cardiovascular disease in pregnancy, pediatrics and neonates

what is the most common medical complication of pregnancy

hypertension

at some point in pregnancy blood volume is almost ____

doubled

what must a PT do regularly with a pregnant patient

check BP both at rest and in response to activity

it is important to report elevated blood pressure to _______ immediately; could indicated a more serious condition

physician

what is the role of estrogen

cardioprotective

what happens to estrogen in postmenopausaul women

it decreases significantly

during the third trimester, voluntary lung volumes are ______

decreased

what voluntary lung volume is decreased in the third trimester in pregnant patients

expiratory reserve volume (ERV) 8%-40%

exercises performed in supine and prolonged periods of motionless standing are inadvisable after what trimester

first

laying supine and standing motionless are associated with decreased _______

cardiac output

the development of the respiratory system beings in week ____ of gestation

4

what are the 4 periods of lung maturation

pseudoglandular period (6-16 weeks)

canalicular period (16-26 weeks)

terminal saccular period (26 weeks-birth)

**alveolar period (32 weeks -8 years)

history taking during evaluation should include the childs __________ at birth

gestational age

what does APGAR stand for

appearance

pulse

grimace

activity

respiratory

an APGAR score of >7 out of 10 is ______

reassuring

fifth gestational week what happens

dorsal part of septum deteriorates, forming a new right to left shunt through the foramen secundum

seventh gestational week what happens

ventricles divide equally

near the end of the eighth gestational week what happens

septum secundum grows from the ventrocranial wall of the atrium on the right side of the septum primum

tenth week of gestation what happens

cardiac development is primarily complete

in fetal circulation, most of the blood bypasses the lungs and reaches the left ventricle via the _________

foramen ovale or ductus arteriosus

what does the fetus use to obtain oxygen and to get rid of carbon dioxide

placenta

the blood vessels of the pulmonary circulation are ________ in the fetus

vasoconstricted

acyanotic defects

-ventricular septal defect (VSD)

-atrial septal defect (ASD)

-patent ductus arteriosus (PDA)

-coarctation

cyanotic defects

-tetraology

-transposition

-trancus arteriosus

-total anomalous pulmonary venous return

-hypoplastic left heart syndrome

what is an acyanotic lesion

increase pulmonary blood flow: fully oxygenated blood is shunted back into lungs and body (LEFT TO RIGHT SHUNTING)

symptoms of acyanotic lesion

sweating, increased respiratory rate, heart failure

problems with acyanotic lesions

low PaO2 to periphery

low systemic stroke volume

increased work on heart

what is a cyanotic lesion

involve right to left shunting, where most of the blood bypasses the lungs

with cyanotic lesions there is INCREASED/DECREASED arterial O2 saturation

decreased

there is an increased risk for what with cyanotic lesions

cerebrovascular insult

what is tetralogy of fallot

heart defect that features 4 problems

1. hold between lower chambers of the heart

2. an obstruction from the heart to the lungs

3. aorta lies over the hole in the lower chambers

4. muscle surrounding the lower right chamber becomes overly thickened

what does VAD stand for

ventricular assist device

what is used in the pediatric population to bridge to candidacy for transplant, recovery from illness or destination therapy

ventricular assist device

prematurity means what

born at <37 weeks of gestation

premature infants may demonstrate _____________, where they take 5 to 10 second pauses in breathing

periodic breathing patterns

what is apena of prematurity

defined as cessation of breathing for 20 seconds or longer in an infant born at less than 37 weeks gestation, causing bradycardia, cyanosis, or both

what is persistent pulmonary hypertension

increased pulmonary vascular resistance

persistent pulmonary hypertension is also seen in infants with what conditions

RDS

meconium aspiration syndrome

what is respiratory distress syndrome

hyaline membrane disease or infant RDS is caused by deficient amount of pulmonary surfactant

respiratory distress syndrome characteristics

airless alveoli

inelastic lungs

RR >60 BPM

nasal flaring

intercostal and subcostal retractions

grunting on expiration

peripheral edema

what is sudden infant death syndrome

sudden unexpected death of an otherwise healthy infant during sleep

*may be linked with respiration

what is meconium aspiration syndrome

fetal stress may cause fetal rectal sphincter muscles to relax resulting in meconium in the amniotic fluid

