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peds > ch 34 neuromuscular dysfunction > Flashcards

ch 34 neuromuscular dysfunction Flashcards

1
Q

early onset and impaired movement and posture

A

cerebral palsy

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2
Q

causes cerebral palsy

A

-prenatal/postnatal infection
-prenatal/postnatal hypoxia/asphyxia
-*preterm birth of LBW
-anoxia

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3
Q

types cerebral palsy

A

-spastic
-athetoid/dyskinetic
-ataxic
-mixed

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4
Q

type cerebral palsy: characterized by persistent primitive reflexes

A

spastic

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5
Q

diplegia

A

all extremities affected (CP)

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6
Q

tetraplegia

A

all extremities + trunk, mouth, pharynx, and tongue affected (CP)

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7
Q

type CP:
-involuntary irregular movements
-slow twisting movements trunk/extremities

A

dyskinetic

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8
Q

type CP:
-wide based gait
-rapid repetitive movements
-disintegration of movement of upper extremities when child reaches for objects

A

ataxia

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9
Q

possible early behavioral signs of CP

A

-excessive irritability
-no smiling by 3 mo
-feeding difficulty

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10
Q

possible early motor signs of CP

A

-poor head control after 3 mo
-stiff/rigid limbs
-arching back/pushing away when being held
-floppy tone
-unable to sit w/o support at 8 mo
-clenched fists after 3 mo

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11
Q

general S+S CP

A

-delayed gross motor development
-abnormal motor performance
-alterations motor tone
-abnormal postures
-reflex abnormalities
-associated disabilities

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12
Q

meds to decrease spasticity in CP (4)

A

-bolulinum toxin (botox)
-baclofen (oral/implanted pump)
-dantrolene sodium (dantrium)
-diazepam (valium)

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13
Q

children more likely to have neural tube defects

A

-girls
-hispanic

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14
Q

med taken during pregnancy to prevent NTDs

A

folic acid

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15
Q

most serious NTD
-incompatible with life
-many stillborn
-no resuscitation efforts
-comfort family

A

anencephaly

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16
Q

types spina bifida

A

-oculta (not visible externally)
-cystica (saclike visible protrusion)
-meningocele (contains meninges and spinal fluid but not neural elements)
-myelomeningocele (contains meninges, spinal fluid, and neural elements)

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17
Q

possible causes myelomeningocele

A

-drugs
-radiation
-maternal malnutrition
-chemicals
-genetic predisposition

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18
Q

S+S myelomeningocele

A

*hydrocephalus
-obvious defect
-urine dribbling/overflow incontinence
-poor anal sphincter tone
-orthopedic deformities

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19
Q

what can be tested prenatally to determine presence of spina bifida

A

alpha fetoprotein

20
Q

nursing interventions with spina bifida

A

-placement on stomach
-catheterization
-neuro checks before and after surgery
-*high prevalence of latex allergy (latex free environment)

21
Q

nursing consideration for kids with hypotonia

A

-resp care
-positioning

22
Q

S+S werdnig-hoffmann disease spinal muscular atrophy (type 1)

A

-onset within 6 mo of birth
-inactivity
-FTT

23
Q

S+S intermediate spinal muscular atrophy (type 2)

A

-onset within 18 mos of birth
-generalized weakness

24
Q

causes guillain barre syndrome (GBS)

A

-vaccines
-nonspecific viral illness

25
Q

S+S guillain barre syndrome

A

-paralysis 10 days after nonspecific viral illness
-rapidly ascending paralysis
-muscle tenderness, weakness
-paresthesia
-breathing difficulties and resp failure
-loss of reflexes (including gag reflex*)
-frequent urinary incontinence/retention and constipation

26
Q

Dx GBS

A

-CSF - increased protein concentration
-physical findings (symmetric paralysis)

27
Q

Tx GBS

A

-supportive care
-possible intubation if resp failure
-steroids, IV immunoglobulin, plasmapheresis
-heparin
-gabapentin

28
Q

how often do you get tetanus shot

A

q10 years
with injury

29
Q

S+S tetanus

A

-incubation period 3-10 days
-muscle rigidity involving masseter and neck muscles
-difficulty swallowing
-rigid abdominal and limb muscles
-resp: atelectasis, pneumonia, resp arrest
-rapid HR, sweating

30
Q

4 requirements for developing lockjaw in tetanus

A

-presence of tetanus spores or vegetative forms of the bacillus
-injury to tissues
-wound conditions that encourage multiplication of organism
-susceptible host (not vaccinated)

31
Q

Tx tetanus

A

-prevent with vaccine or antitoxin after exposure
-Tx of contaminated wounds
-monitor fluid and electrolytes
-ICU admit for resp support
-muscle relaxants
-sedatives
-pancuronium (pavulon) aids with intubation

32
Q

infant sources of botulism

A

honey
light or dark corn syrup

33
Q

S+S botulism in children

A

-abrupt appearance of symptoms (12-36 hrs)
-weakness, dizziness
-headache
-diplopia
-speech difficulties
-vomiting
-progressive resp paralysis

34
Q

Tx botulism

A

-IV botulism immune globulin (babies get “babyBIG”)
-early Tx
-resp support

35
Q

S+S botulism in infants

A

-constipation*
-generalized weakness
-loss of head control
-feeding difficulty
-weak cry
-hypotonia
-diminished gag reflex

36
Q

kids more likely to have myasthenia gravis

A

girls

37
Q

S+S myasthenia gravis

A

-progressive muscle weakness
-difficulty swallowing, chewing, speaking
-ptosis
-diplopia

38
Q

Tx myasthenia gravis

A

-IvIG
-prostigmine or neostigmine

39
Q

common onset age duchenne muscular dystrophy

A

3-5 yo

40
Q

what inheritance pattern is duchenne muscular dystrophy

A

-x linked
-1/3 fresh mutations

41
Q

S+S duchenne MD

A

-waddling gait
-frequent falls
-*gower sign (using hands on legs to stand)
-enlarged muscles (pseudohypertrophy)
-mild to moderate mental impairment
-loss independent ambulation by 9-12 yo
-eventual death resp/cardiac failure

42
Q

Dx duchenne MD

A

-elevated serum CPK and AST
-EMG
-muscle biopsy

43
Q

Tx duchenne MD

A

-maintain function in muscles as long as possible
-bracing
-ROM
-ADLs
-surgical release contractures prn
-genetic counseling

44
Q

meds to treat reyes syndrome

A

-corticosteroids
-seizure meds
-mannitol
-vit k

45
Q

cushings triad signs with increased ICP

A

-increased SBP
-widened pulse pressure
-bradycardia
-irregular respirations

peds (28 decks)

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