Exam 5_Function and Mobility

Care/management - Cerebral Palsy

*adequate nutrition (may require g-tube or j-tube) *promote physical mobility (ROM) *promote safety (clear hazards, no throw rugs, no walkers with wheels) *emotional support *open airways *Therapy (PT, OT, ST) meds: Dantrolene, Baclofen, Botox, Diazepam, Gabapentin

D meningoceles are sacs with CSF only. Myelomeningoceles are sacs with nerve roots and CSF. spina bifida cystica is not even one of the types of spina bifida

A neural tube defect that is not visible externally in the lumbrosacral area would be called: A. meningocele B. myelomeningocele C. spina bifida cystica D. spine bifida occulta

D Babies adjust easily to a harness. Most of them like it. None of these responses are therapeutic communication with the patient either.

A. "Its going to be worth it in the end when the baby doesn't have to have surgery" B. "There is no other choice for treating your baby" C. Perhaps we can convince the pediatrician to release the baby from the harness for a few hours" D. "It is hard to see your baby like this, isn't it: Actually babies adjust readily to the harness"

D The rest of these options are what we thought were way to determine CP, but prenatal brain abnormalities is the most accurate of them all.

Cerebral palsy may result from a variety of causes. It is now known that the most common cause of Cerebral palsy is: A. Birth asphyxia. B. Neonatal diseases C. cerebral trauma D. prenatal brain abnormalities

C Because of the positioning of the sac, Bowels and bladdar is difficult.

The long-term plan of care for a child with a myelmeningocele must include: A. Speech therapy B. Dietary counseling C. Bowel and Bladder training D. emotional guidance.

Fetal Alcohol Syndrome

When mother is drinking alcohol while pregnant.

Cerebral palsy

affects body movement, muscle coordination, and balance. Affects part of the brain that controls muscle movement.

Muscular Dystrophy

x-linked disorder that is characterized by gradual degeneration of muscle fibers.

care/management - Autism Spectrum Disorder

*recognize early *attempt behavior modificaton *STRUCTURE *decrease unacceptable behavior. *stress importance of family counseling *introduce new things slowly *encourage age-appropriate play *communicate briefly and age-appropriately *avoid demands of the child *find out how child communicates and use that method. *increase social awareness *decrease environmental stimuli *positive reinforcement

Care/management - FAS

*send them to therapy/community resources to get help *monitor for respiratory distress and hypoglycemia *assess suck/swallow reflex *small feedings and burp well. *monitor I and O *monitor weight and head circumference *decrease environmental stimuli.

Care/Management - Spina Bifida

*surgery must occur within 24-48 hours after birth to replace the spinal contents and skin defects to prevent infection *surgery may damage meninges, which may lead to brain swelling up. *practice good infection control. *sterile, moist, non-adherent dressing, change dressing frequently. *observe sac for leaks, irritation, abrasions, and infection. *prone position with hips flexed. *feeding issues *c-section for delivery *no rectal temps *assess for allergies to latex *assess head circumference and fontanels daily.

Care/Management - Dysplasia of the Hip

*swaddle baby *harness *f/u appointments *check tissue integrity *when removing the harness, only do as directed and release one side at a time. *light clothing under harness. *do not adjust the harness unless directed to do so. *tummy time, with a pillow under upper body.

Methotrexate

*take this only if NSAIDs do not work. *check liver function, avoid alcohol, some oral contraceptives may be contraindicated, check with HCP

Baclofen

*to help with muscle spasms *SE: constipation, hypotension, CNS depression *change positions slowly, take with stool softener, encourage fluids, monitor effectiveness.

S/S - Autism Spectrum Disorder

*verbalizations *repetitive/restrictive behaviors *unusual attachment to objects *rather play alone than with others *lack of empathy *minimal eye contact *does not adjust well to sudden changes in routine.

B Age 3 is too old for a bottle, plus a tube feed is invasive to the child. The child should be sitting all the way up for feeds, but not with a hyperextended neck. Jaw displacement does affect how he eats, so the best thing to do is to put his jaw in the right place so he eats properly.

