unit 4
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| 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
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| 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
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| Spina Bifida types (2) | spina bifida occulta & spina bifida cystica
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| spina bifida occulta | very mild form - no visible deformity; affects L5S1 area - skin in tact, may have dimple
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| spina bifida cystica (2 degrees) | meningocele & myelomeningocele
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| mengingocele def | fluid filled sack; herniation of meninges, no nerve routes involved, no paralysis or sensory lost below point; could rupture
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| myelomeningocele def | nerve routes embedded in cyst/sac; no sensation below sac; paralysis - no muscle control, no sphincter control below sac/defect
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| 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
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| hydrocephalus def | excess of CSF w/in ventricle of brain
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| 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
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| 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)
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| hydrocephalus dx | US in utero, CT, MRI, ventriculography
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| 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
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| Down Syndrome def | chromosomal abnormality - 3rd chromosome in trisomy 21, woman 35+ increased risk; mild to severe mental impairment
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| 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
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| Down Syndrome at risk for (6) & tx | congenital heart defects, more proned to respiratory infection, diabetes, leukemia, hearing loss, obesity; no known cure
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| 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
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| 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
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| 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+
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| meningitis def & types(3) | inflammation of meninges caused by bacterial (meningococcus, pneumococci & heamophilus influenza), virus (least potent) & TB (least common - untreated TB spreads)
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| 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
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| 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
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| 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
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| seizure types (2) | epilepsy - recurrent chronic; primary - genetic; secondary - result of head trauma, tumor & infection
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| 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
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| epileptic seizures s/sx | may be partial seizures which are limited to particular area of brain or generalized which involve both hemisphere
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| 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
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| 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
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| 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
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| 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
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| types of cerebral palsy (3) | spastic CP, athetoid CP, ataxic CP
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| 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
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| 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
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| 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
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| cerebral palsy dx | may not occur until child tries to walk; neuro exam & hx are primary focus, MRI & nerve conduction studies
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| cerebral palsy tx | focus on improving motor fx & communication skills to help child reach highest potential possible; PT, OT, ST, emotional support
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| 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
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| 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
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| 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
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| amblyopia | if untreated leads to lazy eye - do something to make eye work
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| stye | infection of oil gland in eyelid; sx - swelling, redness, pain; tx - might need antibiotics, warm compress or teabag
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| conjunctivitis causes/types | only bacterial is contagious; allergies - antihistamine, foreign object; viral - only highly contagious
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| hearing impairment causes | inherited diseases, prenatal infections, perinatal anoxia, childhood infections - varying degrees
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| 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
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| 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
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| otitis media s/sx | similar to respir infection; runny nose, fever, ear pain, irritable, waking up at night, VID
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| otitis media dx | visual of middle ear; tympanic membrane - grey/pearl light reflects back - if infected bright red, blugging, no light reflex
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| 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
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| 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
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| hypothyroidism def | disorder in which the thyroid is low - can be absence of thyroid gland at birth & decrease also
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| 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
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| 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
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| diabetes def, s/sx | type 1 most common metabolic disorder in children; s/sx - PPP wt loss, fatigue, headache that comes on abruptly
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