Chapter 30, The Child with Neuromuscular or Muscular

Chapter 30, The Child with Neuromuscular or Muscular Dysfunction Hockenberry, Wong's Essentials of Pediatric Nursing, 10th Edition.

• The nurse is planning a staff in-service on childhood spastic cerebral palsy. What

characterizes spastic cerebral palsy?

• Hypertonicity and poor control of posture, balance, and coordinated motion
• Athetosis and dystonic movements
• Wide-based gait and poor performance of rapid, repetitive movements

d. Tremors and lack of active movement - ANSWER-ANS: A

Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic (athetoid) cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.DIF: Cognitive Level: Understand REF: p. 978 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

• The parents of a child with cerebral palsy ask the nurse whether any drugs can

decrease their child's spasticity. The nurse's response should be based on which statement?

• Anticonvulsant medications are sometimes useful for controlling spasticity.
• Medications that would be useful in reducing spasticity are too toxic for use with

children.

• Many different medications can be highly effective in controlling spasticity.
• Implantation of a pump to deliver medication into the intrathecal space to decrease

spasticity has recently become available. - ANSWER-ANS: D

Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.DIF: Cognitive Level: Understand REF: p. 979 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies

• The nurse is preparing to admit a newborn with myelomeningocele to the neonatal 1 / 2

intensive care nursery. Which describes this newborn's defect?

• Fissure in the spinal column that leaves the meninges and the spinal cord exposed
• Herniation of the brain and meninges through a defect in the skull
• Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural

elements

• Visible defect with an external saclike protrusion containing meninges, spinal fluid,

and nerves - ANSWER-d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

ANS: D

A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

• The nurse is conducting a staff in-service on common problems associated with

myelomeningocele. Which common problem is associated with this defect?

• Hydrocephalus
• Craniostenosis
• Biliary atresia

d. Esophageal atresia - ANSWER-ANS: A

Hydrocephalus is a frequently associated anomaly in 80% to 90% of children.Craniostenosis is the preterm closing of the cranial sutures and is not associated with myelomeningocele.Biliary and esophageal atresia is not associated with myelomeningocele.DIF: Cognitive Level: Understand REF: p. 984 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

• The nurse is teaching a group of nursing students about newborns born with the

congenital defect of myelomeningocele. Which common problem is associated with this defect?

• Neurogenic bladder
• Cognitive impairment
• Respiratory compromise
• Cranioschisis - ANSWER-a. Neurogenic bladder

ANS: A

Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction

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