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unit 4

neurological system def created before birth - neurons created only 100 days of gestation; during remainder of pregnancy spread - no new neurons after 6 month of fetal life - nerve cells do not regenerate
Spina Bifida failure of posterior laminae of vertebrae to close - leaves opening through which spinal meninges & spinal cord may protrude - genetic link; linked to deficiency of folic acid
Spina Bifida types (2) spina bifida occulta & spina bifida cystica
spina bifida occulta very mild form - no visible deformity; affects L5S1 area - skin in tact, may have dimple
spina bifida cystica (2 degrees) meningocele & myelomeningocele
mengingocele def fluid filled sack; herniation of meninges, no nerve routes involved, no paralysis or sensory lost below point; could rupture
myelomeningocele def nerve routes embedded in cyst/sac; no sensation below sac; paralysis - no muscle control, no sphincter control below sac/defect
spina bifida Dx, Tx dx - AFP to test for down syndrome (13-16 wks) & US - not unusual to have hydrocephalus/cleft foot; Tx - delivery via C-section & surgical correction idealy 1st 12-18hrs
hydrocephalus def excess of CSF w/in ventricle of brain
hydrocephalus categories (2) non-communicating - obstruction present so CSF cant pass between ventricles and spinal cord; communicating - defect in absorption of CSF creating pressure on brain or spinal cord, majority, result of head injury, meningitis or developmental problem
hydrocephalus s/sx enlarged head sometimes seen at birth, anterior fontanel bulges, shiny scalp, "setting sun" eyes, increased ICP sx (lethargy, vomiting, irritability, high pitched cry)
hydrocephalus dx US in utero, CT, MRI, ventriculography
hydrocephalus tx; NI relieve ventricular pressure, shunt replacement, VP & VA; complications of a shunt - infection & blockage; NI - keep flat, head circumferences position on non-operative side
Down Syndrome def chromosomal abnormality - 3rd chromosome in trisomy 21, woman 35+ increased risk; mild to severe mental impairment
Down Syndrome s/sx shortness of head; flat forehead; upward & outward slanted eyes w/epicantic fold; short, flat, bridge of nose; neck short & wide; hands short w/simian crease; moro reflex absent; gap between big toe and middle
Down Syndrome at risk for (6) & tx congenital heart defects, more proned to respiratory infection, diabetes, leukemia, hearing loss, obesity; no known cure
reye syndrome def acute inflammation of the brain following viral illness; can have fatty degeneration of liver and other abdominal organs; linked to admin of ASA such as peptobismol
reye syndrome s/sx, dx 3 days to 3 weeks after initial illness child starts w/severe vomiting, irritability, lethargy & confusion; dx - hx of viral illness, liver fx tests & liver biopsy
reye syndrome tx early dx & aggressive tx essential - often child in ICU, improve respiratory fx, control hypoglycemia, meds to reduce cerebral edema, reinforce no ASA or ASA containing products - up to age 20yrs+
meningitis def & types(3) inflammation of meninges caused by bacterial (meningococcus, pneumococci & heamophilus influenza), virus (least potent) & TB (least common - untreated TB spreads)
meningitis s/sx high pitched cry, fever n/v/d, nuchal rigidity (stiff neck), irritability, headache, possible convulsions, coma (esp in older child), hemorrhagic rash
meningitis dx & tx early dx & tx essential for complete recovery, LP, possibly nose & throat cultures; tx - isolation in icu, iv antibiotics if bacterial, NSAIDS, steroids to avoid deafness, anticonvulsants, needle aspiration of fluid in subdural space
seizures def pds of sudden discharge of electrical activity in brain that cause involuntary muscle activity, change in LOC or altered behavior and sensory manifestation; may result of genetic factors, pathologic condition or rapid temp elevation
seizure types (2) epilepsy - recurrent chronic; primary - genetic; secondary - result of head trauma, tumor & infection
febrile seizures s/sx occurs suddenly; child is irritable, restless, may have tonic-clonic movements - sustained contractions of skeletal muscles that occur involuntary followed by clonic phase - quick jerking movement of arms, legs & facial muscles
epileptic seizures s/sx may be partial seizures which are limited to particular area of brain or generalized which involve both hemisphere
seizures NI high priority - safety; note time when starts and stops as well as factors occurring right before onset, eval LOC, pupil response, general behavior, teach to avoid triggers - blinking lights, excess activity/exercise, 6 months seizure free to drive
cerebral palsy def group of disorders that is result of malfx of motor centers & neural pathways in brain affecting motor fx & posture - most permanent disability in childhood
