Peds CardioPulm
first breath after birth
-inflates lungs -O2 dilates the pulmonary vessels, increasing pulmonary blood flow -Fetal shunts in liver close over hours to days
cystic fibrosis
autosomal recessive genetic disorder pathological changes of exocrine glands in the airways, sweat glands, pancreas, biliary tract and gut ultimately will require lung transplant
cyanotic heart defect examples
-Tetralogy of Fallot -transposition of great vessels -tricuspid atresia -hypoplastic L heart syndrome
acyanotic heart defect examples
-atrial septal defect -ventricular septal defect -patent ductus arteriosus -coarctation of aorta
respiratory system development begins
4th week of gestation
horizontal angulation of rib cage until age
10
type 2 pneumocytes develop by
24 wks
acyanotic heart defect
Blood is shunted from left to right Oxygenated blood goes into lungs AND body
cyanotic heart defect
Blood is shunted from right to left Unoxygenated blood returns to the body/heart
in fetal circulation,
Blood travels from placenta --> umbilicus --> liver ½ enters hepatic system, ½ bypasses liver to IVC
is transposition of great vessels compatible w/ life
NO not unless ductus arteriosus or other VSD ASD remains open ductal dependent blood flow
transposition of great vessels/arteries
PA comes off L ventricle and aorta comes off R ventricle systemic blood goes to body unoxygenated and pulmonary blood goes to lungs oxygenated surgery needed ASAP arrhythmias or ventricular dysfxns may develop later
how does blood pass the pulmonary system in fetal circulation
R atrium --> foramen ovale (closes and becomes fossa ovale) to L atrium
s/s of bronchopulmonary dysplasia
RDS symptoms dependence on oxygen abnormal radiographic findings persistence of respiratory symptoms > 1 month
95% of mature alveoli develop
after birth
bronchopulmonary dysplasia
associated w/ the use of mechanical ventilation in preemies w/ RDS scarring of lung tissue thickened pulmonary arterial walls ventilation/perfusion mismatch
Lungs are not yet functioning so most of this blood is shunted
back into aorta through ductus arteriosis (constricts at birth, connects L atrium to aorta)
disease progression of cystic fibrosis
chronic lung infections w/ fibrosis bronchiectasis air trapping COPD
indications of cystic fibrosis
chronic productive cough infections abnormal CXR nasal polyps nutritional problems loss of salt abnormal male genital
assisted cough
completed by placing hands on abdomen child takes on a deep breath and holds 1-3 seconds child attempts to cough, therapists provides compression and upward thrust
Ductus venosus
connects umbilical vein to IVC Constricts at birth, permanent closure takes 1-3 months, becomes ligamentum venosum
atrial septal defect
d/t patent foramen ovale so blood shunted from L atrium --> R atrium repair depends on symptoms but usually before 6 if undetected until adulthood may see signs of HF
Heart tubes develop by
day 21
Heart starts to beat by
day 22—23
Blood begins to circulate by day
day 27
positive expiratory pressure
devices that provide resistance to exhalation can use pursed lip breathing opens airways and facilitates mobility of mucus through open airways
normal development of primary muscles used for inspiration
diaphragm from 0-3 months diaphragm and accessory muscles from 3-6 months diaphragm and intercostals from 6-12 months
symptoms of ventricular septal defect
feeding problems poor weight gain restlessness rapid breathing elevated HR irritability
when is postural drainage contraindicated
head down position in infants and toddlers <2 years old
coarctation of aorta symptoms
high UE BP relative to LE BP dx often during sports physicals
normal development of direction of ribs
horizontal from 0-3 months and 3-6 months angled downward from 6-12 months
hypoplastic L heart syndrome
hypoplasia or complete absence of L ventricle and hypoplasia or ascending aorta surgery required fontan is sub optimal so patient will eventually require a heart transplant depending on s/s
ventricular septal defect
most common congenital heart defect and most common for kids w/ DS one or more small opening in ventricular septum (can close itself if small) increased flow through R ventricle to lungs may lead to pulm HTN
tetralogy of fallot
most common cyanotic defect combo of ventricular septal defect, pulmonary stenosis, hypertrophy of R ventricle, overriding aorta surgery required quickly
respiratory distress syndrome
most common pulmonary disorder of newborns alveolar collapse d/t deficiency of surfactant (impaired gas exchange)
describe newborn breathing
narrow airways simultaneous breathing and swallowing immature alveoli --> inefficient gas exchange diaphragm has fewer type 1 fibers
coarctation of the aorta
narrow of aorta, severe narrowing may develop L ventricular failure early surgery if severe symptoms surgery typically L thoracotomy
sternal precautions
no pushing, pulling, lifting of anything >5 lbs no picking up child under the arms no overhead lifting no prone positioning no crawling
what surgeries correct hypoplastic L heart syndrome
norwood --> days/hrs old Glenn --> 4-6 months old Fontan --> 2-4 years
Tx for respiratory distress syndrome
oxygen fluid control thermal regulation ventilator assistance
breathing issues when born before 37 wks gestation
periodic breathing patterns (5-10 sec pauses) apnea of prematurity (longer pauses and associated w/ bradycardia and hypoexmia)
PT interventions for peds
rib cage mobility flexibility strength posture airway clearance breathing pattern neuro reed assisted cough functional mobility CV endurance training
PT Tx for cystic fibrosis
secretion clearance techniques controlled breathing techniques exercise and strength training inspiratory muscle training thoracic stretching exercises postural reeducation
s/s of respiratory distress syndrome
tachypnea cyanosis intercostal and sternal retractions nasal flaring expiratory grunting
normal development of shape of the thorax
triangular from 0-3 months rectangular from 3-6 months and 6-12 months
Cardiac development essentially completed by
week 10