OB/Peds Final

Question 1

Neural Tube Defects

Answer 1

Most often caused by failure of neural tube closure at either the cranial (top) or the caudal (end) of the spinal cord. Ex: Hydrocephalus and Spina Bifida

Question 2

Hydrocephalus

Answer 2

A condition characterized by an increase of cerebrospinal fluid within the ventricles of the brain, causing pressure changes in the brain and an increase in head size.

Question 3

Noncommunicating Hydrocephalus

Answer 3

Results from the obstruction of CSF flow from the ventricles of the brain to the subarachnoid space.

Question 4

Communicating Hydrocephalus

Answer 4

Results when CSF in not obstructed in the ventricles but is inadequately reabsorbed in the subarachnoid space.

Question 5

Manifestations of Hydrocephalus

Answer 5

Increase in head size, bulging fontanelles, shiny scalp, dilated veins, sclera may be seen above above the pupils “setting sun look”. Infant is helpless and lethargic, body becomes thin, poor muscle tone of extremities, shrill high pitched cry, irritability, vomiting, anorexia, convulsions. In older children headache is predominant, cognitive slowing, personality changes, spasticity, and other neuro signs.

Question 6

Transillumination

Answer 6

The inspection of a cavity or organ by passing light through its walls, useful in visualizing fluid. A small ring of light is normal but a large halo effect is not.

Question 7

Diagnosing Hydrocephalus

Answer 7

Transillumination. Head is measured daily. Ventricular tap or puncture may be performed using sterile technique to determine pressure or drain CSF.

Question 8

Tx of Hydrocephalus

Answer 8

Acetazolamide and furosemide reduces production of CSF. Surgery to shunt the point of obstruction so CSF is carried to another part of the body where it is absorbed and excreted. (Ventriculoperitoneal shunt)

Question 9

Nursing Care of Hydrocephalus

Answer 9

Position must be changed frequently to prevent pneumonia and pressure sores, the head must always be supported, tissue of the head ears and bony prominences tend to breakdown. Infant needs to be held for feedings, side-lying position after feedings, infant is not disturbed once settled because vomiting occurs easily.

Question 10

Symptoms of Increased Pressure within the Head

Answer 10

Increase in BP and a decrease in HR and RR

Question 11

Spina Bifida

Answer 11

AKA: Myelodysplasia. A group of central nervous system disorders characterized my malformation of the spinal cord. It is a congenital embryonic neural tube defect in which there is an imperfect closure of the spinal vertebrae.

Question 12

Spina Bifida Occulta

Answer 12

(hidden)…the opening is small and there is no associated protrusion of structures. Often goes undetected and occurs most often at L5 and S1 levels. Tx is not necessary unless neuromuscular symptoms appear.

Question 13

Symptoms of Spina Bifida Occulta

Answer 13

Progressive disturbance of gait, such as footdrop, or disturbances of bowel and bladder sphincter function.

Question 14

Spina Bifida Cystica

Answer 14

Consists of the development of a cystic mass in the midline of the opening in the spine.

Question 15

Meningocele

Answer 15

Contains portions of the membranes and CSF. Size varies from a walnut to that of a newborns head.

Question 16

Meningomyelocele

Answer 16

More serious than a meningocele. A protrusion of the membranes and spinal cord. May be associated with paralysis of the legs and poor control of bowel and bladder functions. Hydrocephalus is a common complication. Prenatal detection is possible through ultrasound and testing for increased AFP in the amniotic fluid.

Question 17

Tx of Spina Bifida

Answer 17

Surgical closure. Habilitation is necessary after closure because the legs remain paralyzed and the pt is incontinent. The aim is to minimize the child’s disability and put to constructive use the unaffected parts.

Question 18

Nursing Care of Spina Bifida

Answer 18

Prevention of infections of or injury to the sac, correct positioning to prevent pressure on the sac and development of contractures, good skin care, adequate nutrition. Moist sterile dressings of saline or antibiotic solution may be ordered to prevent drying of the sac. Infant is usually placed prone with a pad between the legs to maintain abduction and to counteract hip subluxation. A small roll is placed under the ankle to maintain foot position. May be supported in a side-lying posture to provide periods of relief.

Question 19

Foods to avoid when latex allergy present

Answer 19

Bananas, avocados, kiwi

Question 20

Cleft Lip

Answer 20

Characterized by a fissure or opening in the upper lip. A result of the failure of the maxillary and median nasal processes to unite during embryonic development, usually between the seventh and eighth weeks.

