11 NURSING CARE OF HIGH RISK INFANT Flashcards
_____ is a term used to describe an infant with little interest in feeding.
“Poor feeding in infants”
_____ can become a problem when the infant is losing weight or having trouble gaining the right amount of weight for their age
Feeding
The effortless return of swallowed formula or breast milk through the mouth or nose after feeding
Spitting Up
Almost all infants spit up, although _____babies appear to do this more than _____ babies, possibly due to overfeeding
formula fed, breastfed
The baby who spits up a mouthful of milk (rolling down the chin) two or three times a day (or sometimes after every meal) is experiencing _____ , early infancy spitting up
normal
Associated signs such as diarrhea, abdominal cramps, fever, cough, cold, or loss of activity suggest _____
Illness
As cited by (Pilliteri, 2018), _____ the baby thoroughly after a feeding often limits spitting up. Parents may try sitting an infant in an infant chair for half an hour after feeding.
Burping
Means the backward movement of stomach contents up the esophagus )the “swallowing tube”) into the mouth
Regurgitation
Occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus.
Gastroesophageal Reflux
It is usually noted within the 1st 18
months
Regurgitation
This condition may correct itself as.
the _____ matures, the child eats solid foods, and the child is more often in a sitting or standing position
esophageal sphincter
Clinical Manifestation of Feeding Problem
● Immediately after feeding the child vomit the contents of the stomach
● The vomit is effortless
● The child with GER is irritable and hungry
Diagnostic for Feeding Problem
Endoscopy
This will confirm the relaxed esophageal sphincter
Endoscopy
Treatment for Feeding Problem
● Formula thickened with rice cereal
● Placing the child in an upright position during and after feeding
● Placement of NGT (nasogastric Tube)
● Giving medications like histamine 2 (H@) receptor antagonist, ie. Omeprazole etc.
Surgical Treatment for Feeding Problem
Nissen Fundoplication
In this procedure, a part of the upper portion of the stomach is wrapped around the lower part of the esophagus to create a valve-like structure to prevent the regurgitation of the stomach contents.
Nissen Fundoplication
Nursing Care for Feeding Problem
● Thicken feedings with rice cereal (to decrease the likelihood of aspiration)
● Offer small frequent feedings and burp 2-3 times every after feeding
● Positioning the child before and after feeding
● Elevate the head when in prone position
Notify HCP when infant has feeding problem if:
● Infant vomits 1⁄3 or more of most feedings
● Chokes when vomiting
● Experiences forceful emesis
Cannot digest lactose, the primary carbohydrate in milk, because of an inborn deficiency of the enzyme lactase
Lactose Intolerance
Encompasses at least four different conditions that involve a deficiency of the enzyme lactase, which is needed for the hydrolysis or digestion of lactose in the small intestine.
Lactose Intolerance
Types of Lactose Intolerance
Congenital Lactose Deficiency
Primary Lactose Deficiency
Secondary Lactose Deficiency
This inborn error of metabolism involves the complete absence or severely reduced pressure of lactase, is extremely rare, and requires a lifelong lactose free or extremely reduced lactose die
Congenital Lactose Deficiency (congenital alactasia)
Management of Congenital Lactose Deficiency (congenital alactasia)
Limit intake of food and drink containing lactose - helps control symptoms
Clinical Manifestation of Congenital Lactose Deficiency
Abdominal pain
Bloating
Flatulence
Diarrhea after the ingestion of lactose
The onset of symptoms occurs within the _____ to several hours of lactose consumption
30 minutes
Treatment of Congenital Lactose Deficiency (congenital alactasia)
- elimination of offending dairy products, however, some advocate decreasing amounts of dairy products rather than the total elimination, especially in small children
- Over the counter lactose enzyme supplements may be helpful in these cases
- In infants, lactose-free or low-lactose formula may be used until diarrhea has resolved
Also known as Late-Onset Lactase Deficiency
Primary Lactose Deficiency
Is the most common type of lactose intolerance and is manifested usually after 4 or 5 years of age, although the time of onset is variable
Primary Lactose Deficiency
_____ manifests as lactose intolerance and is characterized by an imbalance between the ability for lactase to hydrolyze the ingested lactose and the amount of lactose ingested
Lactose malabsorption
