T3-Blueprint: Cerebral Defects Flashcards Preview

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Flashcards in T3-Blueprint: Cerebral Defects Deck (45):
1

What is anencephaly?

Absence of brain

2

Etiology of spina bifida?

Neural tube fails to close in utero---usually lumbar area

3

What is spina bifida associated with?

Hydrocephalus

4

What is meningocele spina bifida?

Not associated with a neurological deficit

5

What is diagnosis of meningocele spina bifida?

Positive transillumination--light shines through it---no nerves in it

6

What is myelomeningocele spina bifida?

Included meninges, spinal fluid, and nerves--incomplete closure of vertebral column

7

In myelomeningocele spina bifida, what sometimes protrude as a saclike structure?

Meninges (and sometimes spinal cord)

8

What is the diagnosis of myelomeningocele SB?

Light will not shine through

"crippled children"

9

When is surgery with SB patients and why?

To prevent infection and preserve existing functions---closure within 24-48 hours of being born to prevent infection!

10

During surgery, if SB patient has hydrocephalus, what other procedure can be done?

Shunt procedure

11

What are pre-op care before SB surgery?

1. Make sure "sac" stays intact until surgery
2. Infant in prone position with hips abducted (FROG LIKE)--hips slightly elevated with a towel or sponge role to prevent tension and trauma to sac
3. Keep sac moist and warm--if surgery delayed, toughen sac
4. No fastened diapers until after repair

12

What are post op care for SB?

1. Wound care
2. Special care of site
3. Neuro assessment for increased ICP
4. Infant stimulation--show parents how to hold child without damaging surgical site

13

What is prevention of SB?

Foods that contain folic acid and vit c

14

Folic acid foods?

Leafy green vegetables--spinach

Citrus fruits-OJ

Beans, breads, cereals, rice, pastas

15

What are foods that have Vit C?

BELL PEPPERS

Dark leafy greens, broccoli

Kiwi, Citrus fruits, papayas

Tomatos, peas

16

Abnormal accumulation of fluid within ventricles

Hydrocephalus

17

What are some characteristics of hydrocephalus (7)?

1. Abnormal rate of head growth
2. Bulging fontanels
3. Thinning of skull bones
4. Dilation of scalp veins
5. Frontal enlargement of "bossing"
6. Depressed eyes: "setting sun eyes"
7. Irritability

18

What are some causes of hydrocephalus?

-Blockage/obstruction along circulatory pathway of CSF (between 3rd and 4th ventricle)

Primary: Arnold Chiari Syndrome

Secondary: Acquired

19

What are some "other" causes of hydrocephalus?

-SB: Myelomeningocele
-Meningitis
-Intraventricular hemorrhage
-Tumors
-Head trauma

20

What are S/S of hydrocephalus?

-Sunset sign (see top white of eyes)
-Increased head circumference
-High pitch cry
-Poor feeding (due to high ICP)

21

How do we manage hydrocephalus?

-Antibiotics
-If hydrocephalus due to meningitis, then fluid restrictions!
-Furosemide to decrease production of CSF

22

Birth defect in which one or more of the joints between bones of baby skull close prematurely, before baby brain is fully developed

Craniosynostosis

23

What is the most common premature closing in craniosynostosis?

Sagittal suture

24

How does craniosynostosis baby look?

"Cone head" appearance

25

What is surgery for craniosynostosis?

Excision of long bars of bones (strip craniotomy) along or parallel to fused suture

26

When is advised time for surgery for craniosynostosis?

Prior to 6 months of age for best results

27

What is main treatment for hydrocephalus?

VP shunt

28

____ are the best and most effective treatment for hydrocephalus

Shunt

29

What is a shunt?

Flexible tube placed into childs CSF system, which diverts the flow of CSF from the ventricles into another region of body (peritoneal cavity or atrium of heart)

30

Where is ventricular catheter shunt inserted and what does it drain?

Inserted into ventricles

Drains fluid from brain ventricles into atria

31

What is the peritoneal catheter?

Passes the CSF into the abdomen (peritoneal cavity)

32

Which is the preferred shunt: ventricular or peritoneal and why?

Peritoneal---longer tubing allows for growth

33

Where is atrial catheter placed?

R. atrium of heart

34

Shunt: What does the valve do?

Regulates pressure of CSF flow and prevents backward flow of SF toward ventricles

35

Shunt: What does reservoir do?

Premits MD to remove CSF samples from the shunt with a needle and syringe and to inject the chambers for testing shunt function and for treatment

36

Shunt: The reservoir allows the shunt to be ______ or pumped flushing the chamber sometimes allows the MD to determine whether the shunt is functioning properly

Flushed

37

What should patients and families know about the shunt?

The name of model of shunt pt has

Know if shunt has an on/off valve

38

Pre-op for shunt?

1. Observe signs of ICP
2. Care of externalized shunt if applicable
3. Support their large head
4. Skin care
5. Seizure precautions
6. Maintain adequate nutrition

39

Post op for shunt?

1. Positon on UNAFFECTED SIDE
2. Bed needs to be flat (shunt works better with gravity; avoid over drainage)
3. Check site for infection
4. VS, neuro checks, pain control

40

Parent teaching for hydrocephalus/shunt?

Avoid contact sports and use protective helmets

41

Complications of shunt?

1. Shunt malfunction
2. Shunt obstruction
3. Shunt infection

42

How do you know there is a shunt malfunction?

-Full, tense fontanel when upright
-Prominent scalp veins
-Swelling/redness along shunt tract
-Fever, vomit, irritable
-Sleepiness, downward eye deviation, seizures

43

How do we know there is shunt obstruction?

Recurrent symptom of hydrocephalus

Increased ICP

Fluid along shunt tract

44

How do we know there is shunt infection?

Fever and reddening/swelling along shunt tract

45

T/F: Shunt revisions are needed as the child grows

TRUE

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