Pediatric Cardiovascular and Pulmonary Health Conditions Flashcards
(113 cards)
1
Q
most interventions in pediatic CP conditions are directed at…
A
impairments from developmental abnormalities such as prematurity, infection, immunological deficiencies, trauma, diseases associated with childhood, and surgery
2
Q
t/f: interventions for pediatric patients is different due to body size & physiologic differences
A
true
3
Q
when does alveolar develop take place in utero?
A
32-40/42 weeks up to 8 yo
4
Q
t/f: surfactant is still increasing up to 8 yo
A
true
5
Q
does cardiovascular or pulmonary development occur first in utero?
A
cardiovascular development
6
Q
what happens in cardiovascular development at 3 wks gestation?
A
pair of endothelial strands (angioblast cords) appear (everything else develop from these)
formation of primordial heart chambers
7
Q
what happens in cardiovascular development at 21 days gestation?
A
cords form heart tubes
8
Q
what happens in cardiovascular development at 22-23 days gestation?
A
tubes fuse to form a single heart tube and heart begins to beat
9
Q
when does blood begin circulating in gestation?
A
at day 27
10
Q
what happens in cardiovascular development at 10 weeks gestation
A
cardiac development is primarily complete!
11
Q
blood flow in the womb (fetal circulation) bypasses the lungs and reaches the LV via what?
A
the foramen ovale or ductus arteriosus
12
Q
what does the fetus use to obtain O2 and eliminate CO2?
A
the placenta
13
Q
what happens in cardiovascular development at 4 weeks gestation?
A
early appearance of the septum primum, interventricular septum, and dorsal endocardial cushion
14
Q
what happens in cardiovascular development at 5 weeks gestation?
A
perforations in the dorsal part of the septum primum form
15
Q
what happens in cardiovascular development at 6 weeks gestation?
A
the foramen secudum forms
the heart chambers are forming
16
Q
what happens in cardiovascular development at 8 weeks gestation?
A
the hear this pertioned into 4 chambers
there are normal opening bw the chambers to divert blood away from the lungs while they’re developing that should close by birth
17
Q
what is the foramen secundum?
A
where blood goes through from the umbilical cord
18
Q
what are congenital heart defects?
A
abnormal development of the heart and/or major blood vessels
failure of the heart septum, valves, or chambers to fully close prior to birth
19
Q
when are congenital heart defects diagnosed?
A
prenatally, at birth, or during childhood
20
Q
what is the most common of all birth defects?
A
congenital heart defects
21
Q
what are the 2 categories of CHDs?
A
acyanotic
cyanotic
22
Q
what are acyanotic CHDs?
A
the amount of O2 delivered to the body remains unaffected by the defect
23
Q
what are cyanotic CHDs?
A
the amount of O2 delivered to the body is affected by the defect
the defect is such that it causes oxygen-poor blood to enter systemic circulation, causing a decrease in arterial oxygen saturation
24
Q
t/f: most cases of CHDs are multifactorial and are caused by genetic and environmental factors
A
true
25
what is the predominant factor that causes CHDs?
genetics
26
altered cerebral perfusion affects what?
brain development and fxn
27
what are the major impairments of CHDs?
motor development delays
decreased motor fxn
exercise intolerance
28
what are neurodevelopmental delays that may result from CHDs?
cognitive dysfxn
speech and language delays
attention deficits
decreased executive fxn
decreased visual/spatial skills
emotional/behavioral dysregulation
decreased nutritional intake
decreased QOL
29
cardiomyopathy may be present in CHDs due to what factors?
idiopathic ventricular abnormalities
coronary abnormalities
techycardia or arrhythmias
exposure to infection or toxins
30
what are the risk factors for CHDs?
Down syndrome
German measles (rubella)
viral illness during a mother's early pregnancy
alcohol consumption/smoking during pregnancy
poorly controlled DM
meds taken during pregnancy
advanced maternal age
parent who had a CHD
31
what are the acyanotic CHDs due to increased pulmonary blood flow? (focus on starred ones)
atrial septal defect*
ventricular septal defect*
patent ductus arteriosus*
32
what are the acyanotic CHDs due to obstruction of blood flow from the ventricles? (focus on starred ones)
coarctation of the aorta*(narrowed aorta)
aortic stenosis
pulmonary stenosis
33
in increased pulmonary blood flow in CHDs, is the blood shunting from R-->L or L-->R?
