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CARDIOPULM CONSIDERATIONS IN THE ACUTE PEDIATRIC SETTING
QUESTIONS AND CORRECT ANSWERS!!
when does cardiac system development begins? day 18
cardiac system is primarily complete by ____ ___ _____ week 10 of gestation
A single ventricle turns into the truncus arteriosus which in turn divides to become the _____ and ____ ____ aorta; pulmonary artery
describe the order to cardiac development from primary cardiac tube to aortic arch and coronary arteries primary cardiac tube -> L ventricle -> secondary anterior field cells -> R ventricle and outflow tract -> Tertiary cells -> atrial chambers and portions of the ventricles -> Cardiac neural crest cells -> aortic arch and coronary arteries
what is the main difference between fetal circulation and that of a developed infant? placenta is responsible for oxygenation and release of carbon dioxide
Placenta accepts deoxygenated blood via ____ _____ from the fetus
umbilical arteries
Placenta oxygenates the blood and returns it to the fetus via ____ ____ umbilical vein
Oxygenated blood passes through the liver and enters the ____ side of the heart right
oxygenated blood flow in the fetus: R atrium -> L atrium (via foramen ovale) -> left ventricle -> aorta -> brain
term used to describe any heart defect that is present at birth congenital heart disease
(considered to be moderate to severe occurs in 2.5-3 of every 1000 births with mild occurring in every 10 of 1000 births)
85% of infants born with CHD will survive to ______ adulthood
- Truncus Arteriosus Pulmonary Atresia cyanotic
how are congenital heart defect classified by? (3) direction of altered flow;
level of severity;
if the oxygenation process is altered
oxygen rich and oxygen poor blood mixes so tissues of the body receive deoxygenated blood (cause of blueish skin tint) cyanotic
acyanotic is related to ____ or ____ related issues volume; pressure
- The ductus arteriosus is present in the fetus to allow blood to bypass the lungs for oxygenation
- this condition is characterized if this structure remains open patent ductus arteriosus
patent ductus arteriosus is most common in ___ ____ premature infants
patent ductus arteriosus (PDA) implications:
- due to PDA, extra blood is pumped into the pulmonary arteries causing lung ______ as the heart and lungs are working harder
congestion
symptoms associated with PDA: (2) increased RR and WOB; decreased growth (due to energy expenditure)
interventions for small and large PDA: small: may close spontaneously;
large: SURGERY
- A hole in the septum between the atria
- Implications: The extra blood can cause damage to the pulmonary vessels atrial septal defect
what can increased pressure with atrioventricular canal defect lead to? long term vessel damage
- Narrowing of the aorta which affects blood flow to other vessels and blood traveling to the body
- Pressures increase in the left ventricle which can cause long term damage to the heart muscle working to pump against these pressures coarctation of the aorta
coarctation of the aorta
- Could cause _____ and high _____ and may require a heather cath to broaden the vessel
CHF; BP
poorly working valve allows blood leakage as well as blood to be trapped in the heart resulting in increased heart pressures especially in the left ventricle stenotic aortic valve
interventions for stenosis:
surgery (stretch or replaced)
Thickened or fused valve that doesn't fully open causing increased pressures in the right ventricle and heart stenotic pulmonary valve
the following are 4 components of what heart condition?
- Ventricular Septal Defect
- Pulmonary Stenosis
- Hypertrophy of right ventricle
- Overriding Aorta (Aorta is malpositioned above the VSD) tetrology of fallot
intervention for tetrology of fallot: surgery
Aorta arises from the right ventricle and the pulmonary artery from the left ventricle causing deoxygenated blood to circulate the body and oxygenated blood to enter the lungs transposition of the great arteries (surgery is required for correction)
Both the pulmonary artery and Aorta arise from the right ventricle so the only outlet from the left ventricle is a VSD which allows mixing of oxygenated and deoxygenated
acyanotic
the following are S/S of what type of congenital heart defect?
- Clubbing (caused by prolonged hypoxia)
- Cyanosis (particularly in the face, lips, fingers, and toes)
- Crying
- Irritability/crying
- Tachycardia
- Tachypnea
- History of poor feeding
- Delayed development and growth cyanotic
Cardiomyopathy or congenital heart defects are often conditions that will require ___ ___ heart transplantation
heart transplantation is indicated for children with:
less than two years predicted survival;
end-stage disease (which has been unresponsive to medical management or in which conservative treatment is deemed inappropriate)
what are 2 main things that happen with heart transplant? vagus nerve removed; sympathetic cardiac nerve compromised
how does vagus nerve removal impact PT? altered HR response makes warm up and cool down very important;
increased resting HR, decreased HR response to activity and lower HR recovery
the following should be included in ___ ____:
- History: Demographics, cultural considerations,medications, birth history, social history, developmental history, chief complaint
- Lab values and vital signs
- Pain
- Equipment, devices, and lines
- Integument
- Musculoskeletal
- Functional mobility
- Aerobic Capacity PT examination
the following are all ___ ____:
- Patient and caregiver education
- Positioning and postural education (sternal precautions)
- Aerobic and endurance training
- Functional mobility (developmental delay?)
- Stretching
- Scar massage/mobilization (when appropriate) PT interventions
what period of pulmonary system development is the following?
- Separation of trachea and esophagus and differentiation of trachea into right and left baronial buds which are the precursors to the lungs
- Mesenchymal tissue will become muscle, connective tissue and cartilage within the bronchial walls
- Vascular tissue developed from the Mesenchyme will connect the pulmonary artery to the pulmonary vein
- Non cellular tissue will provide elastic and collagen to support lung structures
embryonic period (0-6 weeks gestation)
what period of pulmonary system development is the following?
- Lung buds continue to grow and subdivide into smaller airways
- Cells continue to differentiate into specific layers of airway cells
- Mucus secreting glands and supportive cartilage appear
- By the end of this period the Bronchial tree is complete from the glottis to the terminal branches
- Diaphragm formation begins
pseudoglandular period (5-16th week gestation)
what period of pulmonary system development is the following?
- Thinning and flattening of epithelium to become alveolar cells
- Type II cells, which later produce surfactant, appear
- pulmonary capillaries appear
- Gas exchange takes place
canalicular period (17-26 weeks gestation)
- Poor development of a cough leading to increased susceptibility of mucus obstruction
- anatomical alignment
- High respiratory rate in infants causes increased oxygen consumption,increased heat loss, and increased water loss
- relative poor muscle fuel supply predisposing factors
asthma is _____ and there is a strong correlation to ____
hereditary; allergies
who is often more affected with asthma?
boys > girls (2:1)
what has the greatest impact in asthma?
environmental factors (Allergy shots, home environment, exercise/lack thereof, medications to prevent bronchoconstriction)
- Progressive and genetic disease
- Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional.
cystic fibrosis
with cystic fibrosis _____ is unable to be moved to the cell surface which in turn decreases ability of water to be attracted to the surface and thus causes mucus in organs to become thick and sticky
chloride
what happens in the lungs with cystic fibrosis?
thick mucus traps bacteria which leads to respiratory complications
what happens in the pancreas with cystic fibrosis?
mucus prevents release of digestive enzymes causing malnutrition and poor weight gain
what are 3 factors that can impact a pt with cystic fibrosis and exacerbation?
medication;
Airway clearance techniques;
postural education and stretching;
physical training and reconditioning
clinical tests for pts with cystic fibrosis: (3) 6 MWT; step test; shuttle walk
