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  • Subject Name : Physiology

Question and Answers: Physiology

Ans 1-

Terms Physiology Normal values/ parameters
Bounding peripheral pulse It is usually observed by an individual as a beating of the heart as if it is pounding or racing. It can be related to aortic insufficiency when the heart valves do no tend to close properly. Presence of heart disease or any other bacterial infection can weaken the heart walls and thus, limiting their contractibility largely. These abrupt closing and opening of the valves can be observed in the form of bounding peripheral pulses. +2 is usually designated for a normal bounding peripheral pulse (Sorelli, 2018) · Please check ( This is correct information as mentioned in the references)
Hyperactive precordium This condition is marked by the fast movement of the precordium of the heart. This precordium covers the area over the chest. This can be caused due to any underlying pathology related to heart disease. It is also caused due to hyperthyroidism, which brings about an increased cardiac contractility tagged along with systolic hypertension (Wani, 2019). The valves over the precordium area is usually palpated for the presence of any abnormal pulsation. Mainly done to assess for any palpable heart murmurs known as thrills. Precordial movements are also inspected for any abnormal pattern. This is done with the heel of the hand placed at the sternal border.
Widening pulse pressure This is also often referred as the hardening of the arteries. The left ventricles tends to contract and gets stiffer. The arteries than becomes less compliant, resulting in an abrupt rise in both systolic as well as diastolic pressure. This evidently leads to the widening of the pulses. Normal pulse pressure is between 40 to 60 mm Hg (Peelukhana, 2017).
Cardiomegaly It is directly associated with congestive heart failure. It is mainly brought by increased working of the myocardial tissues. Due to overwork these fibers tend to increase in size and thus, puts a lot of pressure on heart, leading to cardiomegaly. Transverse cardiac diameter is 15.5 cm for males and 14.5 cm in females, any increases in the diameter by 1.5 cm can be a direct effect of presence of cardiomegaly in the individual (Alghamdi, 2020).
Acyanotic cardiac disorder This condition is brought by a structural defect in the interventricular septum. Due to a hole in this anatomical structure there is a shunting of blood from left side of the heart to the right side of the heart. This brings about a cyanosis in the blood, reflected back as Acyanotic cardiac disorder. Normal pulmonary blood flow through the heart vessels

 

Ans 2- a. The role of ibuprofen in patent ductus arteriosus is to inhibit the synthesis of prostaglandins. These prostaglandins are the most potent vasodilators of the duct. This drug thus, helps in promoting ductal patency. Thus, it is an effective drug that can be used to manage to closure of ducts in PDA in pre-term infants, especially who are born with less body weight (El-Mashad, 2017). It is also helpful in reducing the risk of necrotizing enterocolitis and renal insufficiency in neonates.

b. The nursing evaluations for an infant undergoing pharmacological management for PDA can be inclusive of:

  • Ensuring the delivery of accurate information to the mother or the care giver. This will help in reducing their anxiety, by having a good understanding of the clinical status of the neonates.
  • Ensuring constant monitoring of the IV fluids given to the patient. Dully noting for any presence of fluid overload and thus, reducing the burden on the circulatory system.
  • Safe administration of the medications required for medical management.
  • Monitoring the weight of the infant for any signs of presence of edema. Rapid weight gain can be indicative of fluid retention and can thus, lead to cardiac failure.
  • Monitoring oxygenation status to note for the presence of pulmonary edema.
  • Encouraging the infant to take breast milk.
  • Indomethacin can cause renal insufficiency in the neonates, thus, urine output should be closely monitored.

Post-surgical interventions can be inclusive of the following:

  • Trying to keep the neonate as calm as possible in order to avert for any complication to develop from rigorous movements post-surgery.
  • Trying to maintain a temperature homeostasis post-surgery.

Ans 3- Pulse oximetery is the most easy and non-invasive method to note for the oxygen saturation in neonates (Thangaratinam, 2017). The method of pulse oximetery can reflect upon desaturation of the blood objectively and thus, can be very helpful in detecting congenital defects in neonates, at an early stage without opting for any invasive diagnostic technique. This test can be combined with the other diagnostic test to monitor for the sensitivity in establishing the presence of any congenital defect in the neonates (Gupta, 2017). It is also helpful in noting early signs of hypoxia in neonates

Ans 4 a.