A 3-year-old child has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. His is slightly underweight for his height. The MOST appropriate nursing action related to feeding this child is to: A. bottle or tube feed him a specialized formula until he gains sufficient weight. B. stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing C. Place a well-supported, semireclining position to make use of gravity flow. D. Place him in a sitting position with his neck hyperextended to make use of gravity flow

A If the child has a neurogenic bladdar disorder, then bladdar control cannot be taught. The 6 year old should easily be able to do this herself, it gives the chil d more control/mastery over the disorder. A urinary diversion is not necessary.

A 6-year-old girl born with a myelomeningocele has a neurogenic bladdar disorder. Her parents have been performing clean intermitteng catheterization. The nurse's MOST appropriate action is to: A. teach the child to do self-catheterization B. teach the child appropriate bladdar control C. continue having parents do catheterization D. encourage the family to consider urinary diversion.

C all other components are important, but do not heavily associate with developmental milestones

A child must experience mobility so he or she can explore and learn about the world. Lack of mobility in a child may interfere with which developmental milestone?

B Stay away from latex under every capacity of a child is allergic to it. You don't need to do an allergy test, we already know she is allergic to it. Why put the child through that again?

A child with spina bifida has developed a latex allergy from numerous bladdar catheterizations and surgeries. a PRIORITY nursing intervention is to: A. recommend allergy testing B. provide a latex-free environment C. use only powder-free latex gloves D. limit use of latex products as much as possible.

D You can only cuddle the infant in certain positions, but typically you wait until the surgery is over, especially since it needs to be performed 24-48 hours after birth. You do not take a temperature rectally, as it is not recommended under any capacity. The infant should be in prone position with legs flexed, never in supine.

A nurse caring for an infant who has a myelomeningocele. Which of the following actions should the nurse include in the preoperative plan of care? A. Assist the mother with cuddling the infant. B. Assess the infants temperature rectally. C. Place the infant in supine position. D. Apply a sterile, moist dressing on the sac.

B Barlow test is used on infants. Manipulation of the foot and ankle are used to assess for clubfoot. Ortolani test is used for infants.

A nurse is assessing a preschool-age child for developmental dysplasia of the hip. Which of the following assessments should the nurse include? A. Barlow Test B. Trendelenburg's sign C. Manipulation of the ankle and foot. D. Ortolani test

A and B Oxybutynin is used for bladdar spasms. Methotrexate is the second line drug used to treat Juvenile Idiopathic Arthritis. Predinisone is used not only as a third line drug for JIA, but also for muscle dystrophy.

A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? SATA A. Baclofen B. Diazepam C. Oxybutynin D. Methotrexate E. Prednisone

B Structural interventions should be according to developmental age, not chronological. The toddler's pain level should be monitored routinely, but not with a numeric scale, as they do not understand how to use it. Use a FACES scale instead or something otherwise more appropriate. We need to encourage as much independence as possible, so total care would not help. CP equals increased risk for hearing impairment, so therefore getting the toddler's hearing checked would be the best option here.

A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include? A. Structure interventions according to chronological age. B. Evaluate the toddler's need for an evaluation of hearing ability. C. Monitor the toddler's pain level routinely using a numeric pain scale. D. Provide total care for daily hygiene activities.

D Most activities can be adapted for children. Children with CP should be encouraged to be involved in extra-curricular activities as it promotes high self-esteem.

An 8 year old female child is diagnosed with moderate cerebral palsy. She recently began participation in a regular classroom for part of the day. Her mother asks the school nurse about having her daughter join an after-school Girl Scout troop. The nurse's response should be based on knowledge that: A. most activities such as Girl Scout's cannot be adapted for children with CP. B. after-school activites usually result in extreme fatigue for children with CP. C. trying to participate in activities such as Girl Scouts lead to lowered self-esteem in children with CP. D. after-school activities often provide children with CP oppurtinities for socialization and recreation.

