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neuro/newbrn
neuro/musculo skeletal comp.-hydrocephalus, cleft lip,club foot, hyp dysplasia
| Question | Answer |
|---|---|
| Condition caused by an imbalance in the production and absorption of CSF in the ventricles of the brain. | Hydrocephalus |
| May be congenital or acquired. Symptom of an underlying brain disorder classified as | noncommunicating or communicating. |
| May be a result of a preexisting developmental defect such as | Arnold-Chiari malformation or Dandy-Walker Syndrome. |
| Arnold-Chiari Malformation | Congenital anomaly in which the cerebellum and medulla oblongata extend down through the foramen magnum. |
| Dandy-Walker Syndrome | When the enlarged head involves a prominent occiput, the condition usually involves an atresia of the foramen of Lushka and Magendie. |
| Hydrocephalus Dx Evaluation | In infancy Head circumference. Associated neurologic signs that are present and progressive.Increased ICP. Specific manifestations are related to the focal lesionIn older children. Primary diagnostic tools are CT and MRI. |
| Hydrocephalus Therapeutic Management | Relief of hydrocephalus. Treatment of complications. Management of problems related to the effect of the disorder on psychomotor development.Direct removal of an obstruction (such as tumor). Placement of a shunt. |
| Ventriculoperitoneal Shunt preoperative nursing care | Observe carefully for signs of increasing intracranial pressure.Measure the head circumference daily at the point of largest measurement and recordGently palpate fontanels and suture lines for size and signs of bulging, tenseness and separation. |
| how does the nurse prevent pressure sores? | Change position of the infant frequently |
| How do parents help care of the shunt for the infant? | Teach parents how and when to "pump" the shunt by pressing against the valve behind the ear. |
| what supports the family during this time for the infant? | Nat’l Hydrocephalus Foundation and Hydrocephalus Assoc provide info for families). |
| what are neural tube defects | Abnormalities that are derived from the embryonic neural tube. Normally the spinal cord and cauda equine are encased in a protective sheath of bone and meninges. Failure of neural tube closure produces defects of varying degrees. |
| Spina Bifida is Categorized into what two types? | Spina Bifida Occulta. Spina Bifida Cystica. |
| Spina Bifida Occulta | Failure of the vertebral arch to close, usually without other anomalies. It is seen by a dimple on the back, which may have a tuft of hair over it. |
| Spina Bifida Cystica | Visible defect with an external saclike. protrusion. Are two major forms:Meningocele, Meningomyelocele |
| Meningocele | meninges and spinal fluid. |
| Meningomyelocele | contains meninges, nerve roots, spinal cord, and spinal fluid. |
| Neural Tube Defects Diagnostic Evaluation | MRI. Ultrasound. CT. Myelography. Prenatal detection by elevated AFP, & fetal ultrasound. CVS: chorionic villus sampling. |
| Neural Tube Defects Nursing Considerations | Note position and covering of the defect at birth. Observe movement below the defect. Examine for a relaxed anus and dribbling of stool and urine. Care of the sac. Positioning. |
| Cleft Lip and Cleft Palate | Facial malformations that occur during embryonic development. Most common congenital deformities of the head and neck. Occur together or separately, on one or both sides. |
| May be exposure to teratogens | Alcohol. Smoking (twice the risk). Certain medications. |
| CL / CP Diagnostic Evaluation | Prenatal diagnosis with ultrasound is not reliable until the soft tissues of the fetal face can be visualized at 13 to 14 weeks. |
| what can be done to ease feeding? | Feed infant in an upright position because milk enters nasal passages through the palate, causing an increased tendency to aspirate. Feed slowly with frequent stops to burp because infants tend to swallow excessive air. |
| Postoperative Care Cleft Lip | Position infant on back or side postoperatively. Place infant in arm restraints. Prevent infant from sucking and crying. Avoid injury to operative site. Prevent infection/scarring. Elbow restraints. |
| Post-op Care Cleft Palate | Lie on abdomen. May resume feeding. Oral packing. Clear to full liquids. |
| Parent Education | Teach parents feeding techniques. Prevent infections. Importance of regular follow-up. Psychosocial support. Developmental delays. |
| Congenital Clubfoot | Talipes: varus, valgus, equines, calcaneous |
| Talipes varus | Talipes varus: an inversion or bending inward. |
| Talipes valgus: | an eversion or bending outward. |
| Talipes equines | Talipes equines: plantar flexion in which the toes are lower than the heel. |
| Talipes calcaneus | Talipes calcaneus: dorsiflexion, in which the toes are higher than the heel. |
| Congenital Clubfoot Incidence | Most cases are a combo of these positions. The most frequently occurring type (95% of cases) is talipes equinovarus (TEV).Incidence is 1 to 2 per 1000 live births. Bilateral clubfeet occur in 50% of the cases. |
| Congenital Clubfoot Cause | Abnormal positioning and restricted movement in utero. Arrested or abnormal embryonic development. |
| Goal of treatment is to achieve a painless, plantigrade, and stable foot. what are tree stages of treatment? | Correction of the deformity. Maintenance of the correction until normal muscle balance is regained. Follow-up observation to avert possible recurrence of the deformity. |
| How is casting used to treat clubfoot? | Serial casting is begun shortly after birth, before discharge from the nursery. Manipulation and casting are repeated frequently (weekly) to accommodate rapid growth usually within 8 to 12 weeks. 3mos without normal allignment = surgery b/w 6-12 mos |
| Developmental Hip Dysplasia | abnormalities, in which there is a shallow acetabulum, subluxation, or dislocation. may develop at any time during fetal life, infancy, or childhood. |
| Developmental Hip Dysplasia Incidence | Incidence is approx. 10 per 1000 live births. 60% of patients are girls. Caucasian children have a higher incidence than other groups. |
| Risk of DDH may be: | Gender. Birth order. Family history. Intrauterine position. Delivery type. Joint laxity. Postnatal positioning. |
| three degrees of DDH | Acetabular dysplasia (preluxation), subluxation, dislocation |
| Acetabular dysplasia | Mildest form in which there is neither subluxation nor dislocation. Femoral head remains in the acetabulum. |
| Subluxation: | Largest percentage of DDH implies incomplete dislocation of the hip. Femoral head remains in contact with acetabulum, but a stretched capsule and ligamentum teres cause the head to be partially displaced. |
| Dislocation: | femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim. |
| Diagnostic Evaluation | Ortolani or Barlow tests demonstrate the tendency for subluxation and dislocation. shortening of the limb on the affected side (Galeazzi sign) asymmetric thigh and gluteal folds and broadening of the perineum (in bilateral dislocation). |
| Barlow’s Test & Ortolani’s Sign | Maneuvers used during the physical examination to assess the hips for dysplasia. (Left) Ortolani maneuver. (Right) Barlow maneuver. |
| Newborn to Age 6 months Treatment | Harness is worn continuously until hip is proved stable on clinical X-ray exam, usually in about 3 to 5 months.traction) are used to slowly and gently stretch hip to full abduction, spica cast changed for growth of child. |
| Ages 6 to 18 months Treatment | not recognized until child begins to stand and walk. Gradual reduction by traction3 weeks. closed reduction of the hip using general anesthesia, hip spica for 2 to 4 months |
Created by:
redhawk101
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