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Copy of Nursing Management of Neurological Congenital Disorders

Facts and trivia about the holiday
by Rachelle Hayag on 27 February 2013

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Transcript of Copy of Nursing Management of Neurological Congenital Disorders

Nursing Management of Neurological Congenital Anomalies Spina Bifida Objectives Nursing Interventions Ethics Committee Surgical
neonate Spina Bifida Occulata Birth of child with physical defect Neural Tube Defects Diagnostics Diagnostics Hydrocephalus Latex Allergy Assessment Psychological support for family
Pre-op care similar to HR neonate
Airway
Circulation
Fluids, electrolytes, glucose
Thermoregulation
Post-op care
Operative site
Pain management Failure of tube closure
Folic acid
Alpha-fetoprotein
Anencephaly
Spina bifida 恭喜發財
A couple has just given birth to an infant boy with multiple congenital anomalies including meningomyelocele and severe congenital heart defects. The couple are Christian Scientists and do not believe in conventional medical care. They have refused consent to the surgical repair of the meningomyelocele and treatment of the heart defects.
What should the hospital staff do? RNSG 2514 Unit VIII
Perry, 768-69, 822-41, 1177-86, 1593-97, 1716-33 Usually Lumbosacral L5 S1
Skin indicators (absent, singly or combos)
Sacral dimple
Sacral angioma or port wine nevus
Sacral tufts of dark hair
Sacral lipoma
“Tethered Cord”
Abnormal adhesion to bony or fixed structure
Puts traction on the cord
Altered gait
Bowel/ bladder problems
Foot deformities H.C (F.O.C.)
Fontanel tension
Serial ultrasounds—ventricle size
MRI or CT Diagnostics
X-ray
MRI
CT
Ultrasonography Nursing Problems Risk for infection, CNS, UTI
Risk for trauma, injury (complications)
Risk for impaired skin integrity
Impaired elimination
Latex allergy response, risk for
Interrupted family processes
Knowledge deficit Nursing Assessment for Shunt Infection

Fever & inflammation of tract
Abdominal pain
Emergency situation

What are the priority nursing interventions? Medical Management Ventriculoperitoneal Shunts (VP Shunt) Nursing Assessment for Shunt Malfunction

Shunt malfunction is emergency!!
Increased ICP
Broken high pitched cry
Worsening neuro status/ altered LOC
Increasing hydrocephalus


VP Shunts
Most commonly used
Extra tubing to allow for growth
Minimizes need for revisions
May need replacement 2-4 times as child matures
Nursing problems
Risk for injury
Risk for infection
Risk for impaired skin integrity
Impaired mobility
Delayed growth and development
Risk for Interrupted family processes
Alteration in elimination Other shunt types
Ventriculoatrial
To right atrium
Older child or abnormal abdominal anatomy
Ventriculopleural
Ventricular Bypass
Used w/ non-communicating hydrocephalus
Aqueduct stenosis, cranial masses

Complications of Shunts
Obstruction
Distal or proximal end blocked
Kinking of tubing
Valve breakdown
Shunt Infection Miguel was born with hydroanencephay.
What are your nursing diagnoses and interventions?
What are your goals and outcome statements for both?
What measures should the nurse use to help his parents cope with this birth outcome? Rapid head growth
Tense, bulging fontanels
Bossing of frontal area
Prominent scalp veins
Translucent skin
Poor feeding
Lethargy
Hypertonia, hyperreflexia Discuss the signs and symptoms associated with congenital neurological anomalies.

Integrate the Collin College nursing model to specific situations.

Distinguish treatment modalities

Differentiate among nursing diagnoses, outcome criteria, and nursing interventions.

Attribute specific variables to the etiology and outcome.

Be accountable for unit objectives

Identify and apply nursing implications associated with the cultural needs for patient

Apply current evidenced based strategies for patients Very frequent monitoring for signs ICCP
Immediately report signs of complications
Prepare for diagnostics or shunt placement
Post op care
Positioned flat on non-operative side
Neuro assessment
Signs infection, insertion site care
Early childhood development programs Initial Management
Placement of shunt (to treat excessive CSF) routine post-op care
Prevention/treatment of complications
What specific complications?
Manage problems r/t psychomotor development
What are specific nursing interventions?
Prenatal surgical repair
Prevent infection
Asses neuro status and possible associated anomalies
Elimination management, pharmacologic and non-pharm methods (CIC)
Early closure in 12 - 72 hrs after birth
Prevent stretching of other nerve roots and further damage Assessment Skin integrity
Neuro fuctioning, motor and bowel/bladder
Signs of neonatal infection or complications
Bonding behaviors You hear an overhead page to go immediately to Ricardo’s room. You find that he is having a grand mal seizure.

What do you do?

Mom is becoming hysterical. What do you do with her?
Sensitive or critical prenatal periods
Parental responses
Nursing considerations
Family support
Special care for infant
Accurate up to date information
EXIT surgery Microcephaly FOC > 3 SD below the mean
Primary
Intrauterine exposure to toxins (ETOH) weeks 4-20
Secondary
3rd trimester exposure
Perinatal exposure
Exposure in early infancy
Mild hyperkinesias, mild motor impairment
Decerbration, complete unresponsiveness
Autistic behavior Case Study What are your priorities?
Which patient will you assess first?
Why? Medication Mania Name and classify as many drugs as you can that are used in the treatment of CHF Nursing Interventions Monitoring for complications
Positioning
Skin care, care of sac, diaper care
Elimination management, pharmacologic and
non-pharm methods (CIC, anticholinergics)
Comfort care
Thermoregulation
Family teaching
Short and long term Know what items contain latex
Know what items contain latex
Know what items contain latex
Know what items contain latex Increased risk with NTD and other congenital anomalies Report to Provider Increasing FOC, signs of IICP
Signs of infection
Skin integrity and integrity of sac
I & O balance
Alteration of elimination patterns
Neurological discrepancies What are your primary problems for Ricardo and Jayden?
What are your goals for the care of these patients today?
What are your priority interventions for each? Older Children Results as complication of trauma or illness
NO head enlargement
ICP
Headache, vomiting, esp morning
Altered LOC (fussy, sleepy, confusion)
Verbal incoherence
Ataxia, altered motor function
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