Scoliosis

Functional/Structural lateral curvature of the spine.

B I would not ask the parents about the discrepencies because we do not want to make them worry. Noting it in the cart is something we can do, but not first. The x-ray requires pediatricians orders first.

When assessing an infant during a well baby check up, the nurse notices that one of the infants legs is slightly shorter than the other leg. The nurse's first action should be to: A. Ask the parents if they have noticed any discrepancies in leg length. B. Notify the pediatrician C. Note this physical finding in the infants chart D. Alert the x-ray department

C

When taking an inital health history from an adolescent to state that A. I always have a backache B. I become short of breath easily C. I can't find clothes that fit me properly D. I haven't grown much lately.

A, C, E, and F Do not put pressure on the site, that means do not put her in an infant seat. And there is no evidence of a foley catheter.

Which of these topics would be important to include in the discharge teaching for baby girl r? SATA A. Positioning B. Appropriate stimulation such as sitting in an infant seat or swing. C. Skin care and wound care D. Maintanence of a foley catheter. E. Signs and symptoms of when to call the physician F. Importance of multidisciplinary follow-up.

Autism Spectrum Disorder

complex neurodevelopmental disorder accompanied by intellectual social alterations.

Dysplasia of the Hip

displaced/dislocated hip. More likely in girls than boys.

C With work, continence can be achieved. Enemas/laxatives are sometimes used to achieve continence.

What most accurately describes bowel function in children born with a myelomeningocele? A. Incontinence cannot be prevented B. Enemas and laxatives are contraindicated C. Some degree of fecal continence can usually be achieved. D. Colonostomy is usually required by the time the child reaches adolescence.

Care/Treatment - Scoliosis

*corrective surgery - there will be tubes - warn patient before surgery about these and what they do. *brace - check skin integrity and teach how to properly apply the brace *obtain self-donated blood *orient to ICU *post op: monitor pain level, frequent assessment, log rolling (turn frequently), monitor incision site, monitor Hct and Hgb. ambulate as soon as tolerated, assess for infection, ROM

Prednisone

*corticosteriod: Helps with muscle dystrophy and pain associated with JIA. *take only if NSAIDs and methotrexate do not work. *SE: weight gain, alters growth long term *adequate diet, practice good infection control, monitor height and weight.

S/S - Cerebral Palsy

*failure to meet developmental milestones *stiff/rigid arms and posture * gagging/choking with feeding *poor sucking reflex *tongue thrust *poor head control *assymetrical crawl *hyperflexia *vision/speech/hearing impairments *seizures *impaired social relations

S/S - dysplasia of the hip

*joints not as mobile as they should be *clunky sound *increased risk factors: first time mothers, multiples (twins, triplets), babies born feet first out of birth canal *1 leg is shorter than the other.

S/S - Juvenile Idiopathic arthritis

*joints swelling, stiff, redness, and warmth *mobility limitations *fever *rash *limp in the morning *delayed growth

S/S - Scoliosis

*lateral bend at back *uneven shoulders when bending down.

S/S - Muscular dystrophy

*problems with running, bike riding, and climbing stairs. *waddling gait *frequent falls *stop walking around 12 years old *back arched when walking

Care/Management - JIA

*Keep a good pain regimen *minimize effects of inflammation *ROM (risk vs benefit) *eye exams routinely (as well as good eye care) *good exercise program *adequate diet (obesity equals more pain) *Physical therapy *encourage ADL's (occupational therapy would work too) *encourage activity. Inactivity equals more pain. Meds: NSAIDs, methotrexate, prednisone, biological agents

S/S - Fetal Alcohol Syndrome

*Physical: -small head -epicanthel folds -flat midface -smooth phititrum -low nasal bridge - small eye openings -short nose -thin upper lip *mental: -low birth weight -congential heart defects -behavioral problems -increased tone -unusually fast reflexes -irritability -underdeveloped fine motor skills -neurodevelopmental deficit. -no fear -no concern for safety

care/management - Muscular Dystrophy

*ROM *child should be kept as active as possible *brace *contractures as needed *genetic family counseling for family *no throw rugs *bars in bathroom *doors wide enough to fit a wheelchair *therapy *infection control (washing hands) *immunizations meds: prednisone

NSAIDs

*To help with pain/inflammation associated with JIA - 1st line *take as prescribed, take with food to avoid GI upset, report any changes in bowels or increased bruising, check kidney function.

