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PT 641 Peds > Neuromuscular/Neurodevelopment Disorders and Exam in Neonate > Flashcards

Neuromuscular/Neurodevelopment Disorders and Exam in Neonate Flashcards

1
Q

nurseries caring for newborns

A

neonatal care

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2
Q

level 1 neonatal care

A

basic neonatal care, well baby nursery, stabilization of sick newborns prior to transfer to next level fo care

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3
Q

level II neonatal care

A

speciality neonatal care, care for newborns >32 weeks gestation

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4
Q

level II B neonatal care

A

provide mechanical ventilation/CPAP <24 hours

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5
Q

level III A neonatal care

A

care for newborns < 28 weeks gestation, minor surgery

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6
Q

level III B neonatal care

A

urgent/routine imaging, major surgery

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7
Q

level III C neonatal care

A

provide extracorporeal membrane oxygenation (ECMO), surgery for complex cardiac disorders

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8
Q

States that behaviors emerge as different subsystems interact
All subsystems are equal
Development affected by internal and external components

A

dynamic systems theory

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9
Q

what are the subsystems that are part of the dynamic systems theory

A

body structure, physiology, behavior

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10
Q

many influences on a preterm infant’s function

A

synactive theory of infant development

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11
Q

organization of synactive theory of development

A

autonomic
motor
state
attention/interaction
self-regulation

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12
Q

what two subsystems are the core subsystem an infant relies on to function

A

autonomic and motor

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13
Q

what does stability of the motor and autonomic subsystems allow for

A

awake state and ability to interact with environment

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14
Q

what indicates stability of autonomic subsystem

A

Smooth regular respirations
Pink and stable coloring
Stable digestion

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15
Q

what indicates signs of stress of the autonomic subsystem

A

Respiratory pause, tachypnea
Pale, duskiness (perioral)
Mottled/cyanotic
Hiccuprs, gaggping, grunting, twitching, sneeze, sign, gasp

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16
Q

what are signs of stability of motor subsystem

A

smooth controlled posture
Smooth movements
Hand/foot clasp, leg brace, hand to mouth, sucking

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17
Q

what are signs of stress of motor subsystem

A

Fluctuating tone
Flaccid tone
Hypertonicity
Frantic, diffuse activity

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18
Q

what are signs of stability of state subsystem

A

Clear, well defined sleep states
Alert and animated

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19
Q

what are signs of stress of state subsystem

A

Diffuse sleep, twitching/jerky movements
Irregular breathing, grimacing
Eyes floating, staring, gaze aversion

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20
Q

what are some examples of general stress signs in infants

A

stop sign, retractions/sucking in at ribs, finger or toe splaying

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21
Q

occurs when there is a lack of oxygen or perfusion/blood to the brain

A

asphyxia

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22
Q

lack of oxygen

A

hypoxia

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23
Q

lack of perfusion

A

ischemia

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24
Q

what is associated with asphyxia

A

IVH

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25
Q

what organs are most at risk with asphyxia

A

kidneys, brain, heart, lungs

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26
Q

movement system dx for asphyxia

A

movement pattern coordination deficit, force production deficit, cognitive deficit

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27
Q

can be caused by hypoxia or ischemic insult

A

hypoxic ischemic encephalopathy (HIE)

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28
Q

what are some of the side effects of hypoxia ischemic encephalopathy (HIE)

A

seuizes in neonatal period
CP
hearing impairment
cortical/cerebral visual impairment (cortical blindness)

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29
Q

partial events of asphyxia leads to what

A

diffuse cerebral necrosis

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30
Q

total asphyxia spares what and affects what

A

spares: cortex
impacts: brainstem, thalamus, basal ganglion

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31
Q

how to prevent asphyxia

A

ventilation, perfusion, and avoiding hypotension

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32
Q

what is the movement system dx for hypoxic ischemic encephalopathy

A

hypokinesia, sensory detection deficit, fractionated movement disorder, movement pattern coordination deficit

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33
Q

caused by ingestion of bacteria that turns into a toxin within the body, colonizes in the intestines

A

infant botulism

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34
Q

sources of bacteria clostridium bolulinum

A

honey, microscopic dust/spore particles (common in new construction sites)

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35
Q

how does infant botulism physically effect the body

A

muscle weakness, breathing difficulties, decreased muscle tone

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36
Q

first signs of infant botulism

A

difficulty feeding and constipation, weak cry, loss of facial expressions

37
Q

treatment for infant botulism

A

medical/respiratory support, babybig

38
Q

what is bronchopulmonary dysplasia (BPD) associated with

A

premature birth and low birth weight

39
Q

lung immaturity, respiratory failure, oxygen supplementation and positive pressure ventilation

A

bronchopulmonary dysplasia (BPD)

40
Q

risk factors for bronchopulmonary dysplasia (BPD)

A

preeclampsia, intrauterine growth retardation (IUGR), intrauterine infection

41
Q

treatment for bronchopulmonary dysplasia (BPD)

A

low levels of supplemental oxygen, mechanical ventilation if conservative measures fail, steroid (cause as early use of inhaled steroids has been linked to neurodevelopment delay and CP)

42
Q

complications of bronchopulmonary dysplasia (BPD)

A

retinopathy of prematurity, hearing loss, osteoporosis, pulmonary artery hypertension, developing asthma

43
Q

developmental outcomes of bronchopulmonary dysplasia (BPD)

A

increased incidence of attention deficits, cognitive deficits, developmental coordination disorder, poor visual motor function

