neuromuscular dysfunction

8/8/2019 NeuroMuscular Dysfunction

http://slidepdf.com/reader/full/neuromuscular-dysfunction 1/31

EDUARDO V. BONGAT JR., PTRP, RM, RN(USRN)



TetanusyAlso called lockjaw

yAn acute, preventable, and oftenfatal disease

yCaused by exotoxin of C lostridiumtetani

yCharacterized by muscle rigidityinvolving the masseter and neckmuscles

Mosby items and derived items © 2007,

2003 by Mosby, Inc., an affiliate of ElsevierInc. Slide 2



TetanusySpores are found in soil, dust, and GItract of humans and animals

yBacteria enter body through wound,especially puncture or crush woundor burn

yMay enter through scratch, bee sting,thorn, or needle prick

yExposure greater during outdoor

activitiesMosby items and derived items © 2007,




Pathophysiology of TetanusyExotoxin spreads from wound toCNS by way of neurons orbloodstream

yToxin becomes fixed on nerve

cells of brainstem and spinal cordyToxin produces muscle stiffness





Clinical Manifestations of Tetanus

(cont.)

y Respiratory: accumulated secretions,atelectasis, pneumonia, respiratory arrest

y Patient anxious but alert; mentationunaffected

y Rapid HR, diaphoresis, mild or absentfever

y Incubation: 3 to 10 days

y Mortality approximately 30%; usually fatalin newborn





Therapeutic Management of

TetanusyPrevention by tetanus toxoid ortetanus antitoxin after exposure

yTreatment of wounds contaminatedwith dirt, feces, soil, saliva, puncturewounds, avulsions, crushing, burns,

and frostbite should include tetanusimmune globulin if patientinadequately immunized





Therapeutic Management of

Tetanus (cont.)y ICU for constant observation and respiratory

support availability

y Monitor fluid and electrolyte statusy Tetanus immune globulin therapy to neutralize

toxins

y Wound care to decrease organism

proliferationy Muscle relaxants, sedatives, pancuronium

(Pavulon)





Nursing ConsiderationsyControl environmental stimuli

y

Careful monitoring of respiratorystatus

yAttempt to reduce anxiety of

child and family





BotulismyFood poisoning resulting fromingestion of toxin produced by the

anerobic bacillus C lostridiumbotulinum

ySources:

y Improperly sterilized home cannedfoods for older children

y Infant sources: honey and light or

dark corn syrupMosby items and derived items © 2007,




Clinical Manifestations of

BotulismyCNS symptoms appear abruptly

12 to 36 hours after ingestion

yGeneral signs

yWeakness, dizziness, headache,diplopia, speech difficulties

yVomiting

yProgressive, life-threateningrespiratory paralysisMosby items and derived items © 2007,




Treatment of BotulismyIV botulism antitoxin

y

Supportive measures²respiratory support

yContinue therapy until paralysis

abates





Infant BotulismyCaused by ingestion of spores orvegetative cells of C. botulinum and

subsequent release of toxin

ySource of botulism in infants: honey,and light or dark corn syrup fed to

themyWide variation in severity of disease:mild constipation to respiratory

failureMosby items and derived items © 2007,




Spinal Cord InjuriesyGenerally result of indirect trauma

yEspecially in MVC without childrestraints

yVertebral compression from blows tothe head or buttocks (diving, surfing,

falls from horses)yBirth injuries from traction force onspinal cord during breech delivery





Levels of Spinal Cord

Injuriesy Higher injury²more extensive damage

y Paraplegia: complete or partial paralysis of

lower extremitiesy Tetraplegia: lacking functional use of all

four extremities (formerly calledquadriplegia)

y High cervical cord injury affects phrenicnerve, paralyzes diaphragm ventilatorydependency





Relationships of SpinalCord Segments and SpinalNerves to Vertebral Bodies





Spinal Cord Injuryy Therapeutic management: stabilization

and transport to pediatric trauma center

environmenty Management is complex and controversial

y Nursing considerations

y Stabilization, careful assessment,prevention of complications, maintainmaximum function





Nursing Management

of Spinal Cord InjuriesyRespiratory care

yTemperature regulation

ySkin care

yPhysiotherapy

yNeurogenic bladder

yBowel training

yAutonomic dysreflexiaMosby items and derived items © 2007,




Dermotomes and

Innervation of MajorMuscles





RehabilitationyEvaluation and support

y

RemobilizationyPhysical rehabilitation

yPsychosocial rehabilitation

ySexuality issues





Muscular Dystrophies (MDs)yLargest group of muscular diseases inchildren

yAll have genetic origin with gradualdegeneration of muscle fibers,progressive weakness, and wasting of

skeletal musclesyAll have increasing disability anddeformity with loss of strength





Initial Muscle Groups Involvedin MDs





Duchenne Muscular

Dystrophy (DMD)yAlso called pseudohypertrophic muscular dystrophy

yMost severe and most common of theMDs in childhood

yX-linked inheritance pattern; one

third are fresh mutationsy Incidence: 1 in 3500 male births





Characteristics of DMDyOnset between ages 3 and 5 years

yProgressive muscle weakness,wasting, and contractures

yCalf muscles hypertrophy in mostpatients

yProgressive generalized weakness inadolescence

yDeath from respiratory or cardiac

failure





DMD: Clinical Manifestationsy Waddling gait, frequent falls, Gower sign

y Lordosis

y Enlarged muscles, especially thighs and upperarms

y Profound muscular atrophy in later stages

y Mental deficiency common



neuromuscular dysfunction

Documents