Neuromuscular/Musculoskeletal Disorder Flashcards
Types of Neuromuscular Disorders
- neurologic insult
- genetic dysfunction
- structural abnormality
- autoimmune in nature
Neurologic Insult
trauma or hypoxia to the brain or spinal cord
Anatomic Differences in Child vs Adult
- child’s spinal cord is more mobile
- myelination is incomplete
- full ROM present at birth
What would indicate an abnormality?
sluggish deep tendon reflexes
What are 2 abnormal findings?
hypertonia or hypotonia
What history would we ask about for presence of neuro disorder?
- changes in gait
- recent trauma
- poor feeding
- lethargy
- fever
- weakness
- alteration in muscle tone
- history of developmental milestones
Inspection and Observation
motor function
reflexes
sensory function
Palpation
muscle strength and tone
Auscultation
lungs for adventitious sounds
What is considered normal to be seen in toddlers?
lordosis
When may kyphosis become evident?
adolescence
Internal Tibial Torsion/ Genu Varum
normal variation in infants lower limbs rotated inward
resolves by 2-3 yrs
When should Genu Valgum/Knock Knees by resolved?
7-8 years
Interventions for Preventing Complications of Immobility
- turning/repositioning q 2 hours
- assessing skin for redness/breakdown
- performing ROM exercises
- keep skin clean and dry
- encourage intake of fluids
- encourage coughing/deep breathing q 2 hours prn
Cerebral Palsy S/S
motor impairments including spasticity, muscle weakness, and ataxia
Complications of Cerebral Palsy
mental impairments seizures growth problems impaired vision or hearing abnormal sensation or perception hydrocephalus
Focus of Nursing Care w/ Cerebral Palsy
promoting growth and development
promoting mobility
maintaining optimal nutritional intake
providing support and education
What are two acquired disorders for children?
Rickets
SCFE
Rickets
soft bones from inadequate calcium and vitamin D
SCFE
- femoral head dislocates
- cause unknown
- early surgical intervention will decrease risk of long term deformity
- sudden pain, unable to bear weight
- ages 9-16, sedentary, overweight, African-American or Polynesian
Teaching Topics for parents of Children w/ Myelomeningocele
- positioning
- preventing infection
- feeding
- promoting urinary elimination through intermittent catheterization
- preventing latex allergy
- preventing s/s of complications
Interventions for Neurogenic Bladder
- clean intermittent catheterization
- meds such as oxybutynin chloride (Ditropan) to improve bladder capacity
- prompt recognition and treatment of infection
- surgical interventions
Lab Tests for Myelomeningocele
MRI
CT
Ultrasound
Myelography
Lab Tests for Spinal Muscular Atrophy
Creatinine kinase: elevated w/ muscular damage Genetic Testing Muscle Biopsy Nerve Conduction Velocity test Electromyelogram
Structural Disorders
Spina bifida occulta
Meningocele
Myelomeningocele
Genetic Neuromuscular Disorders
Various types of muscular atrophy
Spinal muscular atrophy
Pectus Excavatum
- a depression in the chest that sinks inward
- does NOT resolve as child grows
- observation, PT, surgical correction before puberty
Polydactyly
extra digit on the hand or foot
-surgical removal
Syndactyly
webbing of the fingers and toes
-no treatment required but can be done for cosmetic reasons
Metatarsus Adductus
inward deviation of the forefoot w/ the hindfoot remaining normal position
- common in utero position
- most resolve w/o treatment
- may need serial casting before 8 months
Congenital Clubfoot
- congenital anomaly
- 1 of 1000 births
- foot resembles golf clubs
- more males
- starts as soon after birth as possible
What is typically done for Clubfoot?
weekly manipulation and serial casting q 2 weeks
shoes and braces
surgery
Osteogenesis Imperfecta
- genetic bone disorder
- low bone mass
- increased fragility
- connective tissue problems
- joint hypermotility
- fractures
- tooth enamels wear easily and brittle; discoloration
- blue/gray sclera
Developmental Hip Dysplasia
femoral head has an abnormal relationship to acetabulum
- frank dislocation can occur
- females
- Pavlik harness
Torticollis
painless muscular condition in infants and children w/ certain syndromes
What may cause congenital torticollis?
From position in utero
What can be done for torticollis?
stretching exercises
surgery in preschool years
Pectus Excavatum
a depression in the chest that sinks inward
-does not resolve as child grows
What can be done for pectus excavatum?
- observations
- PT
- surgical correction before puberty
Muscular Dystrophy
a group of inherited conditions that result in progressive muscle weakness and wasting
What may be the causes of muscular dystrophy?
x-linked
autosomal dominant
recessive
What is the most common neuromuscular disorder of childhood?
Duchenne Muscular Dystrophy
Duchenne Muscular Dystrophy is usually fatal by what age?
20-25 years old
What is the hallmark finding of Duchenne Muscular Dystrophy?
presence of Gowers Sign
Nursing Management Goals for a Child w/ Duchenne Muscular dystrophy
- Promoting mobility
- maintaining cardiopulmonary function
- preventing complications and maximizing quality of life
How to promote mobility for DMD?
- administering corticosteroids and calcium supplements
- perform passive stretching and strengthening exercises
How to help maintain cardiopulmonary function for DMD?
- teach deep breathing exercises
- performing chest physical therapy
How to help prevent complications and maximize quality of life for DMD?
- developing a diversional schedule
- provide emotional support
Spinal Muscular Atrophy
genetic motor neuron disease that affects the spinal nerves ability to communicate w/ muscles
-autosomal recessive mechanism
Death usually occurs at what age for Spinal Muscular Atrophy?
2
Legg-Calve Perthes
avascular necrosis of the femoral head
- painless limp which may be intermittent for months
- mild hip pain or referred knee pain
When does Legg-Calve Perthes usually occur?
4-8 years old
More often males
Transient Synovitis of Hip
hip pain limping
-self limiting, resolves w/in week but may last 4 weeks
When does transient synovitis of hip occur?
3-8 years old
Scoliosis
curvature of the spine
Signs and Symptoms of Spinal Cord Injury
- inability to move or feel extremities
- numbness
- tingling
- weakness
Teaching Topics to Prevent Spinal Cord Injury
- vehicular safety
- seat belts/age appropriate seats
- sports safety
- prevention of falls
- violence prevention
- water safety
