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Cardiopulmonary > Peds Conditions > Flashcards

Peds Conditions Flashcards

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
Q

Etiology of asthma

A

Unknown but thought to be genetics, environment, infections

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26
Q

How common is asthma?

A

Most common chronic childhood disease
1/10 children
160% ages 0-4; 74% 5-14 yo

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27
Q

What are the common medical interventions for asthma?

A

Maintenance medicine = inhaled anti-inflammatory drugs (Prednisone)
Rescue medicine = beta2-adrenergic inhaled bronchodilator (Albuterol)

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28
Q

What are common PT interventions for asthma?

A

Secretion removal
Proper timing/use of inhaled meds before exercise
Posture exercises
Aerobic conditioning

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29
Q

What are ways to prepare for aerobic conditioning?

A

Ensuring pt uses inhaler
Good exercise environment
Longer warmup period
Monitoring closely for asthma sxs

30
Q

What are examples of working on proper posture and thoracic mobility in children?

A

Tummy time
Using bolster
Superman
Core strengthening
Sitting posture
Positioning

31
Q

What are symptoms of exercise-induced bronchospasm (EIB)?

A

SOB, wheezing, coughing, chest tightness induced by exercise
No prior chronic inflammation

32
Q

T/F: People can have EIB w/o diagnosis of asthma

A

True

33
Q

What medication is prescribed for EIB?

A

Cromolyn Sodium - stabilizing med

34
Q

What most commonly triggers bronchospasm in children with asthma?

A

Exercise

35
Q

Symptoms of Cystic Fibrosis?

A

Frequent productive coughing w/ thick sputum
Frequent bronchitis and pneumonia
Salty-tasting skin
Dehydration
Infertility (men)
GI issues

36
Q

Is CF a genetically inherited disease?

A

Yes, autosomal recessive (both parents are carriers)

37
Q

Etiology of CF

A

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein

38
Q

Incidence of CF

A

1 in 3000

39
Q

Typical life expectancy of CF

A

37.4 years

40
Q

What are common medical interventions for CF?

A

Antibiotics
Steroids
Lung or heart transplant

41
Q

What are common PT interventions for CF?

A

Postural drainage, percussion
Secretion removal
Posture exercise for thoracic mobility
Aerobic exercise

42
Q

What type of pulmonary disease is RDS?

A

Restrictive

43
Q

Etiology of RDS

A

Inadequate levels of surfactant and lung immaturity

44
Q

Inadequate surfactant leads to?

A

Decreased lung compliance
Increase work of breathing
Hypoxemia and Hypoxia

45
Q

Incidence of RDS is related to what?

A

Gestational age
75% if born at 26-29 weeks GA
5% if born > 36 GA

46
Q

What type of pulmonary disease is BPD?

A

Obstructive

47
Q

What is BPD thought to occur as a result of?

A

RDS

48
Q

Etiology of BPD

A

Exposure of immature infant to high concentrations of O2
Inadequate surfactant production
Infection

49
Q

What do infants with BPD need for at least 3 days after birth?

A

Ventilatory assistance

50
Q

What do infants with BPD need for 28 days of life?

A

Supplemental oxygen

51
Q

How can RDS and BPD be managed?

A

Surfactant replacement therapy
Supplemental O2
Stress precautions (reduce environmental stimulation)
Positioning to optimize cardiopulmonary function
Secretion removal
Developmental milestone activities

52
Q

Impairments in the musculoskeletal system include

A

Alteration in chest wall mobility
Lung compliance
Muscle strength
ROM
Skeletal formation
Restricted ribcage movement

53
Q

Medical conditions that arise from MSK impairments

A

Arthritis
Arthrogryposis
Osteogenesis imperfecta
Scoliosis
Sternal abnormalities

54
Q

PT management for MSK conditions include

A

Thoracic mobility
Breathing exercise
Posture exercise
Positioning
Secretion removal

55
Q

What is Ventricular Septal Defect (VSD)?

A

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
Q

What is Atrial Septal Defect (ASD)?

A

Opening in atrial septum
O2 blood flows from LA –> RA –> pulmonary artery –> lungs

57
Q

Which is more symptomatic: VSD or ASD?

A

VSD

58
Q

What is Patent Ductus Arteriosus (PDA)?

A

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
Q

Symptoms of Left to Right shunts

A

Murmur on cardiac auscultation
Crackles on lung auscultation
Poor feeders
Fatigue
Diaphoresis
Tachypnea
Decrease systemic blood flow

60
Q

How are Left to Right shunts managed?

A

Repair: cardiac catheterization to close PDA or seal ASD/VSD
Surgery: if needed

61
Q

Vital Signs : Infant

A

HR: 100-140
BP: 80/40
RR: 30-40

62
Q

Vital Signs: Child

A

HR: 80-120
BP: 100/60
RR: 25-30

63
Q

How can cardiopulmonary dysfunction interfere function/participation for infants?

A

Difficulty with feeding, growth, wakefulness, limiting environmental exploration

64
Q

How can cardiopulmonary dysfunction interfere function/participation for young children?

A

Difficulty with mobility, socialization with peers, sports, play and school attendance

65
Q

How can cardiopulmonary dysfunction interfere function/participation for adolescents?

A

Difficulty with socialization, employment, sports, concern about transition into independent adulthood

66
Q

What is a positive pressure ventilator?

A

Invasive
Pressurized gas delivered into airways via endotracheal or tracheostomy tube

67
Q

Examples of positive pressure ventilator?

A

CPAP = continuous positive airway pressure
BiPAP = Bi-level positive airway pressure

68
Q

What is a negative pressure ventilator?

A

Non-invasive, creates negative pressure gradient around pt’s body during inspiration
Uses a chest shell, poncho/wrap, or tank

69
Q

List selection criteria for mechanical ventilation

A

Apnea
Weakening ventilatory effect
Decreased breath sounds
Asystole
Severe brady/tachycardia
Coma
Limpness, no ability to cry

70
Q

What is the ultimate goal for patients on mechanical ventilator?

A

Wean off

71
Q

Proposed criteria for weaning

A

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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