Module 12: Child with Physiologic Alterations on Cognitive-Perception (Part 02) Flashcards
(238 cards)
1
Q
What are the different types of nursing diagnosis for neurologic alterations?
A
(A) Knowledge deficit related to understanding of the complex condition
(B) Risk for self care deficit
(C) Risk for delayed growth and development related to activity restrictions
(D) Risk for imbalanced nutrition: less than body requirements
(E) Impaired verbal communication
2
Q
This is a neural tube defect caused by incomplete closure of the embryonic neural tube, leading to a malformed (incompletely formed) spinal cord and vertebrae.
A
Spina Bifida
3
Q
What anatomical defect occurs in Spina Bifida?
A
The vertebrae overlying the spinal cord do not fully form and remain unfused and open.
4
Q
This is known as the outside later. This surrounds other layers later in development.
A
ECTODERM
5
Q
What are the three (3) germ layers formed at gestation?
A
(A) Ectoderm
(B) Mesoderm
(C) Endoderm
6
Q
What does the ectoderm develop into?
A
Skin and nervous tissue.
7
Q
This germ layer is characterized to be the middle layer.
A
MESODERM
8
Q
What does the mesoderm develop into?
A
Muscles, blood, connective tissues, and the placenta
9
Q
What does the endoderm develop into?
A
Epithelial linings and associated glands of the gut, lungs, and urogenital tracts.
10
Q
What is the role of the primitive node in neural induction?
A
It patterns the mesoderm and initiates neural plate development.
11
Q
What does ectoderm exposed to BMP-4 become?
A
Skin, tooth structures, and components of limb development.
12
Q
What allows ectoderm to become neural tissue?
A
BMP-4 antagonists (Noggin, Chordin, Follistatin) secreted by the node.
13
Q
Where does folding and closure of the neural tube begin?
A
In the cervical region of the embryo.
14
Q
Enumerate the process of neurulation.
A
Folding of the neural plate
(A) Median hinge point forms (probably due to signaling from notochord) — columnar cells adopt triangular morphology (apical actin constriction, like a purse string)
(B) Lateral hinge point forms by a similar mechanism
(probably due to signaling from nearby mesoderm).
(C) As neural folds close, neural crest delaminates and migrates away.
(D) Closure happens first in middle of the tube and then zips rostrally and caudally.
15
Q
How does the neural tube close after folding begins?
A
It “zips” up toward both the head (cranial) and the tail (caudal), forming anterior and posterior neuropores.
16
Q
When does the anterior neuropore close during pregnancy?
A
Around day 25 of gestation.
17
Q
When does the posterior neuropore close during pregnancy?
A
Around day 28 of gestation.
18
Q
What results from failure of the anterior neuropore to close
A
Anencephaly – a fatal condition where major parts of the brain and skull do not form.
19
Q
What results from failure of the posterior neuropore to close?
A
Spina Bifida – incomplete formation of the spinal cord and vertebrae.
20
Q
What are the four (4) neural tube closure defects?
A
(A) Rachischisis
(B) Spina bifida occulta
(C) Meningocele
(D) Myelomeningocele
21
Q
This condition is characterized as the incomplete closure of the spinal cord and the spinal column.
A
Spina Bifida
22
Q
Approximately, how many children are born with a serious genetic birth defect annually (March of Dimes, 2008)?
A
7.8 Million
23
Q
How many of these children die due to their birth defect within the first five years of life?
A
3.3 Million (Majority of affected children who survive are disabled for life).
24
Q
What are the common causes of birth defects?
A
(A) Teratogens (alcohol, certain drugs, etc.)
(B) Maternal Iodine Deficiency Syndrome
(C) Congenital syphilis and rubella syndrome
(D) Folic acid deficiency
24
What are teratogens and give examples?
Substances that cause birth defects; examples include alcohol, drugs, and smoking—they can cross the placenta.
25
What maternal endocrine deficiency may lead to birth defects?
Maternal iodine deficiency → affects T3 and T4 production needed for growth and development.
26
What nutritional deficiency is strongly linked to neural tube defects?
Folic Acid Deficiency.
27
What maternal condition and drug increase risk for birth defects?
Diabetes mellitus and anti-epileptic drug (e.g., Valproate).
28
What is the basic pathophysiology of Spina Bifida?
Failure of the neural tube to close during embryonic development.
28
What are the causes of neural tube defects?
(A) Multifactorial (combination of genetic and environmental causes)
(B) Genetic causes are unknown
(C) Diabetes Mellitus
(D) Anti-epileptic drug (Valproate)
29
What determines the degree of neurological dysfunction in Spina Bifida?
