Peds Exam 3b - NeuroMus

Question 1

cerebral palsy

Answer 1

a problem with the brain so the brain cannot control the muscle groups as it should
either from connectoris which is when you become very jaundice and it crosses the blood brain barrier, premature birth, stroke, or shaken baby

Question 2

is CP progressive?

Answer 2

no, it is just more manageable as a infant / child

Question 3

how is CP classified

Answer 3

by type and severity

Question 4

spastic CP

Answer 4

upper motor neuron muscular weakness, persistent primitive reflex, hypertonicity
the child has a lot of contractures, drooling and is much more severe

Question 5

when is CP dx vs a stroke

Answer 5

if a child is under 2yr old, we will dx as CP but we do not confirm until after 2yrs -> will say they are delayed or need extra help

Question 6

how do we dx CP

Answer 6

-missed milestones
-persistent primitive reflexes
-abnormal muscle tone/ floppy/ grimacing
-not using both side of body equally
-early hand preference
-poor suck & tongue thrust
-uncoordinated movements
symptom based, no test

Question 7

when should an infant sit up without assists

Answer 7

8mo -> send to pt

Question 8

when does an infant develop a dominant hand

Answer 8

early would be 12-15mo

Question 9

reflexes:
rooting
moro(startle)
tonic
grasping
babinski

Answer 9

-4M
-4M
-6M
-6M
-2yr

Question 10

when should a child smile by

Answer 10

2 months

Question 11

what back alignment is commonly seen in spastic CP

Answer 11

opisthotonic posture: curved, C shaped spine

Question 12

scissoring

Answer 12

when the knees buckle together/cross over each other, commonly seen in spastic CP

Question 13

clinical manifestations of CP

Answer 13

-mental impairment
-seizures
-contractures
-incontinence
-ADHD
-non ambulatory spastic
-feeding difficulties FTT
-res, vision, oral & hearing problems

Question 14

what complications does non ambulation cause

Answer 14

-constipation
-orthopedic problems
-skin breakdown
-respiratory infections

Question 15

therapeutic mgt of CP

Answer 15

all symptom based w/ goal to promote as much independence as possible
-botox to relax muscle
-surgery for contractures
-OT + PT + ROM exercises
-braces & walkers

Question 16

medical mgt of CP

Answer 16

-seizure meds if needed
-anxiety meds if needed
-baclofen to help with spasms
-bowel regimen (enemas, schedule, suppository) training

Question 17

CP home care

Answer 17

-support family
-get them into schools & educate on inclusion at school
-use of assistive devices & exercise
-proper med admin
-prevent skin breakdown
-nutrition & play
-safety needs

Question 18

CP nursing care

Answer 18

-assessment & early ID to get into treatment
-reinforce therapeutic plan (positive & offer suggestions)
-help improve muscle tone & control
-make sure they are up to date on immunizations
best thing we can do is to get them into therapy

Question 18

muscular dystrophy

Answer 18

a genetic disorder that effects dystrophin which is what keeps our muscles intact -> the mutation leads to the muscle falling apart

Question 19

CP diet

Answer 19

-increased kcals
-gtube

Question 19

how do we name MD

Answer 19

by the muscle it first effects
duchenne is the most severe type

Question 20

how does MD progress

Answer 20

like ALS where it starts with your outer muscles and then works into the respiratory muscles which leads to death

Question 21

what is the age expectancy of MD

Answer 21

20-30s
brain is intact so they understand what is happening

Question 22

early clinical manifestations of MD

Answer 22

-onset: between 3 to 5 yrs
-rapid progression after initial normal development regression
-waddling gait
-lordosis
-positive gower’s sign

Question 23

what are some of the first signs of MD

Answer 23

difficulty running, riding bikes, and **climbing stairs**

Question 24

what is the hallmark sign of MD

Answer 24

positive gower's sign -> when a child gets down, they cannot get back up **hands on ankles and walk themselves back up d/t not having the thoracic muscle strength**

Question 25

clinical manifestation of MD during progression

Answer 25

-pseudo-hypertrophy: fatty deposits which make it look like muscles are getting bigger -muscular atrophy -lost of ability to walk by 10 to 12 yrs -cardiac or res failure -mild to mod cognitive impairment -mechanical vents around 27 yrs

Question 26

MD complications

Answer 26

-contractures -atrophy of disuse -infection **res** -obesity -cardiac problems near end stages

Question 27

MD dx

Answer 27

-symptoms -serum enzymes -muscle biopsy -EMG

Question 28

therapeutic goals of MD

Answer 28

maintain function in the unaffected muscles as long as possible **keep them walking, crutches before wheelchair**

Question 29

MD nursing care

Answer 29

**treat the symptoms** -surgery -nutrition -therapy -meds for cardiac issues -res treatments + vests + vents -palliative care

Question 30

how can we slow the progression of MD

Answer 30

corticosteroids & newer treatments that block muscle wasting and preserve muscle strength

Question 31

spina bifida

Answer 31

failure of the neural tube to develop correctly within the first 4 wks of pregnancy

Question 32

what vitamin deficiency is associated w/ SB

Answer 32

B9 vitamin **folic acid** of the mother during pregnancy

Question 33

what is a way to help prevent SB

Answer 33

if you are of child bearing years, take a good MV **starting after finding out about pregnancy is too late**

Question 34

dx of SB

Answer 34

can be done prenatally and depending on the type, prenatal surgery can be done

Question 35

birth plan of child w/ SB

Answer 35

if repairs not done prenatally, C section

Question 36

spina bifida occulta

Answer 36

defect is only in vertebrae and you might not even know you have it **no neurological impairments**

Question 37

spina bifida cystica : meningocele

Answer 37

missing vertebrae and also a protruding sac that does not contain nerves -> treatment is to push the sac back in and close **no neurological impairments**

Question 38

spina bifida cystica : myelomeningocele

Answer 38

missing vertebrae and also a protruding sac that does contain nerves causing nerve damage and **neurological deficits** , the higher the sac on the back, more damage is caused

Question 39

most children with SB have what characteristics

Answer 39

incontinent of bowel & bladders, have paralysis from the waist down, & usually see skin breakdown **fine developmental level & smart**

Question 40

nursing care for SB

Answer 40

put baby on belly -> apply non adherence sterile dressing over the sac -> bring to NICU -> sedate & intubate -> surgery

Question 41

what temp should we not take on a SB baby

Answer 41

rectal bc it can cause a prolapse

Question 42

nursing care for SB after infancy

Answer 42

**infancy is the same as normal dev baby's** -in & out caths **do not want them always in a diaper** -bowel regimen

Question 43

when can a child learn how to self cath

Answer 43

by 6 yrs old **clean not sterile so risk of infection**

Question 44

what education is important for a SB child

Answer 44

S/s of a UTI and how to prevent a UTI

Question 45

when a child has myelomeningocele, what are they more at risk for

Answer 45

hydrocephalus

Question 46

nursing care for myelomeningocele

Answer 46

- OFC & fontanel assessments -assess for signs of infections -provide adequate nutrition & hydration -latex free bc increased risk of allergy -promote normal development

Question 47

what do we want to prevent in SB children

Answer 47

renal issues & dialysis d/t increased risk of UTIs