Due to illness or injury. Once the underlying cause is treated lactase level may be restored
Secondary Lactose Deficiency
May occur secondary to damage that has occurred in the intestinal lumen which decreases or destroys the enzyme lactase
Secondary Lactose Deficiency
Diseases such cystic fibrosis, sprue, celiac disease, or kwashiorkor and infections such as giardiasis, HIV, or rotavirus may cause a temporary or permanent _____
lactose intolerance
Diagnosis for Lactose Intolerance
Hydrogen Breath Test
Testing of stool pH and glucose
The person drinks a lactose-loaded beverage and then the breath is analyzed at regular intervals to measure the amount of hydrogen. Normally, very little hydrogen is detectable in the breath, but undigested lactose produces high levels of hydrogen. The test takes 2-3 hours
Hydrogen Breath Test
Specific to infants, lactose malabsorption may be diagnosed by evaluating fecal ph and reducing substances. Fecal ph in infants is usually lower than in older children, but an acidic pH may indicate malabsorption.
Testing of stool pH and glucose
Nursing Care Management for Lactose Intolerance
- Explaining the dietary restrictions to the family
reviewing sources of lactose, including hidden sources - Identifying alternate sources of calcium, such as yogurt
- Discussing the importance of calcium supplementation
- Reviewing strategies for controlling symptoms
Cause is often multifactorial and involves a combination of infant organic disease, dysfunctional parenting behaviors, subtle neurological or behavioral problems, and disturbed parent-child interactions
Failure to Thrive
Primary etiology is inadequate caloric intake regardless of the cause
Failure to Thrive
FTT inadequate growth resulting from an inability to obtain or use _____ required for growth
is a term that is traditionally used for children who have failed to develop and grow normally
calories
Occurs when a child is either not receiving adequate calories or is unable to properly use the calories that are given
FTT
Classifications of FTT
Inadequate Caloric Intake
Inadequate Absorption
Increased Metabolism
Defective Utilization
Incorrect formula preparation, neglect, food fads, excessive juice consumption, poverty, breastfeeding problems, behavioral problems affecting eating parental restriction of caloric intake, or central nervous system problems affecting intake
Inadequate Caloric Intake
Cystic fibrosis, celiac disease, Crohn’s disease, vitamin or mineral deficiencies, cow’s milk allergy, biliary atresia, or hepatic disease
Inadequate Absorption
Hyperthyroidism, congenital heart disease or chronic immunodeficiency
Increased Metabolism
Genetic anomaly such as trisomy 21 or 18, congenital infection, or metabolic storage diseases
Defective Utilization
If FTT is _____, the weight, but not the length/height, is below accepted standards (usually the 5th percentile)
acute
If FTT is _____, both weight and length/height are low, indicating ongoing malnutrition
chronic
Diagnostic Evaluation of FTT
- Diagnosis of FTT is initially made clinically through identification of signs and symptoms
- An assessment of the home environment and parent-child interaction may be helpful as well
- Other tests (eg. lead toxicity, anemia, stool-reducing substances, occult blood, ova and parasites alkaline phosphatase, and zinc levels) are selected only as indicated to rule out organic problems
Clinical Manifestations of FTT
Growth failure
Developmental delays- social, motor, adaptive, language
Undernutrition
Apathy
WIthdrawn behavior
Feeding or eating disorders, such as vomiting, feeding resistance, anorexia, pica, rumination
No fear of strangers (at age when strangers anxiety is normal)
Avoidance of eye contact
Wide eyed gaze and continual scan of the environment (“radar gaze”)
Stiff and unyielding or flaccid and unresponsive
Minimal smiling
The prognosis for children with FTT is related to the _____
cause
Factors that are related to poor prognosis of FTT
severe feeding resistance
lack of awareness in parents
poor parental cooperation
low family income
low maternal educational level
adolescent mothers
preterm birth
IUGR (intrauterine growth restriction)
early age of onset of FTT
The primary management for FTT is to reverse the cause of ____
growth failure
If malnutrition is severe, the initial treatment is directed at reversing the malnutrition while avoiding _____
refeeding syndrome
Goal is to provide sufficient calories to support _____. (Rate of growth greater than the expected rate for age.)
