Neuro disorders Flashcards
frequently associated anomaly in SB Cystica
hydrocephalus
any malformation of spinal canal and cord
Myelodysplasia
neurogenic/neuropathic bladder dysfunction results to
UTI, ureterohydronephrosis, vesiculourethral
reflux)
When infants are detected as having meningocele or myelomenigocele, they may be born by caesarean section to what reason
to avoid pressure and injury to the spinal cord.
Parts of shunt
ventricular catheter, pumping chamber, unidirectional pressure valve, distal catheter
spina bifida =
myelomeningocele
→ Lateral ventricle/lumbar subarachnoid space to ureter→bladder (CSF is not reabsorbed = additional intake of water and sodium) → additional workload on the kidney (a kidney transplant might be considered as a last resort)
→ Older children
→ Necessitates the removal of the kidney
→ Last resort if other types have failed
→ Necessitates prompt treatment of UTI to prevent ascending infection
Ventriculoureteral shunt
GLASGOW COMA SCALE IN INFANTS & CHILDREN: Eye opening in adults
4 Spontaneous
3 To verbal stimuli
2 To pain
1 No response
medical care for mongolism:
* For children participating in sports that may
involve stress on back and neck
* Monitor for neck pain, weakness and
torticollis
atlantoaxial instability
Sac must be kept free from
contamination by urine and feces = *****, must cover dressing loosely
use steridrape
reduce chances of skin breakdown
- sheepskin/lamb’s wool blanket under the head
- s/e of immobility
s/s for spinal cord compression
persistent neck pain, loss of established
motor skills and bladder and bowel control,
changes in sensation
GLASGOW COMA SCALE IN INFANTS & CHILDREN: verbal response in adults
5 Oriented to time, place and person, uses appropriate words & phrase
4 Confused
3 Inappropriate words/verbal response
2 Incomprehensible words
1 No response
surgical procedure for neuropathic bladder dysfunction: → continent neobladder constructed from
bowel/stomach + CIC
→ use when severe bladder dysfunction
compromising renal function not relieved by other means
Urinary diversion
MANAGEMENT of SB
- Early surgery 24-72 hours after birth to replace the contents and to close the skin (skin graft)
- Multidisciplinary = pediatrics, neurosurgery, orthopedic, physical medicine, urology
a. Mobility
b. Bladder elimination
- Defect in closure of posterior vertebral arch with protrusion through bony tissue
- Visible with an external saclike protrusion
SPINA BIFIDA CYSTICA
s/s of shunt malfunction in infants
o early sign: tense bulging fontanel
o late: high pitched, shrill cry, seizures
goals of bladder elimination in older children
preserve renal function and achieve
optimum urinary continence
Associated anomalies in mongolism
a. Congenital heart defects
b. GU structural defects
c. Altered immune function
o Prone to URI due to hypotonicity of chest and
abdominal muscles and dysfunction of the
immune system predispose to the development of
respiratory infection
d. Visual defects
e. Increased incidence of leukemia
f. Thyroid dysfunction (congenital hypothyroidism)
❖ 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.
❖ Failure of the posterior vertebral arches to fuse during the embryologic development.
spina bifida
head is short but wide; sagittal sutures
may separate
Brachycephaly
Mgt of infection in shunt placement
a. Antibiotics
b. The Shunt removal with external drainage and replaced when infection is resolved
how to enhance elimination in mongolism
▪ ↑ fiber and ↑fluid
position of postop in SB
prone or side lying
position of hydrocephalus in preoperative
carefully avoid stretching/straining neck muscles since they must support large head
diagnosis for hydrocephalus: Detects what type of hydrocephalus
Lumbar/ventricular tap
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
AV shunt (Atrioventricular Shunt)
causative conditions of communicating hydrocephalus:
- Tumor, infection, hemorrhage or pre-existing developmental defects
- Extraventricular: there’s a passage of fluid between ventricles and spinal cord.
