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MCN 02 > CHAPTER 5:5 > Flashcards

CHAPTER 5:5 Flashcards

NERVOUS SYSTEM DISORDERS

1
Q

What is secreted by the Choroid plexus. It is clear and colorless. It bathes the surface of the brain in the subarachnoid space between pia & arachnoid matter

A

Cerebrospinal fluid (CSF)

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2
Q

What are the NERVOUS SYSTEM DISORDERS

A

A. HYDROCEPHALUS
B. SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISI)
C. CEREBRAL PALSY
D. DOWN’S SYNDROME/TRISOMY 21/MONGOLISM

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3
Q

Placement of Shunt:
→ Used in older children and in children with abdominal problems
→ CSF drains from the ventricles to the RA bypassing the internal jugular vein→drains into
circulating blood

A

AV shunt (Atrioventricular Shunt)

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4
Q

Its function is to take food to the brain and spinal cord and axcretes metabolites and act as a shock absorber.

A

Cerebrospinal fluid (CSF)

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5
Q

A condition caused by an imbalance in the production and absorption of CSF in the ventricular
system

A

HYDROCEPHALUS

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6
Q

Placement of Shunt:
→ Lateral ventricle/lumbar subarachnoid space to ureter→bladder (CSF is not reabsorbed
=additional intake of water and sodium)
→ Older children

A

Ventriculoureteral shunt

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7
Q

Placement of the shunt:
→ Necessitates the removal of the kidney
→ Last resort if other types have failed
→ Necessitates prompt treatment of UTI to prevent ascending infection

A

Ventriculoureteral shunt

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8
Q

Characterized by increased amount of CSF within ventricles and subarachnoid space resulting to enlargement of the head.

A

HYDROCEPHALUS

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9
Q

predominant sign of hydrocephalus in infancy

A

Head enlargement

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10
Q

what is used to confirm diagnosis and to compare the ration of lateral ventricle to cortex

A

Echoencephalography (neonates-infants whose fontanels are open)

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11
Q

ratio as to how many are affected with hydrocephalus

A

4:1,000 live births

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12
Q

causes of hydrocephalus

A
  1. Congenital=infants
  2. Acquired (complication of illness/trauma) =older children
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13
Q

It is a lifelong problem that needs evaluation regularly=realistic goals to achieve optimum potential , don’t be overprotective

A

hydrocephalus

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14
Q

Placement of Shunt in hydrocephalus

A
  1. Ventriculoperitoneal shunt (VP shunt)
  2. AV shunt (Atrioventricular Shunt)
  3. Ventriculoureteral shunt
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15
Q

Placement of Shunt:
→ Necessitates the removal of the kidney
→ Last resort if other types have failed
→ Necessitates prompt treatment of UTI to prevent ascending infection

A

Ventriculoureteral shunt

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16
Q

Placement of Shunt:
→ Most commonly used type
→ CSF drains from the ventricles to peritoneal cavity – fluid is absorbed across the peritoneal
membrane

A

Ventriculoperitoneal shunt (VP shunt)

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17
Q

Complication of Shunt Placement:
What Complications of Shunt Placement causes blockage, kinking, breakdown, migration

A

Shunt failure

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18
Q

Complications of Shunt Placement:

A
  1. Shunt failure
  2. Infection
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19
Q

What Complications of Shunt Placement is:
→ Most serious
→ Most prevalent in the first 2 months after placement
→ Post op ileus and peritonitis in VP shunt

A

Infection

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20
Q

how do you Provide pre-operative care for those with hydrocephalus

A

a. Measure head circumference daily
b. Monitor for s/s of ↑ICP
c. positioning
d. reduce chances of skin breakdown
e. measures to minimize ↑ICP
f. nutrition

