Neuromuscular Flashcards
What is cerebral palsy?
A group of permanent disorders of the development of movement and posture, causing activity limitation, that are because of a nonprogressive disturbance that occurred in the developing fetal or infant brain
What is the treatment and nursing care for seizures with cerebral palsy?
Antiepileptics
What is the treatment and nursing care for muscle spasms with cerebral palsy?
Botox •Paralyzes overactive muscles •Skeletal muscle relaxants •Dantrolene, Baclofen, Methocarbamol
What is the treatment and nursing care for constipation with cerebral palsy?
Bowel regimen
How do we detect cerebral palsy?
missed milestones abnormal reflexes and tone Persistence of primitive reflexes past 6 months •Moro •Tonic neck •Grasp reflex
How do we help kids with cerebral palsy?
- Coping with a chronic condition
- Support parents and siblings
- Education regarding inclusion in school
• Medication Administration
•Prevent skin breakdown
-prevent respiratory infections
•Nutrition (need for increased calories & rest for what type CP?)
•Play and recreation- offer toys to affected side; put toys at a distance to encourage locomotion
•Safety needs (e.g., prevent accidents; side rails on bed; no scatter rugs)
Frequent rest periods needed for child because they
expend lots of energy in their efforts to accomplish their
ADLs
•Don’t forget immunizations
•Safety precautions (wearing helmets when needed, home adaption, modified car seats, etc)
What skin issues are we looking for with cerebral palsy?
skin breakdown especially with athetoid type, pressure injuries for spastic type
How do we promote muscle development with cerebral palsy?
offer toys on the affected side and build oral muscles
How is spinal bifida detected?
Most diagnosed post-natally, but some defects visible (open with sac only) on prenatal US Prenatal Detection (16-18 weeks gestation) •Diagnosis based on imaging of meningeal sac (US, CT, MRI) •Neurological evaluation is ongoing because some clinical manifestations will not be present until the child is developmentally delayed (failure to potty train, etc)
Varying degrees of sensory and neurological dysfunction
•Poor muscle tone in the bladder
•Poor muscle tone in the rectum
•Flexion or extension contractures
What is pre op care for spinal bifida?
Prevention of infection is primary goal (meningitis, UTI)
•Sac: moist, sterile NS, non-adherent dressing; no diaper
•UT: Keep genitalia clean; may need to catheterize
•Protection of lesion/sac is primary goal
•Positioning: prone
•Early closure of the sac (when?)
•Avoid taking rectal temps b/c of poor anal sphincter
tone which could result in rectal prolapse or lack of
bowel control
What are long term problems with spina bifida?
pressure ulcers
UTI’s from in and out caths
bowl programs - Treatment of bowel incontinence
•Bowel training, prevention of constipation,
laxatives, digital stimulation, and enemas
•Dietary modifications
•Antegrade continence enema procedure
•Appendix or ileum is used to make catheterizable
channel with attachment of the proximal end to
the colon. The distal end of the channel exits
through a small abdominal stoma.
•Every 1-2 days an enema solution is instilled
directly into the colon, 20-30 min later the child
sits on the toilet and is able to have a bowel
movement as the stool is flushed out because of
the enema.
What is the progression of muscular dystrophy?
Pseudohypertrophy •from fatty infiltration; muscles are not larger themselves •Muscular atrophy •Ability to ambulate generally lost by 10-12 years •Facial and respiratory muscles atrophy •Cardiac or respiratory failure (most common cause of death) •Mild to moderate cognitive impairment •Median Age 27 years with mechanical ventilation
What is the treatment for muscular dystrophy?
•Treat complications
•Contractures & atrophy - •PT/OT, Orthotics
•Nutrition - •SLP therapy
•Respiratory failure - •Cough assist devices
Mechanical ventilation/tracheostomy
Vaccines to prevent lung infections
•Cardiac failure - •Diuretics, digoxin
Newer/experimental treatments to SLOW progression •Corticosteroids •CT GalNAc transferase (blocks muscle wasting) •Glutamine and creatine monohydrate (preserve muscle strength)
- Palliative care
- Family and patient coping with disease
- Reduction of preventable disabilities
- Modifying the home environment
How is muscular dystrophy detected?
Onset usually between 3
and 5 years of age
•difficulty running, riding bike, climbing stairs 1st symptoms noted—this happens first •Rapid progressive muscular degeneration after initial normal development •Waddling gait •Lordosis •Positive Gower’s sign
Clinical manifestations present, then diagnostic evaluation
•Serum Enzymes
•Elevated CPK (serum creatinine phosphokinase)
•Elevated SGOT (serum glutamic-oxaloacetic transaminase)
•Muscle Biopsy - Shows degeneration of muscle fibers
•Electromyogram (EMG) - •Shows decreased amplitude and duration of motor unit potentials
What do we need to know about hydrocephalus related to spinal bifida?
these kids are at a higher risk for it
we need to do good head circumference measurements at every visit to detect it
some kids may need a stint to drain the fluid
