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NUR 317 Exam 3 Study Guide
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NUR 317 Exam 3 Study Guide
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NUR 317 EXAM 3 STUDY GUIDEm Neural Tube Defects - -50% or more from folic acid deficiency
-sources of of folic acid: leafy green vegetables (spinach), citrus fruits (orange juice), beans, bread,
cereals, rice, pasta, prenatal vitamin
-should close ~ 30 days after conception
-most common defects: anencephaly and spina bifida
Spina Bifida - -failure of the bony (osseous) spine to close
-two types
>spina bifida occulta: not visible externally
> spina bifida cystica: visible, saclike protrusion
--meningocele
--myelomeningocele
Spina Bifida Occulta - -lumbosacral L5-S1
-skin indicators: sacral dimple, sacral tufts of dark hair, red mark
-problem: adhesion to bony or fixed structure
-backbone (spine) does not fully form during pregnancy
-born with small gap in bones of spine
-usually causes no health problems
-some also have tethered cord (spinal cord that can't move freely inside the spinal canal)
-sometimes tethered cord needs to be released or can stretch (especially during growth spurt) and lead
to pain, trouble walking, and loss of bladder control
Meningocele - -fluid only present in sac at base of the spine
-meninges and spinal fluid: no neural elements
->no neurological defects
Myelomeningocele - -fluid and spinal cord both in sac at base of the spine
-meninges, spinal fluid, nerves
--anywhere along spinal column
--varying and serious degrees of neuro deficit
,---location and magnitude
--->below L2: flaccid paralysis of lower extremities and sensory deficit; bowel and bladder dysfunction
---> below S3: no motor impairment, bowel/bladder def.
Spina Bifida: Nursing Action - -prevention of infection and trauma to the "sac"
->covered with sterile saline dressing
-observe for early signs of infection
-> increased temp; no rectal
-> nuchal rigidity (inability to flex neck forward due to rigidity of neck muscles), irritability, lethargy,
increased ICP
-placement: prone position; no diapers
-assess neurological deficits
-surgical repair: 12-72 hours of birth
Spina Bifida: Bowel and Bladder Dysfunction - -neurogenic bladder: lack of bladder control due to a
brain, spinal cord, or nerve problem
-clean intermittent catheterizations
-anticholinergics
-antibiotics
-surgery
Latex Allergy - -all children with any neural tube defect must be treated as if they had a latex allergy
-- foods most likely to cause this problem: apple, avocado, banana, carrot, celery, chestnut, kiwi, melons,
papaya, raw potato and tomato
-various resources available to give families regarding environmental sources of latex
--The Spina Bifida Association offers handout
Hydrocephalus - -congenital causes or acquired as a result of infection, neoplasm or hemorrhage
-"water on the brain"
-extra fluid in and around brain: can cause spaces in brain (ventricles) to become too large and head can
swell
-causes brain to be positioned further down into upper spinal column than normal (Arnold Chiari II
malformation)
--> normal flow of fluid out of brain is obstructed, causing excess of cerebrospinal fluid in brain
,Neoplasm - new and abnormal growth of tissue in some part of the body, especially as a characteristic of
cancer
Hydrocephalus: Causes - CSF circulates throughout ventricular system and is then absorbed within the
subarachnoid spaces
-2 problems can occur
1. communicating hydrocephalus: impaired absorption of CSF
2. noncommunicating hydrocephalus: obstruction to flow of CSF occurs
-both lead to increased ICP and this is serious
*critical to measure head circumference daily and palpate fontanel for changes
Ventricles - structures that produce cerebrospinal fluid and transport it around the cranial cavity
Subarachnoid Space - interval between the arachnoid membrane and the pia mater; occupied by
delicate connective tissue trabecular and intercommunicating channels containing cerebrospinal fluid
(CSF)
-also contiguous around spinal cord
Hydrocephaly: Signs and Symptoms - -increasing head circumference
0bulging fontanel separated sutu
-"setting sun eyes"
-frontal bossing (prominent, protruding forehead)
-macewen sign
-high pitched cry
-changes in behavior: in older child
-nausea and vomiting: in older child where fontanels are closed
Macewen Sign - sign to detect hydrocephalus and brain abscess
-percussion (tapping) on the skull at a particular spot (near the junction of the frontal, temporal and
parietal bones)
-unusual resonant sound = positive sign
Hydrocephalus: Initial Management - -treatment of excessive CSF (shunt): ventriculoperitoneal (VP) most
common
-treatment of complications: mainly related to the shunt
-> infection: greatest risk first 2 months
-> malfunction: will see increased ICP
, -manage problems related to development
-> m2/3 mare mintellectually mnormal
Ventriculo-Peritoneal mShunt m- mto mhelp mdrain mextra mCSF mfrom mbrain, mplaced minto mhead
-by mtaking mthe mfluid mout mof myour mbrain mand mmoving mit minto myour mabdomen, mwhere mit's mabsorbed
mby myour mbody
-> mthis mlowers mthe mpressure mand mswelling min myour mbrain
Ventriculo-Peritoneal mShunt: mPost mOp mCare m- mBe malert mfor msigns mof mincreased mICP m
-post mop: mdaily mmeasurements mof mFOC mand mpalpation mof mfontanels mfor msize, msigns mof mbulging,
mtenseness, mseperation
-initially mkeep mflat mw/o mpressure mon mincision, mgradually mHOP melevated m(help mmaintain
mhemodynamics, mprevent moverdrainage
-> mover mdraining moccurs mwhen mCSF mdrains mfrom mventricles mat mfaster mrate mthan mproduces; mcan
mcause mventricles mto mcollapse, mwhich mmay mlead mto mheadaches mor mhemorrhage minside mbrain
-> munder mdraining mallows mCSF mto maccumulate mon mthe mbrain mand mcan mcause msymptoms mof
mhydrocephalus mto mreturn m
-neuro massessment, mVS, mI&O
-abdominal mdistention m(peritonitis mor mileus) m
-signs mof minfection: mincreased mtemp, mpoor mfeeding, mvomiting, mseizures, mincreased mLOC
-inspect mincision mline mfor mredness, mdrainage m(test many mdrainage mfor mglucose min mcase mit mis mCSF)
Ventriculo-Peritoneal mShunt: mDischarge mTeaching m- m-signs mof minfection mand mshunt mmalformation:
mtemp↑, mpoor mfeeding, mvomiting, mseizures, m↑LOC
-referrals, mie mearly mchildhood mprograms, mearly mintervention mservices, msupport mgroups
Anencephaly m- m-underdeveloped mbrain mand mincomplete mskull
-incompatible mwith mlife: mstillborn mor mlive mhours mto mweeks
-absence mof mboth mcerebral mhemispheres
-brainstem mfunction mmay mbe mintact m(brain mstem mcontrols mthe mflow mof mmessages mbetween mthe
mbrain mand mthe mrest mof mthe mbody, mit malso mcontrols mbasic mbody mfunctions msuch mas mbreathing,
mswallowing, mHR, mBP, mconsciousness, mand mwhether mone mis mawake mor msleepy)
-cause mof mdeath musually mrespiratory mfailure
-management: mcomfort mmeasures, mfamily msupport, mdiscussion mof mend-of-life missues mlike morgan
mdonation, mpossible mreferral mto mhospice
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