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Joyce Visitacion NCM 104 BSN - 4aj 1 Semester 2008-2009: Risk Factors
Joyce Visitacion NCM 104 BSN - 4aj 1 Semester 2008-2009: Risk Factors
CLINICAL MANIFESTATIONS:
• Anencephaly: large skull defect with no cortex; many are
still born and others die within days of birth.
• Encephaloceles: projections of the cranial content thru a
bony skull defect, usually occipital region.
- Severe mental retardations
- Seizure
- Movement disorder
SPINA BIFIDA
• CNS defect that occurs as a result of incomplete closure of one
or more vertebrae.
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2 TYPES OF SPINA BIFIDA:
1. Spina Bifida Occulta
• Most common and less severe.
• Defect in the vertebral arches without herniation of any spinal
content.
• Birthmarks, dimples or hairy tuft at the base of the back.
• Meninges are not usually exposed on skin surface.
Diagnostic Factor:
• Alpha- Fetoprotein (AFP) at 16-18 weeks AOG as
screening factor for those high risk.
DIAGNOSTIC TESTS:
a) Amniocentesis presence of increase alpha-
fetoprotein
b) Maternal Blood Test
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TREATMENT:
a) Spina bifida occulta – no treatment
b) Spina bifida meningocele – surgical closure
c) Spina bifida meningomyelocele – repair of the sac or cystic
lesion
NURSING MANAGEMENT:
1) Evaluate sac and measure lesion.
2) Perform neurological assessment.
3) Monitor increase in ICP.
4) Protect sac using aseptic technique (put dressing, cover with
sterile gauze soak in Normal Saline)
5) Place in prone position, head turned to one side for
feeding.
6) Assess for early signs of infection.
7) Administer medication as ordered (antibiotics,
anticholinergics, laxatives, anti-spasmodics)
CEREBRAL PALSY
• Main problem: absence of oxygen to the brain (Anoxia)
• Non- progressive disorder of movement and posture that
results from tension of the immature brain.
• Risk factors:
- Pre-maturity
- Birth asphyxia (suffocation / presence of
foreign substances in the airway)
- Early infection or trauma
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-IUGR (Intra-Uterine Growth Retardation)
-Most cases occur in the absence of identifiable risk
factors.
TYPES OF CEREBRAL PALSY:
1) Pyramidal (spastic)
• Most common
• Tense, contracted muscles
2) Athetoid
• Constant, uncontrolled motion of limbs, head and
eyes.
3) Ataxic
• Poor sense of balance often causing falls and
stumbles.
4) Rigidity
• Tight muscles that resist effort to make them move.
5) Tremor
• Uncontrollable shaking, interfering with coordination
CLINICAL MANIFESTATIONS:
• Abnormal muscle tone. Common clinical manifestations
• Abnormal coordination.
• Tones remain relatively constant regardless of activity and
level of arousal.
• Clasp knife rigidity (resistance to applied force with
sudden or give alternating with increased resistance)
• Significant hyperreflexia.
• Stiff and rigid arms or legs.
• Persistent of primitive and pathologic reflexes.
• Extreme irritability and crying.
• Feeding difficulties.
• Delayed gross development.
• Opisthotonus posture (abnormal arching of the back)
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MANAGEMENT:
• Multidisciplinary approach.
• Therapeutic goal includes minimizing impairments,
maximizing function, preserving general health.
NURSING MANAGEMENT:
• Assess child’s development level and intelligence.
• Encourage early intervention and participation in school
programs.
• Prepare fro using mobilizing devices to prevent deformities.
• Communicate with the child on a functioning level, not
chronological age level.
• Provide safe environment.
• Provide safe, appropriate toys for age and developmental age.
• Position upright after meals.
REYE’S SYNDROME
• A syndrome of encephalopathy (brain disease) with associated
liver degeneration.
• Unknown cause, but can be associated with viral agents such as
influenza or varicella, toxins, aspirin and other salicylates and
metabolic defects.
• Reye’s Syndrome = infection + utilization of Aspirin
• Happens 1-3 days after infection
• Problem: infiltration of fats in the brain, heart and lungs.
CLINICAL MANIFESTATIONS:
Stage I: Sudden onset of persistent vomiting, fatigue.
Stage II: Behavior changes, disorientation, confusion,
hyperreflexia.
Stage III: Coma, decorticate posturing.
Stage IV: Deeper coma, decerebrate posturing.
Stage V: Seizures, absent deep tendon and respiratory
reflexes, flaccid paralysis.
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DIAGNOSTIC TESTS:
1. Elevated liver enzymes (indicative of Reye’s Syndrome)
Aspartate Aminotransferase (AST), Alanine Transaminase
(ALT): Normal = 8-20 unit/l
GOAL OF TREATMENT:
1. Maintain effective cerebral perfusion and prevent increase
ICP.
SURGERY:
• Decompressive Craniotomy (surgery to decrease
ICP)
MEDICATION OF CHOICE:
• Acetaminophen (Tylenol)
NURSING MANAGEMENT:
1. Assess neurological status.
2. Monitor for altered level of consciousness and
increased ICP.
3. Monitor I and O.
4. Provide rest and decrease environmental
stimulation.
5. Monitor for signs of bleeding.