T3-Blueprint: Cerebral Defects Flashcards
What is anencephaly?
Absence of brain
Etiology of spina bifida?
Neural tube fails to close in utero—usually lumbar area
What is spina bifida associated with?
Hydrocephalus
What is meningocele spina bifida?
Not associated with a neurological deficit
What is diagnosis of meningocele spina bifida?
Positive transillumination–light shines through it—no nerves in it
What is myelomeningocele spina bifida?
Included meninges, spinal fluid, and nerves–incomplete closure of vertebral column
In myelomeningocele spina bifida, what sometimes protrude as a saclike structure?
Meninges (and sometimes spinal cord)
What is the diagnosis of myelomeningocele SB?
Light will not shine through
“crippled children”
When is surgery with SB patients and why?
To prevent infection and preserve existing functions—closure within 24-48 hours of being born to prevent infection!
During surgery, if SB patient has hydrocephalus, what other procedure can be done?
Shunt procedure
What are pre-op care before SB surgery?
- Make sure “sac” stays intact until surgery
- Infant in prone position with hips abducted (FROG LIKE)–hips slightly elevated with a towel or sponge role to prevent tension and trauma to sac
- Keep sac moist and warm–if surgery delayed, toughen sac
- No fastened diapers until after repair
What are post op care for SB?
- Wound care
- Special care of site
- Neuro assessment for increased ICP
- Infant stimulation–show parents how to hold child without damaging surgical site
What is prevention of SB?
Foods that contain folic acid and vit c
Folic acid foods?
Leafy green vegetables–spinach
Citrus fruits-OJ
Beans, breads, cereals, rice, pastas
What are foods that have Vit C?
BELL PEPPERS
Dark leafy greens, broccoli
Kiwi, Citrus fruits, papayas
Tomatos, peas
Abnormal accumulation of fluid within ventricles
Hydrocephalus
What are some characteristics of hydrocephalus (7)?
- Abnormal rate of head growth
- Bulging fontanels
- Thinning of skull bones
- Dilation of scalp veins
- Frontal enlargement of “bossing”
- Depressed eyes: “setting sun eyes”
- Irritability
What are some causes of hydrocephalus?
-Blockage/obstruction along circulatory pathway of CSF (between 3rd and 4th ventricle)
Primary: Arnold Chiari Syndrome
Secondary: Acquired
What are some “other” causes of hydrocephalus?
- SB: Myelomeningocele
- Meningitis
- Intraventricular hemorrhage
- Tumors
- Head trauma
What are S/S of hydrocephalus?
- Sunset sign (see top white of eyes)
- Increased head circumference
- High pitch cry
- Poor feeding (due to high ICP)
How do we manage hydrocephalus?
- Antibiotics
- If hydrocephalus due to meningitis, then fluid restrictions!
- Furosemide to decrease production of CSF
Birth defect in which one or more of the joints between bones of baby skull close prematurely, before baby brain is fully developed
Craniosynostosis
What is the most common premature closing in craniosynostosis?
Sagittal suture
How does craniosynostosis baby look?
“Cone head” appearance
What is surgery for craniosynostosis?
Excision of long bars of bones (strip craniotomy) along or parallel to fused suture
When is advised time for surgery for craniosynostosis?
Prior to 6 months of age for best results
What is main treatment for hydrocephalus?
VP shunt
____ are the best and most effective treatment for hydrocephalus
Shunt
What is a shunt?
Flexible tube placed into childs CSF system, which diverts the flow of CSF from the ventricles into another region of body (peritoneal cavity or atrium of heart)
Where is ventricular catheter shunt inserted and what does it drain?
Inserted into ventricles
Drains fluid from brain ventricles into atria
What is the peritoneal catheter?
Passes the CSF into the abdomen (peritoneal cavity)
Which is the preferred shunt: ventricular or peritoneal and why?
Peritoneal—longer tubing allows for growth
Where is atrial catheter placed?
R. atrium of heart
Shunt: What does the valve do?
Regulates pressure of CSF flow and prevents backward flow of SF toward ventricles
Shunt: What does reservoir do?
Premits MD to remove CSF samples from the shunt with a needle and syringe and to inject the chambers for testing shunt function and for treatment
Shunt: The reservoir allows the shunt to be ______ or pumped flushing the chamber sometimes allows the MD to determine whether the shunt is functioning properly
Flushed
What should patients and families know about the shunt?
The name of model of shunt pt has
Know if shunt has an on/off valve
Pre-op for shunt?
- Observe signs of ICP
- Care of externalized shunt if applicable
- Support their large head
- Skin care
- Seizure precautions
- Maintain adequate nutrition
Post op for shunt?
- Positon on UNAFFECTED SIDE
- Bed needs to be flat (shunt works better with gravity; avoid over drainage)
- Check site for infection
- VS, neuro checks, pain control
Parent teaching for hydrocephalus/shunt?
Avoid contact sports and use protective helmets
Complications of shunt?
- Shunt malfunction
- Shunt obstruction
- Shunt infection
How do you know there is a shunt malfunction?
- Full, tense fontanel when upright
- Prominent scalp veins
- Swelling/redness along shunt tract
- Fever, vomit, irritable
- Sleepiness, downward eye deviation, seizures
How do we know there is shunt obstruction?
Recurrent symptom of hydrocephalus
Increased ICP
Fluid along shunt tract
How do we know there is shunt infection?
Fever and reddening/swelling along shunt tract
T/F: Shunt revisions are needed as the child grows
TRUE