L-->R
34
why does blood shunting L-->R in CHDs not affect oxygenation?
bc it is oxygenated blood pumped back to the lungs and is continued to be pumped to the body while still containing O2
35
with increased pulmonary blood flow, there is a ___ in pressure in the pulmonary capillaries, ___ in blood volume on the L side of the heart, and ___ in overall stroke volume
increased, decrease, decrease
36
in obstruction of blood flow in CHDs, what is obstructed?
blood flow out of the ventricles
37
is there L-->R shunting in obstructed blood flow CHDs?
no
38
obstruction of the L leads to what?
decreased stroke volume
39
obstruction of the R leads to what?
cyanosis and hypoxia
40
t/f: there is a decrease in cardiac output in obstructed blood flow CHDs
true
41
is obstruction of blood flow in acyanotic CHDs R or L obstruction?
L
42
what are the s/s of acyanotic CHDs?
tachycardia
hypoxia
tachypnea /breathlessness when eating/crying
SOB
heart murmur
crackles/wheezing on lung auscultation
cardiac arrhythmia on ECG
LE and/or abdominal edema
heavy sweating
poor eating/difficulty eating
poor weight gain
failure to thrive
restlessness/irritability
43
what is atrial septal defect (ASD)? (KNOW THIS)
CHD caused by patent foramen ovale (PFO)
opening bw the R and L atria
44
t/f: ASD can lead to an enlarged R atrium and ventricle
true
45
is surgery required for ASD?
yes
46
what is ventricular septal defect (VSD)? (KNOW THIS)
CHD where the wall bw the R and L ventricles fails to form during fetal development
oxygenated and deoxygenated blood gets pumped back to the lungs
smaller amount of blood is pumped into arterial circulation
increases work of the heart
47
surgery for VSD is required if not closed by ____
5 months old
48
where does the fetal circulation come from in utero?
the patent ductus arteriosus
49
what is the patent ductus arteriosus CHD? (KNOW THIS)
CHD caused by prostaglandin E1 production that doesn't decrease after birth once O2 levels increase, leaving the hole open
abnormal opening remains bw the aorta and pulmonary artery
too much blood enters the lungs
50
what meds can be given to a baby with an open patent ductus arteriosus?
indomethacin to decrease prostaglandin E1 production
51
what is atrioventricular septal disorder (AVSD)?
a combo of ASD and VSD
a large hole in the wall that separates the L and R atrai
can be partial or complete
52
what is partial AVSD?
defect in the mitral valve bw the L atria and L ventricle causing it to leak
53
what is complete AVSD?
one large valve bw atria and ventricles
54
what are the clinical signs of AVSD?
pulmonary HTN
HF
tachycardia
arrhythmias
55
what is coarctation of the aorta? (KNOW THIS)
narrowing/constriction of a portion of the aorta
usually occurs with another heart defects
obstructed blood flow out of the LV
increased pressure proximal to the obstruction (HTN in the upper body)
decreased pressure distal to the obstruction (normal to low BP in LEs)
may not be detected until adulthood depending on severity
56
what is Eisenmenger syndrome?
syndrome that develops from a CHD that results in large shunts of blood through multiple defects (any combo of acyanotic defects)
L-->R shunt that turns into R--->L shunt
57
chronic hypoxemia leads to what?
polycythemia (inc RBC volume)
58
what are the clinical s/s of eisenmenger syndrome?
edema
worsening cyanosis
hemoptysis
headaches, dizziness, vision changes, stroke if polycythemia occurs
59
what conditions should be avoided with eisenmenger syndrome?
pregnancy, dehydration, isometric exercise, iron deficiency anemia, and significant time spent at high altitudes
60
t/f: surgery is required for Eisenmenger syndrome
false, bc the body is usually adapting to the defects already
61
in cyanotic CHDs, if there R-->L shunting of blood or L-->R shunting of blood?
