Peds Exam 3b - NeuroMus Flashcards
cerebral palsy
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
is CP progressive?
no, it is just more manageable as a infant / child
how is CP classified
by type and severity
spastic CP
upper motor neuron muscular weakness, persistent primitive reflex, hypertonicity
the child has a lot of contractures, drooling and is much more severe
when is CP dx vs a stroke
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
how do we dx CP
-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
when should an infant sit up without assists
8mo -> send to pt
when does an infant develop a dominant hand
early would be 12-15mo
reflexes:
rooting
moro(startle)
tonic
grasping
babinski
-4M
-4M
-6M
-6M
-2yr
when should a child smile by
2 months
what back alignment is commonly seen in spastic CP
opisthotonic posture: curved, C shaped spine
scissoring
when the knees buckle together/cross over each other, commonly seen in spastic CP
clinical manifestations of CP
-mental impairment
-seizures
-contractures
-incontinence
-ADHD
-non ambulatory spastic
-feeding difficulties FTT
-res, vision, oral & hearing problems
what complications does non ambulation cause
-constipation
-orthopedic problems
-skin breakdown
-respiratory infections
therapeutic mgt of CP
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
medical mgt of CP
-seizure meds if needed
-anxiety meds if needed
-baclofen to help with spasms
-bowel regimen (enemas, schedule, suppository) training
CP home care
-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
muscular dystrophy
a genetic disorder that effects dystrophin which is what keeps our muscles intact -> the mutation leads to the muscle falling apart
how do we name MD
by the muscle it first effects
duchenne is the most severe type
how does MD progress
like ALS where it starts with your outer muscles and then works into the respiratory muscles which leads to death
what is the age expectancy of MD
20-30s
brain is intact so they understand what is happening
early clinical manifestations of MD
-onset: between 3 to 5 yrs
-rapid progression after initial normal development regression
-waddling gait
-lordosis
-positive gower’s sign
what are some of the first signs of MD
difficulty running, riding bikes, and climbing stairs
what is the hallmark sign of MD
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
clinical manifestation of MD during progression
-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
MD complications
-contractures
-atrophy of disuse
-infection res
-obesity
-cardiac problems near end stages
MD dx
-symptoms
-serum enzymes
-muscle biopsy
-EMG
therapeutic goals of MD
maintain function in the unaffected muscles as long as possible
keep them walking, crutches before wheelchair
MD nursing care
treat the symptoms
-surgery
-nutrition
-therapy
-meds for cardiac issues
-res treatments + vests + vents
-palliative care
how can we slow the progression of MD
corticosteroids & newer treatments that block muscle wasting and preserve muscle strength
spina bifida
failure of the neural tube to develop correctly within the first 4 wks of pregnancy
what vitamin deficiency is associated w/ SB
B9 vitamin folic acid of the mother during pregnancy
what is a way to help prevent SB
if you are of child bearing years, take a good MV starting after finding out about pregnancy is too late
dx of SB
can be done prenatally and depending on the type, prenatal surgery can be done
birth plan of child w/ SB
if repairs not done prenatally, C section
spina bifida occulta
defect is only in vertebrae and you might not even know you have it
no neurological impairments
spina bifida cystica : meningocele
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
spina bifida cystica : myelomeningocele
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
most children with SB have what characteristics
incontinent of bowel & bladders, have paralysis from the waist down, & usually see skin breakdown
fine developmental level & smart
nursing care for SB
put baby on belly -> apply non adherence sterile dressing over the sac -> bring to NICU -> sedate & intubate -> surgery
what temp should we not take on a SB baby
rectal bc it can cause a prolapse
nursing care for SB after infancy
infancy is the same as normal dev baby’s
-in & out caths do not want them always in a diaper
-bowel regimen
when can a child learn how to self cath
by 6 yrs old
clean not sterile so risk of infection
what education is important for a SB child
S/s of a UTI and how to prevent a UTI
when a child has myelomeningocele, what are they more at risk for
hydrocephalus
nursing care for myelomeningocele
- OFC & fontanel assessments
-assess for signs of infections
-provide adequate nutrition & hydration
-latex free bc increased risk of allergy
-promote normal development
what do we want to prevent in SB children
renal issues & dialysis d/t increased risk of UTIs
CP diet
-increased kcals
-gtube
CP nursing care
-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
