HESI PEDS Neuromuscular

Common associated problems of Down Syndrome
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Terms in this set (33)
Common associated problems of Down Syndrome
1. Cardiac defects
2. Respiratory infections
3. Feeding difficulties
4. Delayed development & mental retardation
5. Skeletal defects
6. Altered immune function
7. Altered endocrine function
(Ex.) Hypothyroidism or diabetic muscular infarction
Common down syndrome characteristics (upper body)
Small head
Wide/flat nasal bridge
Inner epicanthal eye fold
Upward, outward slant of eyes
Brush-field spots
Small, irregularly shaped, low set ears
Small mouth/protruding tongue
Short neck
Short arms (compared to body)
Short, stubby hands w single crease in palm (Simian crease)
Common down syndrome characteristics (lower body)
short legs (short stature)
Hypotonic flexibility
Atlantoaxial instability
Short, stubby toes (w an enlarged space b w big toes and the others)
Hyperextensible & lax joints (hypotonia)
The IQ range of a child with Down Syndrome is usually
Low IQ range (20-70)
Best way to feed child w down syndrome is to feed how?
Give food to the side & back of mouth
Disorder characterized by impaired movement (spastic) or dyskinesia (involuntary movement) due to injury of the motor centers of the brain
Cerebral Palsy
Common causes/associated factors of CP
1. Anoxic injury (before, during, after birth)
2. Maternal infections
3. Kernicterus
4. LBW (MAJOR risk factor)
Associated problems that may occur w CP
Seizures; cognitive impairment
Monitor for CP in high risk infants such as
Premature infants
Breech births
Cardiac/respiratory distress during birth
Low apgar scores
Product of multiple pregnancies
Sever jaundiced
Common signs of CP on assessment
Persistent neonatal reflexes (Moro, tonic neck) after 6 months
Delayed developmental milestones
Early preference of one hand
Rigid/stiff arms
Poor suck & tongue thrust
Scissoring of legs (extended/crossed over each other w feet plantar flexed; common in spastic)
Involuntary movements (dyskinesia)
Seizures
Spasticity (Mother may describe as difficulty diapering)
Opisthotonos (Exaggerated arching of back)
HESI HINT: For infant/child w CP, a major focus should be on preventing aspiration in was such as:Sit child upright Support lower jaw Keep child upright after feedsAdministering safety precautions for a child w CP includes:Prevent aspiration Seizure precautions Helmet (if child is prone to falls)Some medications that may be prescribed to a child w CP includesAnticonvulsant meds (Ex. Phenytoin/Dilantin) Muscle spasm meds (Ex. Diazepam/Valium)Spina Bifida (Neural tube defect) is a malformation of the ___ & ____ resulting in varying degrees of disability/deformity depending on the location of the malformationVertebrae & spinal cordA type of spina bifida in which it is a defect of the vertebrae ONLY; no sac is present & is usually a bening conditionSpina bifida occultaAlthough usually a benign condition, spina bifida occulta may have what kind of problems?bowel and bladder problemsIn these types of spina bifida, a sac is present at some point along the spine?Meningocele & myelominingoceleType of spina bifida in which a sac is present, and it only contains meninges & spinal fluid; has less neuro involvement than the otherMeningoceleType of spina bifida (most severe) & involves a sac that contains spinal fluid, meninges, & NERVESmyelomeningoceleWomen in child bearing years (during and before pregnancy) are advised to consume a minimum of what to prevent spina bifida400 mcg of folic acidFoods high in folic acidEggs Dark green veggies Citrus fruits Juices BeansEvery child w a history of spina bifida should be screened for what allergy?latexAssessment findings for spina bifida occultaDimple (w or w out hair tuft) at base of spine Continence issuesAssessment finding of sac in myelomeningocele (location)lumbar/lumbar sacralNursing assessment of spina bifidaFlaccid paralysis Limited or no feeling below defect Head circumference at variance w normsCommon problems associated w spina bifida (6)1. hydrocephalus (90% w myelomeningocele) 2. Neurogenic bladder, poor anal sphincter tone 3. Congenital dislocated hips 4. Club feet 5. Skin problems (associated w anesthesia below defect) 6. ScoliosisPreoperative positioning for a child w spina bifida (position of foot of bed, legs, etc.)prone position; child should be placed on abdomen w legs abducted; FOOT of bed should be elevatedWhen caring for a child w spina bifida preoperatively, a nurse should frequently measure & check?Head circumference (at least q8h) or every shift; check fontanelPre operative care of sac from spina bifidaCovered w a moist sterile (Normal saline, NONadherent dressing) to maintain moisture & sac contents; chx whenever soiledUntil the defect (sac in spina bifida is repaired) _____ may be contraindicateddiaperingPreoperative care of a child w spina bifida may involve emptying the child's bladder by ______ or _____Crede method or catheterizationPosition of child w spina bifida postoperativelyProne positionWhat drugs might you administer to a child w spina bifida to help improve continence?Propantheline (Pro-Banthine) Bethanechol (Urecholine)