R-->L shunting of blood
62
what causes the cyanosis in cyanotic CHDs?
decreased gas exchange
deoxygenated blood returning to the L side of the heart
deoxygenated blood pumped into systemic arterial circulation
63
what are the clinical s/s of cyanotic CHDs?
decreased arterial O2 saturation
central cyanosis
polycythemia
digital clubbing
64
what is central cyanosis?
body tissues and muscles not receiving oxygenated blood so the lips, skin, abdomen, tongue, or entire body appear blue when the baby is born
65
what is polycythemia?
increased RBC formation
the body's attempt to improve arterial saturation
66
why does polycythemia increase risk for CVA?
bc it increases blood viscocity
67
what are the 4 abnormalities of tatrology of Fallot? (KNOW THIS)
1) VSD
2) pulmonary valve stenosis
3) overriding aorta
4) R ventricular hypertrophy
68
what is overriding aorta in tetrology of Fallot?
the aorta is misplaced and shifted to the R over the VSD
69
t/f: the misplaced aorta in tetrology of Fallot receives blood from the R and L
true
70
how does tetrology of Fallot lead to decreased oxygenation?
a combo of oxygenated and deoxygenated blood is pumped into systemic circulation leading to an insufficient amount of oxygenated blood in the body
71
does RV hypertrophy lead to L or R HF?
R HF
72
what are the clinical s/s of tetrology of Fallot?
squatting and loss of consciousness (tet spells)
73
what is squatting?
when a child squats to catch their breath
74
what is hypoplastic L heart syndrome?
hypoplastic LV
aortic and mitral valve stenosis or atresia (complete closure)
coarctation do the aorta
underdeveloped L side of the heart
small aorta and LV
75
when does hypoplastic L heart syndrome need to be treated by?
within days/weeks after birth
76
t/f: blood flowing through PFO and PDA increases chances of survival in hypoplastic L heart syndrome
true
77
what meds may be given to someone with hypoplastic L heart syndrome? why?
prostaglandin E1 bc it keep the PFO and PDA open until surgery can be complete
78
what is transposition of the great arteries?
the pulmonary artery and aorta are switched (aorta over the R ventricle and pulmonary artery over the L ventricle)
no communication bw systemic and pulmonary circulation leads to deoxygenated blood being pumped to the body w/o passing through the lungs and oxygenated blood going to the lungs
79
t/f: surgery is required shortly after birth with a transposition of the great arteries
true
80
what are the clinical signs of transposition of the great arteries?
cyanosis and cardiac arrythmias
81
what is tricuspid atresia?
tricuspid valve (bw R atrium and ventricle) is either not petent or absent
solid tissue formation bw heart RA and RV causes restricted blood flow
small, underdeveloped RV
blood goes from the RA to LA through ASD or PFO
82
what are the clinical signs of tricuspid atresia?
severe hypoxia
signs of R HF
severe central cyanosis
83
what is truncus arteriosus?
one large vessel exiting the heart (normal during fetal development but should separate by birth)
normal separation of the aorta and main pulmonary artery doesn't occur in fetal development
R and L ventricles empty into a single large vessel
mixed oxygenated and deoxygenated blood
84
truncus arteriosus requires surgery within ___ of birth
1 month
85
what are the respiratory conditions of infancy?
prematurity
persistent pulmonary HTN
infant respiratory distress syndrome
sudden infant death syndrome
meconium aspiration syndrome
bronchopulmonary dysplasia
primary cilia dyskinesia
CF
86
when is a newborn considered premature?
born b4 37 weeks gestation
87
what are the signs associated with prematurity?
periodic breathing patterns
apnea of >20 sec during sleep
cyanosis
hypoxemia
bradycardia
88
persistent pulmonary HTN is associated with what 2 things?
