Neuromuscular+Round+1

Hydrocephalus Spina Bifida Craniosynostosis Arteriovenous Malformation
 * Neuromuscular Round 1: **
 * Structural Abnormalities: Remember 80/10/10 Rule **

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Primary diagnostic tests are the CT and MRI with sedation in younger children.

Impaired CSF absorption Block in the flow of CSF
 * Hydrocephalus: **

Cerebral Spinal Fluid: Functions: Buffering, Buoyancy, Excretion of waste, Endocrine medium to transport hormones Total CSF = 125 to 150 ml Production = 400-500/day (0.36ml/minute)

Etiology/Pathology: Acquired congenital disorder <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Unknown etiology

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Obstruction outside ventricular system causing decreased absorption, most common in premature after a subarachnoid hemorrhage or infection.
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Communicating hydrocephalus: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Usually obstruction due to a malformation such as aqueductal stenosis, meningomyelocele (MMC), Dandy-Walker syndrome or Arnold-Chiari malformation (brain stem compression due to herniation diff. swallowing, stridor, apnea, respiratory distress, absent gag reflex, upper extremity weakness or spasticity).
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Noncommunicating or obstructive hydrocephalus: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Older children or adolescence may develop hydrocephalus from tumors, infection, or head injury

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Shunts placed soon after diagnosis have a better prognosis. May have some ataxia, decreased fine motor coordination, developmental delays, spasticity.

<span style="color: #d02525; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Case study Baby Klaus:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Baby Klaus has a severe case of Hydrocephalus. He displays several signs and symptoms, which characterize this condition. Watch the video above and answer the questions.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">1. Describe Baby Klaus’s presenting symptoms. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">2. What is the name of the condition and what caused it? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">3. What is the solution to the problem? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">4. What are the nursing concerns (diagnoses) and care (interventions) prior to surgery? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">5. What are the nursing concerns (diagnoses) and care (interventions) after surgery? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">6. Compare and contrast the symptoms of hydrocephalus in an infant with those of an older child with hydrocephalus.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ventriculoperitoneal shunt (VP shunt)

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Signs and symptoms are related to increased CSF imbalance - 80/10/10 Rule ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">leading to increased intracranial pressure as the brain is pressed against the interior skull.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"><span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Infants - bulging fontanelles, high pitched cry, irritability, lethargy, vomiting, strabismus, <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Increasing head circumference, protrusion of the frontal region, translucent skin, wide sutures, visible sclera above eye (sunsetting sign). Positive Macewen's sign - hollow percussion sound, feeding disturbances,

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"><span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Older children complaining of headaches or visual disturbances, nausea, vomiting, irritability, confusion, lethargy, apathy, reasoning impaired, change in motor abilities.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"><span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatment directed toward relief, most often surgical, removal of lesion, insertion of shunt. ventriculoperitoneal most common or ventriculoatrial. Shunt malfunction from kink, migrating, plug = IICP

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Signs of a shunt infection: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ventriculitis with low grade fever, malaise, nausea, headache. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Blood cultures may be negative, increase in serum leukocytes <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">CSF increase in WBCs, protein, decrease in glucose, pathogen seen in cultures or gram stain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Sepsis with modest fever and weakness, positive blood, CSF, leukocytosis and anemia

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">***Signs of Increased Intracranial Pressure opposite of shock*** low heart rate, high blood pressure*

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">**Assessment and nursing care preorperatively:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Head circumference <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Signs and symptoms of IICP <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Respiratory status <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Intake and output <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nutrition - small frequent feeds due to vomiting, may be difficult to hold <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Positioning due to large head <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Change position and sheepskin to decrease skin breakdown

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">**Assessment and nursing care postoperatively:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Vital signs and neuro checks every two hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pain management <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Intake and output <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Skin integrity <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Signs of infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Observe for IICP <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Flat on unoperated side <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Vital signs, neuro checks <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Observation for abdominal distention and peritonitis due to the irritating nature of CSF <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Observe for signs and symptoms of an illeus due to shunt placement, check bowel sounds <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Family teaching, lifelong condition, s&s infection, normal lives, no contact sports

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;"> **Neural Tube Defects** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ancephaly <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cranioschisis <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Exencephaly <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Encephalocele <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Spina bifida occulta <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rachischisis <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Spina bifida cystica: Meningocele, Meningomyelocele (hydrocephalus is often a result of this condition)

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">**Preoperative care:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Prone, tactile stimulation, rubbing, stroking <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Moist sterile dressing with normal saline <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Integrity of sac maintained <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Watch for signs and symptoms of infection - IICP, fever, irritability, nuchal rigidity, <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Neuro assessment for comparison, extremity movement <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Isolette maintain temperature <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Skin care <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hip alignment <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Feeding challenging head to the side bottle, breast milk pumped

