood disease
1/10 children
160% ages 0-4; 74% 5-14 yo
What are the common medical interventions for asthma?
Maintenance medicine = inhaled anti-inflammatory drugs (Prednisone)
Rescue medicine = beta2-adrenergic inhaled bronchodilator (Albuterol)
What are common PT interventions for asthma?
Secretion removal
Proper timing/use of inhaled meds before exercise
Posture exercises
Aerobic conditioning
What are ways to prepare for aerobic conditioning?
Ensuring pt uses inhaler
Good exercise environment
Longer warmup period
Monitoring closely for asthma sxs
What are examples of working on proper posture and thoracic mobility in children?
Tummy time
Using bolster
Superman
Core strengthening
Sitting posture
Positioning
What are symptoms of exercise-induced bronchospasm (EIB)?
SOB, wheezing, coughing, chest tightness induced by exercise
No prior chronic inflammation
T/F: People can have EIB w/o diagnosis of asthma
True
What medication is prescribed for EIB?
Cromolyn Sodium - stabilizing med
What most commonly triggers bronchospasm in children with asthma?
Exercise
Symptoms of Cystic Fibrosis?
Frequent productive coughing w/ thick sputum
Frequent bronchitis and pneumonia
Salty-tasting skin
Dehydration
Infertility (men)
GI issues
Is CF a genetically inherited disease?
Yes, autosomal recessive (both parents are carriers)
Etiology of CF
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein
Incidence of CF
1 in 3000
Typical life expectancy of CF
37.4 years
What are common medical interventions for CF?
Antibiotics
Steroids
Lung or heart transplant
What are common PT interventions for CF?
Postural drainage, percussion
Secretion removal
Posture exercise for thoracic mobility
Aerobic exercise
What type of pulmonary disease is RDS?
Restrictive
Etiology of RDS
Inadequate levels of surfactant and lung immaturity
Inadequate surfactant leads to?
Decreased lung compliance
Increase work of breathing
Hypoxemia and Hypoxia
Incidence of RDS is related to what?
Gestational age
75% if born at 26-29 weeks GA
5% if born > 36 GA
What type of pulmonary disease is BPD?
Obstructive
What is BPD thought to occur as a result of?
RDS
Etiology of BPD
Exposure of immature infant to high concentrations of O2
Inadequate surfactant production
Infection
What do infants with BPD need for at least 3 days after birth?
Ventilatory assistance
What do infants with BPD need for 28 days of life?
Supplemental oxygen
How can RDS and BPD be managed?
Surfactant replacement therapy
Supplemental O2
Stress precautions (reduce environmental stimulation)
Positioning to optimize cardiopulmonary function
Secretion removal
Developmental milestone activities
Impairments in the musculoskeletal system include
Alteration in chest wall mobility
Lung compliance
Muscle strength
ROM
Skeletal formation
Restricted ribcage movement
Medical conditions that arise from MSK impairments
Arthritis
Arthrogryposis
Osteogenesis imperfecta
Scoliosis
Sternal abnormalities
PT management for MSK conditions include
Thoracic mobility
Breathing exercise
Posture exercise
Positioning
Secretion removal
What is Ventricular Septal Defect (VSD)?
Opening in ventricular septum that allows blood to flow from LV to RV (backwards)
O2 blood flows back from LV –> RV –> pulmonary arteries –> lungs
What is Atrial Septal Defect (ASD)?
Opening in atrial septum
O2 blood flows from LA –> RA –> pulmonary artery –> lungs
Which is more symptomatic: VSD or ASD?
VSD
What is Patent Ductus Arteriosus (PDA)?
Ductus arteriosus does not close (within first few weeks of life)
Blood flows from aorta –> pulmonary artery (left to right)
Oxygenated blood returns to lungs
Symptoms of Left to Right shunts
Murmur on cardiac auscultation
Crackles on lung auscultation
Poor feeders
Fatigue
Diaphoresis
Tachypnea
Decrease systemic blood flow
How are Left to Right shunts managed?
Repair: cardiac catheterization to close PDA or seal ASD/VSD
Surgery: if needed
Vital Signs : Infant
HR: 100-140
BP: 80/40
RR: 30-40
Vital Signs: Child
HR: 80-120
BP: 100/60
RR: 25-30
How can cardiopulmonary dysfunction interfere function/participation for infants?
Difficulty with feeding, growth, wakefulness, limiting environmental exploration
How can cardiopulmonary dysfunction interfere function/participation for young children?
Difficulty with mobility, socialization with peers, sports, play and school attendance
How can cardiopulmonary dysfunction interfere function/participation for adolescents?
Difficulty with socialization, employment, sports, concern about transition into independent adulthood
What is a positive pressure ventilator?
Invasive
Pressurized gas delivered into airways via endotracheal or tracheostomy tube
Examples of positive pressure ventilator?
CPAP = continuous positive airway pressure
BiPAP = Bi-level positive airway pressure
What is a negative pressure ventilator?
Non-invasive, creates negative pressure gradient around pt’s body during inspiration
Uses a chest shell, poncho/wrap, or tank
List selection criteria for mechanical ventilation
Apnea
Weakening ventilatory effect
Decreased breath sounds
Asystole
Severe brady/tachycardia
Coma
Limpness, no ability to cry
What is the ultimate goal for patients on mechanical ventilator?
Wean off
Proposed criteria for weaning
No escalation in vent support within 2 days prior
Stable chest radiograph
Blood PaCO2 not more than 10% above baseline
Blood pH within normal range
Supplemental fraction of inspired O2 of 0.6 or lower
Stable BP over 5-7 days prior
HR not greater than 95% of normal for age
Adequate nutrition
No active infection, acute pain, other meds
Understanding by family/guardian