The level of the defect and nerves involved (lumbar, sacral, cervical).
30
Name some clinical manifestations of Spina Bifida.
Paralysis, lack of sensation, poor bowel/bladder control, scoliosis, hydrocephalus, cognitive problems.
31
This type of spina bifida has no opening of the back, but the outer part of some of the vertebrae are not completely closed.
Spina Bifida Occulta
32
Describe the appearance of spina bifida occulta.
The skin at the site of the lesion may be normal, or it may show hair tuft, dimple, or birthmark.
33
This is a rare form of spina bifida where meninges covering the spinal cord herniate through the unformed vertebrae.
Meningocele
34
Describe the appearance of meningocele.
The protrusion or sac may be covered by skin or clear dura.
35
A severe form of Spina Bifida where the unfused portion of the spinal column allows the spinal cord to protrude through an opening of the overlying vertebrae.
Myelomeningocele (spina bifida cystica)
(Meningeal membranes that cover the spinal cord may or may not form a sac enclosing the spinal elements).
36
Where does Myelomeningocele most commonly occur?
In the lumbar region, though it can occur anywhere along the spinal axis.
37
What might be found in a Myelomeningocele sac?
CSF, remnants of nervous tissue, nerve roots, meninges, and malformed vertebral elements.
38
This is a cranial meningocele or myelomeningocele where brain tissue and/or meninges herniate through a skull defect, often in the occipital area.
Encephalocele
39
What are common manifestations of Myelomeningocele?
Lower limb paralysis, sensory loss, bladder and bowel dysfunction, cognitive dysfunction (varies by lesion location).
40
When does teratogen exposure most critically affect neural tube closure?
Between the 17th and 30th day of gestation.
41
What is the result of failed closure of the caudal neural tube?
An open spinal lesion or sac containing dysplastic spinal cord, nerve roots, meninges, vertebral bodies, and skin.
42
What maternal factors contribute to Myelomeningocele?
Poor nutrition and folic acid deficiency during early pregnancy.
43
How does the location of the Myelomeningocele sac affect symptoms?
Higher lesions = more severe neurologic, sensory, and motor impairments; lower lesions = milder symptoms.
43
What are common signs of Spina Bifida Cystica in infants?
Lethargy, poor feeding, irritability, stridor, ocular motor incoordination, and developmental delay.
44
What is the musculoskeletal impact of thoracic-level Spina Bifida?
Upper limb and neck movement are intact; no lower limb movement; often with CNS involvement and cognitive deficits.
44
What are signs of Spina Bifida Cystica in older children?
Cognitive or behavioral changes, decreased strength, increased spasticity, changes in bowel/bladder function, lower cranial nerve dysfunction, back pain, and worsening spinal or lower extremity deformities.
45
What deficits are seen in high lumbar-level Spina Bifida?
Variable hip flexor/adductor strength; absence of hip extension, abduction, and all knee/ankle movement.
45
What are the motor strengths in low lumbar-level Spina Bifida?
Present hip flexor, adductor, medial hamstring, and quadriceps strength; variable lateral hamstring, hip abductor, and ankle dorsiflexor strength; absent plantar flexor strength.
46
What motor function is preserved in sacral-level Spina Bifida?
Full strength in hip and knee groups; variable strength in ankle plantar flexors.
47
Why is preventive management important in reducing neural tube defects in the Philippines?
Because awareness of folic acid supplementation among Filipino women of reproductive age is low, necessitating intensive campaigns.
48
How much can adequate folic acid intake before conception reduce the risk of neural tube defects?
By up to 70%.
49
This is essential for forming new cells, making red blood cells, and producing DNA (building block of human body which carries genetic information).
Folic Acid (Vitamin B9)
(Works along with other vitamins to help the body break down, use, and create new proteins)
50
Why does the body need a continuous supply of folic acid?
Because it cannot be stored in the body and must be replenished through diet or supplementation.
51
Who especially needs folic acid and why?
Women of reproductive age and pregnant women; it helps prevent neural tube defects in early pregnancy.
52
When is the most critical time to take folic acid to prevent neural tube defects?
At least one month before conception and during the first three months of pregnancy.
53
What happens if a woman does not get enough folic acid during early pregnancy?
The baby's brain and/or spine may not develop properly, increasing the risk of neural tube defects.
54
When does the neural tube form, and why is this timing critical for folic acid intake?
It forms within the first 28 days of pregnancy—before most women know they're pregnant—making early folic acid intake crucial.
