MUSCULOSKELETAL AND NEUROLOGICAL ALTERATIONS Flashcards
(160 cards)
1
Q
MUSCULOSKELETAL SYSTEM
A
- Consist of bones, muscles, tendons, ligaments and fascia
- Provides support for soft tissue and protection for organs
within the body - Reservoir for calcium and phosphorus
- Site where red blood cells are produced
- Bones provide rigid framework for the body and are moved when skeletal muscles contract
2
Q
TENDONS
A
Fibrous connective tissue that connects muscles to bones
3
Q
LIGAMENT
A
Fibrous Connective tissue the connect bones together to form a joint
4
Q
FASCIA
A
- covers bones, muscles, and other structures in the body with an uninterrupted web of tissues
- maintains the body’s structural integrity
5
Q
BONES
A
- Covered by PERIOSTEUM
- develop from tissues during OSSIFICATION
where OSTEOBLASTS provide structure for bone cells - Calcium and phosphorus deposits (regulated by thyroid and parathyroid glands) form salt that
strengthens framework for new bone - Placing bones under stress results in increase
deposits in bones - Periods of no stress results in resorption of deposits by the body
6
Q
PERIOSTEUM
A
- double layer of
connective tissue that covers all bone except for joints and nourishes the bone - Children have a thick vascular periosteum that
provides nourishment for bone growth and faster healing
7
Q
OSSIFICATION
A
- also known as osteogenesis or bone mineralization
- process of bone formation
8
Q
OSTEOBLASTS
A
- Bone-Building Cells
- specialized bone cells responsible for bone formation
9
Q
Long bones
A
have growth end called epiphysis where the growth plate or epiphyseal plate is located
10
Q
Epiphyseal plate
A
composed of cartilage (dense connective tissue without blood vessels)
11
Q
JOINTS
A
- where two articulated bones come together
- Held together by ligaments and cartilage cushions the surface area between each bones
12
Q
Types of Joints
A
- Synarthroidal (immovable)
- Amphidiarthroidal (semimovable)
- Diarthrodial (synovial joints, freely movable)
13
Q
SKELETAL MUSCLES
A
striated fibrous bundles covered with connective
tissue that contract when stimulated by an electrical
impulse
14
Q
Contraction
A
muscle shortens (flexing) causing attached bone to be pulled in the direction of contraction
15
Q
BONE MOVEMENT
A
produced when one set of muscle contracts while the opposing muscles relax (extends)
then opposing muscle contracts to return to the original position
16
Q
MUSCULOSKELETAL DISORDERS
A
- SOFT TISSUE INJURY
- FRACTURE
- TALIPES (CLUBFOOT)
- Developmental Dysplasia of the Hip
- SCOLIOSIS
- OSTEOMYELITIS
- JUVENILE RHEUMATOID
ARTHRITIS
17
Q
Soft Tissue Injury
A
sprain, strain or contusion that affects the soft tissue of the
musculoskeletal system
18
Q
STRAIN
A
- tearing, twisting or stretching of a muscle or tendon
- S/Sx: pain, localized swelling, muscle weakness
19
Q
SPRAIN
A
- injury to ligament as a result of stretching or tearing the ligament
- commonly the result of automobile accident, fall or sports injury
- Most ankle injuries that occur in children
- S/Sx: edema, pain, joint immobility
20
Q
CONTUSION
A
- bruise or hematoma
- blood vessels rupture beneath the skin and bleeds into the tissue causing discoloration
- S/Sx: purple discoloration of tissue; discoloration fades to
brown, yellow and green as coagulated blood rises to the upper layers of the skin
21
Q
Fact about Soft Tissue Injury
A
- area of discoloration should decrease as blood coagulates
- Blood disorders and medication may decrease coagulation resulting in ongoing bleeding from a contusion
22
Q
SOFT TISSUE INJURY: Treatment R.I.C.E
A
Rest
Ice
Compression
Elevation for 24-36 hours
23
Q
SOFT TISSUE INJURY: Nursing Intervention
A
- Contusion: encircle area of contusion with pen and label with date and time to document its size; frequent monitoring during the first hour to assess if coagulation occurred
- Assist patient with ADL to reduce pain and prevent further injury
- Teachings: nature of injury, treatment
24
Q
FRACTURE
A
- Separation of bone
- Degree of separation depends on the strength of the bone and energy of events that caused the fracture
- heal faster in children than in adults because children have a thick vascular periosteum,
resulting in increased blood flow
25
Categories of Fracture
1. Complete: bone separates into 2 distinct parts
2. Incomplete: bone does not separate into 2 distinct parts
3. Closed (simple): bone does not break the skin
4. Open (compound): bone breaks the skin
26
Types of Fractures
- Hairline
- Greenstick
- Comminuted
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Type of Fracture Hairline
incomplete fracture
28
Types of Fracture: Green Stick
incomplete fracture where bone is partially
broken resulting in the bone bending like a broken green stick
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Type of Fracture: Comminuted
complete fracture where bone is broken in
several fragments
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FRACTURE S/Sx
- Pain
- Deformity
- Edema
- Crepitus
- Reduced ROM
- unable to bear weight on the injured bone
31
FRACTURE Test Results
- Radiograph
- decreased Hct (indicative of blood loss)
- decreased Hgb
32
FRACTURE Treatment
