5740060
Description
Mind Map by katmmorris, updated more than 1 year ago
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Created by katmmorris
about 10 years ago
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Embryological Dev. and
Assessment of the
Cardiopulmonary
System
- Data in Patient Record
- perinatal history and data:
maternal, paternal and social
history (i.e heart defects,
abnormalities or congenital heart
disease history.
- gestational age: New Ballard
Score, maturation of
neonates from 20-44 wks.
based on neuromuscular and
physical criteria. classified as
Large (LGA, >90%), Appropriate
(AGA 10-90%) or Small (SGA,
<10%) for Gestational Age.
Congenital inf. and
Chromosomal disorders should
be considered in SGA's
- APGAR: 5 categories worth 2 pts.
each assessing skin color, HR,
reflexes, muscle tone and
breathing. higher score is better
- chest X-ray
- cardiac
cath
reports
- blood gas
- vitals
- signs of
distress
- hemodynamic
monitoring
- gestational age
(Dubowitz): uses
physical characteristics
and neurological
characteristics to
estimate the baby's
gestational age within
1-2 weeks of the true
gestational age.
- heart sounds
- perinatal history and data:
maternal, paternal and social
history (i.e heart defects,
abnormalities or congenital heart
disease history.
- Embryonic Lung Growth
- Embryonal (4-7 wks)
- Pseudoglandular
Stage
(7-17wks)
- Canalicular Stage (17-26 wks)
- Saccular Stage (26-36 wks)
- Alveolar Stage (36 wks - 2yrs)
- Lung maturity determined by L/S
ratio (Lecthicin to
Sphygimomylen), a test of fetal
amniotic fluid. maturation and
proliferation, neonates born
w/15-20% adult #, rapid during
first 1.5 yrs - 8 yrs full dev.
- SURFACTANT: a soap like substance that lowers the surface
pressure of the alveoli in the lungs. Surfactant is a mix of lipids,
proteins, glycoproteins (lecithin and sphingomyelin are 2) Lecithin makes
the surfactant mixture more effective. Begins to appear during
pseudoglandular stage when type 11 pneumocytes start to develop in
alveoli, they are rep. for producing -secreting-storing-and recycling surfactant.
- Fetal lung fluid: fetal airways are fluid
filled from canalicular period to birth.
high in chloride and sodium ions, low in
bicarbonate, protein and Ph. essential
for normal lung development,Too much
fluid = dec. in type II cells. Too little
fluid = inc. type II cells. Fluid
maintains patency of developing
airways helping form spaces, bust be
evacuated at birth through rapid
absorption or vaginal birth. C-sections
at risk for transient tachypnea or
respiratory distress syndrome type
II.
- SURFACTANT: a soap like substance that lowers the surface
pressure of the alveoli in the lungs. Surfactant is a mix of lipids,
proteins, glycoproteins (lecithin and sphingomyelin are 2) Lecithin makes
the surfactant mixture more effective. Begins to appear during
pseudoglandular stage when type 11 pneumocytes start to develop in
alveoli, they are rep. for producing -secreting-storing-and recycling surfactant.
- Lung maturity determined by L/S
ratio (Lecthicin to
Sphygimomylen), a test of fetal
amniotic fluid. maturation and
proliferation, neonates born
w/15-20% adult #, rapid during
first 1.5 yrs - 8 yrs full dev.
- terminal struc. = saccules,
sec. crests, Alveoli @
32-36wks, more surface
area for gas ex.
- Alveolar Stage (36 wks - 2yrs)
- capillary networks form, consd. dev.
@ 20 wks., eff. gas exchange occurs,
Acinar (alveoli units start to develop)
Type I/type II cells differentiated
Air-blood barrier thin enough for gas
exchange. survival at 22-24 wks
- Saccular Stage (26-36 wks)
- Conducting airways continue to
develop. Terminal/respiratory
bronchioles and alveolar ducts
differentiate. Chemical
mediators turn respiratory
epithelium into Type II cells. Cilia
, Goblet cells, smooth muscle,
cartilage, and lymphatics appear
- Canalicular Stage (17-26 wks)
- Lung bud forms from
pharynx at 26 days,
then form trachea and
bronchial buds
Tracheoesophageal
septum forms,
Pulmonary arteries and
veins begin to develop,
Respiratory epithelium
develops
- Pseudoglandular
Stage
(7-17wks)
- Embryonal (4-7 wks)
- Embryological Dev. of the
Heart
- begins during 3rd wk
of gestation, fully
formed (chambers,
vales, vessels) by 8
wks. gestation
- Maternal lungs/liver perform functions for
corresponding fetal organs. Fetal
circulation shunts blood away from these
corresponding fetal organs, and close at
birth.