C and D Purposeless, involuntary abnormal movements would be associated with CP. A spinal defect with saclike protrusion would be associated with Spinal bifida (either meningocele or myelomeningocele). Upward slant of the eyes is associated with Down's Syndrome.

A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? SATA A. Purposeless, involuntary abnormal movements B. Spinal defect and saclike protrusion C. Muscular weakness in lower extremities D. Unsteady, wide-based or waddling gait E. Upward slant to the eyes

A and E If anything, heat would help with muscle stiffness. The cold makes it worse and sometimes even make pain worse. Ibruprofen should be taken on a full stomach to preven GI upset. And going to school and being out of the house encourages movement, so staying home would not be beneficial even though it sounds appealing.

A nurse is caring for a school-aged child who has Juvenile Idiopathic Arthritis. Which of the following home care instructions should the nurse include in the teaching? SATA A. Provide extra time for completion of ADL's B. Use cold compress for joint pain C. Take ibruprofen on an empty stomach D. Remain home during periods of exacerbation E. Perform ROM exercises.

C You will need to stay in the hospital for about 1 week for observation before you can go home. You will require a PCA pump, there will be a lot of pain. You can eat as soon as the surgery is over, and advance your diet as tolerated. You will lose some blood during surgery, so blood is required.

A nurse is completing preoperative teaching with an adolescent client who is scheduled to recieve spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? A. "You will go home the same day of your surgery." B. "You will have minimal pain" C. "You will need to recieve blood" D. "You will not be able to eat until the day after your surgery"

D The child is safest in prone position. This guarentees that there will be no pressure on the sac. The sac should be covered with a sterile dressing. Most infants do not have diarrheal stools. The biggest concern with care of a myelomeningocele is hydrocephalus. head circumference and fontanels should be assessed on a daily basis.

An important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to: A. Place child on his or her side to decrease pressure on the spinal cord. B. Apply heat lamp to facilitate drying and toughening of the sac. C. keep skin clean and dry to prevent irritation from diarrheal stools. D. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

Juvenile Idiopathic Arthritis

Arthritis in children of unknown origin. Chronic autoimmune inflammatory disease causing inflammation of joints/other tissues.

A. Semi-fowlers would put pressure on it. On either side, the infant is not capable to staying there, so they are at risk for going back on their backs and putting pressure on the site.

In which position should the nurse place an infant with an unrepaired myelomeningocele? A. Prone B. Semi-Fowlers in an infants chair C. On right side D, On left side with head elevated.

A All other options have to deal with other stages of development.

Non compliance with the brace therapy is common among adolescents with scoliosis. The nurse should recognize that this is primarily due to adolescnet health beliefs that: A. Are oriented to the present, not the future. B. The brace will interfere with their sense of industry C. the brace will interfere with their sense of initiative. D. The brace will interfere with their sense of automony.

S/S - Spina Bifida

Occulta: hair tuft between L5 and S1, to which is also arched. Meningocele/myelomeningocele: sac protruding out of back.

B and C

The father asks questions about the infant's condition but does not look at the newborn. Which of these statements are correct? SATA A. Most news fathers are not interested in looking at their newborns. B. Even though the myelomeningocele was diagnosed in utero, see the congenital anomaly on his infant is very difficult. C. People grieve fro the loss of a "normal newborn" differently. D. This is an abnormal reaction for a parent of a child born with a very visible physical defect. E. it is apparent that he does not care about his newborns condition

D You cannot reverse the disease, but you can optimize growth so it doesn't become more severe. There is no underlying disease causing CP. And it is not contagious.

