Term
| Chronic neuromusculoskeletal DO affect: |
|
Definition
1. brain
2. muscles
3. Joints
4. skeletal structures |
|
|
Term
| T/F Cerebral Palsy (CP) is a nonprogressive impairment of motor function |
|
Definition
TRUE- especially that of:
1. muscle control
2. Coordination
3. Posture |
|
|
Term
| _____ ____ refers to defects in intrauterine closure of the boney spine |
|
Definition
|
|
Term
| Spina Bifida is further classified as: |
|
Definition
| Spina bifida occulta & spina bifida cystica |
|
|
Term
| Spina bifida Cystica can be further classified as ____ |
|
Definition
| 1. meningocele or myelomeningocele, which are visible defects in the spine with a saclink protrusion at any leve of the spinal column at the midline of the back. |
|
|
Term
| ____ occurs when the sac contains meninges and spinal fluid |
|
Definition
|
|
Term
| _____ contains, meningies, spinal fluid, and nerves |
|
Definition
|
|
Term
| T/F Down syndrome is a chromosomal abnormality |
|
Definition
|
|
Term
| _____ group of chronic autoimmune inflammatory diseases affecting joints and other tissues. |
|
Definition
Juvenile idiopathic arthritis (JIA)
- chronic inflammation of the synovium of the joints with effusion that leads to wearing down and damage to articular cartilage |
|
|
Term
| ____ group of inherited DO with PROGRESSIVE degeneration of symmetric skeletal muscle groups |
|
Definition
|
|
Term
| The most common PERMANENT physical disability in children |
|
Definition
|
|
Term
|
Definition
abnormal perception and sensation
2. Visual, hearing, speech impairments
3. Seizures
4. Cognitive disabilities |
|
|
Term
| T/F CP manifests different in each child. |
|
Definition
True
1. most are able to perform, if not all, developmental tasks, will be able to work outside the home as adults
2. Others require complete care for their entire liives |
|
|
Term
| Exact cause of CP is not known. Prenatal, perinatal, postnatal RF are known to be associated with CP include: |
|
Definition
1. Exisiting brain anomalities, cerebral infections, headttrauma (shaken baby syndrome), anoxia of the brain
2. Premature birth
3. Multiple birth
4 .Low or Very low birth weight
5. Inabiilty of placenta to provide developing fetus with oxygen and nutrtients
6 Interruption of oxygen delivery to fetus during birth
7. Kernicterus (as a result of high bilirubin levels in neonatal period. |
|
|
Term
|
Definition
Developmental early warning signs:
1. Poor head control or absence of smiling in 3 mo
2. Difficulty dressing with diaper changes d/t stiff arms or legs during infancy & childhood
--> child may push away or arch his back
3. Floppy or limp body in infants
4. Inability to sit up without support in an 8 mo old infant
5. Use of only one side of body to play/move
6. Feeding difficulties
PAINFUL muslce spasms |
|
|
Term
|
Definition
1. Persistent primitive reflexes (moro or tonic neck)
2. Motor function showing muscle tightness or spasticity, invountary movements and disturbance in gait or moblity |
|
|
Term
SPASTIC CP
Assessment Findings |
|
Definition
1. Hypertonicity -muscle tightness or spasticity
2. Increased DTF
3. Poor control of motion, balance, posture
4. Cause impariments of fine & gross motor skills |
|
|
Term
| spastic CP may be present in all extremtieis, similar parts of body, three limbs, one limb, or one side of body |
|
Definition
1. Quadriplegia
2. Dipleia
3. Triplegia
4. Monoplegia
5. Hemiplegia
It often causes affected limbs to be SHORTER and thnner |
|
|
Term
| T/F Associated scoliosis is never present with CP |
|
Definition
|
|
Term
T/F CP
Gait may appear crouched with a scissoring motion of legs with intoeing |
|
Definition
TRUE
and use of primarily balls of feet (tip toe) |
|
|
Term
T/F Spastic CP
may be present with contractures |
|
Definition
TRUE
-especially in heel cord, hips, or knees
-wrists and elbow are in flexed position with clenching of the hand |
