NUR 301 Comprehensive Guide to Pediatric Pathophysiology and
Nursing Care Questions with Verified Answers
Neural Tube Defects
Neural tube defects encompass a range of congenital malformations resulting
from incomplete closure of the neural tube during embryonic development. The
most common form is spina bifida, which includes myelomeningocele, where
meninges and spinal cord protrude through a defect, and meningocele, involving
only meninges.
Cause: The exact etiology is multifactorial, involving genetic and environmental
factors, with folic acid deficiency being a significant risk factor.
Signs and Symptoms: These vary depending on the defect's severity and location
but often include motor deficits, bladder and bowel dysfunction, and possible
paralysis.
Diagnosis: Prenatal ultrasound and elevated maternal serum alpha- fetoprotein
levels can detect neural tube defects early.
Treatment: Immediate postnatal management involves STAT care of the sac,
preventing rupture and infection, followed by surgical repair as soon as feasible to
reduce risks such as meningitis and further neurological damage.
Nursing Care (NC):
Maintain sterile, moist dressing over the sac to prevent infection.
Protect the sac from trauma and contamination.
Monitor for signs of infection or increased intracranial pressure.
, Prepare for surgical intervention and provide family education about prognosis
and long-term management.
Complications: Include meningitis, hydrocephalus, and motor deficits. Early
surgical repair and ongoing neurodevelopmental support are crucial.
Hydrocephalus
Hydrocephalus is characterized by an abnormal accumulation of cerebrospinal
fluid (CSF) within the ventricles of the brain, leading to increased intracranial
pressure (ICP).
Cause: Imbalance between CSF production and absorption, often due to
congenital malformations, infections, or tumors.
Signs and Symptoms:
In infants: enlarged head circumference, bulging fontanels, widened sutures,
developmental delays.
In older children: headache, vomiting, visual disturbances, behavioral changes,
and signs of increased ICP.
Diagnosis:
Clinical assessment including head circumference measurement.
Imaging studies such as ultrasound (in infants), CT, or MRI. Treatment:
Surgical placement of a ventricular shunt to divert CSF and relieve pressure.
Postoperative care involves daily measurement of head circumference,
monitoring pupils, drainage output, and signs of shunt malfunction.
Nursing Care:
Regular neuro checks for signs of increased ICP.
, Observe for shunt infection or blockage (e.g., vomiting, irritability,
redness along shunt tract).
Maintain HOB elevated to promote drainage.
Educate family on signs of shunt failure and infection.
Seizures in Pediatrics
Seizures involve abnormal electrical activity in the brain, with various types based
on presentation.
Cause: Febrile illnesses, trauma, hypoxia, infections, or structural brain abnormalities.
Signs and Symptoms:
Tonic-clonic (Grand Mal): stiffening and jerking movements, post-ictal
drowsiness.
Absence: brief lapses of consciousness.
Focal seizures: motor or sensory manifestations localized to one area.
Infantile spasms: sudden flexion or extension, often in infancy.
Diagnosis:
EEG to detect electrical abnormalities.
MRI to identify structural causes.
Blood tests for electrolytes, toxins, and infections.
Treatment:
Antiepileptic drugs (e.g., phenobarbital, anticonvulsants).
Ketogenic diet for refractory cases.
Seizure precautions: pad rails, loosen tight clothing, maintain airway.
Nursing Care Questions with Verified Answers
Neural Tube Defects
Neural tube defects encompass a range of congenital malformations resulting
from incomplete closure of the neural tube during embryonic development. The
most common form is spina bifida, which includes myelomeningocele, where
meninges and spinal cord protrude through a defect, and meningocele, involving
only meninges.
Cause: The exact etiology is multifactorial, involving genetic and environmental
factors, with folic acid deficiency being a significant risk factor.
Signs and Symptoms: These vary depending on the defect's severity and location
but often include motor deficits, bladder and bowel dysfunction, and possible
paralysis.
Diagnosis: Prenatal ultrasound and elevated maternal serum alpha- fetoprotein
levels can detect neural tube defects early.
Treatment: Immediate postnatal management involves STAT care of the sac,
preventing rupture and infection, followed by surgical repair as soon as feasible to
reduce risks such as meningitis and further neurological damage.
Nursing Care (NC):
Maintain sterile, moist dressing over the sac to prevent infection.
Protect the sac from trauma and contamination.
Monitor for signs of infection or increased intracranial pressure.
, Prepare for surgical intervention and provide family education about prognosis
and long-term management.
Complications: Include meningitis, hydrocephalus, and motor deficits. Early
surgical repair and ongoing neurodevelopmental support are crucial.
Hydrocephalus
Hydrocephalus is characterized by an abnormal accumulation of cerebrospinal
fluid (CSF) within the ventricles of the brain, leading to increased intracranial
pressure (ICP).
Cause: Imbalance between CSF production and absorption, often due to
congenital malformations, infections, or tumors.
Signs and Symptoms:
In infants: enlarged head circumference, bulging fontanels, widened sutures,
developmental delays.
In older children: headache, vomiting, visual disturbances, behavioral changes,
and signs of increased ICP.
Diagnosis:
Clinical assessment including head circumference measurement.
Imaging studies such as ultrasound (in infants), CT, or MRI. Treatment:
Surgical placement of a ventricular shunt to divert CSF and relieve pressure.
Postoperative care involves daily measurement of head circumference,
monitoring pupils, drainage output, and signs of shunt malfunction.
Nursing Care:
Regular neuro checks for signs of increased ICP.
, Observe for shunt infection or blockage (e.g., vomiting, irritability,
redness along shunt tract).
Maintain HOB elevated to promote drainage.
Educate family on signs of shunt failure and infection.
Seizures in Pediatrics
Seizures involve abnormal electrical activity in the brain, with various types based
on presentation.
Cause: Febrile illnesses, trauma, hypoxia, infections, or structural brain abnormalities.
Signs and Symptoms:
Tonic-clonic (Grand Mal): stiffening and jerking movements, post-ictal
drowsiness.
Absence: brief lapses of consciousness.
Focal seizures: motor or sensory manifestations localized to one area.
Infantile spasms: sudden flexion or extension, often in infancy.
Diagnosis:
EEG to detect electrical abnormalities.
MRI to identify structural causes.
Blood tests for electrolytes, toxins, and infections.
Treatment:
Antiepileptic drugs (e.g., phenobarbital, anticonvulsants).
Ketogenic diet for refractory cases.
Seizure precautions: pad rails, loosen tight clothing, maintain airway.
