PedsNeuroMuscular

Question 1

Explain the brain and spinal development in infants?

Answer 1

CNS is developed within the first 3-4 weeks of gestation. In newborns, the open fontanels mean rf trauma, leading to risk for intraventricular hemorrhages. Neurons are present at birth but connections must be made. Myelinization increases with age, complete by 2-3 years.

Question 2

Explain the cranium and spine in infants and children?

Answer 2

Soft and flexible. If damage is present, one sees decreases in motorization, sucking, swallowing, and breathing.
The spine is mobile, especially the cervical. Head is fastest growing and largest part of the body in infants.

Question 3

Health history for a child with neuro issues?

Answer 3

Pregnancy: complications, drug use, meds, prematurity. Family history: seizures, neuro development. Developmental milestones. Present illness s/s, including LOC, gait, visual, vomiting, etc.

Question 4

Physical examination for a child with neuro issues?

Answer 4

Vital signs. Head, face, neck. Skull shape, sutures, fontanels, symmetry of face and eyes, head circumference (<3yrs), neck ROM. Meningeal irritation, cranial nerves, reflexes (absent, sluggish, increased), senses.

Question 5

Explain the peds Glasgow coma?

Answer 5

Children under 2 years. Eye opening, verbal response, motor response. Score from 3-15. Below or equal to 12 is concerning, under 8 needs intubation.

Question 6

Assessing motor function in children?

Answer 6

Muscle strength and tone tested by lifting with the palmar grasp (by 4-5 months there should be no head lag). Babies are usually flexed but not overly tense. Symmetry of movements, have them walk if mobile.
Posturing and postural reflexes, like decorticate (cerebral cortex) and decerebrate (brain stem).

Question 7

Early signs of increased intracranial pressure?

Answer 7

Headache, vomiting, blurred vision, diplopia, dizziness, decreased HR and RR, increased BP, pupil reaction time unequal and longer, sunset eyes, changes in LOC, irritability, seizure.
In infants: Bulging, tense fontanel, wide sutures, increased head circumference, dilated scalp veins, high-pitched cry

Question 8

Late signs of ICP?

Answer 8

Lowered LOC, decreased motor and sensory responses, bradycardia, irregular respirations, Cheyne-Stokes respirations, decerebrate or decorticate posturing, fixed and dilated pupils

Question 9

Labs and diagnostic testing for neuro in peds?

Answer 9

May have to sedate to make them still but try to avoid it because you’re looking at the LOC, use EMLA if time allows (takes 60 mins). EEG, CT< MRI, PET, lumbar puncture

Question 10

2 or more unprovoked seizures greater than 24 hours apart. Partial or generalized loss of consciousness.

Answer 10

Epilepsy. Neuro assessment. Seizure description: length, precipitating factors, activity during the seizure. Postictal state.
Diagnosed with serum electrolytes and glucose, EEG.

Question 11

Nursing management of epilepsy?

Answer 11

Prevent injury by turning on the side, protect the head. Anticonvulsants, vagal nerve stimulator, ketogenic diet. Education and support, including activities to avoid.

Question 12

Home care to teach for seizures?

Answer 12

Remain calm, stay with child, remove hazards. Prolonged seizure for >5 mins, call 911. Administer benzos, rectal diazepam or intranasal midazolam or lorazepam.

Question 13

One seizure that lasts for longer than 30 minutes or a series of seizures without regaining consciousness.

Answer 13

Status epilepticus. Medical emergency, must be hospitalized. Intubation and sedation. Complication can be decreased cerebral perfusion.

Question 14

What is seen in a febrile seizure? Management?

Answer 14

Rapidly climbing fever, children under 5 years old. Neuro assessment.
Parental support and education. Fever management. May be placed on short-term anti-seizure meds.

Question 15

Increased ICP in the vessels in children. Can be genetic or acquired.

Answer 15

Hydrocephalus. Check health history and risks (intrauterine infection, meningitis, encephalitis, prematurity. Identify early! Increased time during this makes for greater damage.

