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68wm6 p2 Neu Mus New

Neurologic and Musculoskeletal Complications of the Newborn

Define Hydrocephalus: Condition caused by an imbalance in the production and absorption of CSF in the ventricles of the brain
What is hydrocephalus often associated with? myelomeningocele
What may hydrocephalus be a result of? of a preexisting developmental defect such as Arnold-Chiari malformation or Dandy-Walker Syndrome
What is an Arnold-Chiari Malformation? Congenital anomaly in which the cerebellum and medulla oblongata extend down through the foramen magnum
What is Dandy-Walker Syndrome? When the enlarged head involves a prominent occiput, the condition usually involves an atresia (closing) of the foramen of Lushka and Magendie
Visual S/Sx of hydrocephalus: *Fontanel is full or bulging *Head is enlarged *Setting-sun is apparent
What are the primary tools for diagnosing hydrocephalus? CT and MRI
Tx of hydrocephalus: *Direct removal of an obstruction (such as tumor) *Placement of a shunt (such as a Ventriculoperitoneal Shunt)
Nursing care for hydrocephalus: *Observe for S/Sx of ICP *Measure the head circumference daily at point of largest measurement and record *Gently palpate fontanels and suture lines for S/Sx of bulging, tenseness and separation. Observe for bulging during crying/straining
After a ventriculoperitoneal shunt is placed in an infant, how should they be positioned? *On unoperated side to prevent pressure on the shunt valve and pressure areas *Keep flat to help avert complications resulting from too-rapid reduction of intracranial fluid
After a ventriculoperitoneal shunt is placed in an infant to Tx hydrocephalus, what do S/Sx of ICP indicate? an obstruction of the shunt
What can abdominal distension in an infant with a ventriculoperitoneal shunt indicate? peritonitis or postoperative ileus as a complication of distal catheter placement
What are the two classifications for hydrocephalus? Communicating and noncommunicating hydrocephalus
What is Spina Bifida? Midline defect involving failure of the bony spine to close
What are the two types of Spina Bifida? *Spina Bifida Occulta *Spina Bifida Cystica
Where does Spina Bifida Occulta occure most frequently? In the lumbosacral area
How does Spina Bifida Occulta appear on visual inspection? It is seen by a dimple on the back, which may have a tuft of hair over it
What form of Spina Bifida appears as a visible defect with an external sac-like structure? Spina Bifida Cystica
What are the two forms of Spina Bifida Cystica? *Meningocele: meninges and spinal fluid *Meningomyelocele: contains meninges, nerve roots, spinal cord, and spinal fluid
When does therapeutic management of Spina Bifida Cystica offer the most favorable outcome? Early closure within the first 24 to 72 hours
True or False: Early Tx of Spina Bifida Cystica within 24-72 hours of birth with improved surgical techniques do NOT alter major physical disability, spinal defect, or chronic UTIs that affect these infants True.
True or False: In newborns, Cleft Palates are always accompanied by Cleft Lips. False. Occur together or separately, on one or both sides
What causes Cleft Lip? a failure of the maxillary and median nasal processes to fuse
Fill in the blanks: Unilateral Clefts in cleft lip/palate occur _____ as frequently on the _____ side. Twice, Left
In cleft lip/palate, how much more common are unilateral clefts than bilateral clefts? 9 times more common
Smoking increases the risk of cleft lip/palate by how much Twice the risk
For cleft lip/palate, prenatal diagnosis with ultrasound is not reliable until when? the soft tissues of the fetal face can be visualized at 13 to 14 weeks
When is surgery for cleft lip performed? By 3 months. Further surgery may be needed at 4 to 5 years.
How is surgery done for cleft palate? Palate repair surgery is done in stages, depending on the degree, usually beginning before one year to minimize speech problems
What provides an efficient, safe feeding device if the infant with cleft lip/palate has trouble with nipple feeding? *Rubber-tipped medicine stopper *Asepto syringe *Breck feeder (a large syringe with soft rubber tubing)
What position must an infant with cleft palate be fed, and why? *Feed infant in an upright position because milk enters nasal passages through the palate, causing an increased tendency to aspirate
True or False: Post-op care of the infant who recieved surgery for cleft lip also includes arm and elbow restraints. True.
How must the post-op cleft lip infant be placed? On back or side
How must the post-op cleft palate infant be placed? On abdomen
What is congenital clubfoot? A complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus and ankle equinus
In typing congenital clubfoot, what is Talipes varus? an inversion or bending inward
In typing congenital clubfoot, what is Talipes valgus? an eversion or bending outward
In typing congenital clubfoot, what is Talipes equines? plantar flexion in which the toes are lower than the heel
In typing congenital clubfoot, what is Talipes calcaneus? dorsiflexion, in which the toes are higher than the heel
What are the four types of congenital clubfoot? *Talipes varus *Talipes valgus *Talipes equines *Talipes calcaneus
What is the most frequently occuring type of clubfoot? talipes equinovarus (TEV)
What are the causes of clubfoot? *Abnormal positioning and restricted movement in utero *Arrested or abnormal embryonic development
What is the management of clubfoot? *Serial casting is begun shortly after birth, before discharge from the nursery *Manipulation and casting are repeated weekly to accommodate rapid growth, usually within 8 to 12 weeks
If there is a failure to achieve normal alignment withing 3 months in an infant with clubfoot, what is done? surgical intervention, which may take place between 6 and 12 months of age
What is Acetabular dysplasia (or preluxation)? Mildest form of Developmental Hip Dysplasia (DDH) in which there is neither subluxation nor dislocation. Femoral head remains in the acetabulum
What is Developmental Hip Dysplasia (DDH) Subluxation? A form of DDH where Femoral head remains in contact with acetabulum, but a stretched capsule and ligamentum teres cause the head to be partially displaced
What is Developmental Hip Dysplasia (DDH) Dislocation? A form of DDH where femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over fibrocartilaginous rim
What tests demonstrate the tendency for subluxation and dislocation in DDH? Ortolani or Barlow tests
How is DDH managed in newborns to 6 months of age? (Pavlik harness is the most widely used) Hip joint is maintained by dynamic splinting in a safe position with the proximal femur centered in the acetabulum in an attitude of flexion
How long does the Tx of DDH with a Pavlik harness generally last? 3 to 5 months
Why can it take up to 6-18 months before DDH is recognized? Sometimes it is minor enough to not be noticed until the infant is old enough to begin to stand and walk.
Created by: Shanejqb