ch 34 neuromuscular dysfunction Flashcards
early onset and impaired movement and posture
cerebral palsy
causes cerebral palsy
-prenatal/postnatal infection
-prenatal/postnatal hypoxia/asphyxia
-*preterm birth of LBW
-anoxia
types cerebral palsy
-spastic
-athetoid/dyskinetic
-ataxic
-mixed
type cerebral palsy: characterized by persistent primitive reflexes
spastic
diplegia
all extremities affected (CP)
tetraplegia
all extremities + trunk, mouth, pharynx, and tongue affected (CP)
type CP:
-involuntary irregular movements
-slow twisting movements trunk/extremities
dyskinetic
type CP:
-wide based gait
-rapid repetitive movements
-disintegration of movement of upper extremities when child reaches for objects
ataxia
possible early behavioral signs of CP
-excessive irritability
-no smiling by 3 mo
-feeding difficulty
possible early motor signs of CP
-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
general S+S CP
-delayed gross motor development
-abnormal motor performance
-alterations motor tone
-abnormal postures
-reflex abnormalities
-associated disabilities
meds to decrease spasticity in CP (4)
-bolulinum toxin (botox)
-baclofen (oral/implanted pump)
-dantrolene sodium (dantrium)
-diazepam (valium)
children more likely to have neural tube defects
-girls
-hispanic
med taken during pregnancy to prevent NTDs
folic acid
most serious NTD
-incompatible with life
-many stillborn
-no resuscitation efforts
-comfort family
anencephaly
types spina bifida
-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)
possible causes myelomeningocele
-drugs
-radiation
-maternal malnutrition
-chemicals
-genetic predisposition
S+S myelomeningocele
*hydrocephalus
-obvious defect
-urine dribbling/overflow incontinence
-poor anal sphincter tone
-orthopedic deformities
what can be tested prenatally to determine presence of spina bifida
alpha fetoprotein
nursing interventions with spina bifida
-placement on stomach
-catheterization
-neuro checks before and after surgery
-*high prevalence of latex allergy (latex free environment)
nursing consideration for kids with hypotonia
-resp care
-positioning
S+S werdnig-hoffmann disease spinal muscular atrophy (type 1)
-onset within 6 mo of birth
-inactivity
-FTT
S+S intermediate spinal muscular atrophy (type 2)
-onset within 18 mos of birth
-generalized weakness
causes guillain barre syndrome (GBS)
-vaccines
-nonspecific viral illness
S+S guillain barre syndrome
-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
Dx GBS
-CSF - increased protein concentration
-physical findings (symmetric paralysis)
Tx GBS
-supportive care
-possible intubation if resp failure
-steroids, IV immunoglobulin, plasmapheresis
-heparin
-gabapentin
how often do you get tetanus shot
q10 years
with injury
S+S tetanus
-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
4 requirements for developing lockjaw in tetanus
-presence of tetanus spores or vegetative forms of the bacillus
-injury to tissues
-wound conditions that encourage multiplication of organism
-susceptible host (not vaccinated)
Tx tetanus
-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
infant sources of botulism
honey
light or dark corn syrup
S+S botulism in children
-abrupt appearance of symptoms (12-36 hrs)
-weakness, dizziness
-headache
-diplopia
-speech difficulties
-vomiting
-progressive resp paralysis
Tx botulism
-IV botulism immune globulin (babies get “babyBIG”)
-early Tx
-resp support
S+S botulism in infants
-constipation*
-generalized weakness
-loss of head control
-feeding difficulty
-weak cry
-hypotonia
-diminished gag reflex
kids more likely to have myasthenia gravis
girls
S+S myasthenia gravis
-progressive muscle weakness
-difficulty swallowing, chewing, speaking
-ptosis
-diplopia
Tx myasthenia gravis
-IvIG
-prostigmine or neostigmine
common onset age duchenne muscular dystrophy
3-5 yo
what inheritance pattern is duchenne muscular dystrophy
-x linked
-1/3 fresh mutations
S+S duchenne MD
-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
Dx duchenne MD
-elevated serum CPK and AST
-EMG
-muscle biopsy
Tx duchenne MD
-maintain function in muscles as long as possible
-bracing
-ROM
-ADLs
-surgical release contractures prn
-genetic counseling
meds to treat reyes syndrome
-corticosteroids
-seizure meds
-mannitol
-vit k
cushings triad signs with increased ICP
-increased SBP
-widened pulse pressure
-bradycardia
-irregular respirations
