Week 4 - Neurological, Musculoskeletal Flashcards
Birth defect where the neural tube fails to close as a fetus
Spina Bifida
S/sx of spinal bifida
Dimpling near buttocks, neural tube abnormalities, hydrocephalus
Priority intervention for spinal bifida
Infection control
S/sx of hydrocephalus (7)
- Bulging fontanels
- Bulging eyes
- Sunsetting eyes
- Headache
- Increased head circumference
- Vomiting - esp early morning
- Ataxia at later stages
What is considered an emergency with hydrocephalus?
Fever or headache
Surgical prep for hydrocephalus
Prep for life long VP shunt that connects the brain to the abdominal cavity to have the CSF reabsorbed there
What should you monitor for in a hydrocephalus patient?
Head circumference and seizure activity
Cerebral palsy - definition, patho
Definition: Non-progressive and permanent disability that affects movement and speech
Patho: Result of a hypoxic event
Cerebral palsy s/sx: Spastic
aka stiff
- hyper-reflexia, hypertonia
- muscle spasticity
- toe walking
- scissoring
- continues to have neonatal reflexes
Cerebral palsy s/sx: Dyskinetic
aka involuntary
- writhing movement
- trouble speaking
Cerebral palsy s/sx: Ataxic
aka shaky
- uncoordinated
Head injury interventions
- Grade on concussion scale
- CT or MRI
- Concussion teaching: full cognitive rest
- Educate about head safety
Seizure priority intervention
SAFETY
- remain with patient
- bed rails up
- take everything away from patient
- call for help
Seizure intervention for non-febrile
Blood draws, IV
Seizure intervention for febrile
Antipyretics, fluids
Reye’s syndrome definition
Confusion, swelling in the brain, and injury to the liver
Reye’s Syndrome s/sx
- Confusion
- Hypoglycemia
- Increased AMMONIA levels
- Vomiting
- May suffer permanent brain damage
Reye’s Stage 1 (3)
Sleeping, vomiting, tachypnea
Reye’s Stage 2 (3)
Combative, positive Babinski, no response to pain
Reye’s Stage (3-5)
Decorticate to decerebrate posturing - potentially seizures and death
What kind of precautions for Meningitis?
Droplet!
Priority intervention for Meningitis if you don’t know the cause
ANTIBIOTICS
Priority intervention for VIRAL meningitis
Monitor for seizures (safety first!)
Are meningitis patients hyper or hypo thermic?
Either!
Brain tumor s/sx
- Vomiting
- Headache
- Seizures
- Increased head circumference
- Abnormal speech and eye movements
Twisting of a joint, damage to ligaments
Sprain
Tearing or pulling of muscle (maybe tendons)
Strain
Bruises to the muscle
Contusions
S/sx of soft tissue injury
5 P’s
- pain
- pallor
- pulses
- parethesia
- paralysis
You would see edema, pain, heat, redness with strain or sprain?
Sprain
Developmental Dysplasia of Hip (DDH)
Head of the femur slips out (subluxation)
Patho of club foot and DDH
Fetal positioning
DDH s/sx
- asymmetry of thigh folds
- asymmetry of femur length
DDH tests
Barlow: Push knees in and back to make the hips go out
Ortolani: Take knees out to click hips back in
DDH treatment (2)
- Pavlik harness if less than 6 months old; keeps legs abducted
- Spica casting if harness fails or older than 6 months
Legg-Calve Perthes (LCP)
Necrosis of the femur
LCP s/sx
Pain, limp
LCP intervention
Early diagnosis
LCP treatment
NSAIDS, non-weight bearing
Slipped Capital Femoral Epiphysis (SCFE)
Head of the femur separated from the rest of the femur at the growth plate
SCFE patho
Overweight, teenagers, growth spurts
- Hip tenderness
- Painful ROM
- Decreased hip flexion
- Limping
- Pain increases with internal rotation
SCFE
SCFE treatment
Immediate surgery and immobilization
Position of comfort for SCFE
external rotation
Scoliosis patho (2)
- Girls more often than boys
- During pubertal growth
Duchenne Muscular Dystrophy
Progressive loss of function due to muscular loss
Duchenne patho
- Hereditary
- x linked, boys more than girls
- cognitive function remains
- starts around 3 years old
Duchenne s/sx
- Loss of function that had been previously attained
- Initially small functions are lost, then gross motor
- Gower’s sign
- Wheel chair by teenage years
Duchenne interventions: assessment (2)
- monitoring using screening tools
- DNA tests
Duchenne cure/treatment
NO cure
- preserve ambulation and vital organ function, independence for as long as possible
- Fever
- Crying a lot
- Redness
- Warmth
- Swelling
- Pain
- Limping
Osteomyelitis
Osteomyelitis interventions (4)
- Draw WBC, ESR, CRP to monitor progression
- Antibiotics
- Prep for surgery prn
- Prep for xray, MRI, CT scan, bone scan