Clinical presentation

Congenital heart disease reflected

Result in increased pulmonary blood flow

1. Ventricular septal defect

2. Patent ductus arteriosus

Have an obstructive component

1. Patent ductus arteriosus

2. Total anomalous pulmonary venous return defect

Result in decreased pulmonary blood flow

1. Tetralogy of fallot

2. Tricuspid Atresia

Mixed presentation of any of the above

1. Hypoplastic left heart syndrome

2. Truncus arteriosus

b. Tetralogy of fallot is mainly present in neonates due to structural abnormalities. There is an obstruction in the outflow of right ventricular tract. There is a hypoplasia observed in the right ventricular outflow tract, stenosis of the pulmonary wall as well pulmonary annulus and trunk. This restrict the normal blood flow through proper shunting and dispersion of the blood in the body of the infant. The severe cases are bound to have a higher anticipated rate of mortality in the individuals. It is also marked with pulmonary stenosis which leads to cyanosis in the infant. This is also largely responsible for limiting the blood flow in the body of the infant.

Outcomes- Improved outcomes have been observed in the cases where early intervention with surgical correction for PDA closure was done. The individuals with tetralogy of fallot also have an incremental hazard related to their condition. There are improved outcomes in terms of quality of life of neonates, who had received the required management in their initial four years of life. The surgical management of PDA closure in early stages of life has also shown positive results in terms of improved healthcare outcomes (Bokma, 2018).

References for Physiology Assignment

Alghamdi, S. S., Abdelaziz, I., Albadri, M., Alyanbaawi, S., Aljondi, R., & Tajaldeen, A. (2020). Study of cardiomegaly using chest x-ray. Journal of Radiation Research and Applied Sciences13(1), 460-467.

Bokma, J. P., Geva, T., Sleeper, L. A., Narayan, S. V. B., Wald, R., Hickey, K., ... & Mulder, B. J. (2018). A propensity score-adjusted analysis of clinical outcomes after pulmonary valve replacement in tetralogy of Fallot. Heart104(9), 738-744.

Dowd, L. A., Wheeler, B. J., Al-Sallami, H. S., Broadbent, R. S., Edmonds, L. K., & Medlicott, N. J. (2019). Ibuprofen treatment for patent ductus arteriosus: practice and attitudes in Australia and New Zealand. The Journal of Maternal-Fetal & Neonatal Medicine32(18), 3039-3044.

El-Mashad, A. E. R., El-Mahdy, H., El Amrousy, D., & Elgendy, M. (2017). Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates. European journal of pediatrics176(2), 233-240.

Gupta, H., Anand, S., Grover, N., & Negi, P. C. (2017). Role of Pulse Oximetry For the Early Detection of Congenital Heart Diseases: A Prospective Observational Study. Heart134, 3-9.

http://www.uct.ac.za/sites/default/files/image_tool/images/198/PDF/CareProtocol_josephine.pdf

Peelukhana, S. V., Wang, Y., Berwick, Z., Kratzberg, J., Krieger, J., Roeder, B., ... & Kassab, G. S. (2017). Role of pulse pressure and geometry of primary entry tear in acute type B dissection propagation. Annals of biomedical engineering45(3), 592-603.

Sorelli, M., Perrella, A., & Bocchi, L. (2018). Detecting vascular age using the analysis of peripheral pulse. IEEE Transactions on Biomedical Engineering65(12), 2742-2750.

Thangaratinam, S., Daniels, J., Ewer, A. K., Zamora, J., & Khan, K. S. (2007). Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review. Archives of Disease in Childhood-Fetal and Neonatal Edition92(3), 176-180.

Wani, G. R., Parray, N. A., Lone, M. R., Ganie, N. A., Hussain, A., Islam, J. U., & Mohammad, S. M. (2019). Association of patent ductus arteriosus (PDA) with prematurity and low birth weight neonates. International Journal of Contemporary Pediatrics6(2), 781.

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