“catch-up” growth
A suggested goal for catch-up growth is _____ the average rate of weight gain for the child’s corrected age.
2 to 3 times
_____ play a critical role as part of the interprofessional team in the diagnosis of FTT through their assessment of the child, parents, and family interactions
Nurses
The nurse documents the child’s feeding behaviors, as well as the parent-child interaction during feedings, and assesses other caregiving activities, including _____.
play
An accurate assessment of initial weight, hc, length/height, and daily weight is an essential component of nursing care for children for children with _____
FTT
_____ practices often contribute to growth failure. Therefore, parents should be given specific, step-by-step directions for formula preparation, as well as a written schedule of feeding times.
Maladaptive feeding
_____ techniques may be used with older infants and toddlers to interrupt maladaptive feeding patterns.
Behavior modification
Nursing care of children with FTT involves a _____ approach
“family systems”
Four Primary Goals in the Nutritional Management of children with FTT
- Correcting nutritional deficiencies and achieving ideal weight for height
- Providing adequate calories for catch-up growth
- Restoring optimum body composition
- Educating the parents of primary caregivers about the child’s nutritional requirements and age-appropriate feeding methods
Generally occurs in infants under 3 months of age and is marked by loud, intense crying
Paroxysmal Abdominal Pain (Colic)
Cause is unclear and probably results for several reasons. It may occur in susceptible infants from overfeeding or from swallowing too much air while feeding.
Colic
Formula fed babies tend to have more symptoms than breastfed babies, possibly because they swallow more air while drinking or because formula is harder to digest.
Colic
Colic can be characterized by
P - Peak pattern (crying peaks around 2 months of age, the decreases)
U - Unpredictable (crying can come and go for no reason)
R - Resistant to soothing (baby may keep crying no matter what you can do to try to soothe them)
P - Pain-like look on baby’s face
L - Long bouts of crying (crying can go on for hours)
E - Evening cry (baby cries more in the afternoon or evening)
Etiology of Colic
Feeding too rapidly
Overfeeding
Swallowing excessive air
Improper feeding technique (especially positioning and burping)
Emotional stress or tension between parent and infant
Therapeutic Management for Colic
- The use of medications such as antispasmodics, antihistamines, and antiflatulents are sometimes recommended
- Simethicone (Mylicon) may help relieve the symptoms of colic; however, in most controlled studies no medications completely resolved the symptoms of colic
Nursing Care Management for Colic
Initial step in managing colic is to take a thorough and detailed history of the usual daily events.
Key Points in taking History for Colic
the infant’s diet
diet of the breastfeeding mother
timing of the crying
relationship of crying to feedings
Nursing Care Management for Colic
Presence of specific family members during crying
Habits of family members, such as smoking
Activity of the mother or usual caregiver before, during, and after crying
Characteristics of the cry (e.g. duration, intensity)
Measures used to relieve crying and their effectiveness
The infant’s stooling, voiding =, and sleeping patterns
It is also known as the Flat Head Syndrome
Positional Plagiocephaly
A condition in which specific areas of an infant’s head develop an abnormally flattened shape and appearance.