|
|
Term
| Which muscles are more affected in Spastic CP? |
|
Definition
| flexor, adductor, internal rotator muscles |
|
|
Term
| _____ CP: movements increase with stress but are absent with sleep. |
|
Definition
Dyskinetic CP
-normal DTF are present with absence of clonus |
|
|
Term
| ____ CP: involuntary jerking movements, slow, wormlike |
|
Definition
Athetoid
-trunk, neck, face, tongue |
|
|
Term
| ___CP: slow, twisting movements that affect TRUNK and extremities |
|
Definition
|
|
Term
____ CP
-wide based gait and difficulty with coordination
-poor ability to do repetitive movements is a result
-difficulty with quick or precise movements (buttoning a shirt)
-jerky speech pattern |
|
Definition
|
|
Term
|
Definition
MRI
-used to evaluate structures and abnormal areas nar bone
(sedation may be necessary) |
|
|
Term
|
Definition
1. Monitor Developmental Milestones
2. Need for hearing and speech eval
3. Promote independence (positive self image)
4. Fmaily coping, resources
5. ** Communicate with child directly
-use communication tools
-include family to help verify needs if pts communication is impaired |
|
|
Term
| CP child has increased oral secretions, nurs intervention : |
|
Definition
1. maintain open airway by elevating HOB
2. Ensure suction equipment is available |
|
|
Term
|
Definition
-centrally acting skeletal muscle relaxant that decreases muscle spasms & severe spasticity
*Administer PO or intrathecally via specialized, surgically implanted pump
* Monitor for effectivemenss
*MONITOR FOR: muscle weakness, increased fatigue, diaphoresis, constipation
TEACH
1. edu of expected outcomes
2. reinforce family w/ S/E of meds, when to call MD
3. instruct to see HCP q 4-6 wks to monitor effectiveness |
|
|
Term
|
Definition
skeletal muscle relaxant used to decrease muscle spasms and severe spasticity
*used in older children and adolescents
*monitor for drowsiness & fatigue
TEACH:
Educate expected responses
reinforce s/e to family |
|
|
Term
Complications of CP:
1. Aspiration of Oral Secretions |
|
Definition
1. Aspiration of oral secretions
** keep HOB elevated
** keep suction available if copious oral secretions are present or child has difficulty with swallowing
TEACH
-edu family of feeding techniques to decrease risk of aspiration
-encourage CPR classes |
|
|
Term
Complications of CP:
2. Potential for injury |
|
Definition
1. Make sure bed rails are raised
2. Pad side rais and wheelchair arms to prevent injury
3. Secure the child in moility devices
3. Adequate rest
5. helets, seat belts, other safety equipment |
|
|
Term
| T/F Neural tube defects are present at birth and affect the CNS and osseous spine |
|
Definition
|
|
Term
| In pts with spina bifida, how is the degree of neurologic dysfunction determined? |
|
Definition
| -level of sac protrusion and tissue involvment |
|
|
Term
| ____ a defect in the bony spine that is invisible to the eye and has no manifestations or problems |
|
Definition
|
|
Term
Spina Bifida Cystica:
________
-spinal defect and sac-like protrusion are present, but only spinal fluid and meningies are present in sac. |
|
Definition
Meningocele
-after sac is repaird, no further symptoms are usually seen b/c spinal nerves are not damaged |
|
|
Term
Spina Bifida cystica
_________
-impariments depend on level of spinal injury |
|
Definition
Myelomeningocele
--> from complete paralysis to slightly decreased sensation in LE |
|
|
Term
| Findings of myelomeningocele: |
|
Definition
1. Joint deformities
2. Bowel and bladder incotinence
3. Developmental delays
4. Hydrocephalus
5. High risk of latex allergy *** |
|
|
Term
| sac includes meningies, spinal fluid, and NERVES |
|
Definition
|
|
Term
Spina Bifida.
Risk Factors r/t Neural Tube Defects |
|
Definition
NTD c/b failure of the neural tube to close in the first 3-5 weeks of gestation
NTD have been linked to INSUFFICIENT FOLIC ACID in maternal diet.
