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Pediatrics-MJ > T3-Blueprint: Cerebral Defects > Flashcards

T3-Blueprint: Cerebral Defects Flashcards

1
Q

What is anencephaly?

A

Absence of brain

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2
Q

Etiology of spina bifida?

A

Neural tube fails to close in utero—usually lumbar area

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3
Q

What is spina bifida associated with?

A

Hydrocephalus

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4
Q

What is meningocele spina bifida?

A

Not associated with a neurological deficit

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5
Q

What is diagnosis of meningocele spina bifida?

A

Positive transillumination–light shines through it—no nerves in it

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6
Q

What is myelomeningocele spina bifida?

A

Included meninges, spinal fluid, and nerves–incomplete closure of vertebral column

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7
Q

In myelomeningocele spina bifida, what sometimes protrude as a saclike structure?

A

Meninges (and sometimes spinal cord)

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8
Q

What is the diagnosis of myelomeningocele SB?

A

Light will not shine through

“crippled children”

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9
Q

When is surgery with SB patients and why?

A

To prevent infection and preserve existing functions—closure within 24-48 hours of being born to prevent infection!

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10
Q

During surgery, if SB patient has hydrocephalus, what other procedure can be done?

A

Shunt procedure

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11
Q

What are pre-op care before SB surgery?

A
  1. Make sure “sac” stays intact until surgery
  2. 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
  3. Keep sac moist and warm–if surgery delayed, toughen sac
  4. No fastened diapers until after repair
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12
Q

What are post op care for SB?

A
  1. Wound care
  2. Special care of site
  3. Neuro assessment for increased ICP
  4. Infant stimulation–show parents how to hold child without damaging surgical site
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13
Q

What is prevention of SB?

A

Foods that contain folic acid and vit c

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14
Q

Folic acid foods?

A

Leafy green vegetables–spinach

Citrus fruits-OJ

Beans, breads, cereals, rice, pastas

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15
Q

What are foods that have Vit C?

A

BELL PEPPERS

Dark leafy greens, broccoli

Kiwi, Citrus fruits, papayas

Tomatos, peas

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16
Q

Abnormal accumulation of fluid within ventricles

A

Hydrocephalus

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17
Q

What are some characteristics of hydrocephalus (7)?

A
  1. Abnormal rate of head growth
  2. Bulging fontanels
  3. Thinning of skull bones
  4. Dilation of scalp veins
  5. Frontal enlargement of “bossing”
  6. Depressed eyes: “setting sun eyes”
  7. Irritability
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18
Q

What are some causes of hydrocephalus?

A

-Blockage/obstruction along circulatory pathway of CSF (between 3rd and 4th ventricle)

Primary: Arnold Chiari Syndrome

Secondary: Acquired

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19
Q

What are some “other” causes of hydrocephalus?

A
  • SB: Myelomeningocele
  • Meningitis
  • Intraventricular hemorrhage
  • Tumors
  • Head trauma
20
Q

What are S/S of hydrocephalus?

A
  • Sunset sign (see top white of eyes)
  • Increased head circumference
  • High pitch cry
  • Poor feeding (due to high ICP)
21
Q

How do we manage hydrocephalus?

A
  • Antibiotics
  • If hydrocephalus due to meningitis, then fluid restrictions!
  • Furosemide to decrease production of CSF
22
Q

Birth defect in which one or more of the joints between bones of baby skull close prematurely, before baby brain is fully developed

A

Craniosynostosis

23
Q

What is the most common premature closing in craniosynostosis?

A

Sagittal suture

24
Q

How does craniosynostosis baby look?

A

“Cone head” appearance

25
Q

What is surgery for craniosynostosis?

A

Excision of long bars of bones (strip craniotomy) along or parallel to fused suture

26
Q

When is advised time for surgery for craniosynostosis?

A

Prior to 6 months of age for best results

27
Q

What is main treatment for hydrocephalus?

A

VP shunt

28
Q

____ are the best and most effective treatment for hydrocephalus

A

Shunt

29
Q

What is a shunt?

A

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)

30
Q

Where is ventricular catheter shunt inserted and what does it drain?

A

Inserted into ventricles

Drains fluid from brain ventricles into atria

31
Q

What is the peritoneal catheter?

A

Passes the CSF into the abdomen (peritoneal cavity)

32
Q

Which is the preferred shunt: ventricular or peritoneal and why?

A

Peritoneal—longer tubing allows for growth

33
Q

Where is atrial catheter placed?

A

R. atrium of heart

34
Q

Shunt: What does the valve do?

A

Regulates pressure of CSF flow and prevents backward flow of SF toward ventricles

35
Q

Shunt: What does reservoir do?

A

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

36
Q

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

A

Flushed

37
Q

What should patients and families know about the shunt?

A

The name of model of shunt pt has

Know if shunt has an on/off valve

38
Q

Pre-op for shunt?

A
  1. Observe signs of ICP
  2. Care of externalized shunt if applicable
  3. Support their large head
  4. Skin care
  5. Seizure precautions
  6. Maintain adequate nutrition
39
Q

Post op for shunt?

A
  1. Positon on UNAFFECTED SIDE
  2. Bed needs to be flat (shunt works better with gravity; avoid over drainage)
  3. Check site for infection
  4. VS, neuro checks, pain control
40
Q

Parent teaching for hydrocephalus/shunt?

A

Avoid contact sports and use protective helmets

41
Q

Complications of shunt?

A
  1. Shunt malfunction
  2. Shunt obstruction
  3. Shunt infection
42
Q

How do you know there is a shunt malfunction?

A
  • Full, tense fontanel when upright
  • Prominent scalp veins
  • Swelling/redness along shunt tract
  • Fever, vomit, irritable
  • Sleepiness, downward eye deviation, seizures
43
Q

How do we know there is shunt obstruction?

A

Recurrent symptom of hydrocephalus

Increased ICP

Fluid along shunt tract

44
Q

How do we know there is shunt infection?

A

Fever and reddening/swelling along shunt tract

45
Q

T/F: Shunt revisions are needed as the child grows

A

TRUE

Pediatrics-MJ (61 decks)

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