Spina Bifida & Hydrocephalus – Flashcards
38 test answers
Unlock all answers in this set
Unlock answers 38question
Etiology-Pregnancy Related
answer
-Unknown but has been correlated with *alcohol and medication use*. -Seizure and other medications: -Valproic acid (Depakote) -Carbamazapine(Tegretol) -Isotretinion -acne medication -Type I Diabetes -Folate Deficiency
Unlock the answer
question
Prenatal Lab & Diagnostic Tests
answer
-Maternal Blood Test or Amniotic fluid test: -Alphafetoprotein (increased = neural tube defect) -Fetal Ultrasound (visualize defect) -MRI, Myelography, CT -PREVENTION - Folic acid Daily from 1 month before getting pregnant!
Unlock the answer
question
Treatment Surgery
answer
-Surgery -best outcome if done within 72 hrs
Unlock the answer
question
Arnold Chiari Malformation
answer
Downward herniation of the brain stem.
Unlock the answer
question
Tethered Cord Syndrome
answer
Spinal cord is attached and creating tension - can cause cord injury.
Unlock the answer
question
Assess for Complications
answer
-*Key complications are UTI's and Meningitis!* -Paralysis and weakness related to the level of injury -Hip Dislocations -Knee Flexion Contractures -Foot and Ankle Deformities ( Example: Valgus) -Spinal Deformities -Kyphosis and Scoliosis -Assess for Developmental Delays -Sensory loss is worst on the back of the legs and common in the perineal area and the feet.
Unlock the answer
question
Orthopedic Complications
answer
-Maintain physiologic positioning -Position: *prevent hip dislocation (abduct legs)* -ROM and Physical Therapy -Prevent skin breakdown -Maintain locomotor function -Assess and provide developmental stimulation -If occulta observe for disorders of gait, leg weakness, and bowel and bladder dysfunction
Unlock the answer
question
Neurogenic Bladder
answer
-Preserve renal function and optimal continence -"Saddle Anesthesia" = bladder dysfunction occurs -Observe micteration pattern -Treat UTI's Promptly -Do Not CREDE Urinary Bladder -Vesciculo-Ureteral Reflux of Urine may occur
Unlock the answer
question
To improve Bladder Storage and Continence
answer
Oxybutnin Cl (Ditropan) Tolterodine (Detrol) Surgery: -Stoma to abd wall -Augmentation cystoplasty for bladder capacity increase -Urinary diversion and construct a bladder from bowel
Unlock the answer
question
Neurogenic Bowel
answer
Signs: Constipations and Over distention Incontinence / Rectal prolapse Management: Stool History Fluids, Bulk, and Stool Softeners Enemas, Digital Stimulation Toileting Program (schedule eating time and time for BM)
Unlock the answer
question
Medical Diagnosis & Nursing Assessments
answer
Clinical Manifestations CT, MRI, Ultrasound, Myelogram ASSESS FOR INFECTIONS: (UTI, Menigitis, Pneumonia) BUN, Creatinine Orthopedic/ Musculoskeletal Assessment Vision Assessment Latex Allergy Assessment
Unlock the answer
question
Nursing care immediately post birth:
answer
-Avoid cooling and maintain temperature -Assess intactness of membrane and observe for leaks, abrasions, infection ,irritation -Cover with a non-adhesive dressing -NS and/or antibiotics to sac if ordered -Keep clean & dressing change q 2-4 hr -Avoid use of diapers until defect is repaired and healed -Position child on abdomen to avoid pressure on sac -Assess motor and sensory function
Unlock the answer
question
Nursing care:
answer
ASSESS URINE OUTPUT (Suprapubic distention inspite of voiding) Implement BLADDER PROGRAM Assess for signs of MENINGITIS TEMP Elevation (No rectal Temperature!) -Lethargic or Irritable -Nuchal Rigidity -Paradoxical Fussiness -Skin Assessment
Unlock the answer
question
Pre-op nursing care:
answer
-Position Prone -No diaper -Skin checks -Clean intermittent catheterizations -Physical Therapy
Unlock the answer
question
Post-op nursing care:
answer
-Vital signs, I&O, Check for CSF leaks -Avoid Infection, -Latex allergy frequent -Treat Pain and Provide Nourishment -Position Prone and possible side-lying
Unlock the answer
question
How do you measure increased intercranial pressure on an infant? What does this mean?
answer
Infant will have a *firm, non-pulsating fontanel*. Means that intercranial pressure is increased and could indicate meningitis.