- closed reduction to realign surface area of the bone by manipulating bones or by traction for healing
- immobilize the bone to prevent further injury and keep bone realigned
- open reduction: performed when closed reduction is not possible or when repair must be made to torn muscle
and ligaments; pins, screws, plates, or rods ,might be used
- Tractions: skin traction and skeletal traction
- Provide adequate fluid to increase hydration and prevent renal calculi (rare condition for children)
- Attach a sequential pneumatic compression device to prevent stasis of blood in the legs and to prevent emboli from
developing
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Fracture: Nursing Intervention
-assess fracture on the child’s growth
- assess circulation frequently
-assess nerve compression syndrome: pain, tingling and
numbness
- assess for osteomyelitis (signs: irritability, abrupt fever, lethargy, pain & warmth)
- assess for pulmonary embolism that may occur within 24 hours (sudden sever dyspnea and chest pain)
❖ Traction care
- assess the position and placement of bandages and straps
- assess neurovascular status
- treat pain
- assess pt’s psychological response to treatment
- assess the pin sites for infection, inflammation and bleeding
-clean pin site with cotton-tipped sterile applicator soaked in NSS the antibacterial ointment
❖ Minimize immobility by performing ROM exercises and ambulate when possible
34
TRACTION
- Pull or tension exerted on a body part
- Used for immobility and to hold body part in alignment
- Usually used on spine, pelvis, long bones in extremities
- applied to bone or skin
- If used in long bone, pulling force is aligned with long bone
- Countertraction is needed to maintain alignment if body weight is not enough
- Can be continuous or intermittent
- Complications: those associated with extended immobility;
hospitalization
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continuous traction
- constant pulling force
- used for fractures,
dislocations
- pulls/ weights should not be interrupted or changed without orders from the health care provider
36
intermittent traction
- interrupted pulling force
- used for contractures, muscle spasms, low back pain; timing of traction
should always be in care plan
37
Types of Traction
1. Manual Traction
2. Skin Traction
3. Skeletal Traction
38
Manual Traction
- pulling force applied to body part by hand
- primarily used to hold body part in alignment during cast application
39
Skin Traction
- pulling force applied to skin; no anesthesia required
- preferred when invasive procedures are contraindicated
- most effective for children less than 3 years old (<15 kg)
40
Examples of Skin Traction
- Bryant Traction
- Buck Traction
- Russell Traction
41
Bryant Traction
- can be continuous or intermittent
- affected extremity is wrapped
- child is positioned on back with hips flexed to 90 degrees
- traction is applied overhead with just enough force to lift
child’s buttocks off of mattress
- primarily for femur fractures
- may be used for developmental hip dysplasia
42
Buck Traction
- can be continuous or intermittent
- boot or wrap applied to extended lower extremity
- traction affixed to boot or wrap
- child may be positioned on back or on side if extremity is stable
- primarily for short-term immobilization
- may be used for fractures, hip disorders, muscle spasms, contractures
43
Russell Traction
- skin traction is applied to lower leg, and a sling is placed under knee
- force is applied both along the length of the lower leg and along the length of the femur
- used to immobilize flexed hip and knee
44
Skeletal Traction
- pulling force applied directly to bone by pin or wire inserted through bone
- does not exert pulling force on skin
- can be maintained longer than skin traction
- requires general anesthesia for both application and removal
- used hen significant force must be applied to body part to achieve alignment or immobility
- usually applied to skull, ulna, femur, tibia and heel
- creates risk for osteomyelitis; pin sites should be assessed
and care provided at least once per day
45
Nursing Care for Child in Traction
- Ensure weights are hanging freely and affected limb is position so that the pull of traction is not impeded; never interrupt traction
- Maintain affected extremity in functional alignment; encourage use of trapeze or side rails to facilitate movement; teach how to use trapeze to lift body
- Observe for foot drop with buck extension/ traction
because this may indicate nerve damage
- Observe site of insertion of skeletal traction for irritation or
infection; use surgical asepsis when cleansing site of insertion of skeletal traction
- A congenital deformity that occurs in utero due to
adverse effects of medication, infection, trauma or genetic trait resulting in contracture of soft tissue and abnormal development of a joint or muscles
- Bone deformity and malposition of foot with soft tissue
contracture; foot twisted out of alignment
46
TALIPES (CLUBFOOT)
- A congenital deformity that occurs in utero due to
adverse effects of medication, infection, trauma or genetic trait resulting in contracture of soft tissue and abnormal development of a joint or muscles