55
How much folic acid should all women of reproductive age take daily?
400 micrograms (mcg) or 0.4 mg.
56
How much folic acid should women take daily if they’ve had a child with a neural tube defect?
4000 micrograms (mcg) or 4 mg.
57
What are the main sources of folic acid?
(A) Pure folic acid supplements (most effective for NTD prevention)
(B) Fortified foods: bread, pasta, cereals, powdered juice
(C) Natural food folate: green leafy vegetables, fruits, poultry, meat, fish
58
Why is natural food folate less reliable than supplements?
You need to consume twice as much, and cooking can destroy some of the folate content.
59
What should you check when choosing a folic acid supplement?
Ensure the label indicates 400 mcg or 100% daily value of folic acid.
60
Is there a cure for the nerve damage in Spina Bifida?
No, nerve damage is permanent and cannot be reversed.
61
What prenatal surgical option exists for Spina Bifida?
Open fetal surgery may be done during pregnancy if the defect is detected early.
61
What is the main surgical treatment for Spina Bifida?
Surgical closure of the opening on the back.
62
What prenatal tests can detect Spina Bifida between 15–20 weeks?
Ultrasound and alpha-fetoprotein (AFP) screening.
63
What postnatal tests help confirm Spina Bifida?
Newborn assessment, spinal X-ray, and skull X-ray.
64
What is the best position for a newborn with Spina Bifida preoperatively?
Prone position.
65
What should be done if the newborn is placed in a side-lying position?
Place a towel or pillow between the legs to reduce pressure on the sac.
66
How is the lesion protected before surgery?
Cover with sterile saline-soaked gauze, antiseptic or antibiotic dressing.
66
What is placed under the lesion to prevent contamination?
A piece of plastic (like an apron) taped securely below the meningocele.
67
What other pre-op care must be ensured for the infant?
(A) Keep the infant warm
(B) Assess for clear fluid leakage
(C) Maintain leg abduction and hip alignment
(D) Provide meticulous skin care
(E) Prevent fecal or urine contamination of the lesion
68
What is the recommended position of the infant after surgery until the incision heals?
Supine position.
69
Once the incision heals, how should the newborn be positioned?
Prone position with legs in abduction.
70
What are key postoperative assessments for Spina Bifida?
Monitor for signs of increased intracranial pressure (ICP) and protect the surgical site.
71
What factors contribute to improved outcomes in Spina Bifida care?
Speed, efficiency, and comprehensiveness of treatment from birth, plus a coordinated care approach.
72
What is the goal of physical therapy in Spina Bifida?
To parallel the normal achievement of gross motor milestones.
73
What is the purpose of occupational therapy?
To help compensate for motor skill deficits and support normal developmental progress.
74
What does recreational therapy aim to promote?
Independence through enhanced play and recreational opportunities.
75
What are common nursing diagnoses in infants with Spina Bifida?
(A) Risk for infection
(B) Risk for impaired cerebral tissue perfusion
(C) Risk for impaired skin integrity
(D) Impaired physical mobility
76
A condition where a baby is born with a small head or the head stops growing after birth.
Microcephaly
77
How common is microcephaly?
It is rare—occurs in approximately 1 in several thousand births.
78
What is the most reliable way to assess for microcephaly?
Measure head circumference 24 hours after birth and compare it with WHO growth standards, then monitor the growth rate in early infancy.
79
What are possible developmental issues for babies with microcephaly?
Convulsions, physical disabilities, and learning disabilities.
80
Can microcephaly be detected prenatally?
Sometimes, through ultrasound scans during the third trimester.
81
Is there a specific treatment for microcephaly?
No, there is no specific treatment.
82
How is microcephaly defined in simple terms?
It means the baby has a smaller-than-normal head size compared to standard sizes for gestational age.
83
How is microcephaly assessed?
By comparing head circumference to normal values for the baby’s gestational age.
84
What are common causes or risk factors of microcephaly?
(A) Viral infections (e.g., Zika virus)
(B) Chromosomal abnormalities
(C) Decreased oxygen supply to the fetal brain
(D) Infections during pregnancy
(E) Exposure to drugs, alcohol, or toxic chemicals
(F) Severe maternal malnutrition
85
How is microcephaly diagnosed during pregnancy?
Through ultrasound (UTZ), though a single UTZ may not always detect it; repeated scans are often needed.
86
Can microcephaly be diagnosed after birth even if delivery was normal?
Yes, some babies are born with normal head size, but their brain growth slows down later, resulting in postnatal microcephaly.
87
What are the genetic causes of microcephaly?