Positional Plagiocephaly
This can occur when there is crowding in the womb or when the baby is placed in the same position (such as on his/her back) for extended periods of time
Positional Plagiocephaly
Babies are vulnerable to _____ because their skulls are soft and malleable at birth
plagiocephaly
Causes of Positional Plagiocephaly
The most common cause of flattened head is the baby’s sleep position
Premature babies are more likely to have a flattened head
Can also be caused by position in the womb
Signs and Symptoms for Positional Plagiocephaly
The back of the baby’s head is easy for parents to notice
The baby usually has less hair on that part of the head
When looking down at the baby’s head, the ear on the flattened side may look pushed forward
In severe cases of positional plagiocephaly, the _____ might bulge on the side opposite from the flattening, and may look uneven.
forehead
If _____ of plagiocephaly is the cause, the neck, jaw, and face also might be uneven.
torticollis
To check for torticollis, the doctor may watch how a baby moves the _____.
neck and head
Treatment Options for Plagiocephaly
Positional Therapy
Helmet or Band therapy
Physical therapy for neck stretching, if torticollis (neck tightness) is present
The orthotist will create a duplicate of the baby’s head using a plaster impression or a 3-D scan. The band will be precisely fabricated and customized to the baby’s head to achieve improved symmetry and proportion
Positional Molding Helmet Band Therapy
Adjustments to the helmet need to be made every _____ because a baby’s head grows very quickly. This involves adjusting the foam lining and/or portions of the outside plastic helmet
1-2 weeks
Do not purchase _____without first consulting a physician specialist.
helmets
When treatment for plagiocephaly starts at the optimum age of 3-6 months, it usually can be completed within _____
12 weeks
Correction is still possible in babies up to age _____, but will take longer
18 months
The baby will wear a helmet/band _____ hours per day with the exception of _____ hour set aside for bathing and cleaning.
23.5, one-half
The baby’s _____should be monitored to make sure there are no deep red areas developing. If there is an area that has too firm contact with the band, the skin may break down, causing scarring or other issues.
skin
Prevention of PP should begin shortly after birth by placing the infant to sleep supine and alternating the infant’s head position nightly, avoiding prolonged placement in car safety seats and swings, and using prone positioning or “tummy time” for approximately 10-15 minutes three times per day while infant is awake
Therapeutic Management for Positional Plagiocephaly
Infants should be placed prone on a firm surface during awake time (tummy time) for at least _____
10-15 minutes three times a day
Sometimes known as crib death because the infants often die in their cribs.
Sudden infant Death Syndrome
The third leading cause of infant mortality in the United States, accounting for approximately 8% of all infant deaths and claiming the lives of 3500 US infants each year
SIDS
Physical factors associated with SIDS include
Brain defects
Low birth weight
Respiratory infection
Sleep environmental factors
Sleeping on the stomach or side
Seeping on a soft surface
Sharing a bed
Overheating
Sex - _____ are slightly more likely to die of SIDS.
Boys
Age - Infants are most vulnerable between the ____ and ____ of life.
second and fourth months
Race: for reasons that aren’t well-understood, _____ infants are more likely to develop SIDS.
nonwhite
Family History - babies who’ve had _____ or _____ die of SIDS are at higher risk of SIDS.
siblings or cousins
Secondhand Smoke - babies who live with _____ have a higher risk of SIDS.
smokers
Being premature - both being born early and having a _____ increase your baby’s chances of SIDS.
low birth weight
Other Risk factors for SIDS
Maternal Smoking
Co-sleeping
Prone Sleeping
Soft Bedding
About 50-60% of infants manifest _____
cyanosis
Half of the infants who had SIDS experience _____ before death.
breathing difficulties
Although most infants are apparently healthy, many parents state that their babies “ were not themselves” in the hours before death.
Abnormal Limb Movements
Laboratory Studies - For a living patient, initial laboratory studies include a _____, _____ and _____
complete blood count (CBC), electrolyte concentrations, and urinalysis.
Nursing Care Planning and Goals for SIDS
Family caregivers will seek appropriate support persons for assistance.
Family caregivers will use available support systems to assist in coping with fear.
Family caregivers will share feelings about the event.
Family caregivers will verbalize measures to prevent SIDS.
Nursing Interventions for SIDS
Allow expression of feelings
Appropriate referrals
Encourage use of community resources
Monitoring Subsequent infants
The immediate reaction of the staff should be to allow the family to express their grief, encouraging them to say goodbye to their infant, and providing a quiet, private place for them to do so.
