Question 1

What is the most common cause of cerebral palsy (CP)?

Accepted Answer

Approximately 80% of CP is caused by unknown prenatal causes.Neonatal encephalopathy in term and preterm infants is believed to play a significant role in the development of CP.CNS diseases such as meningitis or encephalitis can result in CP.Birth asphyxia does contribute to some cases of CP.Cerebral trauma,including shaken baby syndrome,can result in CP.

Question 2

What is a major goal of therapy for children with cerebral palsy (CP)?

Accepted Answer

The goals of therapy include early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction.The disorder is permanent,and therapy is chiefly symptomatic and preventive.It is not possible at this time to reverse the degenerative processes.CP is not contagious.

Question 3

During a well-child visit,the mother tells the nurse that her 4-month-old infant is constipated,is less active than usual,and has a weak-sounding cry.The nurse suspects botulism and questions the mother about the child's diet.What factor should support this diagnosis?

Accepted Answer

Ingestion of honey is a risk factor for infant botulism in the United States.Honey should not be given to children younger than the age of 1 year.Botulism is not found with the use of commercial infant cereals.Although there is a slight increase in botulism in breastfed infants when compared with formula-fed infants,there is not sufficient evidence to support formula feeding as prevention.Thoroughly cleaning bottles used for formula feeding is sufficient for botulism prevention.Inadequate sterilization of home-canned foods can contribute to botulism.

Question 4

Spastic cerebral palsy (CP)is characterized by which clinical manifestations?

Accepted Answer

Hypertonicity and poor control of posture,balance,and coordinated motion are part of the classification of spastic CP.Athetosis and dystonic movements are part of the classification of dyskinetic or athetoid CP.Tremors and lack of active movement may indicate other neurologic disorders.A wide-based gait and poor performance of rapid,repetitive movements are part of the classification of ataxic CP.

Question 5

An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department.She has completed the tetanus immunization series,receiving the last tetanus toxoid booster 8 years ago.What care is necessary for therapeutic management of this adolescent to prevent tetanus?

Accepted Answer

Protective levels of antibody are maintained for at least 10 years.Children with serious "tetanus-prone" wounds,including contaminated,crush,puncture,or burn wounds,should receive a tetanus toxoid booster prophylactically as soon as possible.This adolescent has circulating antibodies.The immunoglobulin is not indicated.

Question 6

What statement is most accurate in describing tetanus?

Accepted Answer

Tetanus results from an infection by the anaerobic spore-forming,gram-positive bacillus Clostridium tetani.The organism forms two exotoxins that affect the central nervous system to produce the clinical manifestations of the disease.Tetanus is not an inflammatory process.The toxin acts at the neuromuscular junction to produce muscular stiffness and to lower the threshold for reflex excitability.It is usually a systemic disease.Initial symptoms are usually a progressive stiffness and tenderness of the muscles of the neck and jaw.The sustained contraction of the jaw-closing muscles provides the name lockjaw.Meningeal inflammation is not the cause of the muscle spasms.

Question 7

A 12-year-old child with Guillain-Barré syndrome (GBS)is admitted to the pediatric intensive care unit.She tells you that yesterday her legs were weak and that this morning she was unable to walk.After the nurse determines the current level of paralysis,which should the next priority assessment be?

Accepted Answer

Assessment of swallowing is essential.Both pharyngeal involvement and respiratory function are usually involved at the same time.The child may require ventilatory support.The inability to swallow also contributes to aspiration pneumonia.Parental involvement is important after the physiologic assessment is complete.The child is answering questions and describing the onset of the illness,which demonstrates she is alert and oriented.Information regarding antecedent viral infections can be obtained after the child is assessed and stabilized.

Question 8

The parents of an infant with cerebral palsy (CP)ask the nurse if their child will have cognitive impairment.The nurse's response should be based on which knowledge?

Accepted Answer

Children with CP have a wide range of intelligence,and 40% to 50% are within normal limits.A large percentage of children with CP do not have mental impairment.Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.

Question 9

A child,age 3 years,has cerebral palsy (CP)and is hospitalized for orthopedic surgery.His mother says he has difficulty swallowing and cannot hold a utensil to feed himself.He is slightly underweight for his height.What is the most appropriate nursing action related to feeding this child?

