CP Conditions in Peds

Question 1

When does the fetal heart begin to beat?

Answer 1

17 days gestation

Question 2

T/F: If the fetal heart beat cannot be heard at 5-6 weeks of gestation, the parents should be concerned.

Answer 2

False, can’t be detected until 8-10 weeks.

Question 3

T/F: The mother is responsible for oxygenation of fetal blood.

Answer 3

True

Question 4

What cardiac features does the fetal heart have the does not exist in a fully developed heart?

Answer 4

Foramen ovale & Ductus arteriosus

Question 5

Term: Foramen ovale

Answer 5

Opening in atrial septum allowing blood flow from RA to LA

Closes in 1st few hours of life

Question 6

Term: Ductus Arteriosus

Answer 6

Opening b/w pulmonary artery and aorta allowing blood to exit the pulmonary artery and flow into aorta & systemic circulation.
Closes in 1st few weeks of life

Question 7

At what point does the respiratory system develop?

Answer 7

22-26 days gestation

Question 8

A child was born 4 weeks premature. From a respiratory standpoint, what might doctors be concerned about?

Answer 8

Surfactant. Adequate levels are generally reached at 2 wks before full term and is needed for adequate inflation.

Question 9

When does surfactant production begin?

Answer 9

20 wks gestation

Question 10

Structural Differences in Infants (3)

Answer 10

Higher larynx
Smaller airway diameter (increased resistance/work)
Increased rib cage compliance (decreased stability)

Question 11

What are the primary stabilizers of the thorax in newborns?

Answer 11

Chest wall muscles

Question 12

What aids in typical development of the ribcage & how do we work on this with infants?

Answer 12

Upright head, neck & trunk control.

Tummy Time for postural exercise

Question 13

Peds Conditions that Impair Ventilation (4)

Answer 13

Asthma
Cystic Fibrosis
Infant Respiratory Distress Syndrome (RDS)
Bronchopulmonary Dysplasia (BPD)

Question 14

Condition: Asthma

Answer 14

Characterized by episodic periods of reversible airway narrowing caused by inflammation, increased secretions and smooth muscle constriction.

Question 15

Signs of Asthma (4)

Answer 15

Hyperventilation
Cough
Wheeze
Hypercapnia

Question 16

Mgmt of Asthma

Answer 16

Meds: Inhalers/Rescue Inhalers, Oral steroids
PT: Secretion removal, Education on med usage, Postural exercises, Aerobic conditioning

Question 17

Asthma & Aerobic Conditioning (4)

Answer 17

Pre-medication
Environment
Longer warm-up
Monitor closely

Question 18

Condition: Exercise-Induced Bronchospasm (EIB)

Answer 18

SOB, wheezing, coughing, chest tightness induced by exercise
No chronic inflammation
Dx can occur w/o asthma dx

Question 19

Condition: Cystic Fibrosis (CF)

Answer 19

Affects excretory glands causing thicker secretions and obstruction
Affects: Lungs, pancreas, GI, repro, sinuses, sweat glands
Obstruction of airways is most common cause of morbidity

Question 20

T/F: Cystic Fibrosis is a genetic disease.

Answer 20

True. Autosomal recessive, CFTR protein in both parents

Question 21

Mgmt of CF

Answer 21

Medical: Antibiotics, Steroids, Transplant
PT: Postural drainage, Secretion removal, Postural exercise, aerobic exercise, promote fxn

Question 22

Condition: Infant Respiratory Distress Syndrome (RDS)

Answer 22

Restrictive disease usually caused by inadequate surfactant due to lung immaturity

Question 23

Effects of Inadequate Surfactant (3)

Answer 23

Decreased lung compliance
Increased WOB
Hypoxia/Hypoxemia

Question 24

Condition: Bronchopulmonary Dysplasia (BPD)

Answer 24

Obstructive disease thought to occur due to RDS, infection, or exposure to high O2 concentration

Question 25

Clinical Definition of BPD (3)

Answer 25

Need for vent assist @ least 3 days & need for supplemental O2 at 28 days of life Need for supplemental O2 at 36 wks gestation Radiographic abnormalities and chronic ventilation required beyond initial period of RDS (past 1 month = RDS)

Question 26

Mgmt of RDS & BPD (5)

Answer 26

``` Surfactant replacement therapy Supplemental O2 Stress precautions (reduce stimulation) Positioning Secretion removal ```

Question 27

Musculoskeletal Impairments & Chest Mobility (5)

Answer 27

``` Arthritis Arthrogryposis Osteogenesis Scoliosis Sternal abnormalities ```

Question 28

Term: Arthrogryposis

Answer 28

Multiple joint contractures | Typically adduction & internal rotation of shoulder, ROM, club foot, LEs

Question 29

Term: Osteogenica Imperfecta

Answer 29

A collagen defect leading to fragile bones, frequent fx | ie. Rib fx from normal breathing

Question 30

PT mgmt of Musculoskeletal Impairments (5)

Answer 30

``` Thoracic mobility Breathing exercises Postural exercises Positioning Secretion removal ```

Question 31

Ventricular septal defect (VSD)

Answer 31

Opening in ventricular septum allowing blood flow from LV to RV (oxygenated blood skips systemic flow)

Question 32

Atrial septal defect (ASD)

Answer 32

Opening in atrial septum allowing blood flow from LA to RA | Less symptomatic than VSD

Question 33

Patent ductus arteriosus (PDA)

Answer 33

Ductus arteriosus does not close within weeks from birth

Question 34

Symptoms of Left to Right Shunting (7)

Answer 34

``` Heart murmur Crackles Poor feeding Fatige Diaphoresis Tachypnea Decreased blood flow ```

Question 35

Mgmt of Left to Right Shunting (2)

Answer 35

Catheterization to close PDA, ASD or VSD | Surgery in extreme cases

Question 36

Values: Infant, Child & Adult HR

Answer 36

Infant: 100-140 Child: 80-120 Adult: 60-100

Question 37

Values: Infant, Child, Adult BP

Answer 37

Infant: 80/40 Child: 100/60 Adult: 120/80

Question 38

Values: Infant, Child Adult RR

Answer 38

Infant: 30-40 Child: 25-30 Adult: 12-18

Question 39

Secretion Removal Parameters (3)

Answer 39

Postural drainage, 5-20 min Percussion, 2-5 for assisted cough Huffing to tolerance

Question 40

Positive Pressure Ventilator

Answer 40

Invasive, pressurized gas delivered into the airways via endotrache or tracheostomy

Question 41

CPAP

Answer 41

Continuous delivery of distending pressure to open alveoli

Question 42

BiPap

Answer 42

Cycles b/w 2 CPAP levels for spontaneous breathing during ventilation Often used for weaning

Question 43

Clinical Criteria for Mechanical Ventilation (7)

Answer 43

``` Apnea Weakened ventilatory effort Decrease lung sounds Systole Brady/Tachycardia Coma Inability to cry/Limpness ```

Question 44

PaCO2 Lab Criteria for Mechanical Ventilation

Answer 44

Newborn: > 60-65 mmHg Child: > 55-60 mmHg Rapidly rising: > 5 mmHg

Question 45

PaO2 Lab Criteria for Mechanical Ventilation

Answer 45

Newborn:

Question 46

A child has been on mechanical ventilation and providers are assessing him for weaning. His parents are anxious to start the process. His chest radiographs are stable, lab values are within normal range and vitals have been stable for the last week. FiO2 is at .65 and vent support was increased slightly 2 days ago. Is the child a good candidate to begin weaning?

Answer 46

Based on proposed criteria, no. Ideally FiO2 would be less than 0.6 and vent support not increased in last 3 days.