- Bone deformity and malposition of foot with soft tissue contracture; foot twisted out of alignment
47
Types of TALIPES (CLUBFOOT)
- plantarflexion
- dorsiflexion
- Varus deviation
- Valgus deviation
- equinovarus
- calcaneovalgus
48
Types Talipes: plantarflexion
equinus or horse foot position, forefoot lower than heel
49
Types Talipes: dorsiflexion
heel is held lower than forefoot or anterior foot is flexed toward anterior leg
50
Types Talipes: Varus Deviation
foot turns in
51
Types Talipes: Valgus deviation
foot turns out
52
Types Talipes: equinovarus
combination of all types
53
Types Talipes: calcaneovalgus
child walks on heel with foot
elevated
54
Talipes: Clinical Findings, Test Results, Therapeutic Interventions
Clinical Findings
- usually position or forming of one or both feet;
apparent at birth
Test Results
- Radiograph: Talus is superimposed and the
metatarsal is ladder-like
Therapeutic Interventions
- treatment started during newborn period most
successful; delay causes abnormal development of leg
muscles and bones with shortening of tendons
55
Talipes: Nonsurgical treatment
- gentle, repeated manipulation of foot with casting;
- splint the foot in the realigned position (adduction) then cast
the foot for 2 weeks
- remove cast and realign in the heel inversion position and
then cast for 2 weeks
- remove the cast and realign in the flexion of the ankle position
and cast the foot for 2 weeks
- Apply an ongoing night brace once the cast is removed
56
Talipes: Surgical Treatment
-done if casting does not permanently realign the foot
- Tight ligaments released
- Tendons lengthened or transplanted
57
Talipes: Non Casting and nonsurgical intervention
Denis Browne Splint: Special shoes containing adjustable bars are worn to realign the foot
58
Talipes: Follow up care
- Emphasize muscle reeducation (by manipulation) and correct walking
- Corrective shoes: must be maintained in good repair
- Extended orthopedic supervision: tendency to recur;
considered cured when able to wear regular shoes and walk correctly
59
Talipes Nursing Interventions
If foot is in a cast
- elevate the affected foot on pillows
-skin and neurovascular assessment: color, skin
temperature, capillary refill, toe movement (pain, pallor, pulselessness, paresthesia, paralysis) every 2 hours
- check cast for weakness and wear
- teach parents how to assess for ischemia and how to
exercise the affected foot at home
- Limit risk for hypostatic pneumonia due to immobility
*change position frequently (raise head of mattress
frequently rather than head only to prevent neck flexion)
*teach parents postural drainage and to notify doctor if
congestion or cough develops
- Maintain skin integrity
* assess circulation to toes
*prevent slipping of small toys or food in the cast
* Teach parents to recognize signs of infection
*protect cast edges with adhesive tape or waterproof
material especially around perineum
*use disposable diapers with plastic lining to minimize
soiling by feces and urine
- Prevent constipation
* Teach parents to observe child for straining on defecation
* increase fluids and high fiber foods
- Encourage intake of nutritious foods appropriate for activity
level
* small frequent feedings
* teach parents to adjust calorie intake
- Move and position safely when in spica cast
* use wagon or stroller with back flat for transportation
* protect from falling when being positioned
* avoid using bar between two legs of cast for lifting
- Meet emotional needs
* use touch as much as possible; cuddling
*stimulate and provide play activities appropriate for age
60
Developmental Dysplasia of the Hip
- Improper formation & function of the hip socket
- Subluxation or dislocation of the head of the femur
- Acetabulum of pelvis is flat or shallow
- Causes: heredity, uterine position
61
Developmental Dysplasia of the Hip: S/Sx
- affected leg is shorter
- knee is lower than the other
- unequal skin folds on posterior thighs
- (+) Ortolani’s sign and Barlow’s Sign
- limited hip abduction due to dislocation
62
Developmental Dysplasia of the Hip: Medical Management
1. Splints, halters, casts:
- position hip into flexed, abducted, position; traction for older children
*NB- 6 mos: PAVLIK HARNESS (3-5 months duration)
- legs are flexed and knees fall outward
*6-18 mos: HIP SPICA CAST for 2-4 months post surgical
realignment; immobilizes legs and knees and holds hips in
proper alignment
2. surgery- pin is inserted to stabilize hip
63
Developmental Dysplasia of the Hip: Medical Management
diaper area care
- change diapers frequently, wash area w/clear water and apply ointment afterwards
64
Developmental Dysplasia of the Hip: Nursing Intervention
- assess patient for restricted movement and wide perineum
and unequal gluteal folds
- assess for limp or unequal gait
- Spica cast: assess for compartment syndrome; ensure
cleanliness of cast from fecal matter and urine
65
Developmental Dysplasia of the Hip: Nursing Intervention_Pavlik harness
Pavlik Harness
1. examine skin integrity under harness three times a day for
redness;
2. don’t apply lotion or powder;
3. place undershirt between harness and skin;
4. place diaper under harness straps;
5. massage skin once daily;
6. teach parents how to use harness and care for the pt.
