SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

Nursing Department

SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)

Name: CABAHUG, VICTORIA MAE I Date: 5/26/21

I Define the following conditions:

1. Torticollis, also known as wryneck, is a twisting of the neck that causes the
head to rotate and tilt at an odd angle.

2. Craniosynostosis is a birth defect in which the bones in a baby's skull join

together too early. This happens before the baby's brain is fully formed.

3. Achondroplasia is a disorder of bone growth. It is the most common form of

disproportionate short stature.

4. Tongue-tie (ankyloglossia) is a problem with the tongue that is present from

birth. It causes speech and eating problems in some children.

5. Pierre Robin sequence is also known as Pierre Robin syndrome or Pierre

Robin malformation. It is a rare congenital birth defect characterized by an
underdeveloped jaw, backward displacement of the tongue and upper airway
obstruction.

6. Esophageal atresia is a birth defect in which part of a baby's esophagus (the

tube that connects the mouth to the stomach) does not develop properly.

7. Tracheoesophageal fistula is a connection between the esophagus and the

trachea. When a baby with a TE fistula swallows, liquid can pass through the
connection between the esophagus and trachea. When this
happens, liquid gets into your baby's lungs. This can cause pneumonia and
other problems.
 8. An omphalocele is a birth defect in which an infant's intestine or other
abdominal organs are outside of the body because of a hole in the belly
button (navel) area. The intestines are covered only by a thin layer of tissue
and can be easily seen.

9. Gastroschisis results when there is a problem with the belly wall. In this case,
the hole forms next to the belly button, allowing the intestines to push
through. The hole may be small or large. Usually the hole is on the right side
of the belly button.

10. Meconium ileus is a bowel obstruction that occurs when the meconium in
your child's intestine is even thicker and stickier than normal meconium,
creating a blockage in a part of the small intestine called the ileum.

II. Answer the following:

1. Differentiate dislocation from subluxation.

Dislocation is a complete disruption of the joint while subluxation is a partial

dislocation followed by relocation) can damage the ligaments, nerves, joint
surfaces (cartilage), as well as the bones that make up the joint.

2. Develop a teaching plan for parents to perform, a neurologic assessment on

a child discharged from the hospital in a spica cast.

 Prepare the client for cast application.

o Explain the procedure and what to expect.
o Obtain informed consent if surgery is required.
o Clean the skin of the affected part thoroughly.
 Assist the health care provider during application of the cast as needed.
 After the cast application, provide cast care.
o Support an exposed cast, with the palms of your hands to prevent
indentations.
o Ensure that the stockinet is pulled over rough edges of the cast.
o Elevate the casted extremity above the level of the heart.
o Provide covering and warmth to uncasted areas.
o Expose the fresh plaster cast to circulating air, uncovered, until dry
(24 to 72 hours). Expose the fresh synthetic cast until it is
completely set (about 20 minutes).
o Instruct the client to avoid wetting the cast. Instruct him to dry a
synthetic cast with a hair dryer on cool setting if it gets wet.
 Initiate pain relief measure if indicated.
 o Encourage position changes.
o Elevate the affected body part.
o Provide analgesics as appropriate.
o Promote nonpharmacologic pain relief measures, such as guided
imagery, relaxation and distraction.
 Observe for signs and symptoms of cast syndrome with clients who are
immobilized in large casts, such as a body or hip spica cast.
o Report abdominal pain and distention, nausea and vomiting,
elevated blood pressure, tachycardia, and tachypnea which are
physiologic effects of cast syndrome.
o Any client who is claustrophobic is at risk for psychological cast
syndrome, which includes acute anxiety and possible irrational
behavior.
 Provide nursing care for compartment syndrome, if indicated. Observe for
signs and symptoms and discuss and assist with treatments.
 Notify the health care provider immediately if signs or symptoms of other
neurovascular complications occur.
 Notify the health care provider if “hot spots” occur along the cast; they
may indicate infection under cast.
 Provide client and family teaching.
o Encourage isometric exercises to strengthen muscles covered by
the cast. Promote muscle-strengthening exercises for the upper
body if crutches are to be used.
o Advise the client to promptly report cast breaks and signs and
symptoms of complications (i.e. circulatory compromise, cast
syndrome, and hot spots).
o Warn the client against inserting sharp objects (e.g. coat hanger to
scratch itchy skin under the cast). Instruct him to use a cool air
from a dryer to help alleviate the itch.
o Teach the client appropriate cast care, depending on the type of
cast.
o Encourage safety precautions (e.g. avoid walking on wet floors,
watch throw rugs, be careful with stairs).
o Teach the client skin care and muscle-strengthening exercises for
the affected body part after cast removal.
o Encourage mobility and active participation in self-care.
o Reinforce health care provider instructions on the amount of eight
bearing allowed.