Autosomal recessive, autosomal dominant, and chromosomal abnormalities.
88
What infections during pregnancy may lead to microcephaly?
Toxoplasmosis and other prenatal infections (e.g., Zika, rubella, CMV).
89
What environmental and maternal factors contribute to microcephaly?
(A) Exposure to heavy metals
(B) Severe maternal malnutrition
(C) Pre- and perinatal brain injuries
(D) Traumatic brain injury
(E) Cerebral anoxia
(F) Craniosynostosis (premature fusion of skull bones)
90
What are the diagnostic tests used for detecting microcephaly?
(A) Ultrasound (prenatal)
(B) X-ray
(C) CT scan
(D) MRI
(E) Blood and urine tests (to detect infections or genetic issues)
91
How can Zika virus affect pregnancy?
Zika virus can be passed from a pregnant woman to her fetus and may cause microcephaly and other severe brain defects.
92
How is Zika virus primarily transmitted?
(A) Through the bite of an infected mosquito (Aedes species).
(B) Yes, Zika can be spread through unprotected sex with an infected person, even if that person has no symptoms.
93
Is there a cure or vaccine for Zika virus?
No, there is no vaccine or specific medicine to prevent or treat Zika.
94
What are the different signs and symptoms of microcephaly?
(A) Smaller than normal head circumference that usually remains smaller than normal as the child grows.
(B) Failure to thrive (slow weight gain and growth)
(C) High-pitched crying
(D) Little appetite or problems with feeding
(E) Muscle spasms
(F) Facial distortions
(G) Dwarfism or short stature
(H) Delayed motor and speech functions
(I) Mental retardation and seizures; convulsions
(J) Hyperactivity; balance and coordination problems
(K) Other brain related or neurological problems such as vision and speech problems
(L) Motor ability varies, ranging from clumsiness some to spastic quadriplegia in others
(M) Some with the disorder may develop normal intelligence
95
What is an important independent nursing intervention for microcephaly?
Monitor head circumference regularly.
96
What determines the therapeutic management of microcephaly?
It depends on the affected part of the brain.
97
What type of healthcare approach is used for managing microcephaly?
A multidisciplinary team approach (e.g., neurologist, pediatrician, physical therapist, speech therapist).
98
This is a clear and colorless fluid that circulates the surface of the brain and the spinal cord. This is important for the immune and metabolic functions of the brain.
Cerebrospinal fluid
99
What produces the cerebrospinal fluid?
Choroid Plexus of the Brain Ventricles
100
How does the osmotic pressure of CSF compare to plasma?
CSF has equal osmotic pressure to that of plasma.
101
What is the sodium ([Na+]) concentration in CSF compared to plasma?
Nearly equal to plasma.
102
What is the chloride ([Cl–]) concentration in CSF compared to plasma?
Approximately 15% greater than plasma.
103
How does the potassium ([K+]) concentration in CSF compare to plasma?
About 40% less than plasma.
104
How does calcium (Ca²⁺) concentration in CSF compare to plasma?
It is also lower than plasma.
105
What is the glucose concentration in CSF?
Approximately 64 mg% (which is 30% less than plasma).
106
What is the protein concentration in CSF compared to plasma?
20–25 mg% in CSF vs. ~6000 mg% in plasma.
107
What is the normal cell count in CSF?
Very few lymphocytes (1–5 cells/mm³).
108
What is the specific gravity of CSF?
1.005
109
What is the protective function of CSF?
It acts as a cushion to protect the brain from trauma.
110
How does CSF contribute to brain buoyancy?
It reduces the net weight of the brain to about 25 grams, preventing pressure on the brain base.
111
How does CSF help maintain chemical stability?
It provides a stable chemical environment for optimal brain function.
112
Where are the left and right lateral ventricles located?
Within the cerebrum.
112
What are the extensions of the lateral ventricles called?
Horns that project into the frontal, occipital, and temporal lobes.
113
What is the third ventricle?
A narrow, midline cavity between the two halves of the thalamus.
114
What connects the lateral ventricles to the third ventricle?
The interventricular foramina (foramina of Monro).
115
What connects the third ventricle to the fourth ventricle?
The cerebral aqueduct (aqueduct of Sylvius).
116
Where is the fourth ventricle located?
Between the brainstem (pons and medulla) and the cerebellum.
117
What happens to CSF after the fourth ventricle?
It flows into the subarachnoid space via the foramina of Luschka (lateral) and Magendie (median).
118
From the 4th ventricle, where does cerebrospinal fluid (CSF) drain?
