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Nursing 3 Exam 4 > Unit 40 Musculoskeletal, Neuromuscular and Cognitive Disorders in Children > Flashcards

Unit 40 Musculoskeletal, Neuromuscular and Cognitive Disorders in Children Flashcards

1
Q

What are musculoskeletal disorders?

A

Scoliosis

Developmental Dysplasia of the Hip (DDH)

Juvenile Rheumatoid (Idiopathic) Arthritis

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2
Q

Describe Scoliosis.

A
  • Most common spinal deformity
  • Usually involving lateral curvature of spinal rotation causing rib asymmetry and thoracic hypokyphosis
  • Can be congenital, or can develop during infancy or childhood
  • Most common presentation is during the growth spurt of early adolescence
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3
Q

What is the therapeutic management and surgical intervention for Scoliosis?

A

Therapeutic management:

  • Brace if lateral curve 20-40 degrees (Boston brace)
  • Brace is not curative; slows the progression of the curve

Surgical intervention:
-Harrington Rod, Spinal fusion, Spinal stabilization for curves greater than 40 degrees

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4
Q

What is important for nurses regarding Scoliosis after brace or Sx? What are important post op points to remember?

A
  • Screen children
  • Observe child’s reaction to device used
  • Need to assess compliance

-Provide post-op care:
Pain priority
Logrolling, wound care, elimination, mobility

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5
Q

What are the signs and symptoms of Developmental Dysplasia of the Hip (DDH)?

A
  • Restricted abduction
  • Shorter limb affected side
  • Asymmetrical though and gluteal folds
  • Positive Ortolani-Barlow maneuver (tests used to check for DDH)
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6
Q

What is the treatment for DDH?

A
  • Pavlik harness (6months - 1 year old)
  • Skin traction
  • Surgery and Spica Cast (hard cast, can also be used for fractures)
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7
Q

Describe nursing spica cast care in the PERSON format.

A 
P
-Encourage independence 
E
-Protect cast as child urinates or has BM
-Use fracture pan as trained
R
-Turn child q2h
-Provide bedside activity
S
-Pillows under legs with heels off mattress 
-Pillow under chest if lying prone
-Do NOT turn child by grabbing abduction bar
-Keep HOB flat
-Lubricate skin
-No object put in cast for itchy skin*
-Keep cast dry*
O
-Check circulation/RR q2h
-Encourage deep breathing
N
-May need to eat in prone position with head flexed upward
-Use straws
-Stay with child while eating
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8
Q

Describe Juvenile Rheumatoid (Idiopathic) Arthritis. What is the treatment?

A
  • Chronic autoimmune inflammatory disorder affecting the joints (also skin, tissues, tendons, eyes)
  • Clinical Dx, often presents in toddlers with joint pain and physical disabilities

Treatment:

  • NSAIDS
  • methotrexate (decreases immune system function to decrease damage, however increased risk of infection)
  • Steroids
  • Physical and Occupation therapy
  • Heat and whirlpool therapy
  • Non weight bearing exercise (keeping joints mobile is crucial)
  • Biologic drugs such as: etanercept, infliximab (side effect flu like symptoms)
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9
Q

What are neuromuscular disorders in children?

A

Hydrocephalus
Spina Bifida
Cerebral Palsy
Muscular Dystrophy

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10
Q

What is Hydrocephalus?

A

Increased accumulation of CSF in ventricles which compresses the brain and increases pressure.

-Anything that increases CSF in brain

Symptoms of underlying brain disorder resulting in:

  • Impaired absorption of CSF
  • Obstruction to the flow of CSF within the ventricles
  • Destruction of brain

Basically TOO MUCH FLUID = PRESSURE IN THE BRAIN

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11
Q

Why does Hydrocephalus happen?

A
  • Abnormal development of CNS
  • Bleeding in the ventricles (premies)
  • Intrauterine infection (rubella, syphilis)

In older age from:

  • Lesions, tumors in brain
  • CNS infections
  • Bleeding from stroke, head injury
  • Trauma
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12
Q

What are the defining characteristics of Hydrocephalus in Infancy?

A
  • Irritability
  • Lethargy
  • May have changes in LOC
  • Increased BP decreased HR
  • Abnormally rapid head growth
  • Bulging anterior fontanel
  • Dilated scalp veins

(Late signs include: depressed eyes, setting sun sign- eyes, pupils sluggish with unequal response to light)

-In advance cases: difficulty sucking and feeding
, shrill pitched cry

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13
Q

What are defining characteristics of Hydrocephalus in childhood?

A

-Headache on awakening

-Extrapyramidal tracts signs (ataxia) loss of control of
body movements

  • Papilledema (optic nerve swelling because of increased pressure)
  • Confusion
  • Vomiting
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14
Q

What is the Dx for Hydrocephalus in Infants and Children?