44
Q

infants who require supplemental oxygen at 36 weeks post conceptual age (PCA) have a greater risk of

A

developmental delays

45
Q

infants who require mechanical ventilation and oxygen at 36 weeks PCA have a high correlation with dx of

A

diplegic or quadriplegic CP

46
Q

vasoproliferative disorder of the developing retina

A

retinopathy of prematurity (ROP)

47
Q

What can retinopathy of prematurity (ROP) lead to

A

vision impairment or blindness

48
Q

what is the severity of retinopathy of prematurity (ROP) directly linked to

A

poor neurodevelopmental outcomes

49
Q

preterm infants are at higher risk of developing retinopathy of prematurity (ROP) due to the development of blood vessels of the eyes developing between

A

16 weeks and term

50
Q

what is the cause of retinopathy of prematurity (ROP)

A

exposure to high concentrations of oxygen and genetic factors

51
Q

if infant is exposed to too much oxygen is can suppress what and lead to lack of vascular development and vasoconstriction

A

growth factors

52
Q

when does the second stage of retinopathy of prematurity (ROP) occur because there is proliferation of new vessels at the vascular and avascular area of the retina

A

32-34 weeks

53
Q

if blood flow and oxygenation is re-established ROP will

A

regress

54
Q

if blood flow and oxygenation are not re-established, vessels that grow are abnormal, prone to hemorrhage, and swelling which can lead to

A

fibrous scar tissue

55
Q

classification of retinopathy of prematurity (ROP)

A

location, stage, and extent

56
Q

stage IV retinopathy of prematurity (ROP)

A

partial detachment of retina

57
Q

stage V retinopathy of prematurity (ROP)

A

complete detachment of retina

58
Q

ECMO

A

extracorporeal membrane oxygenation

59
Q

heart and lung bypass in which venous blood is drained, CO2 is removed, and returns blood to a venous (VV) or arterial (VA) circulation

A

extracorporeal membrane oxygenation

60
Q

provides rest for infants heart and lungs, and is used in cardiopulmonary conditions causing hypoxia

A

extracorporeal membrane oxygenation

61
Q

neurodevelopment outcomes of extracorporeal membrane oxygenation

A

may have changes in tone, movement patterns, hyperactivity, behavioral problems, developmental delays

62
Q

injury occurs during birthing process and leads to stretch of shoulder/neck which damages the nerves in the brachial plexus

A

brachial plexus injury

63
Q

what are the different types of brachial plexus injuries

A

erb-duchenne palsy
dejerine-klumpke palsy
avulsion
rupture
neuroma
neuropraxia/stretch

64
Q

paralysis to the upper brachial plexus

A

erb-duchenne palsy

65
Q

what nerves does erbs palsy affect

A

C5, C6, C7

66
Q

presentation of erbs palsy

A

arm straight, wrist fully bent (“waiters tip”)

67
Q

what type of brachial plexus injury leads to shoulder instability and weak biceps and deltoids

A

erbs palsy

68
Q

paralysis to the lower brachial plexus

A

dejerine-klumpke palsy

69
Q

what nerves does klumpkes palsy affect

A

C8-T1

70
Q

affects the intrinsics of the hand, flexors of the wrist and fingers, and ulnar half of flexor digitorum profundus

A

klumpkes palsy

71
Q

classic presentation of klumpkes palsy

A

claw hand with forearm supination and wrist/finger flexion

72
Q

nerve is torn from the spine

A

avulsion

73
Q

nerve is torn but not at the spinal attachment

A

rupture

74
Q

nerve has torn and healed, scar tissue puts pressure on the nerve causing dysfunction

A

neuroma

75
Q

nerve is damaged but not torn

A

neuropraxia/stretch

76
Q

what is the most common brachial plexus injury

A

neuropraxia/stretch

77
Q

symptoms of brachial plexus injury

A

Limp/paralyzed arm
Lack of muscle control t/o affected UE
Decreased sensation

78
Q

movement system diagnosis for brachial plexus injury

A

force production deficit

79
Q

at what age is microsurgery completed for brachial plexus injuries

A

3-6 m/o

80
Q

at what age are nerve transfer surgeries performed for brachial plexus injuries

A

12-18 m/o

81
Q

internal organs protrude through a hole in abdomen

A

omphalocele and gastroschisis

82
Q

what is the cause of omphalocele and gastroschisis

A

unknown

83
Q

intestines through a hole in the belly button, covered by a protective sac

A

omphalocele

84
Q

omphalocele can occur commonly up till when but then should retreat

A

11th week of pregnancy

85
Q

intestines through a hole next to the belly button, not covered by a sac

A

gastroschisis

86
Q

examples of protecting intestines during omphalocele and gastroschisis

A

protections of intestines, wrapping of intestines (compression to slowly encourage retreat into abdomen, surgical closure)

87
Q

what scales can be used to assess pain in infants

A

behavioral rating scales
FLACC (face, legs, activity, cry, consolability)
CRIES (crying, requiring oxygen, increased vital signs, expressions, sleeplessness)
Neontal Infant Pain Scale (NIPS - facial expression, cry, breathing pattern, legs, state of arousal)

88
Q

muscle tone presentation in preterm neonates

A

Hypotonia
Decreased ratio of type I (slow twitch) to type II( fast twitch), leading to muscular fatigue
Lig laxity
Limited physiologic flexion
Decreased balance of flexe/ext
Can be influenced by state of arousal

89
Q

how do tone, DTRs and primitive reflexes. develop in preterm infants

A

develop LE to UE and distal to proximal

PT 641 Peds (16 decks)

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