66
SCOLIOSIS
- three-dimensional spinal deformity characterized by a lateral curvature of the spine
greater than 10° (Cobb angle)
- often accompanied by
vertebral rotation
- can be structural (fixed deformity) or non-structural (reversible and due to external
factors like muscle spasm or leg length discrepancy).
67
Types of Scoliosis
1. Idiopathic Scoliosis (80-90%)
2. Congenital Scoliosis
3. Neuromuscular Scoliosis
4. Syndromic Scoliosis
5. Degenerative Scoliosis
68
Idiopathic Scoliosis
- Most common (adolescent idiopathic scoliosis – AIS).
- Unknown cause, but thought to be genetic and biomechanical.
- More common in females and worsens with growth spurts.
69
Congenital Scoliosis
- Present at birth due to vertebral malformations
- Caused by failure of segmentation or formation of vertebrae.
70
Neuromuscular Scoliosis
- Seen in conditions like cerebral palsy, muscular dystrophy, spina bifida.
- Due to muscle weakness and imbalance, leading to poor spinal support.
71
Syndromic Scoliosis
Associated with genetic disorders like Marfan syndrome, Ehlers-Danlos syndrome, and neurofibromatosis
72
Degenerative Scoliosis
Occurs in adults due to age-related spinal degeneration (disc and joint wear).
73
Pathophysiology of Scoliosis
- Uneven spinal growth leads to curvature progression
- Vertebral rotation causes rib prominence (rib hump).
- Asymmetric disc compression causes changes in spine alignment.
- Severe cases may impair lung function if thoracic curvature affects rib cage expansion.
74
Signs & Symptoms of Scoliosis
- Uneven shoulders or hips
- One side of rib cage more prominent
- Visible spinal curvature
- Back pain (in some cases)
- Difficulty breathing (severe cases)
75
Assessment & Diagnosis for Scoliosis
1. Physical Examination
- Adam’s Forward Bend Test: Asymmetry in rib cage when bending forward.
- Shoulder, hip, and spine alignment observation.
2. Imaging
- X-ray: Measures Cobb angle.
- MRI: If neurological symptoms are present
76
Scoliosis Nursing Care & Management
1. Observation & Screening
- Early detection through school screening.
- Monitor for progression, especially in adolescents
2. Non-Surgical Management
- Bracing (for moderate curves 25-40°) to prevent progression.
- Physical therapy: Strengthening and posture exercises.
3. Surgical Management (For severe cases >40-50°)
- Spinal fusion: Straightens the spine using rods and bone grafts
- Growing rods (in young children): Adjusted as the child grows.
77
Scoliosis: Nursing Responsibilities
1. Pre-Operative Care
- Educate patient & family about surgery
- Baseline neurological assessment
2. Post-Operative Care
- Pain management (opioids, NSAIDs)
- Monitor for complications (infection, nerve damage, breathing difficulty).
- Encourage mobility (turning, ambulation with brace if required
3. Long-Term Care
- Support psychosocial well-being (self-esteem issues).
- Encourage adherence to bracing or therapy if prescribed.
78
Scoliosis: Key Nursing Considerations
- Early screening is critical for preventing progression.
- Encourage compliance with bracing and exercises.
- Educate patients about potential progression and treatment options.
- Support emotional well-being, especially in adolescents.
79
OSTEOMYELITIS
- serious bone infection caused by bacteria (most commonly
Staphylococcus aureus), fungi, or other pathogens
- can be acute (develops
quickly) or chronic (persists over time and may lead to necrosis).
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OSTEOMYELITIS: Risk Factors
- Recent trauma or surgery
- Diabetes mellitus (diabetic foot ulcers)
- Peripheral vascular disease
- IV drug use
- Immunosuppression (HIV, chemotherapy, corticosteroids)
81
OSTEOMYELITIS: S/Sx
1. Acute Osteomyelitis
- Severe bone pain (worse with movement)
- Fever, chills, malaise
- Swelling, warmth, and redness over affected area
- Limited mobility
2. Chronic Osteomyelitis
- Persistent pain
- Non-healing ulcers or sinus tracts with drainage
- Low-grade fever
- Bone deformity or instability
82
OSTEOMYELITIS: Dx
1. Lab Tests
- increased WBC count, ESR, CRP (inflammation markers)
- Blood cultures to identify causative organism
2. Imaging
- X-ray (bone changes appear later)
- MRI/CT scan (early detection of infection & abscess)
- Bone biopsy (definitive diagnosis)
83
OSTEOMYELITIS: Treatment & Nursing Care
1. Antibiotic Therapy
- IV broad-spectrum antibiotics initially, then targeted therapy for 4-6 weeks
2. Surgical Management
- Debridement (removal of dead bone/tissue)
- Sequestrectomy (removal of necrotic bone).