Accepted Answer

Jaw control is compromised in many children with CP.More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face.Bottle or tube feeding will not improve feeding without jaw support.The semireclining position and hyperextended neck position increase the chances of aspiration.

Question 10

An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident.The parents keep asking the nurse,"How bad is it?" The nurse's response should be based on which knowledge?

Accepted Answer

The extent and severity of damage cannot be determined initially.The immediate loss of function is caused by anatomic and impaired physiologic function,and improvement may not be evident for weeks or months.It is essential to provide information about the adolescent's status to the parents.Immediate treatment information should be provided.Long-term rehabilitation and prognosis can be addressed after the child is stabilized.During the immediate postinjury period,physiologic responses to the injury make an accurate assessment of damage difficult.

Question 11

What statement best describes Duchenne (pseudohypertrophic)muscular dystrophy (DMD)?

Accepted Answer

DMD is characterized by a waddling gait and lordosis.Gower sign is a characteristic way of rising from a squatting or sitting position on the floor.DMD is inherited as an X-linked recessive gene.Genetic counseling is recommended for parents,female siblings,maternal aunts,and their female offspring.Onset occurs usually between ages 3 and 5 years.DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.

Question 12

An 8-year-old girl with moderate cerebral palsy (CP)recently began joining a regular classroom for part of the day.Her mother asks the school nurse about joining the after-school Girl Scout troop.The nurse's response should be based on which knowledge?

Accepted Answer

After-school and recreational activities serve to stimulate children's interest and curiosity.They help the children adjust to their disability,improve their functional ability,and build self-esteem.Increasing numbers of programs are adapted for children with physical limitations.Almost all activities can be adapted.The child should participate to her level of energy.Self-esteem increases as a result of the positive feedback the child receives from participation.

Question 13

What type of cerebral palsy (CP)is the most common type?

Accepted Answer

Spastic CP is the most common clinical type.Early manifestations are usually generalized hypotonia,or decreased tone that lasts for a few weeks or may extend for months or as long as 1 year.It is replaced by increased stretch reflexes,increased muscle tone,and weakness.Ataxic,dyskinetic,and mixed type are less common forms of CP.

Question 14

An adolescent with a spinal cord injury is admitted to a rehabilitation center.Her parents describe her as being angry,hostile,and uncooperative.The nurse should recognize that this is suggestive of which psychosocial state?

Accepted Answer

During the rehabilitation phase,it is desirable for adolescents to begin to express negative feelings toward the situation.The rehabilitation team can redirect the negative energy toward learning a new way of life.The injury has interrupted the normal adolescent process of achieving independence,triggering these negative behaviors.Severe depression can occur,but it indicates that the child is no longer in denial.Long-term therapy is not indicated.Being angry,hostile,and uncooperative are behaviors that are indications that the adolescent understands the severity of the injury and need for rehabilitation.

Question 15

The parents of a child with spastic cerebral palsy (CP)state that their child seems to have significant pain.In addition to systemic pharmacologic management,the nurse includes which teaching?

Accepted Answer

Parents and children are taught positions to assume while sitting and recumbent that reduce spasticity.The American Academy of Pediatrics has stated that patterning should not be used for neurologically disabled children.Patterning attempts to alter abnormal tone and posture and elicit desired movements through positional manipulation or other means of modifying or augmenting sensory output.Stretching should be done after appropriate analgesic medication has been given and is effective.Topical analgesia is not effective for the muscle spasms of spastic CP.

Question 16

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago.What nursing intervention is a priority for this child?

Accepted Answer

Spinal cord injury patients are physiologically labile,and close monitoring is required.They may be unstable for the first few weeks after the injury.Increased blood pressure may be an indication of autonomic dysreflexia.It is not necessary to minimize environmental stimuli for this type of injury.Spinal cord injury is not an infectious process.Immunoglobulin is not indicated.Discussing long-term care issues with the family is inappropriate.The family is focusing on the recovery of their child.It will not be known until the rehabilitation period how much function the child may recover.

