Cerebral Palsy, Spinal Muscular Atrophy, Neural Tube Defects

Question 1

TRUE OR FALSE

Cerebral Palsy is a progressive disorder of movement and posture.

Answer 1

FALSE

It is NON-PROGRESSIVE

Question 2

What does “palsy” mean?

Answer 2

poor muscle control/muscle weakness because of something neuro

Question 3

TRUE OR FALSE

We will have pt’s admitted for cerebral palsy.

Answer 3

FALSE

There is nothing to be done about cerebral palsy. They would be admitted for symptoms of their condition, not the condition itself

Question 4

What are some basic things we need to keep in mind when we care for a pt w/ cerebral palsy?

Answer 4

• It is a non-progressive disorder
• What’s going on with their muscles is not necessarily what’s going on inside of their minds
• They may not be able to speak or move a lot, but they’re still there and we communicate with them at their developmental level
• CP has a wide range of affliction and can be mild or severe

Question 5

A CP pt with poor swallow and risk of aspiration may be admitted for…

Answer 5

• Pneumonia,
• Nutrition Assessment,
• GT Placement

Question 6

A CP pt with severe spasticity, or mobility/alignment issues may be admitted for…

Answer 6

orthopedic surgery

Question 7

A CP pt with bladder issues, frequent UTIs, or incontinence may be admitted for…

Answer 7

GU surgery

Question 8

If a test question stated “There is a patient with aspiration and cerebral palsy”, what is the issue and why?

Answer 8

• aspiration is the issue
• we can’t treat cerebral palsy

Question 9

What is Baclofen

used for,

how is it administered

and why?

Answer 9

• It is used to decrease muscle spasticity
• It is administered interthecally via pump that provides a steady dose
• The steady dose reduces possible sfx (over oral administration)

Question 10

What are the key points to remember about the Baclofen pump?

Answer 10

• Pump sits inside the skin of the abdomen
• Pump is refilled @ the Dr’s office every 2-6mos
• batteries can last 6-7yrs

Question 11

How does Baclofen work?

Answer 11

It blocks activity of nerves in the part of the brain that controls the contraction and relaxation of skeletal muscles to help them relax.

Question 12

What CP patient may have a Baclofen pump installed?

Answer 12

a CP pt w/ severe contractures

Question 13

What are the three neural tube defects we need to know?

Answer 13

1. Anencephaly
2. Spina Bifida Occulta
3. Spina Bifida Cystica

Question 14

Describe ancephaly.

Answer 14

• “An” means without, “cephaly” means brain.
• A baby can actually be born w/out a fucking brain.
• Nothing to know/say about it.
• It will die.

Question 15

What are the key points to remember for Spina Bifida Occulta?

Answer 15

• hidden split in spine
• Least serious, but most common type
• Sacral dimple w/ some odd hair is what you’ll see
• Some kids w/ this have no problems at all and may not even know they have it unless they have a back xray taken

Question 16

What are the two types of Spina Bifida Cystica?

Briefly describe each.

Answer 16

• Meningocele
  
  • no spinal cord damage
  • least common form of spina bifida
• Myelomeningocele
  
  • most severe
  • meninges and spinal cord are pushed out and damaged
• They can occur anywhere along the spine, but typically in the lower back
• They may also have hydrocephalus - because the flow of CSF can get blocked and backed up and can cause some issues up there

Question 17

What is our nursing care for a newborn with a myelomeningocele?

Answer 17

• Cover w/ WARM cloth
• Protect and keep moist (w/ sterile saline)
  
  • don’t want the site to dry/crack
  • change dressing every 2-4hrs
• Will have surgery very quickly after birth for this

Question 18

What is our pre-op nursing care for a newborn with a myelomeningocele?

Answer 18

• Keep site moist (sterile dressing with saline)
• Prone position
• Inspect site for leaks
• Watch closely for developing infection or increased ICP

Question 19

What is our post-op nursing care for a newborn with a myelomeningocele?

Answer 19

• Prone or side-lying position
• Same as any post-op
  
  • I/O
  • Monitor for infection - like a lot a lot
  • Pain ctrl
  • Neuro checks
  • Location of site will determine type of care needed

Question 20

What are the long-term care issues to keep in mind for a child born w/ myelomeningocele?

Answer 20

• Orthopedic Considerations
• Management of Genitourinary Function
• Bowel Control