Exam 2 Blueprint Neuromuscular

Question 1

what is anencephaly?

Answer 1

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)

Question 2

what is important to know about myelodysplasia (spina bifida)?

Answer 2

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.

Question 3

what are the diagnostic testing and complications associated with spina bifida?

Answer 3

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%)

Question 4

what are congenital problems?

Answer 4

cerebral palsy, neural tube defects, hydrocephalus, and hypotonia.

Question 5

what is cerebral palsy?

Answer 5

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).

Question 6

what are the CP signs?

Answer 6

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.

Question 7

what are the CP CM?

Answer 7

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.)

Question 8

what is the CP assessment?

Answer 8

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.

Question 9

what are the CP associated problems?

Answer 9

seizures, drool, difficulty feed/speech, risk of aspiration, orthopedic complications (hip dislocn/scoliosis), constipation, dental caries, gingivitis, nystagmus, and hearing loss.

Question 10

what is the CP management?

Answer 10

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.

Question 11

what are the CP interventions?

Answer 11

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.

Question 12

what are the causes of hydrocephalus?

Answer 12

primary (Arnold Chiari Syndrome) and secondary (acquired).

Question 13

what are the S/S and treatment of hydrocephalus?

Answer 13

sunset sign, increased head circumference, high-pitched cry, poor feeding if ICP is too high

Surgical treatment with shunt placement/biggest complication is infection

Question 14

what is the nursing care for hydrocephalus?

Answer 14

support child and family, teach signs of infection, and skin care.

Question 15

what is hypotonia?

Answer 15

floppy infant syndrome, when supine is frog legged. Head lag, poor suck, and EMG key diagnostic test. Management by the cause.

Question 16

what are the infectious problems?

Answer 16

Guillian Barre Syndrome, Tetanus, and Botulism.

Question 17

what is guillian barre syndrome?

Answer 17

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

Question 18

what is tetanus?

Answer 18

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.

Question 19

what is the nursing care for tetanus?

Answer 19

ICU (airway) – secretions, communication. Quite environment/ sedatives/ paralytics (aware, in pain, fight: flight, muscle spasms. F/E management, NG/OG feeds, and IV therapy.

Question 20

what is botulism?

Answer 20

serious food poisoning, clostridium botulinum, improperly sterilized food (Honey, corn syrup – infant), S/S: blurred vision, dizzy, vomiting, and dysphagia. Descending paralysis and dyspnea.

Question 21

what is the management for botulism?

Answer 21

HX PE, isolation of organism, botulism IVIG, ICU, monitor muscle impairment, and F/E balance.