From Birth Neural tube defects, Hydrocephalus, HypoHyperthyroidism

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From BirthNeural tube defects, Hydrocephalus,
Hypo-Hyperthyroidism

• Peggy Pannell RN, MSN

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• Neural Tube Defects
• Hydrocephalus
• Congenital Hypo/Hyperthyroidism

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Objectives

• Define each disease process
• Recognize S/S
• Lab and diagnostic studies
• Drugs and treatment modalities
• Emotional needs
• Planning Care

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Congenital

• Condition or disease present at birth. It may be
  due to hereditary factors, prenatal infection,
  injury or the effect of a drug the mother took
  during pregnancy.

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Neural Tube Defects

• What are Neural Tube Defects (NTDs)
• Anencephaly
• Encephalocele
• Spina bifida (myelomeningocele)

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Critical Periods in Human Embryogenesis
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Spina Bifida

• Define
• Failure of spinal canal to close
• Cause
• folic acid deficiency, viral, genetic, Radiation
• Symptoms
• Sac protruding from mid/low back
• Partial or complete paralysis
• Weakness of hips, legs or feet
• Lack of sensation
• Loss of bowel or bladder control
• Treatment
• surgical
• Management
• Prenatal screening
• Triple Screen
• Ultrasound
• amniocentesis
• complex and life long
• Spine Xrays and/or spinal ultrasound

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Nursing Management

• Prevention
• folic acid 0.4 mg daily pre, 1 mg daily preg
• Identify
• Prenatal
• At birth
• Protect pre-op and post-op
• Skin integrity to prevent infection
• Special handling to reduce nerve damage
• Support
• Parental coping
• Pictures of similar defects corrected
• Genetic Counseling
• For future pregnancy
• In early pregnancy, therapeutic abortion
• Complications
• Permanent disability
• Education
• Symptoms of hydrocephalus
• Symptoms of meningitis

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Anencephaly

• Defined
• Absence of brain and skull
• Causes
• Taratogens
• Folic Acid Deficiency
• Symptoms
• Mom- Polyhydramnios
• Baby- absence of brain/skull
• Diagnosis
• Ultrasound
• Treatment
• None, incompatible with life
• Management
• Comfort Measures
• Support Parents

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Encephalocele

• Defined Brain and membranes outside skull
• Causes Genetic, unknown
• Treatment Surgical
• Management complex

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Nursing Management

• Identify
• Prenatal
• At birth
• Protect
• Skin integrity to prevent infection
• Special handling to reduce nerve damage
• Support
• Parental coping
• Pictures of similar defects corrected
• Genetic Counseling
• For future pregnancy
• Complications
• Permanent disability
• Education
• Symptoms of hydrocephalus
• Symptoms of meningitis
• Follow up for monitoring to assess neurologic
  damage

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Hydrocephalus

• Defined Buildup of fluid inside the skull
• Causes Congenital or acquired
• Treatment Surgical
• Management Complex and long term

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What is Hydrocephalus
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• Causes
• Congenital
• Present at birth
• Acquired
• Disease process
• Signs and Symptoms
• Factors influencing the clinical picture
• Time of onset
• Infancy
• Early to late childhood

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Treatment

• Surgical
• Removal of obstruction
• tumor
• Placement of shunt
• VP shunt (ventriculoperitoneal shunt)

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VP Shunt
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Nursing Management

• Identify
• History of NTD
• Symptoms
• Protect
• Skin integrity of head
• Special handling to prevent injury to
  head/neck/airway
• Support
• Parental coping
• Pictures of similar defects corrected
• Complications
• VP shunt obstruction/malfunction
• Infection/meningitis
• Permanent disability
• Education
• Symptoms of Increased ICP
• Symptoms of meningitis
• Follow up monitoring to assess neurologic damage

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Thyroid Hormone, too much or too little

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Hypothyroidism

• Low levels of thyroid hormone
• Diagnosis
• Infant screening- Low T4, lt6.5, elevated TSH, gt10
• False positive if preterm or sick full term,
  Retest
• Symptoms
• Slow metabolism related symptoms
• Causes
• Anti-thyroid Meds, Radioactive iodine, Unknown
• Complications
• Retarded mental and physical growth
• Treatment
• Replacement Hormone (sodium-L-thyroxine)
• Nursing Issues
• Identification
• Education

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Nursing Issues

• Identifying infants
• Accurate lab values
• Hormone replacement
• Education for parents
• Emotional support for parents
• Medical Follow up
• Nutrition
• Delayed development
• Education resources

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Hyperthyroidism

• Excessive thyroid hormone
• Rare at birth
• Usually 12-14 years
• Causes
• Thyrotoxic Mother
• Symptoms
• Increased metabolism issues
• Diagnosis
• T3-T4 gradual increase with TSH suppressed
• Treatment
• Antithyroid drugs
• Propylthiouracil and Methimazole (PTU and MTZ)
• Subtotal Thyroidectomy
• Ablation and radioiodine
• Management
• Limit Activity
• Thyroid Storm
• Pre-Treatment
• Post-Treatment

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Nursing Issues

• Identifying Infants
• Activity level
• Nutrition
• Fluid volume balance
• Pre-treatment
• Post-treatment
• Education
• Medication
• Medical follow up
• Parental support