(A) Central Spinal Canal: Bathes and protects the spinal cord
(B) Subarachnoid cisterns: Spaces between the arachnoid matter and pia matter where CSF accumulates and bathes the brain.
119
What happens to CSF in the subarachnoid cisterns
It is reabsorbed back into the bloodstream by the arachnoid villi or granulations, primarily into the superior sagittal sinus.
120
What is the role of arachnoid villi in CSF circulation?
They act as one-way valves allowing CSF to flow into the venous sinuses but preventing backflow of blood.
121
What drives CSF into the venous sinuses through the arachnoid villi?
A pressure gradient — CSF flows when its pressure is 1.5 mm Hg higher than venous pressure.
122
What maintains the regulation of CSF pressure?
A balance between CSF formation and reabsorption.
122
How is CSF formation characterized in terms of rate?
It occurs at an almost constant rate.
123
What may block CSF reabsorption?
Abnormally high levels of cells or proteins in the CSF.
124
What are common causes of increased CSF pressure?
Blockage of arachnoid villi by large particulate matter, fibrosis, or excess blood cells in the CSF.
125
What happens when the arachnoid villi are diseased or impaired?
There is reduced CSF reabsorption, leading to increased CSF pressure.
126
What factors affect the efficiency of CSF reabsorption through villi?
The number and quality of the arachnoid villi.
127
A space between blood vessels and the pia mater that allows CSF to flow alongside vessels into the subarachnoid space.
Perivascular Space
128
How does CSF interact with the lymphatic system?
Through perivascular drainage, CSF may flow into the lymphatic-like system of the brain, supporting waste clearance.
129
Describe the lymphatic function of the brain's perivascular spaces.
Proteins leaking from brain capillaries move into interstitial spaces, then into perivascular spaces, and finally into subarachnoid spaces for absorption via arachnoid villi into large cerebral veins.
129
How are dead white blood cells and infectious debris removed from the brain?
They are carried through perivascular spaces and drained into subarachnoid spaces, then removed via arachnoid villi.
130
This is a group of conditions caused by an imbalance between the production and absorption of cerebrospinal fluid (CSF).
Hydrocephalus
131
Is hydrocephalus a single disease?
No, it's a group of conditions that result from CSF imbalance.
132
What is a less common cause of hydrocephalus related to inflammation or injury?
Poor absorption of CSF due to damaged or inflamed brain tissues or injury.
132
What is the most common cause of hydrocephalus?
Obstruction — a partial blockage of CSF flow between ventricles or from the ventricles to other spaces.
133
What is the rarest cause of hydrocephalus involving excessive CSF production?
Overproduction — the choroid plexus produces CSF faster than it can be absorbed.
134
A type of hydrocephalus where CSF can still flow between ventricles, but is poorly absorbed in the subarachnoid space.
Non Obstructive (COMMUNICATING)
135
What causes non-obstructive hydrocephalus?
Impaired absorption due to:
(A) Malfunctioning subarachnoid villi
(B) Obliteration of subarachnoid cisterns
136
A type of hydrocephalus due to a block in the ventricular system, preventing CSF from exiting one or more ventricles.
Obstructive (NON COMMUNICATING)
137
Give an example of a cause of obstructive hydrocephalus.
Aqueduct of Sylvius closure — a congenital blockage between the third and fourth ventricles.
138
What are the two (2) types of hydrocephalus according to cause?
(A) Congenital
(B) Acquired
139
What are the different causes of congenital hydrocephalus?
(A) Intrauterine viral infection such as
cytomegalovirus, toxoplasmosis
(B) Brain malformations in utero (faulty genes, gene mutation, exposure to teratogens)
(C) Aqueduct stenosis
(D) Spina bifida
(E) Myelomeningocele
140
What are the different causes of acquired hydrocephalus?
(A) Intraventricular hemorrhage
(B) Tumor
(C) CNF infection
(D) Head injury
141
What condition can lead to increased production of CSF?
Choroid plexus papilloma — a tumor that causes excess CSF production.
142
What are common causes of obstructive hydrocephalus?
Blockage of interventricular foramina due to:
(A) Exudates
(B) Tumors
(C) Blood clots
143
What are congenital causes of hydrocephalus?
Stenosis or atresia of CSF pathways.
144
What are secondary causes of hydrocephalus?
Tumors, hemorrhage, or infections affecting CSF flow.
145
What causes decreased CSF absorption leading to hydrocephalus?
Outflow obstruction in the arachnoid villi or subarachnoid space.
146
What is a key physical sign of hydrocephalus in infants?