- Bone grafting (if needed for stability).
84
OSTEOMYELITIS: Nursing Interventions
- Monitor for signs of infection (fever, worsening pain, wound drainage).
- Administer antibiotics as prescribed (IV therapy often required).
- Pain management (NSAIDs, opioids if needed).
- Wound care & dressing changes (if open wound present).
- Encourage mobility with precautions (prevent complications like
contractures).
- Educate on infection prevention (proper wound care, adherence to antibiotics).
85
OSTEOMYELITIS: Complications
- Bone necrosis (sequestrum formation)
- Sepsis & systemic infection
- Pathologic fractures
- Amputation (severe cases, especially in diabetics)
86
JUVENILE RHEUMATOID
ARTHRITIS
- now called Juvenile Idiopathic
Arthritis (JIA)
- chronic autoimmune disorder that causes inflammation of the joints in children under 16 years old
- can lead to joint pain, swelling, stiffness, and long-term disability if untreated
87
Types of Juvenile Idiopathic Arthritis (JIA)
1. Oligoarticular JIA (Most Common, ~50%
2. Polyarticular JIA (30-40%)
3. Systemic JIA (Still’s Disease, ~10-15%)
4. Enthesitis-Related JIA
5. Psoriatic JIA
6. Undifferentiated JIA
88
Oligoarticular JIA
- Most Common, (~50%)
- Affects ≤4 joints (usually large joints like knees).
- Mildest form
- may cause eye inflammation (uveitis).
89
Polyarticular JIA (30-40%)
- Affects ≥5 joints (small & large joints).
- More common in girls, can be RF-positive (similar to adult RA).
90
Systemic JIA (Still’s Disease, ~10-15%)
- Affects the whole body (fever, rash, swollen lymph nodes, organ involvement).
- Most severe type, may lead to complications like macrophage activation syndrome (MAS).
91
Enthesitis-Related JIA
- Involves inflammation at tendon insertion points
- Associated with HLA-B27 gene and ankylosing spondylitis
92
Psoriatic JIA
- Associated with psoriasis (scaly skin rash).
- Nail changes and dactylitis ("sausage fingers") may occur
93
Undifferentiated JIA
Does not fit into the above categories but still causes joint inflammation.
94
Juvenile Idiopathic Arthritis (JIA): Pathophysiology
- Autoimmune reaction causes immune system to attack synovium (joint lining).
- Chronic inflammation causes excess synovial fluid, joint swelling, and cartilage damage.
- Progression causes joint deformity, contractures, and growth disturbances in children
95
Juvenile Idiopathic Arthritis (JIA): S/Sx
- Joint pain, swelling, and stiffness (worse in the
morning).
- Limited mobility & joint warmth.
- Fever, rash (systemic JIA).
- Fatigue, weight loss, irritability.
- Eye inflammation (uveitis in oligoarticular JIA).
96
Juvenile Idiopathic Arthritis (JIA): Dx
1. History & Physical Exam (persistent arthritis >6 weeks).
2. Lab Tests
- Increased ESR & CRP (inflammation markers)\
- RF & Anti-CCP (for polyarticular JIA).
- ANA (antinuclear antibodies) (uveitis risk in oligoarticular JIA).
3. Imaging
- X-ray (joint damage, bone growth issues).
- MRI/Ultrasound (early joint inflammation detection).
97
Juvenile Idiopathic Arthritis (JIA): Treatment & Nursing Care
1. Medications
- NSAIDs (pain & inflammation relief).
- DMARDs Disease-modifying antirheumatic drug (Methotrexate) (slows disease
progression).
- Biologic agents (Etanercept, Adalimumab) (target immune response).
- Corticosteroids (for severe inflammation, but used cautiously).
2. Physical & Occupational Therapy
- Prevent joint stiffness & muscle wasting
- Use splints & assistive devices for joint support.
98
Juvenile Idiopathic Arthritis (JIA): Nursing Interventions
- Pain management (heat therapy, gentle exercise).
- Encourage mobility & ROM exercises (to prevent contractures).
- Monitor for medication side effects (GI upset, liver toxicity
with methotrexate).
- Educate on eye exams (uveitis risk in some types).
- Psychosocial support (help with school activities &
self-esteem).