An elevated AFP indicates prsence of neural tube defects |
|
|
Term
| Failure of neural tube to close in ___ to ___ weeks of gestation --neural tube defects |
|
Definition
|
|
Term
| Insufficient ____ ___ in maternal diet have been link to NTD |
|
Definition
|
|
Term
| What lab test can indicate the preence of NTD? |
|
Definition
|
|
Term
| Lumbosacral area dimpling may indicate ____ |
|
Definition
|
|
Term
| T/F bladder and bowel functionins is permanently affected in all children with spina bifida |
|
Definition
|
|
Term
| What type of allergy must be assessed for spina bifida? |
|
Definition
|
|
Term
| Assess increase in head cirucmference for spina bifida. WHY? |
|
Definition
| - may occur rapidlly with hydrocephalus until normal cranial growth is reached |
|
|
Term
Spina Bifida
T/F Cognitive Development should be assessed. |
|
Definition
TRUE
-may be permanently delayed in some children |
|
|
Term
| DX Procedures for Spina Bifida |
|
Definition
1. Maternal Serum Analysis
2. Amniocentesis
3. MRI, US, CT, myelography
4. Radioallergosorbent test (RAST) |
|
|
Term
|
Definition
-tested for serum AFP levels b/w 15-20 (16-18 wks are best)
-elevated levels will req further testing --> amniocentesis |
|
|
Term
|
Definition
| -performed to test for AFP --> elevated levels indicate NTD |
|
|
Term
|
Definition
| test used to determine brain & SC involvement |
|
|
Term
| RAST test detects for ____ |
|
Definition
presence of latex allergy
*use nonlatex gloves, catheters, other quipment to crease risk of latex allergy |
|
|
Term
| Type of dressing use to cover spina bifida sac |
|
Definition
| moist, nonadhering dressing |
|
|
Term
| Positioning of spina bifida pt until sac is repaired: |
|
Definition
PRONE
-promote skin integriy
-keep skin clean and dry
-keep pressure off bony prominences
-reposition child hourly
-assess skin under splits or braces |
|
|
Term
| ROM should be provided to extremeties |
|
Definition
TRUE
legs - may be active or passive depending on disability
*prevent contractures |
|
|
Term
| T/F Head circumference should be assessed for increased ICP or shunt failure |
|
Definition
|
|
Term
| Bladder Control Measures include |
|
Definition
1. teach clean, intermittent self catherization
2. Work with family for acceptable bladder care
4. COCA (color, odor, consistency, amount of urine) |
|
|
Term
| Monitor bowel function for : |
|
Definition
contipation and incontence
-avoid taking rectal temperatures to prevent irritaitonon of rectal spinctoer
-administer laxatives or enemas if needed |
|
|
Term
Spina Bifida meds include:
Oxybutynin chloride (Ditropan) & tolterodine (Detrol) |
|
Definition
| -antispasmodics to improve bladder capacity and continence |
|
|
Term
| Closure of myelomeningocele sac is done when? |
|
Definition
| ASAP to prevent complications of injury and infection |
|
|
Term
| Pre-OP for surgical intervention of myelomeningocele |
|
Definition
-reinforce information that was provided by HCP
-cover exposed sac with sterile, mooise 0.9% NaCl); non adherent dresing until surgery
-place newborn in a prone positioin until surgery to protect sac |
|
|
Term
| What surgical intervention would occur if hydrocephalus develops? |
|
Definition
| -insertion of surgical shunt |
|
|
Term
|
Definition
1. Measure head circumference and abdominal girth of infants
1. Observe for signs of ICP (high pitched cry, bulging fontanels, vomitting, irrtiablity)
2. AVOID positioning child on SHUNT site |
|
|
Term
| Bladder surgery for spina bifida |
|
Definition
to manage bladder dysfunction ( spasms or flaccidity)
*dysfunction, infection, bleeding, stoma care |
|
|
Term
| Orthopedic surgeries occured d/t associated potential problems of spina bifida |
|
Definition
1. clubfoot
2. scoliosis
3. other malformation of feet and legs
** monitor for infection; administer pain ; provide cast care; neruosensory deficits |
|
|
Term
| Complications of Spina Bifida |
|
Definition
1. Skin Ulcerations
2. Latex Allergy
3. Increased ICP |
|
|
Term
| Nursing Actions: Skin Ulceration |
|
Definition
=caused by prolonged pressure in one area
*monitor for skin breakdown, reposition frequently to prevent P on bony prominences
*monitor skin under splint and braces |
|
|
Term
|
Definition
Child has high risk of allergy to latex*
-(wheezing --> anaphylaxis)
Foods (bananas, avocados, kiwi, chestnuts) |
|
|
Term
| PT education to parents r/t Latex Allergy |
|
Definition
-avoid exposure
-list of household items
(disposable diapers, clearning of kitchen gloves, elastic found in clothing)
-ID s/s
-use of EpiPen |
|
|
Term
|
Definition