Allow expression of feelings
Referrals should be made to the local chapter of the National SIDS Foundation immediately; Sudden Death Alliance is another resource for help.
Appropriate referrals
In some states, specially trained community health nurses who are knowledgeable about SIDS are available; these nurses are prepared to help families and can provide written materials, as well as information, guidance, and support in the family’s home.
Encourage use of community resources
Caregivers are particularly concerned about subsequent infants; recent studies have indicated that the risk for these infants for the first few months of life to help reduce the family’s stress; monitoring is usually maintained until the new infant is past the age of the SIDS infant’s death.
Monitoring Subsequent infants
Evaluation for SIDS, Goals are me as evidenced by:
Family caregivers sought appropriate support persons for assistance.
Family caregivers used available support systems to assist in coping with fear.
Family caregivers shared feelings about the event.
Family caregivers verbalized measures to prevent SIDS.
Formerly referred to as an aborted SIDS death or a near-miss SIDS, generally refers to an event that is sudden and frightening to the observer in which the infant exhibits a combination of apnea, change in color (e.g., pallor, cyanosis, redness), change in muscle tone (Usually hypotonia), and choking, gagging, or coughing that usually involves a significant intervention such as CPR provided by the caregiver who witnesses the event.
Apnea and Apparent Life-Threatening Event (ALTE)
Then resolve episode including at least one of the following: (BRUE)
Cyanosis or pallor
Absent, Decreased, or irregular breathing.
Marked change in muscle tone (hypertonia or hypotonia) and/or
Altered responsiveness.
The guidelines also state that a _____is diagnosed only when there is no explanation for a qualifying event after completion of a thorough history and physical examination
BRUE
Age limit < 1 yr old
BRUE
No particular age limit
ALTE
Airway not included
BRUE
Choking and Gagging
ALTE
Absent breathing, diminished breathing, and other irregularities
BRUE
Apnea (Central or occasionally obstructive)
ALTE
Cyanotic/Pale
BRUE
Cyanotic / Pallid / Erythematous / Plethoric
ALTE
Marked change in tone, including hypertonia or hypotonia
BRUE
Any change in muscle tone
ALTE
Altered level of responsiveness (May indicate serious cardiac, respiratory, metabolic, or neurologic event)
BRUE
Only if there are no other causes
BRUE
Might have included such as GORD / LRTI / Meningitis / Sepsis
ALTE
Are openings or splits in the upper lip, the roof of the mouth or both.
Cleft lip and Cleft palate
The most common birth defect in the United States and occurs with a frequency of 1 in 600 live births
Cleft lip (CL) with or without cleft palate (CP)
It is more common in males and _____ alone is common in females.
Cleft lip (CL) with or without cleft palate (CP), cleft palate
Exposure to environmental factors or teratogens may be responsible for _____ at a critical point in embryonic development.
clefts
A _____ can occur unilaterally or bilaterally, and it may present a simple notch in the upper lip or extend completely to the base of the nose.
cleft lip
Cleft lip is the most common orofacial cleft. _____ deficiency may also be associated with incomplete anterior midline closure.
Folic acid
Cleft lip s an opening of the palate and occurs when the palatal process does not close as usual at approximately _____ of intrauterine life
9 to 12 weeks
Surgical Intervention for Cleft Lip and Palate
Cheiloplasty
Palatoplasty
10 weeks old, 10lbs, and hemoglobin of 10
Rule of Tens
Typically performed at 3 months of age (as early as 3 months of age)
Cheiloplasty
Most widely used procedure for unilateral cleft lip repair
Cheiloplasty
Creation of velopharyngeal valve for swallowing and speech
Palatoplasty
Preservation of midface growth
Palatoplasty
Based on the timeline we repair it as early as 9-12 months age (minimize speech abnormalities)
Palatoplasty
Facial growth may be less affected if surgery is delayed until 18-24 months, but feeding, speech, socialization may suffer.
Palatoplasty
A condition that occurs when the portion of the bowel folds “TELESCOPES” into itself, resulting in obstruction.