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21
Q

Point of greatest measurement

A

occipitofrontal

just above brow, above pinna of the ears, around occipital prominence

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22
Q

infants with HYDROCEPHALUS:
→ early sign: _____
→ late: _____

A

→ early sign: tense bulging fontanel
→ late: high pitched, shrill cry, seizures

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23
Q

toddlers with HYDROCEPHALUS:
▪ early sign= ____

A

▪ early sign=headache, loss of appetite

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24
Q

Comfort measures for:
- mild pain
- severe pain

A
  • acetaminophen for mild;
  • opioids for severe pain
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25
Q

What is the reason for providing emotional support to parents about their child

A

Due to fear of retardation or brain damage

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26
Q

▪ literally means “cleft spine”
▪ “divided spine”

A

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

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27
Q

What is any malformation of spinal canal and cord called

A

Myelodysplasia

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28
Q

A congenital defect in which the spinal column is imperfectly closed so that part of the meninges or spinal cord protrudes, often resulting in hydrocephalus and other neurological disorders.

A

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

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29
Q

Failure of the posterior vertebral arches to fuse during the embryologic development.

A

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

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30
Q

in SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS):
Failure of the posterior vertebral arches to fuse (or neural tubes to close) during embryologic development, which is usually between what weeks of fetal life.

A

2-4 weeks

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31
Q

in SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS):
Normally, spinal cord and cauda equina are enclose where?

A

protective sheath of bone and meninges

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32
Q

Splitting of the already closed neural tube as a result of an abnormal CSF pressure in the first trimester

A

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

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33
Q

→ May involve entire length/restricted to a small area
→ The most common defect of the CNS
→ The higher the defect, the greater the neurologic dysfunction

A

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

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34
Q

Causes of SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

A
  • unknown (multifactorial inheritance)
  • genes
  • environment- poor maternal nutrition
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35
Q

All women of childbearing age should at eat foods rich in ________(fortified breads and cereals, fruits, dark green leafy vegetables and egg yolk)

A

folic acid

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36
Q

TYPES OF SPINA BIFIDA

A
  1. Spina bifida occulta
  2. Spina bifida cystica

2.a. Meningocele | 2.b. Myelomenigocele

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37
Q

Type of Spina Bifida:
* Failure of the posterior arches to fuse
* Mildest form

A

SPINA BIFIDA OCCULTA

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38
Q

Type of Spina Bifida:
* Not visible; may be identified by a dimple or the pressure of tuft of hair at the point of defect
* Child asymptomatic/with slight deficit-no treatment necessary

A

SPINA BIFIDA OCCULTA

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39
Q

Type of Spina Bifida:
* Defect in closure of posterior vertebral arch with protrusion through bony tissue
* Visible with an external saclike protrusion

A

SPINA BIFIDA CYSTICA

40
Q

Clinically, what does the term spina bifida means

A

myelomeningocele

41
Q

Type of Spina Bifida Cystica:
Encases meninges, spinal fluid but with no neural elements. Sac is covered with a skin

A

MENINGOCELE

42
Q

Type of Spina Bifida Cystica:
Not associated with neurologic deficits

A

MENINGOCELE

43
Q

What does the sac covering of those with meningocele look like?

A

translucent/membranous

44
Q

Type of Spina Bifida Cystica:
Contains meninges, spinal fluid and nerves; fluid leakage may occur

A

MYELOMENIGOCELE

45
Q

Type of Spina Bifida Cystica:
Parallel to dysfunction=loss of muscle function to lower extremities, bowel and bladder

A

MYELOMENIGOCELE

46
Q

Type of Spina Bifida Cystica:
* Lesion poorly covered with imperfect tissue
* In 90-95% of cases, hydrocephalus is frequently associated anomaly

A

MYELOMENIGOCELE

47
Q

Amniocentesis
* _____ =anencephaly, myelomenigocele; omphalocele; SCI
* _____ =chromosomal disorder

A
  • Elevated AFP =(+) NTD
  • Decreased
48
Q

when is amniocentesis Best done because after this time, AFP concentrations normally
diminish + can do therapeutic abortion just in case

A

16-18 weeks

49
Q

what diagnostic procedure is considered for patients with family history of SB

A

Chorionic villi sampling (CVS)

50
Q

When infants are detected as having meningocele / myelomenigocele, they may be born by what mode of delivery to avoid pressure and injury to the spinal cord.

