Week 4 - Neurological, Musculoskeletal

Question 1

Birth defect where the neural tube fails to close as a fetus

Answer 1

Spina Bifida

Question 2

S/sx of spinal bifida

Answer 2

Dimpling near buttocks, neural tube abnormalities, hydrocephalus

Question 3

Priority intervention for spinal bifida

Answer 3

Infection control

Question 4

S/sx of hydrocephalus (7)

Answer 4

• Bulging fontanels
• Bulging eyes
• Sunsetting eyes
• Headache
• Increased head circumference
• Vomiting - esp early morning
• Ataxia at later stages

Question 5

What is considered an emergency with hydrocephalus?

Answer 5

Fever or headache

Question 6

Surgical prep for hydrocephalus

Answer 6

Prep for life long VP shunt that connects the brain to the abdominal cavity to have the CSF reabsorbed there

Question 7

What should you monitor for in a hydrocephalus patient?

Answer 7

Head circumference and seizure activity

Question 8

Cerebral palsy - definition, patho

Answer 8

Definition: Non-progressive and permanent disability that affects movement and speech

Patho: Result of a hypoxic event

Question 9

Cerebral palsy s/sx: Spastic

Answer 9

aka stiff

• hyper-reflexia, hypertonia
• muscle spasticity
• toe walking
• scissoring
• continues to have neonatal reflexes

Question 10

Cerebral palsy s/sx: Dyskinetic

Answer 10

aka involuntary

• writhing movement
• trouble speaking

Question 11

Cerebral palsy s/sx: Ataxic

Answer 11

aka shaky

- uncoordinated

Question 12

Head injury interventions

Answer 12

• Grade on concussion scale
• CT or MRI
• Concussion teaching: full cognitive rest
• Educate about head safety

Question 13

Seizure priority intervention

Answer 13

SAFETY

• remain with patient
• bed rails up
• take everything away from patient
• call for help

Question 14

Seizure intervention for non-febrile

Answer 14

Blood draws, IV

Question 15

Seizure intervention for febrile

Answer 15

Antipyretics, fluids

Question 16

Reye’s syndrome definition

Answer 16

Confusion, swelling in the brain, and injury to the liver

Question 17

Reye’s Syndrome s/sx

Answer 17

• Confusion
• Hypoglycemia
• Increased AMMONIA levels
• Vomiting
• May suffer permanent brain damage

Question 18

Reye’s Stage 1 (3)

Answer 18

Sleeping, vomiting, tachypnea

Question 19

Reye’s Stage 2 (3)

Answer 19

Combative, positive Babinski, no response to pain

Question 20

Reye’s Stage (3-5)

Answer 20

Decorticate to decerebrate posturing - potentially seizures and death

Question 21

What kind of precautions for Meningitis?

Answer 21

Droplet!

Question 22

Priority intervention for Meningitis if you don’t know the cause

Answer 22

ANTIBIOTICS

Question 23

Priority intervention for VIRAL meningitis

Answer 23

Monitor for seizures (safety first!)

Question 24

Are meningitis patients hyper or hypo thermic?

Answer 24

Either!

Question 25

Brain tumor s/sx

Answer 25

- Vomiting - Headache - Seizures - Increased head circumference - Abnormal speech and eye movements

Question 26

Twisting of a joint, damage to ligaments

Answer 26

Sprain

Question 27

Tearing or pulling of muscle (maybe tendons)

Answer 27

Strain

Question 28

Bruises to the muscle

Answer 28

Contusions

Question 29

S/sx of soft tissue injury

Answer 29

5 P's - pain - pallor - pulses - parethesia - paralysis

Question 30

You would see edema, pain, heat, redness with strain or sprain?

Answer 30

Sprain

Question 31

Developmental Dysplasia of Hip (DDH)

Answer 31

Head of the femur slips out (subluxation)

Question 32

Patho of club foot and DDH

Answer 32

Fetal positioning

Question 33

DDH s/sx

Answer 33

- asymmetry of thigh folds | - asymmetry of femur length

Question 34

DDH tests

Answer 34

Barlow: Push knees in and back to make the hips go out Ortolani: Take knees out to click hips back in

Question 35

DDH treatment (2)

Answer 35

- Pavlik harness if less than 6 months old; keeps legs abducted - Spica casting if harness fails or older than 6 months

Question 36

Legg-Calve Perthes (LCP)

Answer 36

Necrosis of the femur

Question 37

LCP s/sx

Answer 37

Pain, limp

Question 38

LCP intervention

Answer 38

Early diagnosis

Question 39

LCP treatment

Answer 39

NSAIDS, non-weight bearing

Question 40

Slipped Capital Femoral Epiphysis (SCFE)

Answer 40

Head of the femur separated from the rest of the femur at the growth plate

Question 41

SCFE patho

Answer 41

Overweight, teenagers, growth spurts

Question 42

- Hip tenderness - Painful ROM - Decreased hip flexion - Limping - Pain increases with internal rotation

Answer 42

SCFE

Question 43

SCFE treatment

Answer 43

Immediate surgery and immobilization

Question 44

Position of comfort for SCFE

Answer 44

external rotation

Question 45

Scoliosis patho (2)

Answer 45

- Girls more often than boys | - During pubertal growth

Question 46

Duchenne Muscular Dystrophy

Answer 46

Progressive loss of function due to muscular loss

Question 47

Duchenne patho

Answer 47

- Hereditary - x linked, boys more than girls - cognitive function remains - starts around 3 years old

Question 48

Duchenne s/sx

Answer 48

- Loss of function that had been previously attained - Initially small functions are lost, then gross motor - Gower's sign - Wheel chair by teenage years

Question 49

Duchenne interventions: assessment (2)

Answer 49

- monitoring using screening tools | - DNA tests

Question 50

Duchenne cure/treatment

Answer 50

NO cure | - preserve ambulation and vital organ function, independence for as long as possible

Question 51

- Fever - Crying a lot - Redness - Warmth - Swelling - Pain - Limping

Answer 51

Osteomyelitis

Question 52

Osteomyelitis interventions (4)

Answer 52

- Draw WBC, ESR, CRP to monitor progression - Antibiotics - Prep for surgery prn - Prep for xray, MRI, CT scan, bone scan