Enlargement of the skull and increased occipitofrontal circumference (OFC).
147
Why does the skull enlarge in hydrocephalic infants?
Due to accumulation of CSF in the ventricles causing ventriculomegaly and increased cranial suture space.
148
What causes compression of the cranium in hydrocephalus?
Dilation of ventricles and pressure from accumulated CSF.
149
What starts the first vicious cycle in hydrocephalus due to edema?
Arteriolar dilation → increased capillary pressure → worsened edema → compression of blood vessels → brain ischemia.
150
What starts the second vicious cycle in hydrocephalus due to edema?
Increased capillary permeability → more fluid leakage → edema → decreased cerebral oxygen delivery → further compression of blood vessels → worsened edema and ↓ cerebral blood flow.
151
What are the end results of both vicious cycles in hydrocephalus?
Cerebral edema, reduced oxygen delivery, and decreased cerebral blood flow — leading to worsening brain damage.
152
What are the different signs and symptoms of hydrocephalus in infants?
(A) Bulging fontanel
(B) Rapid increase in head occipitofrontal circumference
(C) Setting sun sign (eyes that are fixed downward)
(D) Dilated scalp veins
(E) Macewen sign (cracked-pot sound on skull percussion)
(F) Sluggish pupillary reaction
(G) Unequal response to light of pupils
(H) High-pitched cry
(I) Irritability
(J) Projectile vomiting
(K) Poor feeding
(L) Extreme fussiness
(M) Excessive sleepiness
(N) Low muscle tone and strength
(O) Seizures
152
What are the different signs and symptoms of hydrocephalus in toddlers and children?
(A) Short, high-pitched cries
(B) Loss of coordination
(C) Loss of bladder control
(D) Personality changes
(E) Changes in facial structure
(F) Crossed eyes
(G) Larger than normal head
(H) Trouble staying awake or waking up
(I) Vomiting or nausea
(J) Seizures
(K) Problems concentrating
(L) Extreme sleepiness
(M) Headaches
(N) Muscle spasms
(O) Delayed growth
(P) Trouble eating
(Q) Irritability
153
Why is ultrasonography through the anterior fontanelle used in infants?
To detect subependymal/intraventricular hemorrhage and monitor for progressive hydrocephalus.
153
What is the purpose of CT scanning in hydrocephalus?
To assess the size of ventricles and identify structural abnormalities.
154
What is the purpose of MRI scanning in hydrocephalus?
To assess for Chiari malformation or cerebellar/ periaqueductal tumors
155
What is the advantage of Diffusion Tensor Imaging (DTI) in hydrocephalus diagnosis?
It detects subtle microstructural changes in the brain (e.g., fractional anisotropy, mean diffusivity) not visible on conventional MRI.
156
What does skull radiography show in hydrocephalus?
Erosion of the sella turcica or the classic “beaten copper/silver cranium” appearance.
157
What is a secondary use of skull radiography after shunt surgery?
To confirm the correct positioning of the shunt hardware.
158
What are common surgical treatments for hydrocephalus?
Resection of neoplasm, cysts, or hematomas; VP shunt; Endoscopic Third Ventriculostomy (ETV); Ventricular endoscopy.
159
What is the purpose of a Ventriculoperitoneal (VP) shunt?
To divert CSF from the ventricles to the peritoneal cavity, relieving pressure.
160
How should the head of the bed be positioned post-VP shunt?
Elevate the head of bed to 30° to promote CSF drainage.
161
Why should infants not be turned to the shunt side postoperatively (POST VP SHUNT)?
To prevent pressure on the shunt and avoid dislodgement or malfunction.
162
What signs should the nurse monitor for post-VP shunt?
Signs of increased ICP and infection.
163
When should fluids be introduced postoperatively?
Gradually after NGT removal to prevent aspiration or GI upset.
164
Why is it important to observe for constipation after surgery (POST VP SHUNT)?
Straining can increase intracranial pressure and compromise shunt function.
165
What are the different types of nursing responsibilities POST VP SHUNT?
(A) Assess infant's neurologic status closely.
(B) Watch for increasing irritability or lethargy.
(C) Measure and record head circumference every 4 hours.
(D) Assess anterior fontanelle for tenseness and bulging.
(E) Position infant with the head of the bed elevated 15° to 30° and maintain in a neutral position.
(F) Monitor vital signs every 2 hours.
(G) Administer oxygen as ordered.
(H) Monitor intake and output.
(I) Administer diuretics as ordered.
(J) Encourage mother to breastfeed. Position infant properly with head supported. Avoid neck flexion or hyperextension.
