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Maternal Nursing > Neuromuscular Dysfunction > Flashcards

Neuromuscular Dysfunction Flashcards

1
Q

What is cerebral palsy?

A

A permanent disability associated with prenatal, perinatal, and post natal causes; “Brain paralysis”

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2
Q

What are some possible causes for cerebral palsy?

A

Prenatal and birth asphyxia, kernicterus, maternal infection, ELBW, Shaken baby syndrome, severe hypoglycemia

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3
Q

What is Kernicterus?

A

High bilirubin levels

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4
Q

What is the pathophysiology of CP?

A

Anoxia (total depletion of oxygen) with vascular occlusion, atrophy, loss of neurons, and degeneration of neurons that causes severe brain damage.

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5
Q

What are the four types of CP?

A

Spastic, Dyskinetic/Athetoid/Dystonia, Ataxia, Mixed Dystonic

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6
Q

What are characteristics of Spastic cerebral palsy?

A

Increased muscle tone with increased deep tendon reflexes and clonis, fine and gross motor movements are impaired.

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7
Q

What muscles are involved in spastic cerebral palsy?

A

Flexor, adductor, and internal muscles

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8
Q

What is clonis?

A

Sudden dorsiflexion of ankle with spasms

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9
Q

What are some symptoms of spastic CP?

A

Crouched gait, toes are in, scissoring (crossed legs), heel cord contracture, sculiosis

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10
Q

What is spastic CP associated with?

A

Prematurity, preexisting abnormalities

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11
Q

What do 40% of patients with spastic CP have seizures?

A

BC of the location of it in the brain

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12
Q

What are the 3 S’s associated with spastic CP?

A

Seizures, Scissor, Sculiosis

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13
Q

What are some characteristics of Dyskinetic/Athetoid/Dystonia CP?

A

Purposeful, involuntary, uncontrollable movements of face and extremities. Movements increase with stress and puberty. Deep tendon reflexes are normal.

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14
Q

What is dyskinetic?

A

Choreoid movements of involuntary jerking

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15
Q

What is dystonia?

A

Decrease in muscle tone

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16
Q

What is athetosis?

A

Slow movements iwth increased drooling and dysarthria

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17
Q

What is dysarthria?

A

Problems with speech articulation.

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18
Q

What are characteristics of athetoid CP?

A

Slow, wormlike movements, increased drooling, dysarthria

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19
Q

What are characteristics of ataxic CP?

A

Flaccid; Wide gait, disturbed coordination, unsteady gait, slurred speech, nystagmus (dancing eyes), cant gauge distance or speed

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20
Q

What are characteristics of mixed CP (spasicity and athelosis)?

A

Individual is tight and rigid, pronounced reflexes, combined symptoms.

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21
Q

How is CP diagnosed?

A

Prenatal history, assessment- walking, crawling, assess reflexes, MRI for brain lesions, EEG for seizures, genetic evaluation at 16 weeks

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22
Q

What is hypotonia?

A

“Floppy” baby- when lifted they cant support t hemselv. With Dyskenetic.

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23
Q

What are goals of treatment?

A

To establish locomotion and communicatio, gain optimal appearance, correct defects, educational opportunities, provide socialization

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24
Q

What does evidence show about magnesium sulfate treatment?

A

When given to pregnant women with eclampsia 2 hours before delivery, it decreases the risk of cerebral palsy to newborns at risk.

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25
Q

What are some musculoskeletal treatments and interventions?

A

AFO- ankle food orthosis, wheelchairs, orthopedic devices, surgical interventions

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26
Q

What are some surgical interventions for CP patients?

A

Tendon lengthening, heel cord lengthening, muscle releases, hip and adductor muscle correctment, Dorsal rhizotomy

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27
Q

What is Dorsal Rhizotomy surgery?

A

Releasing some nerves to decrease spascity and improve balance and walking

28
Q

What do medications try to treat with CP?

A

Muscle spasms and seizures

29
Q

What are some medications for muscle spasms?

A

Dantrolene, Baclofen, Diazepam, Botulinum

30
Q

What is botulinum?

A

Botox injections into muscles to decrease spascity- causes muscle to relax

31
Q

Which routes can baclofen be given?

A

Orally or intrathecal (through the spine)

32
Q

What are some side effects of Baclofen intrathecal injections?

A

hypotonia, somnolence, seizures, n/v, headaches, cath pump problems

33
Q

What are some anti-epileptic drugs?

A

Tegretol, Depakote, Dilantin (has bleeding risks)

34
Q

What are some physical therapy and occupational therapies?

A

Programmed exercises, usually outpatient, conditioning and patterning muscles, also speech therapy.

35
Q

What is the prognosis of CP individuals?