Question 16

Symptoms of hydrocephalus?

Answer 16

Increased head circumference greater than 90%. Cognitive issues, increased ICP, developmental delay, vomiting, HA, altered LOC

Question 17

Nursing management of hydrocephalus?

Answer 17

Maintain cerebral perfusion, assess VS and neuro, fontanels, etc. Manage external ventricular device (EVD). Minimize shunt complications, like infection and malfunction. Promote growth and development. Educate child and family.

Question 18

Explain head shunts?

Answer 18

Most common is the ventriculoperitoneal shunt.
Ventriculoatrial shunt. Promptly identify issues, such as infection and increased ICP: fever, redness, swelling, increased head growth, LOC.

Question 19

Inflammation of the meninges that often causes brain damage in infants.

Answer 19

Meningitis. Check risks, like babies, exposure, decreased immunization (Hib, meningococcal). Emergent.
LP, CBC, blood and urine cultures within 72 hours.

Question 20

A couple s/s of meningitis? Bacterial vs aseptic (viral)?

Answer 20

An early sign is nuchal rigidity: pain in the neck, increased crying, curled and tense posture due to pain in the neck. Petechial rash that won’t blanch with meningococcemia.
More sick with bacterial vs viral. Treat all as bacterial until cultures prove otherwise.

Question 21

What are two signs of meningeal irritation?

Answer 21

Kernig’s sign, the leg is bent 90 degrees and then go to straighten it. Brudzinski’s neck sign tilt the head down and the legs pop up at the knee. Positive if pain is present due to irritation.

Question 22

S/s of bacterial meningitis?

Answer 22

Increased WBC and protein, decreased glucose.

Do a broad spectrum CSF culture first, then specify after positive culture.

Question 23

Nursing management of bacterial meningitis?

Answer 23

Maintain cerebral perfusion: frequent neuro assessment, reduce ICP, quiet environment, be aware of photosensitivity, reduce fever and pain. Prevent injury from seizures. Droplet precaution, post-exposure prophylaxis for the family and friends. Vaccines for meningococcal and Hib.

Question 24

Most common type of meningitis. Child is usually less ill. Self-limiting cause.

Answer 24

Aseptic or viral meningitis. Aggressive treatment to start, droplet until identified, supportive care because it’s a virus it’s self-limiting.

Question 25

Explain musculoskeletal and spinal cord development in children

Answer 25

Brain and spinal cord are present and done at birth but not utilized due to decreased muscle mass. Neural tube differentiates at 3-4wks gestation. Bones are less ossified, mostly cartilage. Skeleton is fully developed as a teen. Growth plate is fragile, bones heal quickly.

Question 26

Positional alterations in the musculoskeletal in peds?

Answer 26

Metatarsus adductus: intoeing
Genu varum: bowlegs
Genu valium: knock knees

Question 27

Can be associated with other neuromuscular disorders in an otherwise healthy baby. Unilateral or bilateral.

Answer 27

Clubfoot. Serial casting/surgery. Goal is a functional foot.

Question 28

Examples of neural tube defects?

Answer 28

Spina bifida occulta. Meningocele. Myelomeningocele.

Question 29

The most serious from of spina bifida? Pre-op and long-term care?

Answer 29

Myelomeningocele. Caused possibly a low folic acid intake during pregnancy. Inspect the external sac.
Pre: prevent trauma, infection. Promote adequate nutrition, prone position, monitor temp because of the large surface area exposed.
Long: multi-disciplinary. Promote urinary and bowel elimination, latex-free environment. Meticulous skin care due to no sensation or movement. Keep the exposed area moist with sterile wet gauze. Educate/support.

Question 30

Assessment and management of developmental dysplasia of the hip?

Answer 30

Physical exam: Barlow test, Ortolani test, extra folks on skin on one side of leg.
Early recognition, positioning. Pavlik harness.

Question 31

Explain a pavlik harness for developmental dysplasia of the hip?