Intussusception
more common in males than in females and is more common in children younger than 2 years old.
Intussusception
Most common cause of intestinal obstruction in infants and young children with ⅔ of then happening among infants under 1 year of age.
Intussusception
Common Signs & Symptoms of Intussusception
- Sudden onset of intermittent crampy abdominal pain
- Severe pain (children usually draw up their knees and scream)
- Vomiting
- Diarrhea
- Currant-jelly stools, gross blood or hemoccult positive stools
- Lethargy
Nursing Intervention for Intussusception
Assess severity of pain
Observe for Presence of bilious vomiting
Assess for signs and symptoms of peritonitis
Physical examination: Palpate abdomen for presence of sausage-shaped mass upper mid abdomen - a hallmark sign for intussusception.
Nursing Management for Intussusception
Intravenous fluid as ordered by the Physician
Provide emotional support to the anxious parents
Provide appropriate preoperative and postoperative education to the family
Also called as Congenital Aganglionic Megacolon
Hirschsprung’s Disease
A congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine.
Hirschsprung’s Disease
It accounts for about one fourth of all cases of neonatal intestinal obstruction. The incidence is 1 in 5000 live births
Hirschsprung’s Disease
Absence of nerve plexuses due to disruption of the distal migration of neuroblasts along the intestines
Hirschsprung’s Disease
Therapeutic Management for Hirschsprung’s Disease
Surgical resection of the aganglionic bowel and reanastomosis of the remaining intestine.
Providing post operative care and observe for possible complication of enterocolitis signs and symptoms:
Fever
Abdominal distention
Chronic diarrhea
Explosive stools
Rectal bleeding
Straining
_____ are among the more common congenital malformations caused by abnormal development.
Anorectal malformations
Includes several forms of malformation without an obvious opening. Frequently a fistula (an abnormal communication) leads from the distal rectum to the perineum or GU system. The fistula may be evidenced when meconium is evacuated through the vaginal opening, the perineum below the vagina, the male urethra, or the perineum under the scrotum.
Imperforate Anus
Occurs once in every 5,000 live births. Rectourinary fistula is the passage of meconium in the urine.
Imperforate Anus
Surgical closing of any small tube-like openings (fistula), creating an anal opening, and putting the rectal pouch into the anal opening
Anoplasty
Surgical Intervention for Imperforate Anus
Anoplasty
Associated with fever 102 to 104 Fahrenheit or 38.9 to 40.0 Celsius.
Febrile Seizures
Febrile Seizures associated with fever _____ Fahrenheit or _____ Celsius.
102 to 104, 38.9 to 40.0
_____ usually occur due to a sudden spike of temperature.
Febrile seizures
The seizure only lasts _____ or less.
1 to 2 minutes
A febrile seizure is a seizure associated with a febrile illness in a child who does not have a _____.
CNS infection
By definition, children who have a febrile seizure cannot have a history of neonatal or unprovoked _____
seizures
Occurring in 2% to 5% of children between the ages of 1 month and 5 years
Febrile Seizures
Nursing Intervention for Febrile Seizures
After a seizure subsides, to sponge the child with tepid water to reduce the fever quickly
A condition caused by an imbalance in the production and absorption of CSF in the ventricular system.
Hydrocephalus
This condition could also be termed a hydrodynamic SSF disorder.
Hydrocephalus
Can be defined broadly as a disturbance of cerebrospinal fluid (CSF) formation, flow, or absorption, leading to an increase in volume occupied by this fluid in the central nervous system.
Hydrocephalus
Types of Hydrocephalus
Communicating
Non-Communicating
No Blockage in the ventricular system.
Communicating
Blockage in ventricular system - Most common cause of hydrocephalus.
Non-Communicating
Clinical manifestation of Hydrocephalus
Head enlargement (increasing occipitofrontal circumference) is the predominant sign.
