Respiratory and Cardiovascular Review

Respiratory Anatomy and Physiology

• Main Structures of the Respiratory System:
  • Nose
  • Mouth
  • Pharynx
  • Larynx
  • Trachea
  • Bronchi
  • Alveoli

Differences Between Adults and Children

• Airway Differences:
  • Children have smaller airway diameters and lengths.
  • Larger tongues in children can obstruct the airway.
  • Lung size is also smaller in children.

Common Respiratory Conditions in Children

Asthma

• Signs and Symptoms:
  • Shortness of breath
  • Coughing
  • Wheezing
  • Chest tightness
• Triggers:
  • Dust, mold, pollen
  • Exercise
  • Pet dander
  • Secondhand smoke
• Management:
  • Avoid triggers
  • Medication, e.g., rescue inhalers (e.g., albuterol)

Bronchiolitis

• Signs and Symptoms:
  • Tachypnea (60-80 breaths/min)
  • Tachycardia (>40 beats/min)
  • Wheezing and crackles
  • Intercostal or subcostal retractions with or without nasal flaring
  • Cyanosis
• Treatment:
  • Home care: fluids, humidification, rest
  • Hospital care: IV fluids, oxygen administration

Pneumonia

• Types:
  • Bacterial: sudden onset, severe symptoms (caused by bacteria like strep)
  • Viral: gradual onset (caused by viruses like flu or RSV)
• Treatment:
  • Bacterial: antibiotics (e.g., amoxicillin, ceftriaxone)
  • Viral: supportive care; no antibiotics administered

Assessment and Diagnostics

• Assessment Techniques:
  • Auscultation (listening to lung sounds)
  • Palpation for abnormalities (tumors, lymph nodes)
  • Observing for symmetry
  • Vital signs, especially respiratory rate and SpO2
• Diagnostic Tools:
  • Chest X-ray
  • Pulse oximetry
  • Incentive spirometer
  • Arterial blood gases (ABGs)

Emergency Respiratory Care

• Signs of Distress:
  • Cyanosis
  • Retractions
  • Nasal flaring
  • Tachypnea
  • Grunting, wheezing, and panting
• Immediate Interventions:
  • Assess and secure airway
  • Circulation management
  • Repositioning, with oxygen therapy
  • Remove restrictive clothing
  • Elevate head of bed
  • Administer IV medications

Important Asthma Concepts

• Silent Chest:
  • A sign of severe asthma; no wheezing or air movement detected could indicate respiratory failure.
• SABAs and LABAs:
  • SABAs (Short-acting Beta-Agonists): e.g., albuterol (rescue inhalers)
  • LABAs (Long-acting Beta-Agonists): e.g., Advair, Symbicort (maintenance drugs)
• Humidity in Bronchiolitis:
  • Use cool mist humidifiers for pediatric patients, not warm mist.

Cardiovascular Overview

• Heart Structure:
  • Four chambers (two atria, two ventricles)
  • Valves include tricuspid, pulmonary, and aortic valves

Common Cardiovascular Disorders

Ventricular Septal Defect (VSD)

• Description:
  • Hole between the ventricles; congenital defect
• Signs and Symptoms:
  • Loud, harsh systolic murmur
  • Poor diet, failure to thrive, tachypnea
  • Heart failure with moderate to large defect
• Management:
  • Diuretics and ACE inhibitors; may close on its own

Patent Ductus Arteriosus (PDA)

• Description:
  • Persistent opening between major blood vessels from the heart
• Signs and Symptoms:
  • Overeating, sweating while crying or eating
  • Tachycardia and fatigue
• Management:
  • Indomethacin medication to constrict the duct
  • Cardiac catheterization if necessary

Tetralogy of Fallot

• Characteristics:
  • Four defects: pulmonary stenosis, VSD, shifting aorta, and ventricular hypertrophy
• Signs and Symptoms:
  • short breath, fatigue, irritability, TET spells (blue skin during distress)
• Management:
  • PGE1 medication and surgical repair of defects

Diagnostics for Cardiovascular Disorders

• Common Tests:
  • ECG, Holter monitor, chest X-ray, echo, MRI
  • Pulse oximetry for oxygen levels
• Monitoring:
  • Feeding patterns, vital signs, peripheral perfusion, urine output
  • Signs of distress: tachycardia, cyanosis, edema, respiratory distress

Hematologic Disorders

Overview of Blood Components

• Key Components:
  • Red Blood Cells (RBCs)
  • White Blood Cells (WBCs)
  • Platelets

Anemia

• Description:
  • Decreased RBCs; iron deficiency leads to ineffective oxygen transport
• Signs and Symptoms:
  • Pale mucous membranes, tachycardia, fatigue
• Management:
  • Iron supplements; transfusions for severe cases

Sickle Cell Disease

• Description:
  • Genetic disorder causing sickle-shaped RBCs
• Signs and Symptoms:
  • Jaundice, severe pain during crises
• Management:
  • Pain control during crises; prenatal testing options available

Hemophilia

• Description:
  • Deficiency in coagulation factors, mainly factor VIII
• Signs and Symptoms:
  • Persistent bleeding from small injuries
• Management:
  • Factor VIII injections as needed; monitoring of bleeding and hemoglobin levels

Leukemia

• Characteristics:
  • Blood malignancy; acute (rapid onset) vs. chronic
• Signs and Symptoms:
  • Fever, malaise, fatigue, bone pain, excessive bruising
• Management:
  • Chemotherapy and treatment of underlying conditions

Endocrine Disorders

Overview of the Endocrine System

• Function:
  • Secretes hormones; regulates growth, metabolism, reproduction
• Glands:
  • Pituitary (anterior, posterior), thyroid, adrenal, hypothalamus

Common Endocrine Disorders

Hypothyroidism

• Signs and Symptoms:
  • Large fontanelle, slow reflexes, abnormal skin
• Management:
  • Treatment with levothyroxine

Diabetes Mellitus

• Types:
  • Type 1: no insulin production
  • Type 2: insufficient insulin production
• Management:
  • Dietary adjustments, medication, and blood sugar monitoring

Musculoskeletal System

Anatomy Overview

• Types of Bones:
  • Long (femur), short (carpals), irregular (vertebrae)
• Types of Joints:
  • Immovable, slightly movable, freely movable

Common Fractures

• Common Sites:
  • Clavicle, distal forearm
• Types of Fractures:
  • Greenstick, oblique, spiral, transverse, comminuted

Complications

• Compartment Syndrome:
  • Symptoms include increased pain despite medication
  • Immediate actions: cut casts/splints to relieve pressure

Neurological Disorders

Anatomy Overview

• Brain Parts:
  • Cerebrum (thinking, memory)
  • Cerebellum (coordination)
  • Brain stem (connects to spinal cord)

Seizures

• Types:
  • Focal: affect part of the brain
  • Generalized: entire brain affected
• Management:
  • Lorazepam, Valium for acute episodes; vagus nerve stimulation for chronic management

Headaches

• Types:
  • Migraines, tension headaches, increased ICP
• Management:
  • Identify triggers, use medication, and monitor signs/symptoms

Assessments

• Common Tests:
  • EEG, CT scans, MRIs
• Documentation during seizures:
  • Note time, duration, and symptoms observed