Question 21

Cleft Palate

Answer 21

A fissure in the midline of the roof of the mouth

Question 22

Tx of Cleft Lip

Answer 22

Initial tx is surgical repair, know as cheiloplasty. Cleft lip is repaired by age 3 months when weight gain is established and the infant is free of infection. A syringe with a rubber tip, a long nipple with a large hole attached to a squeeze bottle, or a medicine dropper can be used to feed the infant before and after surgery because sucking motions must be avoided to keep from applying tension on the suture line.

Question 23

Postop Care of Cleft Lip

Answer 23

Prevent infant from sucking or crying. Carefule positioning never on the abdomen. Prevent infection and scarring by gentle cleansing of suture line to prevent crusts from forming.

Question 24

Feeding with Cleft Lip

Answer 24

Sucking is prevented as much as possible until the suture line if healed. Small amounts of sterile water will cleanse the mouth after feeding. Holding the infant during feedings, burping frequently, and placing the infant in an infant seat after feeding or on the right side propped with a rolled blanket will aid in a positive outcome.

Question 25

Club Foot

Answer 25

A congenital anomaly characterized by a foot that has been twisted inward or outward. True club foot does not respond to simple exercise.

Question 26

Developmental Hip Dysplasia

Answer 26

Applies to various degrees of deformity: subluxation or dislocation, either partial or complete. The head of the femur is either partially or completely displaced as a result of a shallow hip socket. Hip malformation, joint laxity, breech position, and maternal hormones may all contribute.

Question 27

Manifestations of Hip Dysplasia

Answer 27

Limited abduction of the leg, knee of side of dislocation is lower, skin folds on the thigh are deeper and often asymmetrical, one buttocks appears higher than the other.

Question 28

Barlow’s Test

Answer 28

Detects an unstable hip in the newborn. Physician adducts and extends the hips while stabilizing the pelvis and may feel the dislocation occur as the femur leaves the acetabulum.

Question 29

Phenylketonuria

Answer 29

A genetic disorder caused by the faulty metabolism of phenylalanine, an amino acid that is essential to life and is found in all protein foods. Associated with blood phenylalanine levels above 20 mg/dL. The hepatic enzyme phenylalanine hydrolase, which is normall needed to convert phenylalanine into tyrosine, is missing. Classic PKU results in severe retardation. By the time the urine test is positive, brain damage has already occurred.

Question 30

S/S of PKU

Answer 30

Begins to show delayed development by 4-6 months, may show evidence of failure to thrive, have eczema or other skin conditions, have a musty odor, or personality disorders. Also may have seizures. Occurs mainly in blonde and blue eyed children.

Question 31

Guthrie Blood Test

Answer 31

The most reliable test for PKU. Blood is obtained with simple heel stick. Recommended the blood be obtained after 48-72 hours of life.

Question 32

Signs of Down Syndrome

Answer 32

close-set and upward slanting eyes, small head, round face, flat nose, protruding tongue that interferes with sucking and mouth breathing, deep straight line across the palm (simian crease), hands are short and thick, little finger is curved, wide space between first and second toes, physical and development may be slower than normal, child may be limited intellectually, congenital heart deformities.

Question 33

4 defects of Tetralogy of Fallot

Answer 33

1. stenosis or narrowing of the pulmonary artery, which decreases blood flow to the lungs
2. Hypertrophy of the right ventricle
3. Dextroposition of the aorta
4. VSD

Question 34

Hypospadias

Answer 34

A congenital defect in which the urinary meatus is located not at the end of the penis but on the lower shaft. Tx consists of surgical repair and is usually performed before 18 months of age. Routine circumcision is avoided because the foreskin may be useful in the repair.

Question 35

Nephrotic Syndrome (Nephrosis)

Answer 35

Different types of kidney conditions that are distinguished by the presence of marked amounts of protein in the urine, edema, and hypoalbuminemia. Symptoms are edema first noticed around the eyes and ankles later becoming generealized, edema shifts with the position of the child during sleep, abdomen becomes distended (ascites), child is pale, irritable, listless, poor appetite. Child is turned frequently to prevent respiratory tract infection. pillow between knees when lying on the side, head is elevated from time to time during the day. Monitor I&Os, NO vaccinations or immunizations should be administered.

Question 36

Acute Glomerulonephritis

Answer 36

An allergic reaction to strep. May appear after pt has had scarlet fever or skin infections. Both kidneys are usually affected. Periorbital edema upon wakening, smoky brown urine, or bloody urine, Urine specific gravity will be high, BUN is elevated, and creatinine and sed rate are elevated. Hyperkalemia may produce cardiac toxicity. Hypertension may occur.