neuromuscular dysfunction additional information Flashcards
Describe the pathophysiology, clinical manifestation, and diagnostic evaluation of cerebral palsy.
what is cerebral palsy?
disorder of posture and movement from static Brian injury perinatally or postnatally that limits activity
what is the etiology behind cerebral palsy?
injury usually is the case
what is the clinical manifestations of cerebral palsy?
neuromotor impairment
neuroanatomic disturbance
gait pattern is hindered
notes
spastic - persitant primitive reflexes, hypertonia
dyskinetic
- chorea, involuntary jerky movements
Dystonic
- slow twisting movements
mixed - everything
what are the 7 things to note about the development stages in patients with cerebral palsy ?
persistant primitive reflexes
poor head tone after 3 months
rigid or stiff limbs
arching of the back
floppy tone
unable to sit without support after 8 months
clenching of the hands after 3 months
what is the diagnostic evaluation of cerebral palsy ?
CT scan, ultrasound, MRI
what is the therapeutic management of cerebral palsy ?
establish locomotion, communication and self help skills
gain optimum appearance and integration of motor functions
correct associated defects as early as possible
provide educational opportunities adapted to the individual Childs needs
additional interventions for cerebral palsy
physical therapy
occupational therapy
speech therapy
casting or bracing
botox
oral medications
( analgesics, anti-inflammatory, antispasmodic ,anti convulsants )
Describe the pathophysiology, clinical manifestation, and diagnostic evaluation of spina bifida.
Before we talk about spinal bifida, what is a neural tube defect?
abnormalities that derive from the embryonic neural tube
what is anencephaly?
congenital malformation in which both cerebral hemispheres are absent
what is spinal occult?
refers to a defect that is not visible externally, usually a fatty tissue that grows around the area and gets the spinal cord involved
what section of the spine does spinal bifida occur in ?
L5 to S1
what are the 4 skin indications of the spinal bifida?
sacral dimple
port-win angiomatous
dark tufts of hair
subcutaneous lipoma
what is spinal bifida cystica?
refers to the visible defect with an external saclike protrusion
what are the 2 types of spinal bifida cystica?
meningocele
myelonmeningocele
what is the difference between these two ?
meningocele
myelonmeningocele
mein - the spinal cord is not in the sac
Myles - the spinal cord is in the sac, usually wrapping around the area
how do we prevent spinal bifida from occurring ?
folate acid 0.4mg
what position do we want patients with spinal bifida in and why?
prone because remember thats their spine right there!
remember these children with spinal bifida are going to have a lot of bowel and urination issues
so what are the two big interventions we are going to do ?
straight cath
bowel regiment !
with a lot of straight Cath, most kids get a latex allergy when having spinal bifida, so what are we going to do ?
latex prevention and try to avoid using it as well
what is spinal muscular atrophy?
progressive weakness and wasting of skeletal muscles caused by degeneration primary of the anterior horn cells
what are the clinical manifestation of spinal muscular atrophy?
hypotonia
absent deep tendon reflexes
weak cry and coughs
fatigue
difficulty swallowing
respiratory issues
gi issues
muscle weakness
what are the 2 diagnosis of spinal muscular atrophy?
genetic testing
muscle biopsy
what is the treatment of spinal muscular atrophy?
really there is no cure, but just make them move, emotional support
Describe the pathophysiology, phases of illness, clinical manifestations, and therapeutic management of Guillain-Barré syndrome in the pediatric population.
what is GBS?
otherwise known as infectious polyneuritis
acute demyelinating polyneuropathy with a rapid progressive, usually ascending flaccid paralysis
what is the cause of gbs?
bacterial, viral or some vaccinations can cause it
what is the clinical manfiestations of GBS?
tenderness, numbness, weakness
paralysis being the worst sign
usually starts from the body and going up
what is the main reason why people die from GBS?
respiratory failure because of respiratory paralysis
what is the diagnostic studies behind GBS?
lumbar puncture - elevated protein
absent deep tendon reflexes
paralytic manifestations
electromyography - weak nerves
what is the treatment behind GBS?
IV IG
plasmapheresis
herpain
steroids
pain medications
respiratory ventilaitons
Discuss tetanus and its prevention through primary vaccination and boosters.
what is tetanus?
an acute preventable fetal disease by an exotoxin called clostridium tetani
what is the number 1 prevention of tetanus ?
DtAP - young kids
Tdap - 12 and older
Describe food-borne and infant botulism and risk factors for the development of each.
what is botulism ?
food poisoning that results form the ingestion of the preformed toxin produced by clostridium botulinum
otherwise known as feeding your kids under 2 honey! and canned foods ( not properly made )
when do symptoms start to appear in botulism ?
12-36 hours
what is the main clinical manifestations of botusliam in children?
paralysis
vomiting
unable to with hold their head
what’s the treatment for botusilim with infants vs older kids ?
infants
- respiratory supportive care really : (
older kids
- botulism immune globium or antitoxin
Describe myasthenia gravis (MG) in children: Clinical manifestations, diagnosis, prognosis, and treatment of MG in children
what is myasthenia gravis MG?
autoimmune disorder associated with the attack of circulating antibodies on the acetylcholine receptors, which blocks its function
what is the Clincal manifestations of MG?
remember the anagram (7)
people make faces
but limited to seven!
ptosis - eye dropping
muscle weakness
fatigue
blurred vision / double vision
limited facial expressions
trouble walking
swallowing, speech, chew difficulties
what is the treatment of MG?
in severe cases, cholinestrearse inhibiting drugs are used
Identify the factors that influence the extent of trauma to the spinal cord at the time of injury and the classifications of SCI.
C4 - NECK DOWN
C6 - SHOULDER DOWN
T4- Below chest
L1- waist below
these are some factors that can influence the effect of trauma, so like certain locations of the spine can indicate what type of paralysis you can get
what is autonomic dysreflexia?
upper part of the body (3)
lower part of the body(2) !!!
the paralytic nature of autonomic function is replaced by autonomic dysreflexia, its caused by visceral distention or irritation of the bowel or bladder.
which then nerves are blocked
flushing
bradycardia
throbbing headache
hypertension
cool,clammy pale skin
what is the biggest nursing intervention with autonomic dysreflexia?!!
sit them up at a 90% degree angle
