Pedi Neuromusculoskeletal Disorders

Question 1

Cerebral Palsy

Answer 1

nonprogressive impairment of motor function, especially that of muscle control, coordination, posture
cause unknown

Question 2

Cerebral Palsy

Manifestations

Answer 2

gagging/choking with feeding, poor suck reflex
tongue thrust
poor head control
asymmetrical crawl

Question 3

Cerebral Palsy

Spastic (pyramidal)

Answer 3

hypertonicity; increased DTR; clonus; poor control of motion, balance, posture
impairments of fine and gross
quadriplegia (all)
diplegia (similar parts)
triplegia (three limbs)
monoplegia (one limb)
hemiplegia (one side)
crouched gait, scissoring legs

Question 4

Cerebral Palsy

Dyskinetic (nonspastic, extrapyramidal)

Answer 4

athetoid: involuntary jerking movements, slow, writhing, wormlike involving trunk, neck, face, tongue
dystonic: slow, twisting affect trunk, extremities, abnormal posturing

Question 5

Cerebral Palsy

Ataxic

Answer 5

wide-based gait, difficult coordination
poor ability to do repetitive movements
difficulty with quick or precise movements
shakiness
low muscle tone

Question 6

Cerebral Palsy

Nursing Care

Answer 6

structure interventions and communications around client’s developmental level, not age
open airway
ensure suction equipment available

Question 7

Cerebral Palsy

Baclofen

Answer 7

centrally acting skeletal muscle relaxant decreases muscle spasm and severe spasticity
monitor for muscle weakness, increased fatigue, diaphoresis, constipation

Question 8

Cerebral Palsy

Diazepam

Answer 8

skeletal muscle relaxant decreases muscle spasms and severe spasticity
used in older children and adolescents
monitor for drowsiness and fatigue

Question 9

Cerebral Palsy

Botulinum toxin A

Answer 9

reduces spasticity in specific muscle groups
for spasticity in lower extremities
monitor for temporary weakness
onset 24-72 hr
peak 2 weeks
lasts 3-6 months

Question 10

Cerebral Palsy

Antiepileptics

Answer 10

control seizure activity

Question 11

Spina bifida

Answer 11

failure of osseous spine to close

neural tube defect present at birth

Question 12

Spina bifida occulta

Answer 12

mostly affects lumbosacral area, not visible

Question 13

Spina bifida cystica

Answer 13

visual sac protrusion

Meningocele - sac contains spinal fluid and meninges
Myelomeningocele - sac includes meninges, spinal fluid, nerves

Question 14

Spina Bifida

Risk factors

Answer 14

meds/drug during pregnancy
maternal malnutrition
insufficient folic acid intake
radiation/chemicals
prepregnancy obesity, DM, hyperthermia, low vitamin B12

Question 15

Spina Bifida

Surgical

Answer 15

closure of myelomeningocele sac done ASAP to prevent complications of injury and infection
pre-op - infant in warmer, nude; sterile moist nonadhering dressing with 0.9% sodium chloride on sac, change q2h; prone with hips flexed and legs abducted

Question 16

Down Syndrome

risk factors

Answer 16

maternal age greater than 35

Question 17

Downs Syndrome

Manifestations

Answer 17

separated sagittal suture
enlarged anterior fontanel
small round head
flattened forehead
upward, outward slant to eyes
small nose with depressed nasal bridge
small ears with short pinna
high-arched narrow palate
protruding tongue
short, broad neck
shortened rib cage
possible congenital heart defect
protruding abdomen
broad short feet and hands with stubby toes and fingers
transverse palmar crease
large space between big and second toes with plantar crease
short stature
hyperflexibility and hypotonia