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Nursing 3 Exam 2
Congenital Disorders
| Question | Answer |
|---|---|
| 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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