(K) If vomiting occurs, encourage mother to attempt to refeed. If vomiting persists, anticipate need for enteral or parenteral nutrition.
(L) Explain home care and discharge instructions.
(M) Teach parents how to recognize signs of shunt malfunction.
(N) Advise that contact sports should be avoided in children.
166
What are the different pharmacologic interventions for hydrocephalus?
1. Diuretics:
(A) Acetazolamide (Diamox): 50 mg/kg/day
(B) Furosemide (Lasix): 1 mg/kg/day
2. Anticonvulsants:
Specific drug(s) may be prescribed based on the infant’s condition and seizure activity.
3. Antibiotics:
Specific antibiotics may be prescribed depending on infection risk or underlying cause.
167
What are the different types of nursing diagnosis for hydrocephalus?
(A) Risk for injury
(B) Risk of infection
(C) Risk for ineffective cerebral tissue perfusion
(D) Risk for impaired skin integrity
(E) Risk for imbalanced nutrition: less than body requirements
(F) Impaired family processes
168
A group of disorders affecting movement, posture, and balance, due to damage or abnormal development of the brain, especially the upper motor neurons.
Cerebral Palsy (CP)
169
Which brain structure is most commonly affected in cerebral palsy?
The upper motor neuron, which controls voluntary movement, balance, and posture.
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What does the term "Cerebral Palsy" mean?
“Cerebral” = brain, “Palsy” = muscle weakness or control problems.
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What is the most common motor disability in children?
Cerebral Palsy (CP).
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What is the function of the ascending pathway in relation to CP?
It relays peripheral sensory information to the brain.
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Name four (4) prenatal factors that may lead to cerebral palsy.
(A) Abnormal brain development in utero
(B) Folic acid deficiency
(C) Viral or bacterial infections crossing the placenta
(D) Exposure to teratogenic chemicals
(E) Head injury during childhood
(F) Brain infection
(G) Damage to motor pathway within the CNS that are responsible for voluntary, involuntary movement and coordination.
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What is the function of the descending pathway in CP?
It transmits motor impulses from the cerebral cortex to the muscles.
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This is composed of myelinated and unmyelinated nerve fibers that conduct electrical impulses and neurotransmitters.
WHITE MATTER
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These are bundles of myelinated and unmyelinated nerve fibers that carry signals to and from the brain.
SPINAL CORD TRACTS
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What is the primary motor pathway from the cortex to the brainstem called?
The Corticobulbar tract.
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What is the function of the lateral corticospinal tract?
It conveys motor commands to the limbs (e.g., playing the piano, tap dancing).
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What is the primary motor pathway from the cortex to the spinal cord called?
The Corticospinal tracts.
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What is the function of the anterior corticospinal tract?
It controls trunk muscles (e.g., hula hooping, core exercises).
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Which parts of the CNS receive inputs from sensory receptors?
The cortex, brainstem, and spinal cord.
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What are the two subcortical systems that modulate activity at the brainstem and cortical levels?
The Cerebellum and the Basal Ganglia.
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Is cerebral palsy progressive or non-progressive?
Non-progressive.
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One side of the body is affected. The arm is usually more involved than the leg.
HEMIPLEGIA
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All four limbs are affected, but the legs are more involved than the arms.
DIPLEGIA
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All four limbs are affected.
QUADRIPLEGIA
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One limb is affected, usually the arm.
MONOPLEGIA
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Three limbs are affected, usually both arms and one leg.
TRIPLEGIA
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All four limbs, the head, and the neck are affected.
PENTAPLEGIA
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What type of cerebral palsy is caused by damage to the motor cortex?
Spastic (Pyramidal) Cerebral Palsy
(It causes excessive tone in the voluntary muscles).
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Which part of the brain is primarily affected in spastic cerebral palsy?
The motor cortex in the frontal lobe.
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What kind of neuron damage leads to spasticity in cerebral palsy?
Loss of upper motor neurons (It generates signals to direct voluntary movement).
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What are the clinical manifestations of spastic (pyramidal cerebral palsy)?
(A) Hypertonic muscles
(B) Abnormal clonus
(C) Exaggerated deep tendon reflexes
(D) Abnormal reflexes (e.g., Babinski)
(E) Continuation of neonatal reflexes (e.g., tonic neck)
(F) Infants arch backs and extend arms and legs abnormally when held in ventral position
(G) Fail to demonstrate parachute reflex
(H) Scissor gait
(I) Tightening of heel cord by school age
(J) Involved arm is shorter
(K) Astereognosis
(L) Pseudobulbar palsy
(M) Difficulty in swallowing
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What are the primary difficulties in athetoid cerebral palsy?
