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Peds Conditions Flashcards

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1
Q

What is the first functioning organ within the growing fetus?

A

Heart

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2
Q

At what gestational age can fetal heart sounds be detected?

A

8-10 weeks

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3
Q

At what gestational age can heart contractions begin?

A

17 days

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4
Q

Fetal blood is oxygenated by what?

A

Placenta
Maternal circulation

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5
Q

What percent of blood flow of the fetus follow the pathway of adult circulation?

A

12%

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6
Q

Why does fetal circulation have an alternative pathway?

A

b/c of the fluid-filled lungs

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7
Q

Where is blood circulated to effectively bypass the lungs?

A

Foramen Ovale
Ductus arteriosus

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8
Q

Foramen Ovale

A

One way door in atrial septum
RA –> LA –> LV –> Aorta –> systemic circulation

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9
Q

When does the foramen ovale close?

A

First few HOURS of life

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10
Q

What is the Ductus Arteriosus?

A

Vascular link outside heart b/t pulmonary artery and aorta
Allows blood to exit pulmonary artery directly in aorta for systemic circulation

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11
Q

When does the ductus arteriosus close?

A

First few WEEKS of life

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12
Q

When does the ductus arteriosus close?

A

First few WEEKS of life

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13
Q

At what gestational age does the respiratory system begin?

A

22-26 days

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14
Q

At what gestational age is when surfactant is produced?

A

20 weeks

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15
Q

What is surfactant?

A

Lipid like substances that allows for adequate alveolar expansion by limiting surface tension across the alveolar membrane

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16
Q

When does ventilation occur and why?

A

Right after birth
First few breaths to inflate lungs and force fluid into lymphatic system

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17
Q

[Infants/Adults] have higher larynx

A

Infants

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18
Q

A newborn’s chest wall is mostly made of?

A

Cartilage, for increased compliance of ribcage

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19
Q

What muscles are the primary stabilizers of the thorax in newborns?

A

Chest wall muscles

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20
Q

Infants have…(read)

A

Smaller airway diameter
Increased resistance of airflow
Increased work of breathing
Increased ribcage compliance –> leads to decreased thoracic stability

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21
Q

What anatomical position helps with development of ribcage structure and function?

A

Upright antigravity head, neck, and trunk control
TUMMY TIME

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22
Q

Conditions that impair ventilation

A
  1. Asthma
  2. Cystic Fibrosis
  3. Infant Respiratory Distress Syndrome (RDS)
  4. Bronchopulmonary Dysplasia (BPD)
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23
Q

Asthma is what type of pulmonary disease?

A

Obstructive

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24
Q

Asthma is caused by?

A

Airway inflammation that causes increased secretions and smooth muscle bronchoconstriction

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25
Etiology of asthma
Unknown but thought to be genetics, environment, infections
26
How common is asthma?
Most common chronic childhood disease 1/10 children 160% ages 0-4; 74% 5-14 yo
27
What are the common medical interventions for asthma?
Maintenance medicine = inhaled anti-inflammatory drugs (Prednisone) Rescue medicine = beta2-adrenergic inhaled bronchodilator (Albuterol)
28
What are common PT interventions for asthma?
Secretion removal Proper timing/use of inhaled meds before exercise Posture exercises Aerobic conditioning
29
What are ways to prepare for aerobic conditioning?
Ensuring pt uses inhaler Good exercise environment Longer warmup period Monitoring closely for asthma sxs
30
What are examples of working on proper posture and thoracic mobility in children?
Tummy time Using bolster Superman Core strengthening Sitting posture Positioning
31
What are symptoms of exercise-induced bronchospasm (EIB)?
SOB, wheezing, coughing, chest tightness induced by exercise No prior chronic inflammation
32
T/F: People can have EIB w/o diagnosis of asthma
True
33
What medication is prescribed for EIB?
Cromolyn Sodium - stabilizing med
34
What most commonly triggers bronchospasm in children with asthma?
Exercise
35
Symptoms of Cystic Fibrosis?
Frequent productive coughing w/ thick sputum Frequent bronchitis and pneumonia Salty-tasting skin Dehydration Infertility (men) GI issues
36
Is CF a genetically inherited disease?
Yes, autosomal recessive (both parents are carriers)
37
Etiology of CF
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein
38
Incidence of CF
1 in 3000
39
Typical life expectancy of CF
37.4 years
40
What are common medical interventions for CF?
Antibiotics Steroids Lung or heart transplant
41
What are common PT interventions for CF?
Postural drainage, percussion Secretion removal Posture exercise for thoracic mobility Aerobic exercise
42
What type of pulmonary disease is RDS?
Restrictive
43
Etiology of RDS
Inadequate levels of surfactant and lung immaturity
44
Inadequate surfactant leads to?
Decreased lung compliance Increase work of breathing Hypoxemia and Hypoxia
45
Incidence of RDS is related to what?
Gestational age 75% if born at 26-29 weeks GA 5% if born > 36 GA
46
What type of pulmonary disease is BPD?
Obstructive
47
What is BPD thought to occur as a result of?
RDS
48
Etiology of BPD
Exposure of immature infant to high concentrations of O2 Inadequate surfactant production Infection
49
What do infants with BPD need for at least 3 days after birth?
Ventilatory assistance
50
What do infants with BPD need for 28 days of life?
Supplemental oxygen
51
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
52
Impairments in the musculoskeletal system include
Alteration in chest wall mobility Lung compliance Muscle strength ROM Skeletal formation Restricted ribcage movement
53
Medical conditions that arise from MSK impairments
Arthritis Arthrogryposis Osteogenesis imperfecta Scoliosis Sternal abnormalities
54
PT management for MSK conditions include
Thoracic mobility Breathing exercise Posture exercise Positioning Secretion removal
55
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
56
What is Atrial Septal Defect (ASD)?
Opening in atrial septum O2 blood flows from LA --> RA --> pulmonary artery --> lungs
57
Which is more symptomatic: VSD or ASD?
VSD
58
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
59
Symptoms of Left to Right shunts
Murmur on cardiac auscultation Crackles on lung auscultation Poor feeders Fatigue Diaphoresis Tachypnea Decrease systemic blood flow
60
How are Left to Right shunts managed?
Repair: cardiac catheterization to close PDA or seal ASD/VSD Surgery: if needed
61
Vital Signs : Infant
HR: 100-140 BP: 80/40 RR: 30-40
62
Vital Signs: Child
HR: 80-120 BP: 100/60 RR: 25-30
63
How can cardiopulmonary dysfunction interfere function/participation for infants?
Difficulty with feeding, growth, wakefulness, limiting environmental exploration
64
How can cardiopulmonary dysfunction interfere function/participation for young children?
Difficulty with mobility, socialization with peers, sports, play and school attendance
65
How can cardiopulmonary dysfunction interfere function/participation for adolescents?
Difficulty with socialization, employment, sports, concern about transition into independent adulthood
66
What is a positive pressure ventilator?
Invasive Pressurized gas delivered into airways via endotracheal or tracheostomy tube
67
Examples of positive pressure ventilator?
CPAP = continuous positive airway pressure BiPAP = Bi-level positive airway pressure
68
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
69
List selection criteria for mechanical ventilation
Apnea Weakening ventilatory effect Decreased breath sounds Asystole Severe brady/tachycardia Coma Limpness, no ability to cry
70
What is the ultimate goal for patients on mechanical ventilator?
Wean off
71
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

Cardiopulmonary (8 decks)

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