A

Normal intelligence but 30-50% can be mentally retarded, decreased growth, 50% live individually.

36
Q

What are some nursing care goals related to CP patients?

A

Aquire mobility, communication skills, self help activities, appropriate education, positive self image, appropriate hospitilization.

37
Q

What is myelomeningocele?

A

Spina Bifida- an abnormality that is derived from the embronic neural tube when it does not close. Can be extensive or minimal.

38
Q

What is the pathophysiology of spina bifida?

A

Neural tube defect with failure of the neural tube to close during the first 3-5 weeks of embryonic life. The degree of neurologic dysfuntion depends on where the sac protrudes through the vertebral column.

39
Q

Where is the most common place for spina bifida to occur?

A

Lumbar or Lumbosacral

40
Q

What is a complication of spina bifida?

A

Hydrocephalus- 80-90% of pts have it.

41
Q

What are possible causes of spina bifida?

A

Drugs- dilantin (depletes folic acid), radiation exposure, chemo, maternal malnutrition, lack of folic acid in diet, alcohol, tobacco, genetic mutation, maternal obesity, previous NTD

42
Q

What are some significant neural tube defects?

A

cranioschisis, exancephaly, anencephaly, spina bifida oculta or cystica

43
Q

What is cranioschisis?

A

Incomplete closure of the cranium

44
Q

What is anencephaly?

A

Only a small portion of the brain is developed, usually respiratory function.

45
Q

What is exancephaly?

A

When the brain is exposed.

46
Q

What are the two types of spina bifida?

A

Oculta- less severe

Cystica- more severe

47
Q

What is a meningocele?

A

Fluid in a sac protruding from the spine, type of spina bifida.

48
Q

What is a myelomeningocele?

A

Nerve roots in the sac that protrudes from the spine.

49
Q

What are clinical manifestations of spina bifida cystica?

A

Sensory disturbance with parallel motor dysfunction- usually affects senses, bowel control

50
Q

What is effected below the 2nd lumbar vertabrae?

A

Flaccid paralysis, sensory deficits, lack of bowel control, and rectal prolapse

51
Q

What is affected below the 3rd sacral vertebra?

A

Usually no motor impairment besides weakeness, saddle anesthesia (numbness across hips)

52
Q

What are some common joint deformities associated with spina bifida cystica?

A

Clubbed feet, outward feet, kyphosis, scoliosis, hip dislocation

53
Q

What are some clinical manifestations of spina bifida occult?

A

Little/no symptoms. Dark tufts of hair, skin depression, progressive gait disturbance, bowel and bladder sphincter disturbances.

54
Q

How are NTD diagnosed?

A

Assessment of symptoms, MRI, CT scan, ultrasound, myelography, prenatal detection, high alphafetoprotein levels in amniotic fluid.

55
Q

How are infants with NTD treated?

A

Prevent infection, assess neuro status, keep moist with sterile saline and gauze, keep prone, shunt procedure

56
Q

How does orthopedic care help with NTD?

A

Prevent joint contractures with ROM, corect deformaties, minimize motor and sensory defects, prevent skin breakdown, use of orthodonics like braces, walking devices, wheelchairs, also may have surgery.

57
Q

How is neurogenic bladder dysfunction treated?

A

Cath schedule, medications to improve bladder storage, surgery to create a drainage system and reduce pressure.

58
Q

What are some bowel control programs?

A

Maintain diet to promote normal bowel evacuation, use laxatives, fluids, MACE- irrigate the colon every few days.

59
Q

What are some care guidelines for the myleomeningocele sac?

A

Positioning, prevent infection, prevent drying

60
Q

What is innovated therapeutic management?

A

Early surgical closure of the myelomingocele sac through fetal surgery on the mother while in utero- good outcome, danger of misscarraige

61
Q

What are some preventive measures for NTD?

A

Increase folic acid

62
Q

What are some latex precautions?

A

Children with spina bifida are at greater risk for latex allergies- avoid latex products and foods associated with it- bananas, kiwi, peaches, avocado, chestnut, test for allergies with RAST

63
Q

What is a latex allergy?

A

An allergic response to rubber products- patient may be sensitive or allergic

64
Q

What is an irritation reaction to latex?

A

Sensitivity- redness, crusting, peeling, sores from contact with latex. Remove irritant.

65
Q

What is a type 1 latex reaction?

A

An anaphylaxis shock reaction- hives, pink raised areas, itching, wheezing, difficulty breathing, high pulse, nausea, increased BP= EMERGENCY!

66
Q

What is a type 4 latex reaction?

A

Itching with skin breakdown, redness, swelling, vasicles, allergic reaction- positive RAST test. treat skin eruptions.

Maternal Nursing (22 decks)

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