Answer 31

Continuous use for 2 weeks. 24/24 hour for 3 months. Skin care, with shirt on and clean diaper.
If discovered under 6 months, then harness 23 hours a day with legs bent. If discovered at 6 months to 2 years, surgery and then casts.

Question 32

Non-Progressive brain dysfunction. Motor disorder, hypertonic. Associated with anoxia to the brain, usually perinatal occurrence.

Answer 32

Cerebral palsy. Spastic type is the most common, with an increased RF fractures.
Multidisciplinary treatment with therapy and surgery.

Question 33

Medications for cerebral palsy?

Answer 33

Anticonvulsants, benzos to relax muscles, baclofen for antispasmodic, anticholinergics, botulin toxin to relax the muscles

Question 34

Skin traction examples? Skeletal traction?

Answer 34

Skin: Bryant traction, Buck traction, Balanced (Thomas) traction
Skeletal: 90-90 traction, Halo traction

Question 35

Skin or skeletal, free hanging rope and weights.

Answer 35

Traction. Frequent neuromuscular checks, distal injury. Meticulous skin care, care of pin sites, prevent complications of immobility, promote normal growth and development.

Question 36

Symptoms of spastic cerebral palsy?

Answer 36

Poor feeding with decreased growth patterns. Issues swallowing so do not do a swallow test. Seizures, vision and hearing deficits, delayed development, persistent primitive reflexes, spasticity, hypertonicity, cognitive disabilities.

Question 37

Nursing management for spastic cerebral palsy?

Answer 37

Baclofen, PO or intrafecal. Promote mobility: orthotics, braces, wheelchairs, skin care. Promote nutrition: special diet, upright positioning, G-tube, soft diet, increased caloric needs, speech therapist. Support/education

Question 38

Lack of protein in muscles leading to progressive muscle weakness and wasting. Inherited x-linked recessive gene expressed in males. Life expectancy is 20-25 years.

Answer 38

Duchenne muscular dystrophy.
Late walkers, clumsy. Pseudohypertrophy of the calves, making them look big. Gowers sign in school age, get up with arm strength.

Question 39

Dx and treatment of Duchenne muscular dystrophy?

Answer 39

Electromyography (EMG), which shows the problem is in the muscles and not the nerves. Muscle biopsy.
Corticosteroids, prednisone, calcium, vitamin D supplements. Supportive care.

Question 40

Softened bones caused by a nutritional deficit in phosphorous, calcium, and vitamin D. Risks? Physical exam?

Answer 40

Rickets. Inadequate nutrition, chronic renal disease, chronic GI disorder, limited sun, dark skin tone, prematurity.
Exam: dental deformities, bowlegs, bone pain, decreased muscle tone

Question 41

Nursing management of rickets?

Answer 41

Correct the deficiency, vitamin D 400 IU per day for infants. Nutrition: fish, liver, processed milk, mushrooms. Education.

Question 42

Risk factors and physical exam for scoliosis?

Answer 42

Risks are female and family history.

Exam: Shoulder and back asymmetry, possible neruo deficits, leg length discrepancy

Question 43

Nursing management for scoliosis?

Answer 43

Depends on the degree. Bracing for curves 25-40 degrees. Surgery for curves greater than 45 degrees: neurovascular checks, blood loss assessment, bedrest, foley care, log rolling, pain management, make sure they’re up and moving the next day.

Question 44

Nursing assessment and management for a fracture?

Answer 44

Symptoms, physical, check affected limb last: deformity, disability, point tenderness, neruovascular deficits (CMS), compartment syndrome.
Immobilization, ice, elevation, pain, frequent neurovascular checks, possible DTaP or Td depending on the type of injury, education, prevention

Question 45

Cerebral palsy that is tense, contracted muscles, most common.
Type that is poor sense of balance, often causing falls and stumbles

Answer 45

Spastic.

Ataxic

Question 46

Cerebral palsy that involves constant, uncontrolled motion of limbs, head, and eyes.
Type that involves tight muscles that resist effort to make them move
Type that involves uncontrollable shaking, interfering with coordination.

Answer 46

Athetoid
Rigidity
Tremor