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Nursing 3 Exam 2

Congenital Disorders

QuestionAnswer
One of the most common congenital anomalies of the central nervous sytem... spina bifida (myelomeningocele)
spina bifida (myelomeningocele) neural tube defect, incomplete formation of the bones of the spinal cord, spinal cord and meninges located outside of the body in a sac on the babys back
spina bifida (myelomeningocele) can cause... nerve damage, clinical manifestations depend on location of defect, most common effects are: limited use of lower extremities, bowel and bladder limitations, average mental capacity
what is needed in order to help prevent neural tube defects in pregnant pt's... folic acid
nursig care of newborn pre-op with myelomeningocele (spina bifida)... keep sac covered w/sterile saline soaked dressing, monitor for leakage of CSF, measure head circumference, place infant in prone position w/hips slightly flexed and legs abducted to minimize tension on sac, meticulously clean buttock and genitalia
nursing care of newborn post op with myelomeningocele (spina bifida)... monitor vitals, monitor for s/s of infection(meningitis), inspect surgical site for CSF leakage, position in prone or side-lying position, perform gentle ROM exercises, offer support to parents
hydrocephalus may be congenital or acquired, commonly associated with myelomeningocele
hydrocephalus disorder involving CSF absorption or flow where extra CSF in ventricles of brain
2 types of hydrocephalus communicating(absorption) and noncommunicating(blockage)
noncommunicating hydrocephalus blockage so CSF isnt flowing correctly, type thats more common in children
communicating hydrocephalus CSF is able to flow freely but its not getting absorbed
hydrocephalus assessment congenital, early signs... rapidly increasing head circumference,bulging fontanels,split sutures,protrusion of frontal area(face is disproportionate for skull size), sun setting eyes, prominent,distended scalp veins,irritability or lethargy,decline in LOC,difficulty holding head up
hydrocephalus assessment late signs... apnea, shrill,high pitched cry, difficulty swallowing or feeding, vomitting, cardiopulmonary depression(severe cases)
increased intracranial pressure must be treated right away to prevent... death
treatment for hydrocephalus removal of obstruction(surgical removal of tumor), diverting excess CSF(ventriculoperitoneal shunt)
ventriculoperitoneal shunt initial shunt is placed in infancy, antibiotics post op as prophylaxis to reduce shunt infection
potential complications from the shunt or surgery... infection, shunt malfunction,bleeding,fever,vomiting,irritability,redness,swelling along the tubing,decreased alertness or lethargy, these complications require prompt medical evaluation
nursing care for infant with hydrocephalus assess for signs of shunt failure and infection
shunt failure... increased intracranial pressure,measure infant head circumference daily
infection of shunt... #1 problem(mostly in 1st 2months of placement), changes in LOC, irritability, low grade fever
hydrocephalus nursing care... provide pre and post op care and teaching, prevent skin breakdown, small frequet feedings w/freq burps(prone to vomiting), place in flat position to prevent rapid CSF drainage post op, provide emotional support to parents
classification of common congenital heart defects... increased pulmonary blood flow and decreased pulmonary blood flow
Increased pulmonary blood flow heart defects include... patent ductus arteriosis, atrial septal defect, Ventricular septal defect
Decreased pulmonary blood flow heart defects include... tetralogy of fallot
Three most common manifestations of cardiac defects... 1.cyanosis 2.detectable heart murmur 3.signs of congestive heart failure:tachycardia,tachypnea,diaphoresis
usually 1st sign of heart defect? detectable heart murmur
Increased pulmonary blood flow... connection between left & right side of the heart, blood flows btwn the L & R side of the heart...pressure on the L side increases...so blood shunts to the R...results in increased amts of blood being pumped to the lungs
Patent ductus arteriosus... usually closes 10-12 hrs after birth, opening btwn aorta & pulmonary artery, remains open due to low O2 levels
PDA... remains open so more blood to flow to lungs, increased respiratory effort, cardon dioxide retention, bounding femoral pulses
Treatment of PDA indomethacin(prostaglandin inhibitor,in utero helps ductus vasodilate), surgical ligation(tie or clip vessel),occlusion coil(occludes opening),O2 therapy,blood transfusion,fluid restriction & diuretics
Atrial septal defect... opening in the atrial septum that allows L to R shunting of blood,usuall no sympoms w/small ASD, Lg ASD-CHF,easy tiring,poor growth,spontaneous closure may occur by 4yrs old, FTT, URI,& poor exercise tolerance, usually closes 1st 1-2 hrs
ASD... mixing of oxygenated and deoxygenated blood
Ventricular septal defect... most common congenital heart defect,opening in the ventricular septum, blood is hunted from L into pulmonary artery, increased pulmonary blood flow, R ventricular hypertrophy
VSD clinical manifestations... rapid respirations,growth failure,feeding difficulties,CHF at 6wks to 2 months of age
VSD treatment... some spontaneously close, lanoxin, diuretics, surgical closure
tetralogy of fallot... decreases pulmonary blood flow and is the most common cyanotic heart defect
4 disorders of tetralogy of fallot... 1.pulmonary stenosis(narrowing of pulmonary artery) 2.overriding aorta 3.Rt ventricular hypertrophy 4.ventricular septal defect(VSD)
Aorta has opening to L and R ventricle in this disorder of the heart... tetralogy of fallot
assessment for someone with tetralogy of fallot... cyanosis shortly after birth,dypsnea,loud murmur,cyanosis doesnt respond to O2(classic sign),crying or feeding increases cyanosis and resp distress
Helps to relieve with tetralogy of fallot... knee chest position or squatting, relieves dyspnea, O2 therapy, morphine(vasodilator) & propanolol(beta blocker) IV, surgical repair often before 6months of age
Created by: jbittner
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