99
CENTRAL NERVOUS SYSTEM
- comprised of the brain and spinal cord
- cranium: portion of the skull that encloses the brain
- brain and spinal cord are covered by a three-layer membrane called the
meninges
100
Layers of Meninges:
1. Dura mater: outer membrane; folds brain into compartments
2. Arachnoid mater: inner membrane (fibrous & elastic tissue); contains a
spongy structure of subarachnoid fluid
3. Pia mater: third layer of fine membrane that contains small blood vessels
101
Cerebral Spinal Fluid
- formed in the choroid plexus
- contains water, glucose, protein and minerals
- surrounds the brain helping to absorb shock and reduces forces that
might be applied to the brain
- fills the 4 cavities in the brain called ventricles
- reabsorbed in blood vessels in the arachnoid villi
102
Brain divided into 3
1. Cerebrum
2. cerebellum
3. brainstem
103
Cerebrum
- fissures divide the cerebrum into 2 hemispheres
- hemispheres are connected by nerve fibers called corpus callosum to transmit impulses between hemispheres
- left hemisphere controls the right side of the body
- hemisphere controls the left side of the body
104
thalamus
- located below the corpus callosum
- acts as relay station to help cerebral cortex manage information
105
hypothalamus
- beneath the thalamus
- regulates BP, temperature,
appetite, breathing and sleep`
106
fissure of Sylvius
separates frontal and parietal lobes from temporal lobe
107
fissure of Rolando
- separates parietal lobe from frontal lobe
108
parieto-occipital fissure
separates parietal lobe from occipital lobe
109
4 Lobes of the Brain
1. Frontal lobe
2. Temporal lobe
3. Parietal lobe
4. Occipital lobe
110
Frontal lobe Function
- moving voluntary muscles
- speech (Broca area)
- personality
- behavior
- judgement
- problem solving
- memory
- intelligence
- autonomic functions
- emotional response
- cardiac response
111
Temporal lobe Functions
interprets spoken language, smell, taste and hearing
112
Parietal lobe Functions
interprets sensory information
113
Occipital lobe Functions
interprets visual stimuli
114
Cerebellum
- base of the brain
- maintains muscle tone, equilibrium, smooth muscles and coordinates impulses to muscles
115
Brainstem
connects the spinal cord to other parts of the brain
116
3 parts of the brain stem
1. Midbrain
2. Pons
3. Medulla oblongata
117
Parts of the brain stem: Midbrain
reflex center for the eye
118
Parts of the brain stem: Pons
regulates chewing, saliva secretion, taste and helps in
respirations, equilibrium, hearing
119
Parts of the brain stem: Medulla oblongata
responsible for vasomotor function, cardiac and respiratory function
120
Spinal Cord
- Leads from the brainstem through the 2nd lumbar vertebra
- Has 31 pairs of spinal nerves
- Generates reflex impulses (deep tendon reflex)
121
Spinal Cord 2 Subsystems
1. Somatic Nervous System voluntary function; reflex actions; conscious and subconscious mental processes
2. Autonomic Nervous System: involuntary function
122
2 Systems of the Autonomic Nervous System
1. Sympathetic Nervous System: expends energy by releasing
adrenergic catecholamines
2. Parasympathetic Nervous System: conserves energy by absorbing cholinergic neurohormone acetylcholine
123
Spinal Nerves (identified by its originating point in the vertebra)
1. Cervical (C1-C8)
2. Thoracic (T1-T12)
3. Lumbar (L1-L5)
4. Coccygeal
124
Cranial Nerves
I- Olfactory
II- Optic
III- Oculomotor
IV- Trochlear
V- Trigeminal
VI- Abducens
VII- Facial
VIII- Vestibulocochlear
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
125
SPINA BIFIDA (NEURAL TUBE DEFECT)
- Congenital defect of the spinal/neutral tube
- incomplete closure of the spinal column due to one or two missing vertebral arches
- occurs during 4th week of embryonic life
- exact cause is unknown.
126
SPINA BIFIDA (NEURAL TUBE DEFECT): CLASSIFICATIONS
1. Spina Bifida Occulta
2. Meningocele
3. Myelomeningocele
127
Spina Bifida Occulta
- seen as a small dimple at the lower back
- usually asymptomatic
- creates health problems
- no treatment is
needed
128
Meningocele
sac like cyst that contains meninges and spinal fluid
129
Myelomeningocele
- with herniated sac of meninges, spinal fluid and
a portion of the spinal cord and its nerves
- protrude through the defect in the spine.
- It is the most severe form.
