NUR331 Exam 3b Flashcards
1
Q
cerebral palsy
A
- def - group of permanent disorders of the development of movement and posture causing activity limitation that are because of nonprogressive disturbances that occurred in the development of the fetal brain
- nothing is wrong with the muscles, just the brain’s ability to use the muscles
- etiology - brain bleed, premature, shaken baby syndrome, stroke, umbilical cord wrapped around neck, infection during pregnancy, etc.
- classified by motor abnormalities, associated impairments, anatomic and radiologic findings, and timing
- patho - narrow gyri, wider sulci, anoxia causes natural death, or brain did not form properly
- congenital causes - maternal infections, jaundice, Rh incompatibility with mom, or disruption in first 2 years of life
2
Q
CP diagnosis, CM, motor abnormalities
A
- diagnosis - neuro exam, persistent primitive reflexes, failure to meet developmental milestones, imaging (CT, MRI, ultrasound, serum testing, EEG), rule out other brain lesions
- cannot be confirmed until 2 years of age
- CM - infant doesn’t reach developmental milestones, may not present until second half of first year of life, motor abnormalities, abnormal muscle tone, associated impairments, facial grimacing, writhing movements, ataxia
- gross motor abnormalities - cannot sit up by 8 months, floppy or limp posture, stiff arms and legs, uses one side of body to crawl
- behavioral abnormalities - failure to smile by 2 months, feeding difficulties, tongue thrust after 6 months, extreme irritability or crying
- hypotonic movements - up to 1 year
- hypertonic movements - resistance to passive ROM, increased DTR, hips higher than trunk when prone, spine deformities, contractures
- associated abnormalities - seizures, mental impairment, incontinence, ADHD, consequences of non-ambulatory status, feeding difficulties, affects chewing/swallowing/talking, respiratory problems, impaired hearing, oral disorders,
3
Q
types of CP movement disorders
A
- spastic - upper motor neuron muscular weakness, scissoring*
- dyskinetic - often have chorea (jerking movements that are involuntary and irregular), worm movement, writhing movement
- ataxic - unsteady shaking movements, wide based gait, poor balance and coordination
- mixed - combo of other types
4
Q
management of CP
A
- PT/OT/ST
- assistive mobility devices
- surgery
- meds to help associated symptoms - antiepileptics, stimulants, botox, Anti anxiolytics, bowel regimen
- prevent injury, side rails on bed, no scatter rugs
- NC - frequent rest periods, meet nutritional needs, routine skin assessment, immunizations, safety precautions
- respite care
5
Q
muscular dystrophy
A
- mom passes to male offspring or new mutation where mom is not a carrier
- mutation in the gene that encodes dystrophin (protein product in the muscles, absence leads to muscle degeneration)
- onset between 3-5 (have progressed normally until then), rapid progressive muscular degeneration after initial normal development
- signs - waddling gate, lordosis, positive gower’s sign (use legs to stand up)
6
Q
CM of MD
A
- pseudohypertrophy - fatty infiltration
- muscular atrophy - ability to ambulate is lost by 10-12
- facial and respiratory muscles atrophy
- cardiac or respiratory failure
- mild to moderate cognitive impairment
- median age is 27 with mechanical ventilation (ALS for kids)
7
Q
complications of MD
A
- contractures of the hips, knees, ankles, and spine
- atrophy of disuse caused by inactivity
- infections - respiratory from immobility
- obesity, may not decrease life expectancy
- cardiac manifestations occur in later stages
8
Q
dx of MD
A
- clinical manifestations with diagnostic evaluation
- serum enzymes
- muscle biopsy
- EMG
9
Q
treatment of MD
A
- primary goal - maintain function in unaffected muscles as long as possible
- treat complications - PT/OT, nutrition, respiratory failure, cardiac failure
- experimental treatments to slow progression - corticosteroids, CT GaINAc transferase, glutamine and creatine monohydrate
- palliative care
10
Q
spina bifida
A
- malformation in the spine in which the posterior portion of the lamina of vertebrae fails to close, failure of the neural plate to develop into a tubular structure
- could be due to inadequate consumption of B vitamin folic acid during first trimester
- neural tube fails to close during 4th week of pregnancy
- dx - mostly prenatally, diagnose based on imaging of meningeal sac, and neuro eval
11
Q
types of spina bifida
A
- spina bifida occulta - defect is only in vertebrae (spinal cord and meninges normal), generally have no neuro involvement, may see skin depression, dimple, or tuft hair in lumbosacral area of newborn
- spina bifida cystica - external sac encases meninges and spinal fluid, not associated with neuro deficit, OR encases meninges, spinal fluid, and nerves
12
Q
myelomeningecele
A
- CM - sac like protrusion evident at birth, hydrocephalus - (accumulation of fluid in ventricles), varying degree of sensory and neuro dysfunction, poor tone in bladder, poor muscle tone in rectum, flexion or extension contractures
- treatment - surgery, closure of sac within 24-72hrs
- nursing care - prevent infection in preop (sterile covering), avoid taking rectal temps
- NC - VS, weight, IO, assess pain, observe incision, prone, feed when awake/parents hold, ortho eval, treat urinary incontinence, treat bowel incontinence (antegrade continence enema procedure), accurate measurement of head circumference and fontanel, assess for s/s of infection, latex free environment*, promote normal development
13
Q
criteria for cognitive impairment
A
- at least 2 domains
- communication, self-care, home living, social skills, use of community resources, self-direction, health and safety, functional academics, leisure, work
- impairment is mild or severe
14
Q
NC for children with cognitive impairments
A
- identify early signs of CI (ex. - unable to maintain eye contact)
- work with school system to develop educational plan
- educate child and family - only give one or two tasks at a time, teach fading and shaping
- promote optimum development (communication, sexuality, play)
- promote independent self-help skills
15
Q
trisomy 21 (down syndrome) - definition, RF, and CM
A
- 3rd copy of 21st chromosome
- risk factor - maternal age over 35
- CM - inner epicanthel folds, depressed nasal bridge, small nose, excess skin on back of neck, high arched palate, large protruding tongue, wide space between first and second toe, decreased muscle tone, lower intelligence, social developmental delay, cognitive anomalies, sensory problems, reduced height and obesity, delayed sexual development
- associated illnesses - feeding difficulties, obesity, congenital heart disease, acute otitis media, leukemia, hypothyroidism, upper respiratory infections
16
Q
DS nursing care
A
family support, assist family in preventing physical problems, promote child’s developmental progress, assist with genetic counseling
17
Q
ASD - RF, CM criteria
A
- unknown cause
- RF - male
- CM - demonstrate core deficits in social interactions, communication, and behavior
18
Q
ASD social interaction deficits
A
- abnormal eye contact often earliest sign
- failure to smile
- failure to orient to name
- lack of imitation
- lack of interactive play
- lack of gesture use such as pointing or waving
19
Q
ASD - associated illnesses
A
- GI problems
- epilepsy
- feeding issues
- disrupted sleep
- ADHD
- anxiety
- depression
- OCD
- schizophrenia
- bipolar disorder