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">**Postoperative care:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Prone position <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antibiotics <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Watch infection and hydrocephalus <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Bowel, bladder function <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Maternal care <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Family teaching, s&s infection, hydrocephalus, IICP, urinary/bowel difficulties, shunt failure

<span style="color: #d02525; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Case study Mounib:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Mounib is 2 years old. It is a miracle he is still alive. As stated by the doctors he owes his life to his mother’s expert and conscientious care. Watch the video and answer the following questions.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">1. What is the technical name for Mounib’s condition? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">2. What are the challenges of this condition prior to repair? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">3. What are the post-surgical nursing concerns (diagnoses)? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">4. What post-surgical nursing care will this entail (Interventions)? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">5. What are possible complications of this condition short and long term?

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;"> *Infants, children and adults with spina bifida are 40% more likely to have a latex allergy***

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Neuromuscular Round 2 <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Congenital Neuromuscular Disorders:

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Cerebral Palsy <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">media type="youtube" key="cOfUGUNxEqU" width="560" height="315" <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Emma's Cerebral Palsy media type="youtube" key="1dxRYY_qbP0" width="560" height="315"


 * Cerebral Palsy **

Cerebral Palsy (CP) is a nonprogressive injury to the motor centers of the brain, which can cause spastic and involuntary movements. CP can also be associated with developmental delays and seizure activity. Persistence of tonic neck reflex and moro reflex beyond 4 months.

Though the exact cause is often unknown, birth injuries, maternal infections, kernicterus, and low birth weight are felt to contribute to this disorder. It can range in presentation from mild to severe.

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Diagnosis: MRI, hx, genetics, EEG, hearing, vision tests useful in diagnosis. Approximately 30-50% mentally disabled with some with cognitive delays. Vocational rehabilitation and higher education possible.

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Assessment may reveal:

Poor head control after 3 months Stiff arms, legs, back arching Floppy, limp Cannot sit unsupported after 8 month Irritability, crying Feeding difficulties, choking

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 16pt;">Classifications:

Spastic – one or both side, hypertonicity, impaired fine motor skills, increased reflexes, scoliosis common, gait scissoring, contractures common, elbows, wrist and fingers flexed.

Dyskinetic/Athetoid – involuntary movements of the face, extremities, involvement of oral muscles causes drooling and speech difficulties, increased movements with stress, not during sleep, normal deep tendon reflexes, contractures are rare.

Ataxic – uncoordinated, unsteady, hyporeflexia, speech slurred jerky, few orthopedic problems.

Mixed – Combination of spastic and dyskinetic

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Management:

Early recognition and optimum development Establish communication, locomotion, self care Gain optimum appearance of motor functions – ankle foot orthoses (braces) worn to prevent deformity and as an assistive device, scooter devices, Correct defects as much as possible – corrective surgeries to help contractures or lengthen tendons Provide appropriate educational opportunities Promote socialization, promote self image Pain may occur with spasms, valium, Baclofen < spasms Botox injected into muscle to < muscle movement Antiepileptic drugs – Tegretol, Depakote < seizures

Clinical Manifestations:

Neonatal reflexes after 6 months (Moro, tonic neck) Delayed development Poor suck, tongue thrust Spasticity Scissoring of legs Involuntary movements Seizures

Nursing Interventions:

Care coordination: community support agencies, PT, OT, speech therapist, neurologist, orthopedist, nutritionist. Support and assist with chronic sorrow, grief Administer anticonvulsants as needed

<span style="color: #c82226; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">*Emma’s case study:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Emma has a milder form of cerebral palsy as it is more localized. She does a great job explaining what has caused this and how she feels about it. Watch the video and answer the following questions.


 * 1) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">What are typical presenting symptoms of cerebral palsy and suspected causes?
 * 2) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">What are common nursing diagnoses and related nursing interventions for cerebral palsy?
 * 3) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">What nursing diagnoses and interventions would be specific for Emma?
 * 4) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Is this a genetic condition? Will it worsen with time?
 * 5) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Compare and contrast Cerebral Palsy with SMA and Muscular Dystrophy.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Zachary's Cerebral Palsy

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Cerebral Palsy ... Cohen

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Zachary, Emma and Cohen demonstrate the differing abilities and appearances of Cerebral Palsy. This is a non-progressive condition resulting from prenatal, perinatal or postnatal central nervous system damage or dysfunction. Though the exact cause is not known the prevalence has increased with the rise in survival rates of pre-term low birth weight and very low birth rate infants.