cerebral palsy stages (3) prenatal - maternal infection, nutritional insufficient, age incompability, 02 definency to fetus; perinatal - anoxia before, during & after birth, birth trauma , prematurity, any respiratory fx decreased; post-natal - infection, head trauma, CVA
cerebral palsy s/sx prim characterized by abnormal muscle tone & lack of coordination; child may also have: seizures, mental impairment, sensory & behavior defects, difficulty meeting milestones; sx right after birth - weak/absent sucking, jitteriness, slow/absent reflexes
types of cerebral palsy (3) spastic CP, athetoid CP, ataxic CP
spastic CP def involve one or both sides of body, impairment of fine & gross motor skills, hyperactive stretch reflex in affected muscle group, increase activity of deep tendon reflexes, clonus, contractures affecting extensor muscles, scissor-like gait - hips adducted
athetoid CP def abnormal involuntary movement, constant slow worm-like, writhing movement usually of extremities, trunk, neck, facial muscles & tongue, involvement of pharyngeal, laryngeal & oral muscles cause drooling & poor speech
ataxic CP def least common; may not be dx until child starts to walk; wide-based gait; lack of coordination particularly of upper extremity; about 40-50% are intellectually normal
cerebral palsy dx may not occur until child tries to walk; neuro exam & hx are primary focus, MRI & nerve conduction studies
cerebral palsy tx focus on improving motor fx & communication skills to help child reach highest potential possible; PT, OT, ST, emotional support
Senesory system def newborns focus clearly until about 2 months - navigate toward black & white; vision is complete at age 7 = 20/20; hearing is present at birth - no change occurs
strabismus (2 types) cross eyed - misalignment of eyes d/t muscles not being coordinated - can result in double vision; esotropia - devating inward toward nose; extotropia - devating outward - external - squinting, frowning, closeing eye, misjudgment in picking up objects
strabismus dx/tx cover one eye & see what eye does when picking up object; tx - if monocular - patch one eye to let other be used; if untreated - visionloss, surgery on muscles
amblyopia if untreated leads to lazy eye - do something to make eye work
stye infection of oil gland in eyelid; sx - swelling, redness, pain; tx - might need antibiotics, warm compress or teabag
conjunctivitis causes/types only bacterial is contagious; allergies - antihistamine, foreign object; viral - only highly contagious
hearing impairment causes inherited diseases, prenatal infections, perinatal anoxia, childhood infections - varying degrees
hearing impairment s/sx - vary by age infants - not startled when loud noise; no reaction to parents; toddler - lack of speech; ps - repeat words; profound deafness is dx b4 1yr; amt will determine tx; cochlear implants @ 12m ; conductive - partial; h.l. up to 6 m after infection
otitis media inflammation of middle ear; often accompanied by fluid in middle ear; most common; accompanied by respire disease/infection; more common in kids who are bottle fed, pacifier used and 2nd hand smoke
otitis media s/sx similar to respir infection; runny nose, fever, ear pain, irritable, waking up at night, VID
otitis media dx visual of middle ear; tympanic membrane - grey/pearl light reflects back - if infected bright red, blugging, no light reflex
otitis media antibiotics, decongestants, no ASA, antipyretics, analgesics, hearing loss up to 6 months after; myringotomy (tubes) for recurrent episodes - in place 6-12 months - ear plugs important to keep dry
endocrine system def controls/regulates metabolic processes governing energy production, growth, fluid & electrolyte balance & response to stress & sexual reproduction; done by hormones secreted by glands into blood & transported to right body gland - most difficult to dx
hypothyroidism def disorder in which the thyroid is low - can be absence of thyroid gland at birth & decrease also
hypothyroidism s/sx don't appear until a few months after birth; thickening of tongue and lips, puffy eyes, dull expression to face, jaundice, feeding probs, bradycardia & lethargic, poor muscle tone, leads to chronic constipation & enlargement
hypothyroidism dx, tx dx - blood test, all newborns are required to have screening - TSH, T4 levels; early dx is essential to prevent mental impairment; tx - replacement of thyroid hormone; needs meds for rest of life - synthroid & thyroxine
diabetes def, s/sx type 1 most common metabolic disorder in children; s/sx - PPP wt loss, fatigue, headache that comes on abruptly
Created by: breinard
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