Rib hump asymmetrical rib cage uneven shoulder or

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Rib hump Asymmetrical rib cage Uneven shoulder or pelvic heights Prominence of scapula Hip/leg discrepancy Size difference in space between arm and body (rt.vs left) MEDICATIONS Pain medication after surgery if no paralytic ileus. Xrays determine severity and guide treatment plan. TREATMENT MILD- 10-20 degrees: Exercise MODERATE: 20-40 degrees: Lumbar curve- typically wear nighttime only. SEVERE: 40 degrees- aggressive treatment/curve patterns require a brace be worn 22-23 hours/day. Tee shirt should be worn underneath brace to prevent skin Surgery 45-50 degrees. NURSING ISSUES Skin Issues/breakdown Disturbed body image
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Compliance issues Braces/fixtures 1. Milwaukee brace 2. Boston Brace 3. Adjustable internal rods- TSRH Post op care Paralytic ileus- listen for bowel sounds before giving pain meds. Pin care, wound care Circulation Pain management Log roll May have catheter/catheter care CEREBRAL PALSY (pg. 1287-1290) Does not get worse over time. Damage done may not be known until milestones are not being met.
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Maximize potential PATHOPHYSIOLOGY Not genetic or hereditary. Cerebral damage caused by hypoxia during prenatal, perinatal or post-partum period. Area of brain affected determines type of disability. Risk factors: Maternal diabetes, blood type incompatibility, Rubella, toxoplasmosis, maternal infections, precipitous delivery, birth trauma, anoxia, pregnancy induced hypertension, prolonged labor, intracranial hemorrhage, asphyxia, low birth weight, prematurity, postnatal infections, trauma, stroke or poisoning. Spastic cerebral palsy is most common type. Affected area is cortex. Deep tendon reflexes Hypertonia Flexion Contractures. Ataxia- poor co ordination Cognitive developmental delays Epilepsy ADHD Hearing issues FTT- failure to thrive GERD issues. MANIFESTATIONS Not meeting milestones (sitting, crawling etc.) 8mth old should be able to sit. 10 mth old should crawl Uncontrolled movements in extremities Seizures, ADD, Sensory impairment, equilibrium impairment Speech and swallowing impairments DIAGNOSIS Usually not diagnosed before 2 years old. (>2 diagnoses may be called static encephalopathy or permanent brain damage.) Child may be intellectually intact, but may be overlooked because of physical limitations. EEG, CT scan or MRI, electrolyte levels, metabolic workup, complete history, including prenatal records, complete neurologic examination. Genetic evaluation if parents present with congenital malformations. MULTI-DISCIPLINARY MANAGEMENT Speech therapy, PT, OT Neurologist
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Family members Pediatrician Orthopedic surgeon Nurse Hearing therapist Social worker Psychiatrist Orthodontist Neurosurgeon MEDICATIONS Baclofen Pump- intrathecal (head) pump- spasm control Antacids- GERD Botulinum toxin A (non ambulatory children only) - comfort and care.
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  • Fall '17
  • Julie Gwin

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