Question 17

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome.A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease)is made.What should be included in the nursing care for this child?

Accepted Answer

Werdnig-Hoffmann disease (spinal muscular atrophy type 1)is the most common paralytic form of floppy infant syndrome (congenital hypotonia).An infant stimulation program is essential.Frequent position changes,including changes in environment,provide the child with more physical contacts.Verbal,tactile,and auditory stimulation are also included.Contractures do not occur because of muscular atrophy.Sensation is normal in children with this disorder.Frequent touch is necessary as part of the stimulation.Werdnig-Hoffmann disease is inherited as an autosomal recessive trait.Parents should be referred for genetic counseling.

Question 18

What functional ability should the nurse expect in a child with a spinal cord lesion at C7?

Accepted Answer

Individuals who sustain injuries at the C7 level are able to achieve a significant level of independence.Some assistance is needed with transfers and lower extremity dressing.Patients are able to roll over in bed and to sit and eat independently.Patients with injuries at C3 or higher have complete respiratory paralysis.Those with injuries at C4 or higher do not have voluntary function of higher extremities.Injuries at C5 or higher prevent rolling over or sitting.

Question 19

Gingivitis is a common problem in children with cerebral palsy (CP).What preventive measure should be included in the plan of care?

Accepted Answer

Meticulous oral hygiene is essential.Many children with CP have congenital enamel defects,high-carbohydrate diets,poor nutritional intake,and difficulty closing their mouths.These,coupled with the child's spasticity or clonic movements,make oral hygiene difficult.Children with CP have high carbohydrate intake and retention,which contribute to dental caries.Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste.Certain medications such as phenytoin do contribute to gingival hyperplasia.If that is the drug of choice,then meticulous oral hygiene must be used.

Question 20

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]).When explaining this disease process to the parents,what should the nurse consider?

Accepted Answer

Recovery usually begins within 2 to 3 weeks,and most patients regain full muscle strength.The paralysis is progressive with proximal muscle weakness occurring before distal weakness.The recovery of muscle strength occurs in the reverse order of onset of paralysis.Most individuals regain full muscle strength.Better outcomes are associated with younger ages.GBS is an immune-mediated disease often associated with a number of viral or bacterial infections or the administration of vaccines.

Quiz 35: The Child With Neuromuscular or Muscular Dysfunction

What is the most common cause of cerebral palsy (CP) ?

What is a major goal of therapy for children with cerebral palsy (CP) ?

During a well-child visit,the mother tells the nurse that her 4-month-old infant is constipated,is less active than usual,and has a weak-sounding cry.The nurse suspects botulism and questions the mother about the child's diet.What factor should support this diagnosis?

Spastic cerebral palsy (CP) is characterized by which clinical manifestations?

An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department.She has completed the tetanus immunization series,receiving the last tetanus toxoid booster 8 years ago.What care is necessary for therapeutic management of this adolescent to prevent tetanus?

What statement is most accurate in describing tetanus?

The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment.The nurse's response should be based on which knowledge?

A child,age 3 years,has cerebral palsy (CP) and is hospitalized for orthopedic surgery.His mother says he has difficulty swallowing and cannot hold a utensil to feed himself.He is slightly underweight for his height.What is the most appropriate nursing action related to feeding this child?

An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident.The parents keep asking the nurse,"How bad is it?" The nurse's response should be based on which knowledge?

What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD) ?

An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day.Her mother asks the school nurse about joining the after-school Girl Scout troop.The nurse's response should be based on which knowledge?

What type of cerebral palsy (CP) is the most common type?

An adolescent with a spinal cord injury is admitted to a rehabilitation center.Her parents describe her as being angry,hostile,and uncooperative.The nurse should recognize that this is suggestive of which psychosocial state?

The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain.In addition to systemic pharmacologic management,the nurse includes which teaching?

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago.What nursing intervention is a priority for this child?

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome.A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made.What should be included in the nursing care for this child?

What functional ability should the nurse expect in a child with a spinal cord lesion at C7?

Gingivitis is a common problem in children with cerebral palsy (CP) .What preventive measure should be included in the plan of care?

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]) .When explaining this disease process to the parents,what should the nurse consider?