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">*Cerebral Palsy Case Study:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Compare and contrast the different types of cerebral palsy depicted in the videos above (Emma, Zachary, Cohen) and the resulting nursing diagnoses and nursing interventions specific to each case.

<span class="paracontent" style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Spinal Muscular Atrophy (SMA) Thought to be autosomal recessive genetic disorder Muscles weaken and waste away (atrophy) due to degeneration of motor neurones (nerve cells in the spinal cord). Motor neurons relay signals from the brain to the muscle cells. When motor neurons fail to function, the muscles deteriorate. Brain and the sensory nerves (that allow us to feel sensations such as touch, temperature, pain etc.) are not affected. Intelligence is normal.

Three common types of SMA in childhood: SMA Type 1 Severe -Werdnig-Hoffman Disease SMA Type 2 Intermediate SMA Type 3 Milder - Kugelberg-Welander Disease

The major difference between these types are the age of onset and the severity of the condition.

Inherited autosomal-recessive Genetic analysis, EMG, muscle biopsy Affects anterior horn cells of the spinal cord producing muscle atrophy Most severe form of SMA Evident in the first six months of life. The child is unable to roll or sit unsupported Severe muscle weakness eventually causes feeding and breathing problems These children usually do not live beyond about 18 months of age. Have normal intelligence Verbal, tactile and auditory stimulation important Often succumb to respiratory problems
 * Infantile Spinal Muscular Atrophy, SMA Type 1, (Werdnig-Hoffman Disease) **

onset after 2 years of age milder than the infantile or intermediate forms
 * Juvenile Spinal Muscular Atrophy, SMA Type 3, (Kugelberg-Welander disease) **

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 * Case’s case study:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Case’s video is a story of love and sacrifice. These parents are so devoted to their child; it is touching and inspiring.


 * 1) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Knowing what we know about the different types of SMA, what type does Case probably have?
 * 2) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">What is his prognosis?
 * 3) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">He seems cognitively developmentally appropriate; is this what we would expect?
 * 4) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Name the main nursing diagnoses for Case and the related nursing care. His parents have pretty much provided this for you.
 * 5) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Compare and contrast SMA and Muscular Dystrophy.


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Muscular Dystrophy **

Largest muscular disease in children Inherited disease Degeneration of muscle fibers, wasting of muscles Genetic analysis, EMG, muscle biopsy


 * Facioscapulohumeral **

Face and shoulder muscles Autosomal dominant Appears in teen years


 * Limb-girdle **

Autosomal recessive Late childhood/adolescence Pelvic and shoulder muscles


 * Duchenne (Pseudohypertrophic) **

Duchenne most common x-linked recessive, males Appears ages 3-5 Progressive Respiratory and cardiac complications Often fatal by age 25

Manifestations:

Waddling gait Clumsiness Gower's sign difficulty rising pseudohypertrophy of muscles (fat deposits) Muscle degeneration/weakening Cognitive delays Scoliosis, respiratory and cardiac difficulties > wheelchair

Nursing Interventions:

Assistive services Coordinate PT, OT, neurologist, orthopedist, nutritionist. Protect from exposure to illness Active and passive exercise Dietary support to decrease obesity Support, chronic sorrow, grief

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Duchenne Muscular Dystrophy Timeline <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">media type="youtube" key="KA8W5UfE4ts" height="375" width="503"

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 * <span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">The emotional side of DMD, Ian's Story **

<span style="color: #d21134; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">***Case Study Comparisons:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">The Duchenne Muscular Dystrophy (DMD) Timeline is very telling as it notes the changes, which occur over time with Muscular Dystrophy patients. Ian’s story demonstrates the rollercoaster a family goes through with chronic sorrow.


 * 1) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Note the various physical changes that occur over time with DMD patients.
 * 2) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">What are some of the top nursing concerns (nursing diagnoses) and some of the resulting nursing interventions (nursing care) for the child and family of a child with DMD?