130
SPINA BIFIDA (NEURAL TUBE DEFECT): ETIOLOGY
- Deficiency in folic acid of the mother during pregnancy
- Hereditary and environmental factors
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SPINA BIFIDA (NEURAL TUBE DEFECT): ASSESSMENT
1. Visible sac-like structure or dimpling of the skin at any point on the spinal column
2. Associated defects/problems found in myelomeningocele
- Hydrocephalus
- Bowel/bladder dysfunction
- Paralysis of lower extremities
- Associated meningitis
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SPINA BIFIDA (NEURAL TUBE DEFECT): MANAGEMENT- SURGERY
done as soon after birth as possible (usually within 24
to 48 hours) so infection through the exposed meninges does not occur
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SPINA BIFIDA (NEURAL TUBE DEFECT): NURSING INTERVENTION
- Women are advised to undergo amniocentesis
- Women who have had one child with a spinal cord disorder are advised to have a maternal serum assay or amniocentesis for AFP levels to determine if
such a disorder is present in a second pregnancy (levels will be abnormally increased if there is an open spinal lesion)
- Evaluate sac and lesions
- Perform neurological assessment
- Monitor ICP
- Measure head circumference, assess anterior fontanels for fullness protect the sac, cover with a sterile, moist non adherent dressing
- Place in a prone position to minimize tension on the sac and the risk of trauma
- Use aseptic technique to prevent infection
- Assess the sac for redness, clear or purulent drainage, abrasion, irritation and signs of infection
- Administer antibiotics as prescribed
- Administer anti-cholinergics to improve urinary continence and laxatives to achieve bowel continence
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SPINA BIFIDA: PREVENTION
ingest 600 micrograms of folic acid daily to help prevent these disorders during the first trimester
135
HYDROCEPHALUS
- excess cerebrospinal fluid (CSF) accumulates in the brain, leading to increased intracranial
pressure (ICP).
- Imbalance in CSF production and absorption → ventricular
dilation → brain compression → increased ICP.
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TYPES OF HYDROCEPHALUS
1. COMMUNICATING
- Occurs as a result of impaired absorption within the sub-arachnoid space
2. NON COMMUNICATING/
OBSTRUCTIVE
- Obstruction of cerebrospinal flow within the ventricular system occurs
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HYDROCEPHALUS RISK FACTORS
1. Infant meningitis/encephalitis – leave adhesion behind
2. Hemorrhage of Tumor – blocks passage of fluid
3. Arnold-Chiari disorder – elongation of the lower brainstem & displacement of the 4th ventricle into the upper cervical canal
4. Surgery for meningocele – portion of subarachnoid space is removed causing less surface area for absorption of CSF
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CAUSES OF EXCESSIVE CSF (cerebrospinal fluid)
- Overproduction of fluid by choroids plexus in 1st or 2nd ventricle
- Obstruction of the of fluid in narrow aqueduct of sylvius (most common)
- Interference with the absorption of CSF from subarachnoid space
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HYDROCEPHALUS S/Sx
- Anterior fontanel bulging
- (Macewen’s sign) Bones of the head are widely separated that produces a cracked pot sound upon percussion
- (Bossing sign) Brow bulges
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HYDROCEPHALUS - TREATMENT: SURGICAL SHUNTING
Ventriculoperitoneal (V-P) shunt
- Connects the lateral ventricle of the brain to the peritoneal cavity
- Most commonly used shunt in children Atrioventricular (A-V) shunt
- Connects the lateral ventricle to the right atrium of the heart Ventriculoureteral (V-U) shunt
- Connects the lateral ventricle of the brain to the ureter; requires unilateral nephrectomy which, may
cause recurrent fluid and electrolyte imbalance
141
HYDROCEPHALUS: NURSING INTERVENTIONS
1. Assess daily head circumference
2. Protect the child’s head
3. Maintain nutrition and hydration
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HYDROCEPHALUS: PREOPERATIVE INTERVENTIONS
1. Monitor intake and output; give small frequent feedings as tolerated until a preoperative NPO status is prescribed
2. Reposition head frequently and use an egg crate mattress under the head to prevent pressure sores
3. Prepare the child and family for diagnostic procedures and surgery
143
HYDROCEPHALUS: POSTOPERATIVE INTERVENTIONS
1. Monitor vital signs and neurological signs
2. Position the child on the unoperated side to prevent pressure on the shunt valve
3. Keep the child flat as prescribed to avoid rapid reduction of intracranial fluid
4. Observe for increased ICP; if increased ICP occurs, elevate the head of the bed to 15 to 30 degrees to enhance gravity flow through the shunt
5. Monitor for signs of infection and assess dressings for drainage
6. Measure head circumference
7. Monitor intake and output
8. Provide comfort measures; administer medications as prescribed, which may include
diuretics, antibiotics, or anticonvulsants
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BACTERIAL MENINGITIS AND ENCEPHALITIS
- acute bacterial infection of the central nervous system
- acquired as the primary disease or as a result of a local infection (e.g., otitis media, sinusitis), systematic infections, trauma and neurosurgery