A

Infants:
-Head circumference that crosses one or more grid lines on the chart within a period of 2-4 weeks**

Both infants and children:

  • Neurological signs that are present and progressive
  • Ultrasound on anterior fontanelle
  • CT/MRI (both require sedation)
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15
Q

What is the management of Hydrocephalus/CSF?

A
  • Treat underlying brain disorder if applicable
  • Look for early signs
  • Teach parents
  • Diagnoses usually requires Sx to prevent brain damage

**VP Shunt which provides drainage of the ‘CSF’ from the ‘ventricle’ to an extra-cranial compartment usually the ‘peritoneum’

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16
Q

What is done postoperatively for Hydrocephalus VP shunt? What are the complications?

A
  • Position flat* (for GRADUAL drainage)
  • Stay off operated side
  • Pain management
  • Observe for signs of ICP (pupil changes, LOC, BP up HR down

Infants - should see a gradual decrease in head circumference if successful

Complications: Infection, Malfunction (ICP)

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17
Q

What is Spina Bifida?

A

Congenital defect of incomplete closure of the vertebrae and *neural tube during fetal development.

  • Neural tube fails to close at 3-5 weeks gestation
  • Hydrocephalus plays a role

(Folic acid is important to take)

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18
Q

What are the types of spina bifida?

A

Occulta - defect is not visible externally (very tiny, occurs in lumbar-sacral area, little hair spot)

Cystica - visible defect with an external saclike fluid
2 types:
>Meningocele- encases meninges and spinal fluid; CFS (may have normal function)

> Myelomeningocele - contains meninges, spinal fluid and spinal cord nerves!, spinal tissue as well (spinal dysfunction likely)

19
Q

What are Spina Bifida risk factors during pregnancy?

A

Genetic mutation in FOLATE pathways

IDM (Insulin dependent diabetes)

Anticonvulsant meds

Low VitB12/ Low folic acid

Exposure to high temps and radiation

More in Caucasian women

20
Q

What is the Dx for Spina Bifida and the clinical manifestations?

A 
Fetal ultrasound (may due intrauterine Sx)
MRI

Manifestations:

  • Short, small lower extremities
  • Club feet
  • Dysplastic hips
  • Uppe extremities normal
21
Q

What are Myelomeningocele nursing considerations?

A
  • Application of sterile, moist non-adhesive dressing over the defect
  • Place child prone position in warmer
  • Check head circumference
  • Latex precautions
  • Prevent Infection
  • Anticipate Sx
22
Q

What is spasticity treated with in Spina Bifida?

A

spasticity (treat with baclofen/Lioresal)

23
Q

What are Spina bifida Bowel and GU considerations?

A
  • Brain cannot tell when rectum as stool = no signal for keeping sphincter closed
  • Constipation due to decreased activity and meds
  • Will need bowel regimen of high fiber foods/fluids, laxitives/enemas, and bowel training
  • Neuropathic bladder dysfunction, GU goal is to preserve renal function
  • Prone to UTI’s
  • May need oxybutynin or other musculotropics/antispasmodics
24
Q

What are Spina Bifida orthopedic problems and cognitive challenges?

A

Orthopedic problems:

  • Paralysis of lower extremities (no feeling below defect)
  • Contractures (*prevent them!)
  • Scoliosis/kyphosis
  • Dislocated hips/club foot
  • Obesity can result from mobility challenges (lower their BMI*)

Cognitive problems:

  • Difficulty with time management
  • Difficulty with planning skills/abstraction
  • May have leaning disabilities/visual perception challenges/attention challenges
25
Q

What is the prevention of Neural Tube Defects?

A

Folic acid 0.4 mg prevents 50-70% of neural tube defects

All women of childbearing age should take!

Neural tube closes often before women realizes she’s pregnant.

26
Q

What is Cerebral Palsy (CP)? What can accompany it?

A
  • Early onset, NON-progressive impaired muscle movements and posture
  • Coordination deficits
  • May be accompanied by language deficits, intellectual problems, and swallowing difficulties
  • Most common physical disability in childhood
27
Q

Why does CP happen?

A
  • Birth trauma
  • After birth could be various congenital intrauterine insults to brain
  • Unexplained reasons
  • Premie status
  • Low birth weight
  • Multiples
  • Breech
  • Maternal factors such as: thyroid, seizures, infections, drug use
28
Q

What are the clinical classifications of CP?

A

Spastic: constantly contracted/tight (premies) painful

Dyskinetic: athetoid, slow involuntary writhing (shakey movements), difficulty controlling voluntary movements, can be hypotonic

Ataxic: cerebellar injury - coordination, depth perception, balance, tremors effected

Mixed:

29
Q

What is the Diagnosis for CP?