Nursing Management for Hydrocephalus
Maintaining cerebral perfusion
Minimizing neurologic complication
Recognizing and preventing shunt infection and malfunction
Maintaining adequate nutrition
Promoting growth and development
Meningitis can be caused by a variety of organisms, but the three main types are:
bacterial or progenic, caused by pus-forming bacteria, especially meningococci and pneumococci organisms
viral or aseptic, caused by a wide variety of viral agents
tuberculous, caused by the tuberculosis bacillus.
The majority of children with _____ have either bacterial meningitis or viral meningitis as the underlying cause.
acute febrile encephalopathy
Age affected by Escherichia coll: Streptococcus group B Listeria monocytogenes pseudomonas aeruginosa; streptococcus species
Newborns and Infants (birth to 3 mos)
Age affected by Streptococcus pneumonia; Neisseria meningitides (meningococcal meningitis) Haemophilus influenzae type B
Infants and children (3 mos to 6 years)
Age affected by Streptococcus pneumonia; Nissena meningitidis (meningococcal meningitis) Mycobacterium Tuberculosis.
Older children And adolescents (6 yrs. To 16 yrs.)
A major priority of nursing care of a child suspected of having meningitis is to administer _____ as soon as they are ordered.
Antibiotics
The child is placed on respiratory isolation for at least _____ after initiation of antimicrobial therapy.
24 hours
Nursing Alert for Meningitis
Reducing intracranial pressure (ICP) and maintain cerebral perfusion
Administer antibiotics immediately
Oxygen Inhalation - Ensure proper ventilation, reduce the inflammatory response and prevent injury to the brain.
Reducing fever - reduce metabolic needs of the brain. TSB, reduce environmental temperature.
Treat fluid volume deficit - Intravenous fluids
Control seizures - use of anticonvulsant drugs, anti- inflammatory drugs
Prevent injury resulting from altered LOC or seizure activity
Initiate appropriate droplet isolation until 24 hours of antibiotic therapy -to prevent transmission
Part of a group of birth defects called neural tube defects.
Spina Bifida
Caused by a defect in the neural arch generally in the lumbosacral region
Spina Bifida
A failure of the posterior laminae of the vertebrae to close; this leaves an opening through which the spinal meninges and spinal cord may protrude.
Spina Bifida
Posterior laminae of vertebrae fail to fuse
Spina bifida occulta
Dimpling at the point of poor fusion, abnormal tufts of hair or, discolored skin
Spina bifida occulta
Membranes herniate thru unformed vertebrae -protrude as a circular mass change size at the center of the back-lower lumbar or lumbosacral region
Spina bifida with meningocele
With eternal saclike
Spina bifida with meningocele
The spine, spinal cord and spinal canal do not form or data normally
Spina bifida with myelomeningocele
A sac of fluid comes thru as opening in the to’s back
Spina bifida with myelomeningocele
Most severe and the spinal cord and meninges
protrudes
Spina bifida with myelomeningocele
Prevention of Spina Bifida
Folic acid 60 mg with prenatal vitamin and mandatory inclusion of folic acid in all cereals and grain products.
Risk Factors of Spina Bifida
Folic acid deficiency
Maternal age under 20 and over 40 year
Maternal education below 12 grade level
Low socioeconomic status
Result of an extra chromosome 21
Trisomy 21 or Down Syndrome
1:700 children
Trisomy 21 or Down Syndrome
Characteristic facial features, short stature; heart defects, shorter lifespan._ etc.
Trisomy 21 or Down Syndrome
Has been correlated to the age of the mother but can also be result of nondisjunction of father’s chromosome 21
Trisomy 21 or Down Syndrome
_____ first described the condition in 1866, but its cause was a mystery for many years.
Langdon Down
In 1932, it was suggested that a _____ might be the cause, but the anomaly was not demonstrated until 1959.
chromosomal anomaly
A congenital malformation in which both cerebral hemispheres are absent.
Anencephaly
The condition is usually incompatible with life, and many affected infants are stillborn. For those who survive, no specific treatment is available.
Anencephaly
Nursing Management for Anencephaly
Provide emotional support to the grieving family.