1. High pitched cry
2. Lethargy
3. Vomiting
4. Vomiting
5. Bulging fontanels
6. Widening cranial suture lines |
|
|
Term
|
Definition
1. HA
2. Lethargy
3. N/V
4. Double vision
5. Decreased performance of learned task
6. Decreased LOC
7. seizures |
|
|
Term
| Most likely cause of increased ICP in spina bifida |
|
Definition
|
|
Term
| Nursing Actions for Increased ICP |
|
Definition
1. Gentle movements with ROM
2.Minimize environmental stressors (noise, frequent visitors)
3. Assess and manage pain |
|
|
Term
| Clinical Manifestations of Down Syndrome |
|
Definition
1. Hypotonicity
2. Congenital heart defects
3. Congenital hypothyroidism
4. Dysfunctional immune system
5. High Risk for leukemia
IQ avg 50 |
|
|
Term
| Prenatal testing for AFP for Down Syndrome |
|
Definition
|
|
Term
| Dx procedures for Down Syndrome |
|
Definition
1. AFP
2. Chromosomal analysis |
|
|
Term
| T/F Child with downsyndrome needs holding and cuddling. |
|
Definition
TRUE --- but child may not hold back d/t hypotonia
-swaddle infants to maintain warmth and security |
|
|
Term
| Complications for Down Syndrome |
|
Definition
1. Respiratory Infections
d/t decreased muscle tone and poor drainage of mucus because of hypotonicity and associated under developed nasal bone. |
|
|
Term
| Nursing Actions: Complications of Down Syndrome - Respiratory Infections |
|
Definition
1. Rinse child's mouth with water after feeding & dry
2. Provide cool mist humidficiation and clearing of nasal passages (w/ bulb syringe if necessary) |
|
|
Term
| Down syndrome children have dry mucous membranes d/t constant mouth breathing. T/F |
|
Definition
TRUE
--> increases risk for resp infection |
|
|
Term
| Juvenile Idiopathic Arthritis (JIA) |
|
Definition
- No def dx.
-Onset of DO starts prior to 16, s/s occur one or more joints and lasts for 6 wks or longer w/ no other cause |
|
|
Term
| Peak incidence b/w 1 - 3 years of age |
|
Definition
|
|
Term
| T/F Risk factor to JIA are suscptible individuals who have an autoimmune response to internal or external triggers |
|
Definition
|
|
Term
|
Definition
1. ESR (may be elevated or not)
2. CBC with differential may demonstrate elevated WBC
3. ANA antibodies indicate an increased risk for uvities
4. Rheumatoid factor ma or may not be present |
|
|
Term
|
Definition
Radiographic Studies -X-ray
-used for baseline comparison
Xray may demonstrate synovial fluid in joint --> swelling or widening of joint |
|
|
Term
| JIA child should use splints and applied to knees, wrists, and hands |
|
Definition
| to decrease pain and prevent flexion deformities |
|
|
Term
| T/F Discourage use of pillows under knees for jIA |
|
Definition
TRUE.
use NO pillow for head |
|
|
Term
| What should be done prior to exercise for child with JIA |
|
Definition
| apply heat or warm moist packs to child's affected joints |
|
|
Term
| Provide well balanced diet that is high in _____ |
|
Definition
| fiber and contains adequate fluids to prevent constipation from immobility |
|
|
Term
|
Definition
1. NSAIDS
2. Methotrexate (Rheumatrex)
3. Corticosteroids
4. Etranercept (Enbrel) |
|
|
Term
|
Definition
Naproxen (Naprelan) ibuprofen (Motrin_ tolmetin sodium (Tolectin)
-to control PAIN and inflammation
-take w/ food to minimize gastric irritation
REPORT- changes in stool, GI discomfort, increase in bruising |
|
|
Term
| methotrexate (Rheumatrex) |
|
Definition
cytotoxic disease modifying antirheumatic drug (DMARD) that slows joint degernation and progression of rheumatoid arthiris when NSAIDS don't work alone
*** MONITOR CBC and LFT regularly
TEACH
Avoid ETOH
Use of effective BC to avoid birth defects from this medication |
|
|
Term
|
Definition
=glucocorticoids provide symptomatic relief of inflmmation and pain
*RESERVEd for life threatening complications, severe arthritis, uvetities
*Administer as eye solution, PO, or IV
* administer loweest effective dose for short term therapy, then d/c by tapering dose
TEACH
1. WT gain is common side effect
2. Monitor ht and wt
3. Advice alteration in growth is possible long term complication of corticosteroids
4. Avoid exposure to infectious agents
5. Practice healthy eating habits |
|
|
Term
|
Definition
1. Tumor necrosis factor alpha receptor blocker, another DMARD, that is used when methotrexate is NOT effective for immunosuppression
*Administer etanercept once or twice each week SQ
TEACH
-potental allergic rxn |
|
|
Term
|
Definition
Joint Deformity and functional disability
* reinforce individualized therapeutic plan of care
*encourage self care and active particpation in exercise program |
|
|