A

caesarean section

51
Q

as management to spina bifida, Early surgery of how many hour/s is done after birth to replace the contents and to close the skin (skin graft)

A

24-72 hours

52
Q

It is one of the most common causes of neurogenic/neuropathic bladder dysfunction→frequent cause of UTI, ureterohydronephrosis, vesiculourethral reflux)

A

spina bifida

53
Q

Goals to those with spina bifida:
Infants= ???
Older children= ???

A
  • to preserve renal function
  • preserve renal function and achieve optimum urinary continence
54
Q

what Surgical procedure for Bladder elimination:
→ stoma created on the abdominal wall for urinary drainage

A

Vesicostomy

55
Q

what is it called when head is short but wide; sagittal sutures may separate

A

Brachycephaly

56
Q

what Surgical procedure for Bladder elimination:
→ increases bladder capacity and reduces high bladder pressure

A

Augmentation enterocystoplasty

57
Q

what Surgical procedure for Bladder elimination:
→ continent neobladder constructed from bowel/stomach +CIC
→ use when severe bladder dysfunction compromising renal function not relieved by other means

A

Urinary diversion

58
Q

The most common chromosomal abnormality; 1.66: 1,000 live births

A

DOWN’S SYNDROME/TRISOMY 21/MONGOLISM

59
Q

WHat occurs due to hypotonicity of chest and abdominal muscles and dysfunction of the immune system predispose to the development of respiratory infection

A

prone to upper respiratory infection (URI)

60
Q

A chromosomal abnormality involving an extra chromosome (21) characterized by a typical
appearance and mental retardation

A

DOWN’S SYNDROME/TRISOMY 21/MONGOLISM

61
Q

other terms for:
- nearsightedness
- involuntrary rapid eye movement

A
  • myopia
  • nystagmus
62
Q

what diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM uses:
Sample of peripheral venous blood/a sample of cells from the buccal membrane is taken;
cells are allowed to grow (2 weeks) then observed though a microscope

A

Karyotyping

63
Q

what diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
Shows the 3rd chromosome 21 that is attached to another in translocation

A

Karyotyping

64
Q

what diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM uses:
Visual presentation of a chromosome pattern of an individual

A

Karyotype

65
Q

diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
▪ Most commonly done at 8-10th week
▪ Retrieval and analysis of chorionic villi for chromosome analysis

A

Chorionic Villi Sampling CVS

66
Q

diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
▪ Done at 14-18th week

A

Amniocentecis

67
Q

diagnosis for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
▪ Done at 18-22th week
▪ Greatest risk of miscarriage
▪ Most accurate to confirm CVS and amniocentecis

A

Percutaneous Umbilical Blood Sampling (PUBS)

68
Q

Regular medical care for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
▪ For children participating in sports that may involve stress on back and neck
▪ Monitor for neck pain, weakness and torticollis

A

Atlantoaxial instability

69
Q

Regular medical care for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:
▪ At risk for spinal cord compression (s/s persistent neck pain, loss of established
motor skills and bladder and bowel control, changes in sensation)

A

Atlantoaxial instability

70
Q

4 Regular medical care for DOWN’S SYNDROME/TRISOMY 21/MONGOLISM:

A
  1. eyesight
  2. hearing
  3. thyroid function
  4. atlantoaxial instability
71
Q

What is setting sun also known as

A

Sunken Eyeballs

HALLMARK SIGN

72
Q

It means without coordination. People with this lose muscle control in their arms and legs

