Exam 2 - neuromuscular/musculoskeletal Flashcards
1
Q
Neural tube defects (3 kinds)
A
spina bidifia occulta
meningocele
myelomeningocele
2
Q
spina bifida occulta
A
defective vertebrae bodies with NO PROTRUSION
3
Q
spina bifida occulta has…
A
no protrusion, hair patch, small back dimple, discoloration
4
Q
spina bifida occulta TX:
A
will close with time; surgical intervention if does not
5
Q
Meningocele is…
A
little to no neural problem, with small protrusion (meninges herniate through defect in vertebrae)
6
Q
meningocele TX:
A
surgical intervention
7
Q
myelomeningocele is…
A
large protrusion that happens in utero; neural tubes fail to close, leaving an external sac that encases the meninges, spinal fluid, and spinal nerves
8
Q
myelomeningocele TX
A
surgical intervention
9
Q
myelomeningocele risks
A
seizures
meningitis
hypoxia
hemorrhage
paralysis
10
Q
myelomeningocele linked to…
A
maternal drug/alcohol use
malnutrition
11
Q
the spinal cord ends…
A
WHERE THE MYELOMENINGOCELE BEGINS
12
Q
odd finding for myelomeningocele
A
latex allergy
13
Q
Pectus excavatum
A
also known as funnel chest; when sternum goes inward; leaves oblong dimple midline
14
Q
pectus excavatum S/S
A
SOB
withdrawal from physical activities
poor body image
15
Q
pectus excavatum TX
A
surgical intervention depending on severity (preferably before puberty b/c skeleton is more pliable)
PT to help correct musculoskeletal defect
16
Q
pectus carinatum
A
sternum goes outward
17
Q
pectus carinatum S/S
A
decreased exercise tolerance
tachycardia
recurrent respiratory infections
wheezing/coughing
chest pain
fatigue/dizziness
18
Q
pectus carinatum TX
A
bracing while still young
19
Q
clubfoot
A
one or both feet; foot twisted out of shape
20
Q
clubfoot TX
A
series of casts in different phases to correct defect
21
Q
metatarsus adductus
A
metatarsal bones deviated inward; only affects one foot
22
Q
metatarsus adductus TX:
A
series of casts in different phases to correct defect
23
Q
polydactyly
A
extra digits; either center, preaxial, postaxial
24
Q
preaxial
A
extra digit on thumb side (radial side)
25
postaxial
extra digit on pinky side (ulnar side)
26
polydactyly TX
surgical intervention to have extra digit removed
27
Syndactyly
webbing of the skin, and possible fusion of bones
28
simple syndactyly
joined by skin and soft tissue
29
complex syndactyly
underlying bones joined together
30
complicated syndactyly
extra bones and abnormal tendons and/or ligaments
31
dysplasia of hips
dislocation of the hip joints
32
dysplasia of the hips TX
Pavlik harness
33
pavlik harness rules
NEVER REMOVE UNLESS INSTRUCTED TO DO SO BY PROVIDER
do not apply lotion, otherwise can cause maceration of the skin
supine for sleep
diaper goes under harness
34
torticollis
preferential turning of head and stiffening of neck when laying down
35
Tibia Vara
idiopathic structural defect of the legs
36
tibia varum
bow legged , knees spread apart
37
tibia valgum
knees touched; X shaped legs
38
Osteogenesis Imperfecta
bone disorder that results in low bone mass, increased fragility of bones, connective tissue problems
39
Osteogenesis Imperfect S/S
BLUE SCLERA
brittle teeth
mutiple fractures
hearing loss
joint hyper mobility
40
Osteogenesis Imperfecta TX
surgical intervention to decrease fractures and maintain mobility
splints/braces for breaks
insertion of rods
PT/OT to prevent contractures and maximize mobility
41
Osteogenesis Imperfecta medications
biphosphonate (for moderate to severe OI) to slow to loss of existing bone
42
Muscular Dystrophy
GENETIC DISORDER: motor neuron disease that affects spinal nerve communication with muscles
43
Muscular Dystrophy complication
muscles lose function over time d/t misuse --> atrophy; progressive
44
Duchenne
diagnoses early in childhood; fatal, generalizes weakness, muscle wasting, limbs and trunk go first
45
Becker
similar to Duchenne but less severe; not fatal
DXed at ages 2-16
46
congenital muscular dystrophy
present at birth; generalized muscle weakness, joint deformity. contractures, hypotonia
47
emory dreifuss
weakness, wasting of shoulders, upper arms, shins
48
limb girdle
DXed teens to middle age; weakness and wasting away of pelvic girdle
49
fascioscapulohumeral
DXed late childhood to early teens; facial muscles weaken first, then upper arms
50
Myotonic
DXed teens to adulthood
generalized weakness, wasting of the face, feet, neck, hands
delayed relaxation of muscles after contractures
51
Muscular Dystrophy TX
administer analgesics for pain management
passive strengthening and stretching exercises
manage elimination
maintain cardiopulm. function (deep breathing and CPT)
52
spinal atrophy
motor neurons are affected --> muscles cannot respond to signals from the nerves --> atrophy d/t inactivity
53
Rickets
softening and weakening of bones
54
Rickets complications
nutritional deficiencies d/t inadequate consumption of calcium and vitamin D, inadequate exposure to sunlight
body cannot regulate calcium and phosphorus in appropriate balance --> chronic renal disease