Unlock the answer
question
What else can you measure?
answer
Head circumference (just above eyebrows)
Unlock the answer
question
What else should I watch out for?
answer
-Seizure -Altered vital signs -Change on LOC -Poor feeding
Unlock the answer
question
Summary of Care: Spina Bifida
answer
Follow up medical care is important for: -Immunizations (May cause seizures) -Screen for Growth (FOC /HC) -Development and scoliosis Skin care: -Daily checks, clean & dry, Pressure points -Gel filled cushions -Avoid Burns - Bath water, car seats, hot liquids +
Unlock the answer
question
What allergy are patients with spina bifida prone to?
answer
Latex
Unlock the answer
question
Care Summary/Home Care: Spina Bifida
answer
-Latex Precautions/Epinepherine "Pen" -Safe wheel chair and ambulation device use- -Watch for signs of Menigitis / UTI -Watch for signs of Increased ICP -Surgical postop care -Catherizations and Bowel Training -Diet - Nutritious without causing obesity
Unlock the answer
question
Hydrocephalus
answer
A DISTURBANCE IN THE CSF Caused by: maldevelopment, infection, hemorrhage, trauma neoplasm and others
Unlock the answer
question
Communicating Hydrocephalus
answer
-Impaired absorption (arachnoid villi) -Increased production (choroid plexus)
Unlock the answer
question
Non-communicating Hydrocephalus
answer
-Obstruction to the flow of CSF
Unlock the answer
question
Clinical Manifestations: Hydrocephalus
answer
-Increased HEAD CIRCUMFERINCE -Tense & Non-pulsatile ANTERIOR FONTANEL -Shrill CRY -MACEWEN SOUND (CRACK-POT) -Bossing Forehead / N&V -SETTING-SUN Sign -SEIZURES/ -IRRITABLE , LETHARGIC /POOR FEEDING
Unlock the answer
question
Early signs of increased inter-cranial pressure
answer
-H/A -Vomiting (possibly projectile) -Blurred vision -Dizziness -Decreased pulse -Decreased respirations -Increased BP & pulse pressure -Pupils unequal and slower to react -Sunset eyes -*Changes in LOC* -Bulging, tense fonatnel -Wide sutures -Dilated scalp veins -High-pitched cry
Unlock the answer
question
Late signs of increased inter-cranial pressure
answer
-Lowered LOC -Decreased motor & sensory responses -Bradycardia -Irregular resp.
Unlock the answer
question
Medical Diagnosis & Nursing Care related to Dx
answer
-Head Circumference Daily -Pre and post procedure care -CT/MRI -Echoencephalogram: to measure Ventricles -Isotope Ventriculogram: to AssessCSF Flow
Unlock the answer
question
Ventriculo-peritoneal Shunt
answer
Most common
Unlock the answer
question
Signs of Shunt Obstruction
answer
-Headache, malaise, not feeling well -Vomiting, altered mental status -Increased blood pressure & head circumference -Cushing's triad (HR ; RR slow ; wide pulse pressure -Bulging fontanel, 6th cranial nerve palsy, -Macewen's sign, changes in gait -Changes in personality & school performance -Possible seizures and neck pain
Unlock the answer
question
Complications
answer
-If you drain too fast - you can end up with a subdural hematoma. -Peritonitis: and or abdominal abscess - External ventricular drainage until CSF infection free -External drainage ~> level of drainage bag and clamping with movement of bag
Unlock the answer
question
Nursing Care
answer
PREOP CARE Small Frequent Feedings Support HEAD if LARGE Assist with diagnostic tests Avoid scalp IV if to have surgery
Unlock the answer
question
POST OP CARE
answer
-Position on NON-OPERATIVE SIDE -Do NOT PUMP SHUNT unless ordered -POSITION FLAT (Rapid decompression can cause subdural hematoma) -Observation as PRE-OP -NEURO SIGNS including PUPILS -Antibiotics PER ORDER/Assess infections -ASSESS INCISION FOR LEAKS -TEST DRAINAGE FOR GLUCOSE -Monitor IV +po Intake and All Output -Skin condition
Unlock the answer
question
DISCHARGE TEACHING
answer
-Teach Signs of SHUNT MALFUNCTION and INFECTION IMMEDIATE CARE (Neuro status, temperature, skin care and family concerns) -Long-term- Follow discharge instructions -Avoid OVERPROTECTION -Avoid CONTACT SPORTS -Assess EDUCATIONAL NEEDS -Use car seat and seat belts
Unlock the answer