- Inflammation of the meninges (brain coverings) due to bacterial or viral infection
- Pathogen enters bloodstream → meningeal inflammation → increased ICP → neurological damage
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BACTERIAL MENINGITIS AND ENCEPHALITIS: CAUSES
1. Bacterial meningitis (Haemophilus influenza type B, Streptococcus pneumonia, or Neisseria meningitidis)
- occurs in epidemic form
- can be transmitted by droplets from nasopharyngeal secretions
2. Viral meningitis
- associated with viruses such as mumps, paramyxovirus, herpesvirus, and enterovirus
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Meningitis
Inflammation of membranes surrounding the brain and spinal cord
147
Encephalitis
Inflammation of the brain itself
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BACTERIAL MENINGITIS AND ENCEPHALITIS: S/Sx
- Opisthotonus position
- Stiff neck and nuchal rigidity
- (+) Kernig’s sign: Inability to extend the leg when the thigh is flexed anteriority at the hip
- (+) Brudzinski sign: Neck flexion causes adduction and flexion movements of the lower extremities
149
BACTERIAL MENINGITIS AND ENCEPHALITIS: DIAGNOSTIC TEST
1. Lumbar Puncture: Clouding of CSF, Increased Protein and Decreased Glucose
2. Smear and culture of CSF and blood demonstrate the presence organism
150
BACTERIAL MENINGITIS AND ENCEPHALITIS: TREATMENT
Antibiotic Therapy/ I.V: Penicillin G (Drug of Choice)
151
BACTERIAL MENINGITIS AND ENCEPHALITIS: NURSING INTERVENTIONS
1. Isolate infant: first nursing implementation on admission
2. Ensure patent airway and promote safety during seizures
3. Monitor and control temperature
4. Perform neurological assessment and monitor for seizures; assess for the complication of
inappropriate antidiuretic hormone (ADH) secretion, causing fluid retention (cerebral edema)
and dilutional hyponatremia
5. Assess for changes in level of consciousness and irritability
6. Monitor intake and output
7. Assess nutritional status
8. Determine close contacts of the child with meningitis because the contacts will need
prophylactic treatment
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CEREBRAL PALSY
- neuromuscular disorder characterized by lack of control of the voluntary muscles, abnormal muscle tone and incoordination
- non-progressive motor disorder
- caused by brain injury or abnormal brain
development before, during, or shortly after birth, leading to impaired muscle movement and coordination.
- Brain damage affects motor areas, disrupting signals to muscles → spasticity, weakness, or involuntary movements
- Can be caused by prenatal, perinatal, or postnatal injuries (e.g., lack of oxygen, infections, trauma).
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CEREBRAL PALSY: ETIOLOGY
- Anoxia to the brain: the most significant factor to causation
- Infection
154
THREE TYPES OF CEREBRAL PALSY
1. Spastic (most common)
- cortex is affected resulting in the child having a scissor-like gait where one foot crosses in front of the other foot
2. Athetoid
- basal ganglia are affected resulting in uncoordinated involuntary motion
3. Ataxic
- cerebellum is affected resulting in poor balance and difficulty with muscle coordination
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CEREBRAL PALSY S/Sx
1. early signs of cerebral palsy
- Abnormal posturing
- Difficulty feeding
- Tremors/Seizures
- Persistence of primitive reflexes
2. Signs of delayed motor development
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CEREBRAL PALSY: Treatment
- Exercises: passive and active
- Medications: muscle relaxants(baclofen, diazepam), anti-convulsants and tranquilizers(botulinum toxin injections)
- Braces, ambulation devices: Crutches, walkers
- Surgery: Orthopedic procedures (tendon release, selective dorsal rhizotomy) to reduce contractures
157
CEREBRAL PALSY: NURSING INTERVENTIONS
- Encourage physical therapy and use of assistive devices (braces, wheelchairs).
- Monitor swallowing and nutrition to prevent aspiration.
- Provide speech and occupational therapy to enhance communication and independence.
- Educate parents on home safety and adaptive techniques.
- Ensure safety when ambulating
- Promote maximum mobility and development of self-help skills.
- Promote adequate nutritional intake
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DOWN SYNDROME (TRISOMY 21)
- chromosomal aberration characterized by Trisomy 21 or the tripling of chromosome number 21
- Presence of an extra copy of chromosome 21 resulting in a total number of 47 rather than 46
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DOWN SYNDROME (TRISOMY 21): Assessment
1. Facial characteristics:
- wide gap between the eyes, flat nose, large tongue
2. Head characteristic flattened posterior and anterior surfaces of the skull, obviously flat
occiput
3. Extremities: simian crease: abnormal single horizontal line on the palm of the hands;
plantar furrow: vertical line on the sole; first and second toes widely spaced
4. Brushfield’s spots – white specks in the iris of the eye
5. Low-set ears
6. Potbelly – High waist circumference
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DOWN SYNDROME (TRISOMY 21): ASSOCIATED PROBLEMS AND FINDINGS
- Intelligence varies from severely retarded to below normal (IQ less than 20 to IQ between 50-70)
- Congenital anomalies, VSD, Hirschsprung’s disease and leukemia
- Growth is reduced, with rapid weight gain
- Sexual development maybe delayed, incomplete or both
