Peds Exam 3b - NeuroMus Flashcards

1
Q

cerebral palsy

A

a problem with the brain so the brain cannot control the muscle groups as it should
either from connectoris which is when you become very jaundice and it crosses the blood brain barrier, premature birth, stroke, or shaken baby

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2
Q

is CP progressive?

A

no, it is just more manageable as a infant / child

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3
Q

how is CP classified

A

by type and severity

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4
Q

spastic CP

A

upper motor neuron muscular weakness, persistent primitive reflex, hypertonicity
the child has a lot of contractures, drooling and is much more severe

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5
Q

when is CP dx vs a stroke

A

if a child is under 2yr old, we will dx as CP but we do not confirm until after 2yrs -> will say they are delayed or need extra help

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6
Q

how do we dx CP

A

-missed milestones
-persistent primitive reflexes
-abnormal muscle tone/ floppy/ grimacing
-not using both side of body equally
-early hand preference
-poor suck & tongue thrust
-uncoordinated movements
symptom based, no test

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7
Q

when should an infant sit up without assists

A

8mo -> send to pt

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8
Q

when does an infant develop a dominant hand

A

early would be 12-15mo

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9
Q

reflexes:
rooting
moro(startle)
tonic
grasping
babinski

A

-4M
-4M
-6M
-6M
-2yr

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10
Q

when should a child smile by

A

2 months

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11
Q

what back alignment is commonly seen in spastic CP

A

opisthotonic posture: curved, C shaped spine

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12
Q

scissoring

A

when the knees buckle together/cross over each other, commonly seen in spastic CP

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13
Q

clinical manifestations of CP

A

-mental impairment
-seizures
-contractures
-incontinence
-ADHD
-non ambulatory spastic
-feeding difficulties FTT
-res, vision, oral & hearing problems

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14
Q

what complications does non ambulation cause

A

-constipation
-orthopedic problems
-skin breakdown
-respiratory infections

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15
Q

therapeutic mgt of CP

A

all symptom based w/ goal to promote as much independence as possible
-botox to relax muscle
-surgery for contractures
-OT + PT + ROM exercises
-braces & walkers

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16
Q

medical mgt of CP

A

-seizure meds if needed
-anxiety meds if needed
-baclofen to help with spasms
-bowel regimen (enemas, schedule, suppository) training

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17
Q

CP home care

A

-support family
-get them into schools & educate on inclusion at school
-use of assistive devices & exercise
-proper med admin
-prevent skin breakdown
-nutrition & play
-safety needs

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18
Q

CP nursing care

A

-assessment & early ID to get into treatment
-reinforce therapeutic plan (positive & offer suggestions)
-help improve muscle tone & control
-make sure they are up to date on immunizations
best thing we can do is to get them into therapy

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18
Q

muscular dystrophy

A

a genetic disorder that effects dystrophin which is what keeps our muscles intact -> the mutation leads to the muscle falling apart

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19
Q

CP diet

A

-increased kcals
-gtube

19
Q

how do we name MD

A

by the muscle it first effects
duchenne is the most severe type

20
Q

how does MD progress

A

like ALS where it starts with your outer muscles and then works into the respiratory muscles which leads to death

21
Q

what is the age expectancy of MD

A

20-30s
brain is intact so they understand what is happening

22
Q

early clinical manifestations of MD

A

-onset: between 3 to 5 yrs
-rapid progression after initial normal development regression
-waddling gait
-lordosis
-positive gower’s sign

23
Q

what are some of the first signs of MD

A

difficulty running, riding bikes, and climbing stairs

24
Q

what is the hallmark sign of MD

A

positive gower’s sign -> when a child gets down, they cannot get back up hands on ankles and walk themselves back up d/t not having the thoracic muscle strength

25
Q

clinical manifestation of MD during progression

A

-pseudo-hypertrophy: fatty deposits which make it look like muscles are getting bigger
-muscular atrophy
-lost of ability to walk by 10 to 12 yrs
-cardiac or res failure
-mild to mod cognitive impairment
-mechanical vents around 27 yrs

26
Q

MD complications

A

-contractures
-atrophy of disuse
-infection res
-obesity
-cardiac problems near end stages

27
Q

MD dx

A

-symptoms
-serum enzymes
-muscle biopsy
-EMG

28
Q

therapeutic goals of MD

A

maintain function in the unaffected muscles as long as possible
keep them walking, crutches before wheelchair

29
Q

MD nursing care

A

treat the symptoms
-surgery
-nutrition
-therapy
-meds for cardiac issues
-res treatments + vests + vents
-palliative care

30
Q

how can we slow the progression of MD

A

corticosteroids & newer treatments that block muscle wasting and preserve muscle strength

31
Q

spina bifida

A

failure of the neural tube to develop correctly within the first 4 wks of pregnancy

32
Q

what vitamin deficiency is associated w/ SB

A

B9 vitamin folic acid of the mother during pregnancy

33
Q

what is a way to help prevent SB

A

if you are of child bearing years, take a good MV starting after finding out about pregnancy is too late

34
Q

dx of SB

A

can be done prenatally and depending on the type, prenatal surgery can be done

35
Q

birth plan of child w/ SB

A

if repairs not done prenatally, C section

36
Q

spina bifida occulta

A

defect is only in vertebrae and you might not even know you have it
no neurological impairments

37
Q

spina bifida cystica : meningocele

A

missing vertebrae and also a protruding sac that does not contain nerves -> treatment is to push the sac back in and close
no neurological impairments

38
Q

spina bifida cystica : myelomeningocele

A

missing vertebrae and also a protruding sac that does contain nerves causing nerve damage and neurological deficits , the higher the sac on the back, more damage is caused

39
Q

most children with SB have what characteristics

A

incontinent of bowel & bladders, have paralysis from the waist down, & usually see skin breakdown
fine developmental level & smart

40
Q

nursing care for SB

A

put baby on belly -> apply non adherence sterile dressing over the sac -> bring to NICU -> sedate & intubate -> surgery

41
Q

what temp should we not take on a SB baby

A

rectal bc it can cause a prolapse

42
Q

nursing care for SB after infancy

A

infancy is the same as normal dev baby’s
-in & out caths do not want them always in a diaper
-bowel regimen

43
Q

when can a child learn how to self cath

A

by 6 yrs old
clean not sterile so risk of infection

44
Q

what education is important for a SB child

A

S/s of a UTI and how to prevent a UTI

45
Q

when a child has myelomeningocele, what are they more at risk for

A

hydrocephalus

46
Q

nursing care for myelomeningocele

A
  • OFC & fontanel assessments
    -assess for signs of infections
    -provide adequate nutrition & hydration
    -latex free bc increased risk of allergy
    -promote normal development
47
Q

what do we want to prevent in SB children

A

renal issues & dialysis d/t increased risk of UTIs