Exam 2 Blueprint Neuromuscular Flashcards
what is anencephaly?
severely underdeveloped brain –
A rare birth defect occurs early in pregnancy when the neural tube, which becomes the spinal column and brain, fails to close. Infants with this usually have a brain stem, which controls reflex actions such as breathing. But they don’t have a forebrain (the front part of the brain) or a cerebrum (the thinking part of the brain)
what is important to know about myelodysplasia (spina bifida)?
Occulta/ not visible externally / may have a dimple
Cystica / visible defect with sac like protrusion – meningocele (not associated with a neuro deficit) and Myelomeningocele (spina bifida meninges, spinal fluid and nerves)
Neural tube fails to close in utero, usually lumbar area (symptoms depend on where the defect is, paralysis of legs, loss of bowel and bladder function, hip dislocations and club feet). Frequently associated with hydrocephalus.
what are the diagnostic testing and complications associated with spina bifida?
Maternal alpha fetal protein (AFP), ultrasound, CT, MRI
Complications: urinary and bowel continence (self-cath, vesicostomy), not all are mentally deficient, wheelchair, and latex allergy (50%)
what are congenital problems?
cerebral palsy, neural tube defects, hydrocephalus, and hypotonia.
what is cerebral palsy?
non-progressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (involuntary movements). Cognitive disability, seizures, etiology: anoxic injury around birth, maternal infection, kernicterus, and low birth weight (risk factor).
what are the CP signs?
behavioral – extreme irritability or cry, failure to smile by 3 months, feeding difficulties, choking when fed, persistent gag when fed, and persistent tongue thrusting after 6 months.
what are the CP CM?
abnormal postures (scissoring of legs), reflex abnormalities (persistent primitive reflexes, tonic neck reflex (curved to side and ridged)), associated problems (intellectual impairment (70% norm), speech difficulties, and ADHD.)
what is the CP assessment?
persistent reflexes, delayed developmental milestones, apparent early preference for one hand, poor suck, tongue thrust, spasticity “difficulty with diapering”, involuntary movements, scissoring of legs, and seizures.
what are the CP associated problems?
seizures, drool, difficulty feed/speech, risk of aspiration, orthopedic complications (hip dislocn/scoliosis), constipation, dental caries, gingivitis, nystagmus, and hearing loss.
what is the CP management?
early recognition, PT (wheelchairs, walkers, braces. No infant walkers or dandy jumpers), OT, speech therapy, surgery (Rhizotomy), Meds: anti-anxiety/muscle relaxers. Botox, using implanted pump infusers (Baclofen), anti-convulsant, ADHD meds.
what are the CP interventions?
referral to community-based agencies, coordinate care, during feeding prevent aspiration (Jaw support, child upright), support family, admin anti-convulsant meds (Dilantin), and admin valium for muscle spasms.
what are the causes of hydrocephalus?
primary (Arnold Chiari Syndrome) and secondary (acquired).
what are the S/S and treatment of hydrocephalus?
sunset sign, increased head circumference, high-pitched cry, poor feeding if ICP is too high
Surgical treatment with shunt placement/biggest complication is infection
what is the nursing care for hydrocephalus?
support child and family, teach signs of infection, and skin care.
what is hypotonia?
floppy infant syndrome, when supine is frog legged. Head lag, poor suck, and EMG key diagnostic test. Management by the cause.
what are the infectious problems?
Guillian Barre Syndrome, Tetanus, and Botulism.
what is guillian barre syndrome?
infectious polyneuritis (Immune mediated), ascending paralysis (acute peripheral weakness). Post viral, some vaccines. Adolescents – young adult. Supportive care – ventilatory support, IVIG, steroids, pain control, Plasmapheresis (pull blood out of body, separate plasma from the blood, and puts in fresh frozen plasma (FFP), and DVT prevention
what is tetanus?
Lockjaw, clostridium tetani (neurotoxin fixes on nerve cells): trismus leads to lock jaw, risus sardonicus (natural grin look), and opisthotonos (arching of head, neck, and spine). Painful muscular rigidity involving neck muscles, spores found in dust, soil, intestinal tract. Enter host by wound, burn, crushed area, and puncture. Newborn (contaminated surroundings). Incubation 3 days to 3 weeks. Prevention is KEY. Td booster every 10 years, trauma (tetanus toxoid or antitoxin). NOT necessary to clean wound in immunized kids (no antitoxin) get booster. Unimmunized with wound gets tetanus immune globulin (TIG) for protection and tetanus toxoid to begin active immune process. ABX.
what is the nursing care for tetanus?
ICU (airway) – secretions, communication. Quite environment/ sedatives/ paralytics (aware, in pain, fight: flight, muscle spasms. F/E management, NG/OG feeds, and IV therapy.
what is botulism?
serious food poisoning, clostridium botulinum, improperly sterilized food (Honey, corn syrup – infant), S/S: blurred vision, dizzy, vomiting, and dysphagia. Descending paralysis and dyspnea.
what is the management for botulism?
HX PE, isolation of organism, botulism IVIG, ICU, monitor muscle impairment, and F/E balance.
