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Week 11 - Peds Exam 3
Cerebral, Neuromuscular, and MSK dysfunction
28
Nursing
Undergraduate 3
11/11/2013

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Term
Leggs Calve Perthes
Definition
-Self-limiting disorder where there is aseptic necrosis of the femoral head. Cause is unknown.
-Children 2-12 years, but most common in boys between 4-8 years. Most affected kids have a skeletal age below their chronological age.
-Has an insidious onset. May have limp on affected side or hip soreness, ache, or stiffness
-4 radiographic stages
Term
Hip spica cast
Definition
-Cast that immobilizes the hip
-Complete evaporation of water froma hip spica cast made with older type plaster materials can take 24-48 hours while fiberglass dries in minutes.
Term
Interventions for hip spica cast
Definition
-Turn the child at least every 2 hours to help cast dry evenly
-Body part should be elevated to prevent compartment syndrome
-Sensation and movement should be checked below the cast
-The prone position should be used for self-feeding from a small table placed next to dining room table
Term
What is causing a marked increase in skeletal injury in school age and adolescent children?
Definition
-Increased amount of training done by young athletes leads to overuse injuries. Overuse injuries account for nearly half of all injuries evaluated in pediatric sports medicine.
Term
Major differences in pediatric MSK system
Definition
-Children's bones are less dense, more porous and pliable (bones break easier, and will bow and cause torus or buckle fractures)
-Childrens bones grow from an epiphyseal plate (damaging growth plate can affect growth)
-Ligaments and tendons are stronger than bones until puberty (broken bones more common than sprains)
-Fractures heal much quicker in children than adults
-Normal bone remodeling process can correct malalignment making near anatomic reductions less important in children than adults
Term
Treatment for developmental dysplasia of the hip in infants to 6 months
Definition
The hip joint is maintained by dynamic splinting in a safe position with the proximal femur centered on the acetabulum in an attitude of flexium. Pavlik harness is most widely used. It is worn continuously and works the hip into a more abducted, reduced position. If it difficult to maintain stable reduction then a hip spica cast is applied.
Term
What is the treatment for developmental dysplasia of the hip in infants greater than 6 months to 18 months
Definition
Dislocation is usually not recognized until child stands and walks. A surgical closed reduction is performed and the child is placed in a spica cast for 12 weeks.
Term
Club foot
Definition
Common birth defect, occurs in males twice as much as females. Can involve one foot or both. Affected foot looks as though it has been turned inward at the ankles.
Term
Gold standard treatment for moderate to severe scoliosis?
Definition
Bracing is the gold standard for moderate curvatures in growing children
Term
Hematogenous osteomyelitis
Definition
When a bloodborne bacterium causes an infection in the bone. Most often occurs due to infected lesions, upper respiratory tract infections, otitis media, tonsilitis, abscessed teeth, pyelonephritis, and infected burns.
Term
Cerebral palsy
Definition
Group of permanent disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain.
Term
Most common type of cerebral palsy
Definition
"Spastic CP": represents an upper motor neuron muscular weakness. Characteristic physical signs are increased stretch reflexes, decreased muscle tone, and weakness.
Term
Cerebral palsy is defined as being non-progressive. What does this mean?
Definition
A chronic, nonprogressive disease is considered a static condition. The neurological disturbances occurred in the developing fetus and are not acquired otherwise. CP itself can be considered non-degenerative.
Term
What is the prognosis for children having cerebral palsy?
Definition
Depends on type and severity of the condition.
-Children with mild-moderate involvement (85%) have the capability of achieving ambulation between the ages of 2 and 7 years.
-30-50% of children with CP have significant cognitive impairments, and an even higher percentage have mild cognitive impairments, and an even higher percentage have mild cognitive and learning deficits.
Term
When a clinician states that the child has spina bifida, what are they referring to?
Definition
Spina bifida myelomeningocele
Term
Difference between meningocele and myelomeningocele spina bifida?
Definition
Spina bifida meningocele is a visible defect defect involving the failure of the osseous spine to close due to an external saclike protrusion that encases the meneges and spinal fluid but no neural elements. Spina bifida myelomeningocele has the same definition except the saclike protrusion contains the meninges, spinal fluid, and nerves.
Term
Arnold Chiari Malformation
Definition
It is a consolation of neurologic findings, the most important of which is herniation of the hindbrain down into the cervical portion of the neck. This interferes with cerebrospinal fluid circulation and is the principle driver in the cause for hydrocephalus.
Term
Ventroperitoneal shunt
Definition
If hydrocephalus is causing the baby to be symptomatic, a neurosurgeon will put a shunt in through the skull into the ventrical of the brain to decompress the fluid in the brain caused by hydrocephalus. The shunt will then be threaded under the skin, over the chest and down to the abdomen.
Term
Why are children with spina bifida more prone to latex allergies?
Definition
Because of repeated exposure to latex products during surgery and procedures. Therefore, such children should not be exposed to latex products from birth onward to minimize the occurrence of latex hypersensitivity.
Term
Nursing care of the unconcious child
Definition
Respiratory
-Adequate airway always priority
-CO2 potent vasodilating effect
-Positioning to prevent aspiration
-Frequent suctioning
Nutrition and hydration
-Ensure not to overhydrate
Medications
-Cause of unconsciousness depends on drugs: seizure-anti epileptics; cerebral edema-osmotic diuretics
Thermoregulation
-Medically induced hypothermia decreases metabolic demands
Term
3 major causes of brain damage in children
Definition
-Falls
-Motor vehicle accidents
-Bicycle injuries
Term
Bacterial meningitis
Definition
-Lumbar puncture to diagnose
-Pain managment especially in first 24 hours, Tylenol with codeine often given
-Safety measures I.e. seizure precautions
-Very specific and focused Neurological assessments to including vital signs
-Fluid and nourishment determined by child's status
Term
Seizures
Definition
-Most common and treatable disorder in children and can occur with a wide variety of conditions involving the CNS
-Epilepsy: a condition with two or more unprovoked seizures
-Seizures: symptom of underlying disease, head trauma, meningitis, hypoxia
Term
Diagnosing and treatment of seizures
Definition
-EEG: most useful diagnostic tool
-Drug therapy: raise the threshold for neuronal excitability
-Other treatments: Diet changes, nerve stimulation, surgery
Term
Febrile seizures
Definition
-Cause uncertain
-Most often seen in children 12-30 months
-Occur during temperature rise
-Usually do not last long
-Usually no antiepileptic medication but rather antipyretic therapy
Term
Hydrocephalus
Definition
-Imbalance of production and absorption of CSF in the ventricular system
-Dandy-Walker and Arnold-Chiari malformations: complex disorders that have difference causes and mechanisms and begin at different times in the embryonic period.
Term
Dandy-walker syndrome
Definition
Congenital brain malformation involving the cerebellum
Term
Nursing care management of ventralperitoneal shunt
Definition
-Monitoring for increased intracranial pressure
-Positioned on unoperative side of shunt
-Often kept flat to avoid too rapid reduction of intracranial fluid
-Observe for abdominal distension
-Accurate I&O
-Teaching
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