A

May be missed at birth!

  • Missing developmental milestones*
  • Abnormal reflexes (may keep primitive ones)
30
Q

What is the CP treatment?

A

Treat EARLY for best outcomes/reach child’s potential

-Meds for seizures
-Meds for spasms:
baclofen
botox injections if an isolated muscle spasms.

  • Orthotics for balance/body support
  • Mechanical aids: utensils/ communication devices
  • Speech/behavior therapy
  • Sx if needed to decrease spasticity and contractures
31
Q

What are Cerebral Palsy medical problems?

A

Seizures:

  • can cause more brain damage
  • often high doses of AED’s (antiepileptic drugs)

Aspiration:

  • inability to cough/clear secretions
  • often have GT or JT for meds/feeding

Incontinence

Constipation: from inactivity and meds

Wounds: from pressure of same positions

Osteopenia: because lack of weight bearing

32
Q

What is important socially regarding cerebral palsy?

A

Physically impaired NOT socially!

  • Don’t assume that they are also cognitively impaired!
  • They understand, but can’t communicate verbally
  • Speak TO them, not AROUND them
  • Use normal tone of voice
33
Q

What are the nursing care/therapeutic interventions for CP?

A
  • Care is preventative for complications and symptomatic
  • maximize quality of life**
  • Address families needs
  • May need help with ADL’s
34
Q

What is Duchene’s Muscular Dystrophy (DMD)? who is exclusively effected and who are the carriers?

A

An inherited disorder of progressive muscular weakness, males effected exclusively.

  • sex linked recessive
  • prenatal Dx
  • lack Dystrophin, protein found in skeletal muscle
  • Females are carriers
  • Deadly
  • Family hx present in more than half of the cases
35
Q

What are the defining characteristics of Duchene’s Muscular Dystrophy (DMD)?

A
  • Early onset usually 3-5 years
  • Progressive muscular weakness, wasting and contractures
  • *Calf muscle hypertrophy
  • Loss of independent ambulation by 9-11 years old
  • May have cardiorespiratory involvement in adolescence (palpations, irregular HR)
  • Relentless progression until death from respiratory or cardiac failure
  • Gower’s sign
36
Q

What is Gower’s sign?

A

Patient uses their hands and arms to “walk” up their own body from a squatting position due to lack of hip and thigh muscle strength.

37
Q

How is the dx for DMD made? What is the therapeutic management?

A

-Dx is made by muscle biopsy, EMG and a serum enzyme level

Therapeutic management:

  • Maintain function in unaffected muscles for as long as possible
  • Sx to release contractures deformities
  • Bracing
  • Help with performing ADL’s
  • Genetic counseling for family
38
Q

What are Cognitive Disorders? What is the etiology?

A

Cognitive impairment, intellectual disability, developmental disability or delayed
(Down syndrome is example)

Etiology:
Hereditary/chromosomal
Early fetal alterations
Acquired childhood diseases
Environmental factors
39
Q

Describe Cognitive Impairment/Developmental Disability.

A
  • Intellectual functioning IQ 70-75 or below
  • Functional impairment in at least 2 of 10 adaptive skills
  • Dx at 18 years of age or younger
  • Social behaviors immature or outside norm for age
40
Q

What is the difference between chronological age and developmental age? Which should be considered when developing care plan?

A

Chronological age - actual age

Developmental/Functional - Age group where skills and milestones are met, etc
*(Key for care plans)

41
Q

What is Down Syndrome?

A

Most common disorder causing moderate to severe Developmental Disability.

  • Trisomy 21
  • Higher incident with advanced maternal age
  • Etiology unknown
42
Q

What is the Diagnoses for Down Syndrome? What are they are higher risk for?

A
  • Chromosome analysis will confirm the genetic abnormality
  • Congenital heart defects are at a higher incident for them
  • Upper respiratory infections at a higher risk for them
  • Hypotonicity of best and abdominal muscles
  • Increased incidence leukemia
43
Q

What are the characteristics of down syndrome?

A

Musculoskeletal :

  • short stature
  • muscle weakness
  • hypotonia

Head:

  • flat occiput
  • seperated saggital suture

Eyes:

  • Oblique fissures (slant)
  • Short sparse eyelashes

Ears:
-Low set and small

Mouth:
-Protruding tongue

Hands:
-Simian crease (line going through entire hand)

44
Q

What is first priority regarding parents and them finding out they have a child with a cognitive disorder?

A
  • First priority is to have parents express their feelings about the loss of a normal child
  • Feelings of grief, anger, guilt, and acceptance are part of the process all parents must go through
  • Encourage parents to be involved in meetings parents with similar children

Nursing 3 Exam 4 (9 decks)

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