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NURS 474 Spring 2018Exam 3 BlueprintTopics# Exam ItemsAlteration in Mobility/Neuromuscular or Musculoskeletal DisorderPosterior fontanel closes at 2-3 months; anterior fontanel by 18 months.At birth, the brain is 12% of body weight versus 2% in the adult.Brain and spinal cord development begins earliest and continues through age 12 years.Brain ossification is complete by age 12.Brain and Spinal Cord DevelopmentIn gestation, 3-4 weeks the neural tube of the embryo begins to differentiate into the brain and spinal cordpremature infant has less mature central nervous systemhigher risk of cervical spine injurychildren’s spine is very mobileMyelinationnot complete at birth, complete by age 2proceeds in a cephalocaudal and proximodorsal fashiongaining head and neck control firstMuscular Developmentnewborn is capable of spontaneous movement but lacks purposeful controlhypertonia and hypotonia are abnormal findingsDuchenne Muscular Dystrophy Management of & Sign & SymptomsX-linked inheritedPrimarily seen in males; females are carriersChild progresses normally; muscle weakness appears between 3 to 6 years Ambulation not possible by age 12Complications: “…contractures, scoliosis, disuse atrophy, infections, obesity, respiratory and cardiopulmonary problems.”S/S - Muscle weakness, hypertrophied calves, positive Gower’s maneuver (walking handsup the legs to achieve standing posture), frequent falls. All voluntary muscles are affected initially as well as cardiac and respiratory muscles. Waddling gait, balance is disturbed, TreatmentoPromoting mobility- weight bearing activity, supportive equipment, use of a wheelchair become full time around the age of 12. oMaintaining cardiopulmonary function – deep breathing, coughing, assessoMaximizing quality of life – do not place limits on the child, modify as needed for the childoSupportive careoCollaborative2-3Cerebral Palsy Management of Pathologic drooling is a problem for many children with cerebral palsy. It can lead to dehydration, dental enamel erosion, and maceration of the skin, and an odor can result, along withsocial stigmatization. Recent research has shown that intra-glandular injection of botulinum toxin 1-2This is the Blueprint for Exam 3. This Blueprint is meant to be used as a general guide. There may be times when a question must be removed and replaced last minute changing the number of exam items.
NURS 474 Spring 2018Exam 3 Blueprinttype A can improve drooling with few side effects in children with neurologic disorders. Management – oMedical Management: Baclofen Pump see Drug Guide Guidelines 22.1 p.807oCollaborative Care Goal: Early recognition and interventions to maximize the child’s abilities. Includes many health care providers, such as, PT, OT, Hearing andSpeech, Orthopedics, Medicine, Nursing, Education System, Technology Support ServicesoNursing Care: Devoted to supportive care; community advocacy with parents to preserve child function and maximize normal daily activitiesoPromote mobilityo