3. Identify the major components of assessment when examining the infant for
a diaphragmatic hernia. What are the physiologic explanation for the positive
findings that you might find on assessment?
 During pregnancy, there are screening tests to check for some birth defects
and other conditions. Doctors can usually diagnose diaphragmatic hernia
before the baby is born. Doctors use an ultrasound to create a picture of the
diaphragm and lungs to look for abnormalities. In some cases, ultrasounds
during pregnancy do not show the diaphragmatic hernia. However, once the
baby is born, doctors may diagnose the condition after noticing that the baby
has trouble breathing. A chest x-ray can show that organs normally in the
abdomen are in the chest, and the lungs look smaller than normal or are
pushed to one side.

4. Visit the physical therapy unit of SWU-MC, and identify the equipment used
for motor development by the patient in the hospital and by the patients who
visit for outpatient therapy.

Basic Gear

 Mobile

 Musical toys

 Mirrors in the crib or play pen

 Soft fabric toys with differing sounds and textures

 Fabric dolls or animals with easy to grab limbs

 Activity mat

 Rattles

Equipment for Moderate use

 Strollers (with car seat carry along)

 Car seats (carry along)

 Bouncy seats

III. Case Study

Patrick is approximately 24 hours old. The doctors are implementing test and
procedures to determine whether his congenital neural tube defect is a meningocele
or myelomeningocele.

A. How does a meningocele different from myelomeningocele?

 Myelomeningocele is the most serious type of spina bifida. With this
condition, a sac of fluid comes through an opening in the baby’s back. Part of
the spinal cord and nerves are in this sac and are damaged while
meningocele is a sac of fluid comes through an opening in the baby’s back.
But, the spinal cord is not in this sac. There is usually little or no nerve
damage. This type of spina bifida can cause minor disabilities.

B. What are the physical characteristics that Patrick would exhibit if diagnosed
with myelomeningocele?

The effects of myelomeningocele, the most serious form of spina bifida, may
include muscle weakness or paralysis below the area of the spine where the
incomplete closure (or cleft) occurs, loss of sensation below the cleft, and
loss of bowel and bladder control. In addition, fluid may build up and cause
an accumulation of fluid in the brain (a condition known as hydrocephalus).

C. Preoperatively, Patrick should be placed on what position?

Prone Position

D. The nurse should give special attention to Patrick’s elimination status. What
procedure might the nurse implement to aid in bladder elimination.

It is important to keep the bladder and bowel as healthy as possible and that
you eat a healthy, balanced diet with plenty of fibre and consume enough
fluid (ideally water and around 6-8 glasses a day) in order to regulate the
bowel and keep stools at the right consistency to avoid constipation. Bowel
retraining and bladder retraining involves establishing your bladder or bowel
into a regular routine and retraining your brain to hold on. You start by going
to the bathroom when you get the urge to go and hold for 1 minute before
sitting down. Gradually increase the length of time until you feel more
confident with your control. It is also helpful to regulate the times that you
visit the toilet. Creating a routine can help to avoid accidents.

SOURCCES :

https://www.luriechildrens.org/en/specialties-conditions/pediatric-physical-
therapy/resources/motor-development-gear/
https://www.nursingcenter.com/journalarticle?
Article_ID=3245974&Journal_ID=403341&Issue_ID=3245938
https://www.ucsfbenioffchildrens.org/education/caring-for-a-child-in-a-spica-cast
https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/cast-application-
nursing-management/