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Peds Exam 3b > Neuromuscular > Flashcards

Neuromuscular Flashcards

1
Q

Cerebral Palsy pathophysiology

A

not caused by problem in muscles or nerves. caused by faulty development or damage to motor areas of the brain
r/t anoxic brain event causing brain damage prior to birth, during birth, or in the first 2 years of life when brain is rapidly developing

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2
Q

CP classified by

A

motor abnormalities (type and severity)
associated impairments (seizures, cognitive, communication, behavior)
anatomic and radiologic findings
causation and timing

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3
Q

congenital causes of CP

A

maternal infections
jaundice
Rh incompatibility
stroke

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4
Q

what to watch for in CP?

A

skin breakdown, pressure ulcers, missed milestones, abnormal reflexes and tone

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5
Q

missed motor milestones in CP

A

not sitting unsupported by 7 months
failure to smile by 6-8 weeks
feeding difficulties (gagging, chocking, tongue thrust after 6 months)
extreme irritability or crying

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6
Q

Abnormal muscle tone in CP

A

persistence of primitive reflexes past 6 months (moro, tonic neck, grasp reflex)
floppy or limp body posture
stiff or rigid arms or legs

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7
Q

motor abnormalities in CP

A 
early sign is hand preference in the first 18 m
abnormal crawl (only uses one side of the body or only arms to crawl)
uncoordinated or involuntary movements
facial grimacing
writhing movements
poor suck
tongue thrust
ataxia
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8
Q

hypotonic body tone in CP

A

present at birth and may persist to 1 year then replaced by hypertonic muscles

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9
Q

hypertonic body tone in CP

A

resistance to passive ROM
hips higher than trunk when prone
spine deformities r/t opisthotonic posture
contractures

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10
Q

clinical manifestations associated with spastic CP

A

seizures
contractures
incontinence ADHD
non-ambulation leads to constipation, orthopedic problems, skin breakdown, and respiratory infections

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11
Q

associated impairments with CP

A

feeding difficulties manifests as FTT, poor suck, tongue twist
affects chewing, swallowing and talking
- nurses can help improve function by helping child blow bubbles, pen wheels, and chewing gum under supervision

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12
Q

therapeutic management of CP

A

PT/OT and speech
assistive devices for mobility and ADL’s
computers
surgery ( to release tendons, and improve function)

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13
Q

med management of CP

A 
used to manage associated symptoms
antipyretics
stimulants ( ADHD) 
botox ( paralysis of overactive muscles)
skeletal muscle relaxants ( dantrolene, baclofen, methocarbamol) 
anxiolytics
bowel regimen
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14
Q

home management of CP

A 
helping family cope with a child  with chronic illness
education about inclusion at school
use of assistive devices and exercise
proper med administration
prevent skin breakdown and respiratory infections
nutrition (increase calories and rest)
play and recreation
safety needs
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15
Q

nursing care of CP

A 
assessment and early identification
reinforce therapeutic plan
address home care needs
routine skin assessments
immunizations
safety precautions (wearing helmets when needed, home adaption, modified care seats)
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16
Q

Duchenne Muscular Dystrophy causes

A

x-linked disorder
males only
absence of dystrophin leads to muscle degeneration

17
Q

early clinical manifestations of Duchenne MD

A

onest between 3-5 yr
positive gower sign (ask child to stand from kneeling position if they have to walk hands up legs to stand it is positive)
kids will meet milestones normally until 3-5yr and will regress
rapid PROGRESSIVE muscular degeneration after normal development
waddling gate
lordosis
kids waste from inside out

18
Q

progressive clinical manifestations of duchenne MD

A 
pseudohypertrophy 
muscular atrophy
ability to ambulate generally lost by 10-12 yr
facial and respiratory muscle atrophy
cardiac and respiratory failure
mild to moderate cognitive impairment
median age 22 yr with mechanical ventilation
fatal disease child will die no cure
19
Q

Duchenne MD dx by

A

clinical manifestations
muscle bx
EMG

20
Q

Therapeutic goals of MD

A

to maintain function in the unaffected muscles as long as possible with bracing, range of motion, performing ADL’s and surgery to release contractures

21
Q

spina bifida

A

malformation of spine where lamina of vertebrae fails to close

22
Q

causes of spina bifida

A

inadequate consumption of folic acid before conception and during the first trimester
neural tube closes at 4 weeks
folic acid found in green leafy veggies, multi-vitamins

23
Q

diagnosis of spina bifida

A

most diagnosed post-natally, but can be dx in prenatal ( 16-18 weeks gestation)

24
Q

spina bifida occulta

A

only in vertebrae spinal cord and meninges are normal

no neuro problems

25
Q

spina bifida cystica 2 types

A

meningocele ( external sac encases meninges and spinal fluid, no associated neurological deficit)
myelomenigocele (external sac encases meninges and spinal fluid, and nerves, most common in lumbar or lumbosacral area, location and size of the lesion determines the degree of neuro deficit, the higher the lesion the worse it is)

26
Q

clinical manifestations of myelomeningocele SB

A 
sac like protrusion evident at birth
hydrocephalus
varying degrees of sensory and neurological dysfunction
poor muscle tone in bladder and rectum
flexion of extension contractures
27
Q

treatment of myelomeningocele SB

A

closure of sac withing 24-72 hours if possible, within 12-18 hours to prevent infection and preserve nerve roots
done by neurosurgery and plastics
prior to surgery cover area with sterile warm saline get to nicu asap, prone position

28
Q

preop nursing care of myelomeningocele SB

A

prevent infection
cover sac with mosit sterile NS gauze , no diaper
keep genitalia clean, may need to catheterize
position prone
avoid rectal temps because of poor sphincter tone

29
Q

nursing care of myelomeningocele SB

A

VS, weight, I and O, assess pain, observe incision, leave prone
feed when awake and parent is holding
orthopedic interventions to improve locomotion and prevent deformities post op (ROM)
treatment of urinary incontinence by intermittent cathing (prevent UTI’s) can learn to self cath at age 6
urinary diversions

30
Q

treatment of bowel incontinence with myelomeningocele SB

A

bowel training
prevent constipation (laxatives, digital stimulation, and enemas)
dietary modifications
antegrade continence enema procedure

31
Q

why are SB kids at risk for developing a latex allergy?

A

surgery at an early age can cause latex allergy, kids kids in latex free environment

Peds Exam 3b (3 decks)

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