foods rich in folic acid
(fortified breads and cereals, fruits, dark green leafy vegetables and egg yolk
PROGNOSIS of SB
dependent on the type of defect, the level of the lesion and the presence of other complicating factors
s/s of shunt malfunction in toddlers
o early sign=headache, loss of appetite
Early surgery for SB Prevent further neurological deterioration/impairment (menigeal sac expands during the first few hours after birth-stretching of other nerve roots; trauma to the sac can lead to rupture; potential for infection )
discharge teaching for hydrocephalus
▪ s/s of shunt malfunction
▪ s/s of infection
▪ replacement of shunt as child grows
▪ avoid contact sports
▪ hydrocephalus is a lifelong problem that needs evaluation regularly
frontal enlargement, brow bulges
bossing
Regular medical care for mongolism
a. Eyesight
b. Hearing
c. Thyroid function
d. Atlantoaxial instability
visual defects associated with mongolism
o Strabismus
o myopia (nearsightedness)
o nystagmus (involuntrary rapid eye movement)
o cataract
Manifestations of hydrocephalus in childhood
➢ No head enlargement
➢ Headache on awakening: improvement following emesis/upright posture,
➢ Decline in LOC
➢ Ataxia/spasticity
➢ s/s of ↑ICP
➢ visual defects secondary to pressure on optic nerve
when is the Initial placement of shunt
3 – 4 months of age then replaced as child
grows
physical CLINICAL MANIFESTATIONS of mongolism in head and face
a. Brachycephaly-head is short but wide; sagittal sutures
may separate
b. Flat facial profile- small, broad and flat nose
(underdeveloped nasal bone; saddle nose)
c. Oral cavity is smaller than normal- protruding tongue
d. Upward and outward slanting palpebral fissure
e. Small Low set ears
f. Short webbed neck with excess loose skin (puppy’s
neck)
PRENATAL diagnosis for SB
- Elevated MSAFP (maternal serum AFP (alpha feto protein))
- Ultrasound for scanning of uterus
- Amniocentesis
- Chorionic villi sampling (CVS)
DIAGNOSTIC EVALUATION of SB
- Clinical manifestations and examination of meningeal sac
- MRI
- UTZ
- CAT
- Myelography
- Lab exams
position to maintain hydration and nutrition in preop of SB
head turned to side
1) Isolate the segment of ileum chosen for augmentation on an adequate mesentery and re-establish intestinal continuity.
2) Close the ends of the segment with suture and open the antimesenteric surface.
3) Fold the segment of ileum for augmentation cystoplasty and sew it upon itself. This detubularizes the segment, reduces enteric contractions, and maximizes the volume that the segment contributes to urinary storage.
4) Anastomose the augmenting segment to the prepared bladder. Perform a wide-mouthed anastomosis to ensure that the augméntation is spherical.
Augmentation enterocystoplasty
Management of neuropathic bladder dysfuction:
a. Regular urologic care and prompt and vigorous treatment of infection
b. Regular emptying of the bladder
c. Meds to improve bladder storage and continence
d. Surgical procedure
CAUSE of mongolism
unknown; multiple causality
a. Advanced maternal and paternal age
* 35 y/o= 1: 1,500
* 40 y/o= 1:100
b. Hereditary = translocation
taking of folic acid supplements
of ***** each day for the month before and the first three months of pregnancy can reduce
the risk of neural tube defects
0.5 mg.
PRENATAL diagnosis for SB:
* Elevated AFP =(+) NTD =anencephaly, myelomenigocele; omphalocele; SCI Decreased =chromosomal disorder
* Best done at 16-18 weeks because after this time, AFP concentrations normally diminish + can do therapeutic
abortion just in case
Amniocentesis
what to cure in hearing in mongolism that is required to prevent hearing loss (hearing
loss influences cognitive function)
otitis media
measures to minimize ↑ICP
- minimize stimulation=quiet environment
- elevate HOB 30 degrees unless c/i
- administer osmotic diuretic, corticosteroid as needed=monitor I & O, no IVF at scalp
- Failure of the posterior arches to fuse
- Mildest form
- Occult-hidden, 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
SPINA BIFIDA OCCULTA
Anterior fontanel closes at
12-18mos
Function of CSF:
- to take food to the brain and spinal cord
- excretes metabolites
- act as a shock absorber
to rapid reduction of ventricular size may cause the cerebral cortex to pull away from the dura and tear the small interlacing veins ==
subdural hematoma
GLASGOW COMA SCALE IN INFANTS & CHILDREN: Eye opening in infants
4 Spontaneous opening
3 To loud noise
2 To pain
1 No response
diagnosis of mongolism:
▪ Done at 14-18th week
Amniocentecis
s/s of ↑ICP
↑RR, BT and BP (↑SBP); ↓PR
preop position to Prevent trauma to the sac in SB
prone with hips slightly flexed
and legs abducted with a pad between
knees (ex. Rolled towel
Management for hydrocephalus
- Identify cause – infection/tumor
- Treat cause – surgery, antibiotics
- Managing hydrocephalus: placement if shunt
acquired causes of hydrocephalus
- Neoplasm
- Hemorrhage
- Infection Clinical
diagnosis of mongolism:
▪ Most commonly done at 8-10th week
▪ Retrieval and analysis of chorionic villi for
chromosome analysis
Chorionic Villi Sampling CVS
3 reasons of Excess CSF in the Newborn
- Overproduction of fluid by choroid plexus in the lateral ventricles
- Obstruction of the passage of fluid somewhere between the point of origin and the point of absorption
- Interference with the absorption of fluid from subarachnoid
Nursing care for hydrocephalus
- Provide pre-operative care
- Provide post-op care
- Emotional support to parents=fear of retardation or brain damage
- Discharge teachings
→ Most serious complication of shunt placement
→ Most prevalent in the first 2 months after placement
→ Post op ileus and peritonitis in VP shunt
infection
severe pain comfort measure in hydrocephalus
opioids
Splitting of the already closed neural tube as a result of an abnormal CSF pressure in the first trimester
→ 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
spina bifida