A

ataxia

73
Q

2 types of HYDROCEPHALUS

A
  • Non-communicating (Intraventricular, Obstructive)
  • Communicating (Extraventricular, Non-obstructive)
74
Q

type of HYDROCEPHALUS:

  • Obstruction to the flow of CSF within the ventricles
  • Obstruction of CSF flow to subarachnoid space
A
  • Non-communicating (Intraventricular, Obstructive)
75
Q

type of HYDROCEPHALUS:

Reduced absorption of CSF within the
subarachnoid space

A
  • Communicating (Extraventricular, Non-obstructive)
76
Q

HYDROCEPHALUS:

What is most effective when disorder is recognized early because once ↑ ICP becomes so acute, the brain tissue is damaged and motor/mental deterioration results

A

Treatment

77
Q

last resort for managing HYDROCEPHALUS:

A

Ventriculoureteral shunt

78
Q

Why is there a need to monitor if:
v/s=↑RR, BT, and BP (↑SBP); ↓PR

A

Possibility of increased intracranial pressure

79
Q

What must be done: if ↑ICP to prevent rapid CSF
drainage

A

Gradually elevated not greater than 30 degrees

Best position: FLAT | >30’ causeover draining of fluid

80
Q

SPINA BIFIDA (RACHISCHISIS/ SCHISTORRHACHISIS)

What is the reason why neural tubes are to close

A

due to mother nottaking folic acid during pregnancy

81
Q

2 types of SPINA BIFIDA CYSTICA

A

MENINGOCELE & MYELOMENIGOCELE

82
Q

a group of non progressive neurodevelopmental disabilities mainly involving muscle control and other sensory and/or intellectual function to some degree

A

cerebral palsy

Most common CHRONIC disorder of childhood

83
Q

characterized by impaired movement and posture resulting from an abnormality in the EPS/PS

A

cerebral palsy

Most common CHRONIC disorder of childhood

84
Q

Types of Cerebral Palsy according to topography

A
  1. Hemiplegia
  2. Diplegia
  3. Quadriplegia
85
Q

Type of Cerebral Palsy according to topography:

one side of body with upper extremities being dysfunctional rather than the lower extremities

A

Hemiplegia

86
Q

Type of Cerebral Palsy according to topography:

involvement of the lower extremities, usually spastic

A

Diplegia

87
Q

Type of Cerebral Palsy according to topography:

involvement of all extremities with the arm in flexion and leg in extension

A

Quadriplegia

88
Q

Types of Cerebral Palsy according to Neuromuscular Dysfunction:

A
  1. Spastic
  2. Athetoid (dyskinetic)
  3. Ataxic
  4. Mixed (dystonic)
89
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • may involve one/both sides
  • the most common form
  • hypertonicity with poor control of posture, balance and coordinated motion
A

spastic

90
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • impaired fine and gross motor skill
  • active attempts at motion increases abnormal posture and overflow of movements to othre pars of the body
A

spastic

91
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

Manifestations:
1. scissor gait when held upright
2. walk on toes

A

spastic

92
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • abnormal involuntary movement
  • slow wormlike writhing movements that usually involve the extremities, trunk, facial muscle and tongue
A

Athetoid (dyskinetic)

93
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • involuntary muscles may take on choreoid and dystonic manifestations
  • involvement of a pharyngeal, laryngeal, and oral muscles cause drooling and dysarthia (imperfect speech articulation)
A

Athetoid (dyskinetic)

93
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • irregularity and muscle coordination or action
  • awkward wide-based gate
A

Ataxic

94
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • rapid repetitive movements performed poorly
  • disintegration of movements of the upper extremities when the child reaches for objects
A

Ataxic

95
Q

Type of Cerebral Palsy according to Neuromuscular Dysfunction:

  • combination of spasticity and athetosis
A

mixed (dystonic)

96
Q

It is a condition that affects the bones in the upper spine or neck under the base of the skull.

A

Atlanto-axial instability (AAI)

MCN 02 (6 decks)

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