55
Rickets TX
calcium and phosphorus supplements
vitamin D supplements
56
slipped capital femoral epiphysis (SCFE)
femoral head dislocated from shaft of femur
if chronic, may lead to shortening of affected leg and atrophy
57
SCFE TX
needs early surgical intervention to decrease long term deformity (prevents slippage, minimize deformity, avoid complication of future fractures)
58
legg-calves-perthes disease
condition where femoral head temporarily loses blood supply (avascular necrosis) --> femur collapses --> area becomes inflammed
59
legg-calves-perthes S/S
limping
pain or stiffness of hip, groin, thigh
limited ROM of hip
pain that worsens with activity and improves with rest
60
legg-calves-perthes TX
surgical intervention - femoral ostomy (reorients the femoral head to fit perfectly into hip socket)
should be done at ages 18-24 months
61
62
transient synovitis
inflammation of hip d/t infection; most common in children ages 3-8
63
transient synovitis S/S
limping
refusal to bear weight
low grade fever
previous viral infection
64
transient synovitis TX
complete rest (typically lasts for weeks, some 3-6 weeks)
NSAIDS to decrease inflammation
65
Cerebral Palsy
disorder of movement, muscle tone
most common disorder in childhood; longlong impairment
66
CP S/S
motor impairments
spasticity
muscle weakness,
ataxia (lack of coordination of muscle movements during voluntary muscle movements)
abnormal brain functions (NOT PROGRESSIVE)
67
CP complications
mental impairments
seizures
growth problems
impaired vision and hearing
abnormal sensation or perception
hydrocephalus (abnormal buildup of CSP in ventricles of brain)
68
CP pathophysiology
damage to motor areas of the rain, resulting in neurologic lesion
lesion cannot change over time
considered nonprogressive since the brain cannot progress
69
types of CP
spastic
dyskinetic (athetoid)
ataxic
mixed
70
spastic CP description
permanent contractures and hypertonicity
hemiplegia
quadriplegia
di/paraplegia
71
spastic CP TX
ORAL: baclofen, cantrolene sodium, diazepam
PARENTERAL: botulinim toxin, phenol block
SX: surgical placement of baclofen pumo, correction of deformities , placement of shunt if hydrocephalus present
72
Dyskinetic CP description
abnormal involuntary movements
infant is limp and flaccid
uncontrolled, slow, worn-like writhing or twisting movements
affects all 4 extremities and involvement of head, face, neck
movements increase during periods of stress
dysarthria
73
dyskinetic CP TX
anticholinergics (blocks and inhibits activity of acetylcholine <-- helps decrease abnormal movements
scopalamine
glycopyrrolate
74
Ataxic CP description
affects balance, depth perception
poor coodination
unsteady gait
wide based gait
motor milestones and language skills delayed
75
SCOLIOSIS description
lateral curvature of spine that exceeds 10 degrees
congenital, associated with disorder (neuromuscular), or idiopathic
76
idiopathic scoliosis
cause unknown
77
neuromuscular scoliosis
associated with neurologic or muscular disease like...
CP
myelomeningocele
spinal cord tumors
spinal muscular atrophy
muscular dystrophy
78
congenital scoliosis
results from anomalous vertebral development
79
scoliosis pathophysiology
involved vertebrae rotate around a vertical axis --> results in lateral curvature and asymmetry of the shoulder and waistline
vertebrae rotate on convex side, spinous process rotates on concave side
80
scoliosis TX
braces (boston brace, milwaukee brace, nighttime bending brace)
81
NEUROVASCULAR CHECKS INCLUDE
changes in gait
activity level compared to peers
recent trauma
poor feeding
lethargy
fever
weakness
alteration in muscle tone
history of developmental milestone
inspet/observe motor function, reflexes, sensory function
palpate muscle strength and tone
auscultate for adventitious lung sounds
82
scoliosis post op care
neurovascular checks
log roll q2 hours
pain management (before repositioning and ambulation)
ABX prophylaxsis
assess drainage
strict I/O
EOM
ambulation done slowly
assess skin for redness, breakdown, inflammation
deep breathing and coughing q2
83
neurogenic bladder is...
lack of bladder control d/t brain, spinal cord, nerve problems
84
neurogenic bladder interventions
clean intermittent catheterization to promote bladder emptying
85
neurogenic bladder meds
ditropan (oxybutin chloride)
86
neuorogenic bladder SX
continent urinary reservoir or vesicotomy
(vesicotomy is small opening made in lower abd. just below umbilicus to allow urine to drain from opening)
87
indications of spinal cord damage
numbness
tingling
weakless
paralysis (the higher the injury in the spinal cord, the more extensive the damage)
88
HIGH SPINAL CORD INJURY BIG COMPLICATION
may damage phrenic nerve (phrenic nerve in the nerve that innervates the diaphragm --> can't breath without assistance
89
Spinal cord injury DX tests
radiograph
MRI
CT
90
spinal cord injury cord TX
cervical traction
surgical intervention
ongoing therapeutic rehab post surgery
91
fracture is...
broken bone
92