- placenta - umbilical vein - ductus venosus
(50% to liver 50% to Inf. VC) - inferior vena
cava - r. atrium - foramen ovale (80-90% to
L. atrium, 10-20% to r. ventricle - pulmonary
artery - ductus arteriosus (75-90% to
aorta 10-25% to lungs - pulmonary veins) -
l. artrium - l. ventricle - aorta - umbilical
arteries - placenta.
- as the blastocyst implants in the
uterine lining for nourishment, the
umbilical cord attaches to the
chorionic villi and diffuses nutrients
through the endometrial lining. The
umbilical cord connects the fetus
to the placenta , consists of 2
arteries and 1 vein. Wharton's Jelly
inside the cord protects vessels
and prevents kinking of the cord.
- The placenta is an organ of respiration formed
by the chorionic villi embedded deep in the
endometrium. It receives nutrients and eliminates
waste, small pockets contain fetal vessels and
spaces with maternal blood, there is no mixing of
blood, the exchange follows a high to low
concentration gradient.
- Amniotic Fluid allows the fetus to move
and provides protection, thermoregulation,
and aids in dilation/effacement of the
cervix during labor. It cont. maternal fluids
and fluids from amniotic membrane,
replenished by fetal urine and lung fluid.
- polyhydramnios is
excessive amniotic
fluid
- oligohydramnios
is too little
amniotic fluid.
urinary
obstruction, limb
deformities and
lung hypoplasia
- Assessment of Fetal Growth and Development
- Ultrasound is used to
evaluate fetal growth,
anatomy and position
- amniocentesis can be
performed by sampling a
small amount of the amniotic
fluid, can be used for
detecting fetal infections or
chromosomal abnormalities.
- L/S ratio for testing lung maturity
- detection of certain
congential defects
through (alpha)
fetoprotein testing
- biliruben testing
for elevated
levels that could
indicate fetal
hemolytic
disease,liver
disease or
insetting
obstruction.
- creatinine
concentrations could
indicate fetal maturity
of 36-37 wks. and
should correspond with
the L/S ratio.
- meconium
staining tints
the fluid
yellow, red,
brown, or
red and
indicates
possible
distress,
death, or
hemolytic
disease.
- cytological examination of
fetal cells for
determining fetal
maturity
- L/S ratio for testing lung maturity
- fetal asphyxia occurs when the fetus is deprived of an
adequate supply of oxygen, testing the scalp pH can help
the doctor decide whether the fetus is getting enough
oxygen during labor. norm >7.25
- NST vs. CST: NonST's
monitor fetal HR with
spontaneous movements,
while ContrationST monitor
HR with induced
contractions while mother
is given diluted oxytocin
solution
- Vibroacoustic stimulation
(VAS), or fetal acoustic
stimulation test (FAST),
is the application of a
vibratory sound stimulus
to the abdomen of a
pregnant woman to
induce FHR (fetal heart
rate) accelerations.
- Vibroacoustic stimulation
(VAS), or fetal acoustic
stimulation test (FAST),
is the application of a
vibratory sound stimulus
to the abdomen of a
pregnant woman to
induce FHR (fetal heart
rate) accelerations.
- Ultrasound is used to
evaluate fetal growth,
anatomy and position
- polyhydramnios is
excessive amniotic
fluid
- Amniotic Fluid allows the fetus to move
and provides protection, thermoregulation,
and aids in dilation/effacement of the
cervix during labor. It cont. maternal fluids
and fluids from amniotic membrane,
replenished by fetal urine and lung fluid.
- The placenta is an organ of respiration formed
by the chorionic villi embedded deep in the
endometrium. It receives nutrients and eliminates
waste, small pockets contain fetal vessels and
spaces with maternal blood, there is no mixing of
blood, the exchange follows a high to low
concentration gradient.
- as the blastocyst implants in the
uterine lining for nourishment, the
umbilical cord attaches to the
chorionic villi and diffuses nutrients
through the endometrial lining. The
umbilical cord connects the fetus
to the placenta , consists of 2
arteries and 1 vein. Wharton's Jelly
inside the cord protects vessels
and prevents kinking of the cord.
- pressure is higher in the right
atrium than the left due to
influx of maternal blood and
the shunting if blood to the
l.artrium
- placenta - umbilical vein - ductus venosus
(50% to liver 50% to Inf. VC) - inferior vena
cava - r. atrium - foramen ovale (80-90% to
L. atrium, 10-20% to r. ventricle - pulmonary
artery - ductus arteriosus (75-90% to
aorta 10-25% to lungs - pulmonary veins) -
l. artrium - l. ventricle - aorta - umbilical
arteries - placenta.
- begins during 3rd wk
of gestation, fully
formed (chambers,
vales, vessels) by 8
wks. gestation
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