The major goals of therapy for children with Cerebral palsy include: A. reversing degenerative processes that have occured. B. curing the underlying causing disorder C. preventing spread to individuals in close contact with the child. D. recognizing the disorder early and promoting optimal development.

A and B All other choices are considered Instrumental ADLs

The nurse is assessing a patients ability of perform basic activities of daily living (BADLs). Which of the following activities are considered in the BADLs assessment? (SATA) A. Brushing teeth or dentures B. Dressing oneself. C. Washing, drying, and folding laundry D. Counting own pulse and taking heart pill. E. Taking the bus to a park. F. Calling family members.

C and F All other choices are examples of Basic ADL's

The nurse is assessing a patients ability to perform instrumental activities of daily living (IADL's). Which of the following activities are considered in the IADLs assessment? (SATA) A. Feeding oneself. B. Preparing a meal C. Balancing a checkbook D. Walking E. Toileting F. Grocery shopping

D The earlier the med, the better the pain will be when it is time for the child to get up for the day. This helps with good pain management.

The nurse is caring for a school-aged child with juvenile arthritis. The nurse should give this child's bath: A. At bedtime B. in the later afternoon C. just before lunch D. Early in the morning.

B Hygiene and visitors is important because of integrity, but skin breakdown needs to the primary source of focus. Incontinence only applies to some of the patients, not all of them.

The nurse is reviewing skin care of an immobilized patient with a UAP. The nurse knows the employee understands the importance of skin care when making which statement? A. "Proper care of the skin is important because the immobilized patient does not want to smell bad" B. "Proper care of the skin is important because the immobilized patient is at high risk for skin breakdown" C "Proper care of the skin is important because the immobilized patient will have many visitors" D. "Proper care of the skin is important because the immobilized patient will be incontinent"

B

The parents of a boy with muscular dystrophy ask the nurse when they should expect that their son will need to be in a wheelchair. The nurse would be most correct in advising them that most children with muscular dystrophy generally lose the ability to walk on their own by age: A. 6-8 years B. 9-11 years C. 12-16 years D. 17-24 years

A This can be done by ROM, increased activity, having a good pain regimen, and taking medication timely as prescribed.

The primary goal of treatment for a child with juvenile arthritis is to prevent: A. Loss of joint function B. Excessive weight gain C. Social isolation D. Skin breakdown.

Spina Bifida

There are 3 types: Occulta, Meningocele, Myelomeningocele. Occulta: arch between L5 and S1 and no herniation of spinal cord or meninges Meningocele: External meningies with CSF only. Myelomeningocele: External meninges and nerve roots with CSF

A

What is the nurse's primary rationale for keeping the sac of an infant with an unrepaired myelomeningocele moist, via applications of sterile normal saline? A. To prevent the sac from rupturing B. To aid in delivering additional fluids to the infant C. To prepare the sac for surgical removal D. To prevent cerebral spinal fluid from leaking onto the surgical incision site.

C It is an X-linked trait, so only boys are affected by this. The first weakness is in walking. Developmental milestones are reached normally, but weakness is noticed at 3 years of age.

Which statement BEST describes pseudohypertrophic muscular dystrophy? A. It is inherited as an autosomal dominant disorder B. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles C. It is characterized by muscle weakness usually beginning at 3 years of age. D. Onset occurs in later childhood and adolescence.

B Surgery must happen 24-48 hours after birth.

While you are getting vital signs, a father of his baby tells you that he has been trying to research myelomeningocele and meningocele. You discuss the difference with the father using laymens terms. After you discussion with the father, whihch of the father's statements would indicate a need for more teaching? A. "My baby's manifestation can also be reffered to as spina bifida cystica" B. "My baby will probably not require surgery until she is a year old." C. "My baby will need to lie on her stomach in her incubator" D. "I need to wash my hands carefully to prevent spread of germs"