Neuromuscular

Question 1

Cerebral Palsy pathophysiology

Answer 1

not caused by problem in muscles or nerves. caused by faulty development or damage to motor areas of the brain
r/t anoxic brain event causing brain damage prior to birth, during birth, or in the first 2 years of life when brain is rapidly developing

Question 2

CP classified by

Answer 2

motor abnormalities (type and severity)
associated impairments (seizures, cognitive, communication, behavior)
anatomic and radiologic findings
causation and timing

Question 3

congenital causes of CP

Answer 3

maternal infections
jaundice
Rh incompatibility
stroke

Question 4

what to watch for in CP?

Answer 4

skin breakdown, pressure ulcers, missed milestones, abnormal reflexes and tone

Question 5

missed motor milestones in CP

Answer 5

not sitting unsupported by 7 months
failure to smile by 6-8 weeks
feeding difficulties (gagging, chocking, tongue thrust after 6 months)
extreme irritability or crying

Question 6

Abnormal muscle tone in CP

Answer 6

persistence of primitive reflexes past 6 months (moro, tonic neck, grasp reflex)
floppy or limp body posture
stiff or rigid arms or legs

Question 7

motor abnormalities in CP

Answer 7

early sign is hand preference in the first 18 m
abnormal crawl (only uses one side of the body or only arms to crawl)
uncoordinated or involuntary movements
facial grimacing
writhing movements
poor suck
tongue thrust
ataxia

Question 8

hypotonic body tone in CP

Answer 8

present at birth and may persist to 1 year then replaced by hypertonic muscles

Question 9

hypertonic body tone in CP

Answer 9

resistance to passive ROM
hips higher than trunk when prone
spine deformities r/t opisthotonic posture
contractures

Question 10

clinical manifestations associated with spastic CP

Answer 10

seizures
contractures
incontinence ADHD
non-ambulation leads to constipation, orthopedic problems, skin breakdown, and respiratory infections

Question 11

associated impairments with CP

Answer 11

feeding difficulties manifests as FTT, poor suck, tongue twist
affects chewing, swallowing and talking
- nurses can help improve function by helping child blow bubbles, pen wheels, and chewing gum under supervision

Question 12

therapeutic management of CP

Answer 12

PT/OT and speech
assistive devices for mobility and ADL’s
computers
surgery ( to release tendons, and improve function)

Question 13

med management of CP

Answer 13

used to manage associated symptoms
antipyretics
stimulants ( ADHD) 
botox ( paralysis of overactive muscles)
skeletal muscle relaxants ( dantrolene, baclofen, methocarbamol) 
anxiolytics
bowel regimen

Question 14

home management of CP

Answer 14

helping family cope with a child  with chronic illness
education about inclusion at school
use of assistive devices and exercise
proper med administration
prevent skin breakdown and respiratory infections
nutrition (increase calories and rest)
play and recreation
safety needs

Question 15

nursing care of CP

Answer 15

assessment and early identification
reinforce therapeutic plan
address home care needs
routine skin assessments
immunizations
safety precautions (wearing helmets when needed, home adaption, modified care seats)

Question 16

Duchenne Muscular Dystrophy causes

Answer 16

x-linked disorder
males only
absence of dystrophin leads to muscle degeneration

Question 17

early clinical manifestations of Duchenne MD

Answer 17

onest between 3-5 yr
positive gower sign (ask child to stand from kneeling position if they have to walk hands up legs to stand it is positive)
kids will meet milestones normally until 3-5yr and will regress
rapid PROGRESSIVE muscular degeneration after normal development
waddling gate
lordosis
kids waste from inside out

Question 18

progressive clinical manifestations of duchenne MD

Answer 18

pseudohypertrophy 
muscular atrophy
ability to ambulate generally lost by 10-12 yr
facial and respiratory muscle atrophy
cardiac and respiratory failure
mild to moderate cognitive impairment
median age 22 yr with mechanical ventilation
fatal disease child will die no cure

Question 19

Duchenne MD dx by

Answer 19

clinical manifestations
muscle bx
EMG

Question 20

Therapeutic goals of MD

Answer 20

to maintain function in the unaffected muscles as long as possible with bracing, range of motion, performing ADL’s and surgery to release contractures

Question 21

spina bifida

Answer 21

malformation of spine where lamina of vertebrae fails to close

Question 22

causes of spina bifida

Answer 22

inadequate consumption of folic acid before conception and during the first trimester
neural tube closes at 4 weeks
folic acid found in green leafy veggies, multi-vitamins

Question 23

diagnosis of spina bifida

Answer 23

most diagnosed post-natally, but can be dx in prenatal ( 16-18 weeks gestation)

Question 24

spina bifida occulta

Answer 24

only in vertebrae spinal cord and meninges are normal

no neuro problems

Question 25

spina bifida cystica 2 types

Answer 25

meningocele ( external sac encases meninges and spinal fluid, no associated neurological deficit) myelomenigocele (external sac encases meninges and spinal fluid, and nerves, most common in lumbar or lumbosacral area, location and size of the lesion determines the degree of neuro deficit, the higher the lesion the worse it is)

Question 26

clinical manifestations of myelomeningocele SB

Answer 26

``` sac like protrusion evident at birth hydrocephalus varying degrees of sensory and neurological dysfunction poor muscle tone in bladder and rectum flexion of extension contractures ```

Question 27

treatment of myelomeningocele SB

Answer 27

closure of sac withing 24-72 hours if possible, within 12-18 hours to prevent infection and preserve nerve roots done by neurosurgery and plastics prior to surgery cover area with sterile warm saline get to nicu asap, prone position

Question 28

preop nursing care of myelomeningocele SB

Answer 28

prevent infection cover sac with mosit sterile NS gauze , no diaper keep genitalia clean, may need to catheterize position prone avoid rectal temps because of poor sphincter tone

Question 29

nursing care of myelomeningocele SB

Answer 29

VS, weight, I and O, assess pain, observe incision, leave prone feed when awake and parent is holding orthopedic interventions to improve locomotion and prevent deformities post op (ROM) treatment of urinary incontinence by intermittent cathing (prevent UTI's) can learn to self cath at age 6 urinary diversions

Question 30

treatment of bowel incontinence with myelomeningocele SB

Answer 30

bowel training prevent constipation (laxatives, digital stimulation, and enemas) dietary modifications antegrade continence enema procedure

Question 31

why are SB kids at risk for developing a latex allergy?

Answer 31

surgery at an early age can cause latex allergy, kids kids in latex free environment