Difficulty controlling speech, movement, and posture.
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What part of the brain is damaged in athetoid (extrapyramidal) cerebral palsy?
Basal ganglia
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What does the term "athetoid" mean in relation to cerebral palsy?
It means worm-like, referring to abnormal involuntary movements.
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What is a common feature of movement in athetoid cerebral palsy?
Abnormal involuntary movements, which can be slow or jerky (HYPOTONIC).
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What are some clinical manifestations of athetoid cerebral palsy?
(A) Children make slow, writhing motions
(B) Can involve all 4 extremities plus face, neck, and tongue
(C) Poor tongue swallowing movement
(D) Cramping
(E) Difficulty in speech
(F) Involuntary movements:
(1) Choreoid – Irregular jerking
(2) Dyskinetic – Disordered muscle tone
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What part of the brain is damaged in ataxic cerebral palsy?
The cerebellum
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What type of gait is typically seen in individuals with ataxic cerebral palsy?
An awkward, wide-based gait.
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What are the primary motor issues in ataxic cerebral palsy?
Difficulty with balance and coordination.
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What fine motor functions are impaired in ataxic cerebral palsy?
The ability to perform fine coordinated motions, such as the finger-to-nose test or rapid/repetitive movements.
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What is the mixed type of cerebral palsy?
A combination of damage showing symptoms of both spasticity and ataxic/athetoid movements.
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Which type of medication inhibits seizure activity by reducing excessive brain stimulation?
Anticonvulsant
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What type of drug inhibits parasympathetic nerve responses that cause involuntary muscle movements and excessive drooling?
Anticholinergic
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What type of medication may complement therapy to promote mental and emotional well-being?
Antidepressant
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Which medications are used to manage pain symptoms in cerebral palsy?
Anti-inflammatory medications, including corticosteroids, NSAIDs, and OTC medications like Tylenol.
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What type of drug is used to treat spasticity, increase range of motion, and inhibit excessive muscle contractions?
Muscle relaxants
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What medication is commonly used to treat constipation in cerebral palsy?
Laxatives
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What respiratory problems might individuals with cerebral palsy experience?
Daily coughing, wheezing, coughing with drinking, abnormal pulmonary exams, sleep apnea, or other respiratory issues.
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What drug is used to treat sleeping difficulties in individuals with cerebral palsy?
Melatonin
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What type of aids can help correct vision-related problems in individuals with cerebral palsy?
Glasses and contact lenses.
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What hearing-related devices may benefit individuals with hearing impairments?
Hearing aids and cochlear implants.
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How do vagus-nerve stimulators help individuals with cerebral palsy?
They control seizures by sending pulses of electrical energy to the brain, preventing seizure activity.
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It delivers pain medication directly to the spinal fluid to manage spasticity. It can also be self-administered and given transdermally or orally.
Intrathecal baclofen pump
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What type of surgery addresses gastrointestinal motility problems in cerebral palsy?
Gastroenterology surgery, which focuses on improving the motility of the gastrointestinal tract.
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What types of hearing correction surgeries are available for individuals with cerebral palsy?
Cochlear implants and stapedectomy to correct hearing impairments.
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What type of surgery may be needed for individuals with cerebral palsy to correct joint deformities?
Orthopedic surgery to correct deformities of the joints.
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What is the purpose of vision correction surgery in cerebral palsy?
To address or improve vision-related issues caused by cerebral palsy.
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This focuses on addressing neurological issues that may arise, such as controlling spasticity or correcting brain damage.
NEUROSURGERY
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What is the goal of occupational therapy in cerebral palsy treatment?
To identify problems in performing everyday tasks and provide guidance on best practices to improve self-esteem and independence.
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How does physical therapy benefit individuals with cerebral palsy?
It increases range of motion, strength, coordination, and motor control through exercises, massage, and other activities. Some exercises can also be done at home.
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What is play therapy in the context of cerebral palsy treatment?
It involves age-appropriate activities to aid in development, often in coordination with a developmental or neuro pediatrician.
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How does speech therapy help individuals with cerebral palsy?
It addresses issues with speaking and swallowing caused by the control problems in the face and upper airway.
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What are the different types of nursing diagnosis for nursing diagnosis?
(A) Knowledge deficit related to understanding of the complex condition
(B) Risk for self-care deficit
(C) Risk for delayed growth and development related to activity restrictions
(D) Risk for imbalanced nutrition: less than body requirements
(E) Impaired verbal communication