Term
|
Definition
loss of muscular strength is insidious
-developmental milestones are likely to be met until onset of disease |
|
|
Term
| Duchenne muscular dystrophy (DMD) |
|
Definition
-most common form of MD
-inherited as X-linked recessive trait
DMD has onset b/w 3-7 years of age
-life expectancy with current technology for DMD reaches into early adulthood |
|
|
Term
|
Definition
1. Symptomatic to assist with maintaining highest level of mobility
2. and preevnting complications as disease progresses. |
|
|
Term
|
Definition
family reports:
1. Delay in walking
2. Changes in gait & difficulties with climbing stair, riding a bike |
|
|
Term
|
Definition
1. Muscular weakness in LW
2. Muscular hypertrophy (calves)
3. Mild delay in motor skill development
4. Mobility with general muscle strength DECLINING OVER TIME
5. Unsteady, wide-based or waddling gait & loss of walking (by age 12)
6. Difficulty riding a tricycle, running, rising from a seated position
7. Mild cognitive delay with learning disabilities
8. CV complications |
|
|
Term
Objective Data: MDM
CV complications |
|
Definition
1. assoicated with progression of DMD
-weight loss
-increased fatigue during usual ADLS
-orthopnea |
|
|
Term
|
Definition
1. DNA analysising using peripheral blood, serum polymerase rx (PCP) for dystrophine gene mutation OR muscle tissue biopsy
2. Serum creatine prosphokinase (CK) elevated
3. Electromyography EMG |
|
|
Term
|
Definition
1. ADLS
2. Resp function
3. Cardiac function
4. Understanding of long term effects
5. Coping and support |
|
|
Term
| Maintain optimal physical function for as long as possible: |
|
Definition
1. encourage child to be independent as long as possible & to perform ADLs
2. Perform ROM exercises and provide appropriate physical activity |
|
|
Term
| Important to maintain Resp function in MDM: |
|
Definition
TRUE
1. Encourage use of incentive spirometry
2. Position child to enhance expansion of lungs
3. Oxygen
4. Noninvasive ventilation |
|
|
Term
|
Definition
Prednisone (Deltasone)
-corticosteroid that increases muscle stregth
*Monitor for infection **** |
|
|
Term
| Surgical Interventions for MDM |
|
Definition
| -r/t contracturs or instertion of gastrostomy tube or tracheostomy |
|
|
Term
|
Definition
RESPIRATORY COMPRISE
-resp muscles unable to maintain adequate resp function
*help child turn hourly/more frequently
*TCDB
*suction/ oxygen
*intermittent positive pressure ventilation & mechanically assisted cough devices
*antibiotics if Rx |
|
|
Term
| A nurse is caring for a child who has cerebral palsy. Which of the following meds should be administered to treat painful, muscle spasms? |
|
Definition
1. Backlofen (Lioresal)
2. Diazepam (Valium)
- both are muscle relaxants |
|
|
Term
| anti-spasmodic, anticholinergic medication used to treat bladder spasms |
|
Definition
| Oxybutynin chloride (Ditropan) |
|
|
Term
| cytoxic disease modfiying anti-rheumatic drug (DMARD) that slows joint progression and progression of rheumatoid arthritis |
|
Definition
Methorexate
- used for children with JIA |
|
|
Term
| corticosteroid that increases muscle strength for children with _____ and decreases inflmaation in children with ____ |
|
Definition
Prednisone
who have muscular dytrophy and decreases inflammation with JIA |
|
|
Term
| A Nurse is caring for a school-aged child who has JIA. APpropriate home care instructions: |
|
Definition
1. Sleep on firm mattress
- to help prevent joint deforminities and maintain body alighnment
2. Frequent rest periods throughout the day
-to conserve E
3. Perform ROM exercies when inflammation subsided
-to minimize pain
4. Heat or warm , moist packs
-to provide comfort and reduce stiffness
5. Ibprofen or other NSADS taken with food
to prevent GI distress |
|
|
Term
| A Nurse is completing D/C teaching with parents of an infant who have Down Syndrome. Which following interventions should be discussed with parents to prevent resp infection? |
|
Definition
1. Perform frequent hand hygine
2. Bulb syringe to remove nasal mucus
3. Keep membranes noise
4. Change position frequently to promote resp function
5. Antibiotics not used prophylactically to prevent infection |
|
|
Term
| Nurse caring for a child with muscular dystrophy. Findings to assess: |
|
Definition
1. Muscular weakness in lower extremeties
2 Unstead, wide ased or waddling gait |
|
|
Term
| purposeless, involuntary, abnormal movemtns seen in child with ___ |
|
Definition
|
|
Term
| Child with spinal defect and sac link protrusion |
|
Definition
|
|
Term
| upward slant to eyes in pts with : |
|
Definition
|
|
