Peds neuro.txt

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Peds neuro.txt
2013-10-06 15:16:47
Peds neuro

Peds neuro
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  1. Positional plagiocephaly is caused by what
    prolonged pressure on one side of skull (kid lying on bed)
  2. What causes microcephaly
    failure of brain development
  3. Issues with kid with Crouzon
    anterior fontanel completely closed, bluging eyes, wide-set eyes, underdeveloped jaw, cleft lip/palate
  4. Ages of head growth
    8 weeks-posterior fontanel closed; 6 months-fibrous union of suture lines and interlocking of serrated edges; 18 months-anterior fontanel closed; after 12 years-sutures unable to be separated by increased ICP
  5. When is greatest risk for shunt with hydrocephalus
    1-2 months after placement
  6. Problems with shunt
    only last 2 years, infection, developmental delays, vision impairment, vomiting, setting-sun sign, enlarged head, dilated scalp veins
  7. Hydrocephalus
    caused by imbalance of production and absorption of CSF in the ventricular system; when production is greater than absorption, CSF accumulates within the ventricular system usually under increased pressure which produces passive dilation of the ventricles
  8. Clinical manifestations of hydrocephalus infant early
    abnormal head growth, bulging fontanels, dilated scalp veins, separated sutures, macewen’s sign (cracked pot sound on percussion), thinning of skull sbones
  9. Clinical manifestations of hydrocephalus infant later
    depressed eyes, sclera above iris, sluggish pupils with unequal response to light, frontal enlargement (bossing)
  10. Clinical manifestations of hydrocephalus infancy general
    irritability, lethargy, cries when picked up, quiet when left still, change is LOC, vomiting, lower extremity spasicity, difficulty in suckling and feeding, shrill cry, cardiopulmonary embarrassment
  11. Clinical manifestations of hydrocephalus in childhood
    headache on awakening, (improvement after emesis or upright), papilledema, strabismus, EPS, irritability, lethargy, apathy, confusion, incoherence, vomiting
  12. Complications of VP shunt
    malfunction and infection; great risk 1-2 months after placement
  13. Nursing care of hydrocephalus
    look for increased ICP, do not place IV lines in scalp vein; don’t arbitrarily pump shunt; post op keep child flat; pain relief with acetaminophen w or w out codeine or opioids for severe pain
  14. If increased ICP, position will be
    elevation of HOB
  15. Priority nursing dx for SB
    potential for infection
  16. Issues with SB
    ruptured myelo, meningitis, risk for infection, needs braces and walker, PT/OT
  17. Meningocele
    encases meninges and spinal fluid but no nerve elements
  18. Myelomeningocle
    contains meninges, spinal fluid and nerves
  19. Etiology of SB
    may have genetic component
  20. SB kinds might have
    urinary dysfunction, may have to cath, fecal incontinence
  21. In SB patients it is important to observe child’s behavior in conjunction with the stimulus because limb movements can be induced in response to spinal cord reflex activity that has no connection with higher centers
  22. In SB patients monitor urinary output
    especially if diaper remains dry may indicate urinary retention; ABD assessment revealing bladder distention even with wet diaper may indicate urinary overflow in retentive bladder; head circumference is monitored daily
  23. Dressing changes of SB patient
    sterile normal saline, changed frequently (2-4 hours) and sac is closely inspected for leaks, abraisons, irritation and any signs of infection
  24. Positioning before surgery with SB patient
    prone, abduction, head turned to one side for feeding, CIC is used for urinary retention, no cuddling, caress or stroke ; prone, side lying or partial side lying
  25. Breastfeeding in SB
    keep mother pumping until infant is stable to try breastfeeding
  26. Facioscapulohumeral MD
    autosomal dominant disorder with onset in early adolescence; difficulty in raising the arms over the head, lack of facial mobility and forward slope of shoulders; slow progression and normal lifespan
  27. Limb-girdle MD
    heterogenous group of disorders with autosomal dominant and recessive inheritance whose manifestations often appear in later childhood, adolescence or early adulthood with variable but usually slow progression; weakness of proximal muscles of pelvis and shoulder girdle
  28. Duchenne MD
    most severe, most common, X-linked recessive trait, single gene defect on short arm of X chromosome; dystrophin is absent
  29. Characteristics of duchenne’s
    early onset (37- years old); progressive muscular weakness, wasting and contractures, calf muscle hypertrophy; loss of independent ambulation by 9-12 years old; slow progression; gower’s sign (walk hands up body to get up)
  30. Nursing DX for duchennes
    impaired physical mobility related to muscle destruction
  31. Common complication of duchenne’s
    obesity; mild to moderate cognitive impairment
  32. Clinical manifestations of duchenne’s
    relentless progression of muscle weakness; waddling gait; lordosis, frequent falls, enlarged muslces, mental deficiency; complications-contractures of hips, ankles and knew, cardiomyopathy, obesity/undernutrition, respiratory compromise and cardiac failure
  33. Clinical classification of CP
    motor abnormalities, associated impairments, anatomic and radiologic findings, causation and timing
  34. Four types of CP
    spastic, dyskinetic, ataxic and mixed
  35. Spastic CP
    70-80% of all CP, persistent primitive reflexes, positive Babinski sign, ankle clonus, exaggerated stretch reflexes, impairment of fine and gross motor skills
  36. Dyskinetic CP
    jerking movements characterized by dlow, wormlike movements, dystonic-slow twisting of trunk, drooling, dysarthria
  37. Ataxic CP
    wide based gait, rapid repetitive movements performed poorly
  38. Clinical manifestations of CP
    delayed gross motor development, abnormal motor performance, alterations of muscle tone, abnormal posture, reflex abnormalities, associated disabilities (seizures, sensory impairment), crouched gait, intoeing, late crawling, late sitting up, arched back, stiff posture, knee contractures, hip dislocation
  39. Should CP kids use walkers?
  40. Nursing DX for CP
    impaired physical mobility, risk for injury, pain