17.) Musculoskeletal (part 2) Flashcards
A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse’s response should be based on what?
a. ) Prenatal detection is not possible yet.
b. ) There is no genetic basis for the defect.
c. ) Open neural tube defects (NTDs) result in elevated concentrations of α-fetoprotein in amniotic fluid.
d. ) Chromosome studies done on amniotic fluid can diagnose the defect prenatally.
c.) Open neural tube defects (NTDs) result in elevated concentrations of α-fetoprotein in amniotic fluid.
Ultrasound scanning and measurement of α-fetoprotein may indicate the presence of anencephaly or myelomeningocele. The optimum time for performing this analyzing is between 16 and 18 weeks. Prenatal diagnosis is possible through amniocentesis. A multifactorial origin is suspected, including drugs, radiation, maternal malnutrition, chemicals, and possibly a genetic mutation. Chromosome abnormalities are not present in NTDs.
What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)?
a. ) It has an autosomal dominant inheritance pattern.
b. ) Onset occurs in later childhood and adolescence.
c. ) It is characterized by presence of Gower sign, a waddling gait, and lordosis.
d. ) Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.
c.) It is characterized by presence of Gower sign, a waddling gait, and lordosis.
DMD is characterized by a waddling gait and lordosis. Gower sign is a characteristic way of rising from a squatting or sitting position on the floor.
DMD is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. Onset occurs usually between ages 3 and 5 years. DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.
What is a major goal of therapy for children with cerebral palsy (CP)?
a. ) Cure the underlying defect causing the disorder.
b. ) Reverse the degenerative processes that have occurred.
c. ) Prevent the spread to individuals in close contact with the child.
d. ) Recognize the disorder early and promote optimum development.
d.) Recognize the disorder early and promote optimum development.
The goals of therapy include early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction. The disorder is permanent, and therapy is chiefly symptomatic and preventive. It is not possible at this time to reverse the degenerative processes. CP is not contagious.
What is the most common cause of cerebral palsy (CP)?
a. ) Central nervous system (CNS) diseases
b. ) Birth asphyxia
c. ) Cerebral trauma
d. ) Neonatal encephalopathy
d.) Neonatal encephalopathy
Approximately 80% of CP is caused by unknown prenatal causes. Neonatal encephalopathy in term and preterm infants is believed to play a significant role in the development of CP.
CNS diseases such as meningitis or encephalitis can result in CP. Birth asphyxia does contribute to some cases of CP. Cerebral trauma, including shaken baby syndrome, can result in CP.
The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.)
a. ) Dark tufts of hair
b. ) Skin depression or dimple
c. ) Port-wine angiomatous nevi
d. ) Soft, subcutaneous lipomas
e. ) Bladder and sphincter paralysis
a.) Dark tufts of hair
b.) Skin depression or dimple
c.) Port-wine angiomatous nevi
d.) Soft, subcutaneous lipomas
Clinical manifestations of spina bifida occulta include dark tufts of hair; skin depression or dimple; port-wine angiomatous nevi; and soft, subcutaneous lipomas. Bladder and sphincter paralysis are present with spina bifida cystica but not occulta.
What type of cerebral palsy (CP) is the most common type?
a. ) Ataxic
b. ) Spastic
c. ) Dyskinetic
d. ) Mixed type
b.) Spastic
Spastic CP is the most common clinical type. Early manifestations are usually generalized hypotonia, or decreased tone that lasts for a few weeks or may extend for months or as long as 1 year. It is replaced by increased stretch reflexes, increased muscle tone, and weakness. Ataxic, dyskinetic, and mixed type are less common forms of CP.
The nurse is preparing to admit a 10-year-old child with Duchenne muscular dystrophy. What clinical features of Duchenne muscular dystrophy should the nurse recognize? (Select all that apply.)
a. ) Calf muscle hypertrophy
b. ) Late onset, usually between 6 and 8 years of age
c. ) Progressive muscular weakness, wasting, and contractures
d. ) Loss of independent ambulation by 9 to 12 years of age
e. ) Slowly progressive, generalized weakness during adolescence
a.) Calf muscle hypertrophy
c.) Progressive muscular weakness, wasting, and contractures
d.) Loss of independent ambulation by 9 to 12 years of age
e.) Slowly progressive, generalized weakness during adolescence
Clinical features of Duchenne muscular dystrophy include calf muscle hypertrophy; progressive muscular weakness; wasting and contractures; loss of independent ambulation by 9 to 12 years of age; and slowly progressive, generalized weakness during adolescence. The onset is early, not late, usually between 3 and 5 years of age.
Spastic cerebral palsy (CP) is characterized by which clinical manifestations?
a. ) Athetosis, dystonic movements
b. ) Tremors, lack of active movement
c. ) Hypertonicity; poor control of posture, balance, and coordinated motion
d. ) Wide-based gait; poor performance of rapid, repetitive movements
c.) Hypertonicity; poor control of posture, balance, and coordinated motion
Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic CP. Athetosis and dystonic movements are part of the classification of dyskinetic or athetoid CP. Tremors and lack of active movement may indicate other neurologic disorders. A wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic CP.
What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column?
a. ) Rachischisis
b. ) Meningocele
c. ) Encephalocele
d. ) Myelomeningocele
d.) Myelomeningocele
A myelomeningocele has a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves.
Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac.
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate?
a. ) Prone with the head turned to the side
b. ) On the side
c. ) Supine in an infant carrier
d. ) Supine, with defect supported with rolled blankets
a.) Prone with the head turned to the side
The prone position with the head turned to the side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma.
The side-lying position is avoided preoperatively. It can place tension on the sac and affect hip dysplasia if present. The infant should not be placed in a supine position.