1) prematurity
2) PDA
89
what is persistent pulmonary HTN?
pulmonary HTN that persists after gestation where it is normal
hypertrophy of smooth muscle of arterioles
constriction of pulmonary arterioles
increased in pulmonary vascular resistance due to constriction
enlargement of RA and RV due to shunting of blood L-->R through the PDA
90
what are the s/s associated with persistent pulmonary HTN?
cyanosis
tachypnea
respiratory acidosis
loud S2 heart sound/tricuspid murmur
low APGAR score
intercostal retractions
nasal flaring
grunting
91
what are the long term affects of persistent pulmonary HTN?
developmental delays, learning disabilities, and hearing problems
92
what is infant respiratory distress syndrome? (KNOW THIS)
decreased pulmonary surfactant
most often in infants born b4 28th weeks of gestation
buildup of hyaline membrane debris along the alveolar walls
decreased gas exchange due to decreased alveolar surface area
thickened and inflammed alveoli (can collapse)
decreased lung elasticity
93
what are the s/s of infant respiratory distress syndrome?
increased RR >60
nasal flaring
intercostal and subcostal retraction w/breathing
grunting on expiration
peripheral edema
94
what is the treatment for infant respiratory distress syndrome?
supplemental O2, CPAP, or mechanical ventilation
95
what is sudden infant death syndrome?
sudden unexpected death of an infant (<1 yo) during sleep
otherwise healthy infant
may be linked to respiration and possible asphyxia during sleep
96
what are the risks associated with stomach sleeping in infants?
overheating
rebreathing expired air increases CO2 and decreases O2
temporary changes to heart and lung fxn and control which could affect the amount of O2 getting to the brain during sleep
97
what is meconium aspiration syndrome? (KNOW THIS)
fetal sphincter muscles relax and meconium is released into amniotic fluid during labor or delivery
infant may aspirate on amniotic fluid and meconium
obstruction of airway
surfactant inactivation
98
what is the treatment for meconium aspiration syndrome?
mechanical ventilation
supplemental O2
ECMO in more severe cases
99
what is bronchopulmonary dysplasia? (KNOW THIS)
the most common cause of respiratory issues in infancy
caused by prematurity, need for ventilation, bacterial infection of placenta, sepsis
scaring/fibrosis of lung tissue/alveoli
thickened pulmonary arterial walls
inflammed lung parenchyma
lung ventilation perfusion mismatch
100
what are the characteristics of bronchopulmonary dysplasia?
persistance of respiratory symptoms after 1 month
abnormal radiograph findings (cysts on lungs with spongey appearance)
dependence on supplemental O2
101
what are the s/s of bronchopulmonary dysplasia?
wheezing
waking w/coughing
breathlessness
GERD (reflux)
heart defects (PDA)
pulmonary HTN
102
what is pulmonary cilia dyskinesia?
rare autosomal recessive genetic disorder affecting cilia in the lungs, nose, and ears
deformation and dysfxnal abnormalities of cilia
fibrosis of lung parenchyma
thickened bronchial and tracheal walls
impaired ciliary clearance and transport of mucus from the airways
103
what is the treatment for primary cilia dyskinesia?
same as CF
104
what is CF?
genetic autosomal recessive disease affecting exocrine glands fxn
105
what is the treatment for CF?
airways clearance 2x/day
rib cage mobility
postural training
exercise
nebulizer
enzymes with all meals
frequent eating
106
what are the pediatric health conditions w/secondary cardiopulmonary issues?
Down syndrome
DiGeorge syndrome
Marphan's syndrome
William's syndrome
arthrogryposis multiplex congenita
FAS
107
what are the secondary cardiopulmonary issues associated with Down syndrome?
endocardial cushion defect, VSD, ASD, tetrology of Fallot
cardiac defects and sleep apnea
108
what is DiGeorge syndrome?
deletion of csome 22
primary immunodeficiency disease
cardiac abnormalities, abnormal facial features, thymic hypoplasia, cleft palette, hypocalcemia
109
what is Marphan's syndrome?
autosomal dominant CT disease commonly associated with aortic dissection and aorta mitral valve dysfxn/insufficiency
long extremities, tall, thin, scoliosis, pectus excavatum, stooped shoulders, elastic skin, fragile vessels
110
what is Williams syndrome?
deletion of csome 7
supravalvular aortic stenosis and supravalvular pulmonary stenosis caused by a change in elastin production
111
what is arthrogryposis multiplex congenita?
non-progressive neuromuscular disease
multi jt contractures requiring surgery
112
what is FAS?
chronic alc exposure in utero
fascial dysmorphology, post natal growth retardation, poor coordination, hyperactivity, learning disabilities, developmental delays
cardiac abnormalities
113
what are other pediatric health conditions w/decreased activity level and altered posture?
CP, spina bifida, DMD, and SMA