 * <span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Acquired Neuromuscular disorders **

Screened at age 1 and 2 Cleanse the site, finger stick If positive repeated with a venous draw Can effect renal, hematological and neurological Ingested because it is sweet, sometimes cultural, dust, in soil, toys, pipes Handwashing, wash toys, do not eat from pottery, drink cold water
 * <span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Lead Toxicity **

Rarely have symptoms Can cause encephalopathy and cerebral edema Anemia

Treatment depending on level <10 reassess in 1 year Environmental investigation, management 20-44 Chelating agents > 45

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Postinfectious Polyneuritis Uncommon, acute, demyelinating polyneuropathy ascending Children < adults Most common 4-10 Immune mediated associated with illness and vaccines 3 phases: Acute may last 4 weeks with progressive symptoms Plateau symptoms remain the same, can last for days or weeks Recovery pt begins to improve, from days to weeks
 * <span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Guillain-Barre Syndrome **

Symptoms: Muscle tenderness Parasthesia Muscle weakness Ascending Reflexes absent Incontinence Recovery is descending, with legs last

Diagnosis:

CSF has increased protein EMG shows symmetric denervation versus polio

Treatment:

Supportive May need respiratory and pharyngeal support IV immunoglobulin Steroids Plasmapheresis Immunosuppressive drugs

Nursing Considerations: Supportive Observe for respiratory depression, difficulty swallowing Vital signs and neuro checks Recovery, prevent complications Communication ROM, PT

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Lockjaw Preventable, can be fatal
 * <span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Tetanus **

Causative organism: anaerobic spore forming gram + bacillus Clostridium tetani Occurs in a susceptible host after injury of tissue and introduction of spore Spore in intestines of humans, animals and soil

Signs and Symptoms:

Stiffness and tenderness of muscles in neck and jaw Difficulty opening mouth Sardonic smile, muscle spasm Board like rigidity of abdomen and limbs Sensitivity to stimuli causes muscle spasms Laryngospasm Tetany of respiratory muscles Patient anxious and alert

Nursing Consideration:

Decrease stimulation Low light, low sound Observe respiratory status Emergency equipment Muscle relaxants, opiods, sedatives Monitor O2 saturation IV hydration Nutrition Suctioning as needed Due to awareness it is terrifying Comfort, explain and do not leave alone media type="youtube" key="AzCDKC06WLw" height="315" width="560"

Flaccid Paralysis due to anaerobic bacillus Clostridium botulinnum Toxin in contaminated food source Often in Honey and corn syrup, so none till over 12 months old Wound botulism Infant botulism Man made botulism
 * <span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Botulism **

Diagnosis: History, Physical Blood and stool cultures EMG

Treatment: IV administration of botulism antitoxin Supportive measures Recovery may take 44 days Death rate 2%

<span style="color: #c91d24; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Activities:

<span style="color: #c91d24; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">***Name ways to prevent lead poisoning and why this is important.**


 * Sofi’s Case Study:

<span style="color: #c91d24; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Briefly describe the progression and recovery of Guillain-Barre Syndrome. Are there any treatments?

<span style="color: #c91d24; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">***Compare and contrast Tetanus and Botulism.

<span style="color: #e42121; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Spinal Cord Injuries

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Axton, S. E., & Fugate, T. (2003). Chapter 8: Care of Children with musculoskeletal dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 187-216). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Axton, S. E., & Fugate, T. (2003). Chapter 9: Care of children with neurological/neuromuscular dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 217-252). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Videos: Cerebral Palsy https://youtu.be/cOfUGUNxEqU

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Emma speaks about CP <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/1dxRYY_qbP0

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Zachary's Cerebral Palsy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/u0kTAPDCo7A

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Cohen's Story <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/Kzb1XYGO0IQ

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">A day in the life of SMA <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/Vj6TZdEzXj0

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">BrainPop Animation about Duchenne Muscular Dystrophy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/6wLnR7GJakY

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Duchenne Muscular Dystrophy Timeline <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/KA8W5UfE4ts

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ian's Story MD <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/cY3M_A_BkG0

<span style="color: #c91d24; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Lead Poisoning <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/hNUcN7yf1cc

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Guillain-Barre syndrome <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/Zwr83v96y2M

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Tetanus <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/AzCDKC06WLw <span style="color: #d02525; font-family: 'Times New Roman',Times,serif; font-size: 130%;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Axton, S. E., & Fugate, T. (2003). Chapter 8: Care of Children with musculoskeletal dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 187-216). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc..

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Axton, S. E., & Fugate, T. (2003). Chapter 9: Care of children with neurological/neuromuscular dysfunction. In M. Connor & Y. Kopperman (Eds.), Pediatric nursing care plans (2nd ed., pp. 217-252). Upper Saddle River, New Jersey: Prentice Hall Pearson Education, Inc..

<span style="color: #d02525; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Videos: Spina Bifida https://youtu.be/YG4nrRnAlcc

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hope for baby Klaus <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/WkWguVEx-uk

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Insertion of a CSF shunt <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/Qmym2iFVNw8

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Shunt for hydrocephalus <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/0h7Xa-Lsnac

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Spina Bifida Surgery Mayo Clinic <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/E080qJuHWdQ