-infant then may aspirate amniotic fluid and meconium

what is bronchopulmonary dysplasia

chronic respiratory disorder characterized by scarring of lung tissue, thickened pulmonary arterial walls, and mismatch between lung ventilation and perfusion

what is ECMO

an external heart lung bypass machine used as advanced life support

what are the two types of ECMO

1. venovenous for when the lungs need assistance in functioning

2. venoarterial for when both the heart and lungs need assistance

what is cystic fibrosis

affects exocrine gland function

what condition has most prominent symptoms related to pulmonary, intestine and pancreatic involvement

cystic fibrosis

in cystic fibrosis, the pulmonary system is affected by what

chronic airway obstruction and inflammation

in cystic fibrosis the intestines develop thick mucus that interferes with what

nutrient absorption and results in malnourishment and low weight

in cystic fibrosis, the pancreas develops what

exocrine pancreatic insufficency

what other organs are affected in cystic fibrosis

upper airway

male reproductive tract

sweat glands

what are the goals for cystic fibrosis

controlling lung infection

promoting mucus clearance

improving nutritional status

what is asthma

chronic inflammatory disorder of the airways

asthma causes recurrent episodes of what

wheezing, dyspnea, chest tightness and coughing

what is the hallmark sign of asthma

reversibility of airway obstruction following the use of bronchodialator medication

what are the 4 treatment recommendations for asthma (long list sorry)

1. use objective measures of pulmonary function to assess severity and monitor therapy effectivness

2. identify and elliminate factors that worsen symptoms, precipate exacerbations, or promote ongoing airway inflammation

3. provide pharmicologic therapy to reverse bronchoconstriction and to reverse and prevent airway inflammation

4. create therapeutic partnership between pt and care provider

what is a PT implication important for asthma

use of bronchodialator 30 minutes before exercise

down syndrome is associated with what other conditions (4)

1. endocardial cushion defect

2. VSD

3. ASD

4. tetralogy of fallot

what is DiGeorge syndrome

primary immunodeficency disease caused by deletion of chromosome 22

VATER

vertebral defects

imperforate anus

tracheoesophageal fistula

radial and renal dysplasia

VACTERL

cardiac anomalies are added

renal and limb anamolies replace renal or radial anomalies

what is marfan syndrome

connective tissue disease commonly associated with aortic aneurysm and aortic/mitral insufficency

what is primary ciliary dyskinesia

rare disease in which mucociliary clearance is impaired because of defective motility of cilia

what is willimas syndrome

involves deletion of the long arm of chromosome 7

fetal alcohol syndrome

results from chronic alcohol exposure in utero

commonly associated with cardiac anomalies of VSD, TOF, pulmonary valve stensois, and PDA

possible causes of a child's decreased activity level or impairments to breathing mechanics

muscle weakness

abnormal muscle tone

motor planning and learning deficits

medical fragility

what are some common pediatric diagnoses that may lead to pulmonary system impairments (6)

CP

spina bifida

muscular dystrophy

SMA

Arnold-chiari type II malformation

Spinal cord injury

infants and young children have a HIGHER/LOWER baseline heart rate and a HIGHER/LOWER stroke volume

higher HR

lower SV

what is used in neonates and pediatrics who have arrhythmias

caffeine

what standardized testing to document baseline function and/or developmental age equivalency may include what

alberta infant motor scales (AIMS)

gross motor function measurement (GMFM)

peabody developmental motor scales (PDMS)

gentle rib cage mobilization can be performed in

supine, prone or side lying positions

stretches targeting what muscles for flexibility may be indicated

quadratus lumborum

latissimus dorsi

rectus abdominis

address LE muscles with attachments into the pelvis due to position of pelvis ________

affecting posture and breathing