E-learning modules for Integrated Virtual Learning


    Online Class Day 3

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    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    infant's case..

    Post  ara_portillo on Wed 12 Aug 2009, 8:34 pm

    according to the literature.. it can be a case of Chiari II abnormality which is associated with meningomyelocele, anencephaly, and encephalocele, all of which belong to a group of disorders known as neural tube defects. These serious congenital anomalies of the nervous system, which occur during the 1st 4 weeks of gestation, result
    from faulty formation of the neural tube.

    jenny c.
    Guest

    Re: Online Class Day 3

    Post  jenny c. on Wed 12 Aug 2009, 8:33 pm

    For diagnosis of fetal hydrocephalus, either US or MRI had become dominantly utilized and CT had gone out of use in 19962000.

    Diagnosis of congenital hydrocephalus and delivery of its patients in Japan
    Kouzo Moritake, Hidemasa Nagai, Noriko Nagasako, Mami Yamasaki, Shizuo Oi and Toshiyuki Hata. (2007).

    railibo-
    Guest

    Re: Online Class Day 3

    Post  railibo- on Wed 12 Aug 2009, 8:31 pm

    During pregnancy, routine ultrasound can detect enlarged ventricles (spaces) within the babys brain. (Source: http://www.hydroassoc.org/education_support/learning/diagnosis)

    Diagnostic Ultrasonography is the most commonly used method for examining pregnant women and tracking fetal development because it allows real time xamination of the fetus while avoiding radation.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:28 pm

    thank you for the input thea and ara. i have a follow-up question, since we are talking about diganostic tests and we've mentioned ultrasound and amniocentesis where amniocentesis detects chromosomal defects, thea mentioned trisomy 21 and 18, with your best guess, what could be the possible underlying problem of this infant?

    Angel Ve
    Guest

    answer 1

    Post  Angel Ve on Wed 12 Aug 2009, 8:23 pm

    Hydrocephalus may be diagnosed on a routine ultrasound. The ventricles within the head will measure larger than normal. The head circumference may remain within the normal limits or it may become enlarged as the pregnancy progresses.

    Hydrocephalus is also occasionally associated with chromosomal abnormalities. Some of the conditions that can cause hydrocephalus are caused by chromosomal abnormalities such as Down Syndrome (also known as Trisomy 21) or Trisomy 13 or 18 which are generally fatal. The perinatologist typically will offer an amniocentesis to look for chromosomal issues.

    Another test that may be recommended is a fetal MRI. Ultrasound imaging can be limited by the mother's body habitus, the surrounding amniotic fluid and the position of the fetus. Fetal MRI is a non-invasive diagnostic test that produces better images of soft tissue, and bone or dense tissue does not interfere with the image. The biggest limitation of fetal MRI is that the best images are obtained when the fetus stays still.

    Seppala and Unnerus (1974) postulated that the increase in amniotic fluid alpha-fetoprotein levels that they observed in four cases of fetal hydrocephalus might be due to passage of AFP-containing cerebral spinal fluid across the greatly thinned fetal skull into the amniotic cavity. In such cases, excess AFP in the amniotic fluid might pass into the maternal serum by diffusion across the placenta and fetal membranes. However, none of their patients had elevated MSAFP levels and at least one other report failed to document even an elevation of AFAFP.


    Szajkowski .2006. Maternal serum alpha-fetoprotein levels in fetal hydrocephalus: a retrospective population based study. Available at: http://www.biomedcentral.com/1471-2393/6/23


    http://www.chw.org/display/PPF/DocID/35471/Nav/1/router.asp

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    To add up..

    Post  ara_portillo on Wed 12 Aug 2009, 8:22 pm

    >and to add, the diagnostic test that will really prove it would be the sonogram/UTZ.

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Online Class Day 3

    Post  Althea Perez on Wed 12 Aug 2009, 8:20 pm

    Traditionally, fetal hydrocephalus has been detected prenatally using sonographic measurements of the enlarged ventricles.

    A complete ultrasound examination is carried out to search for additional abnormalities. But ultrasound evaluations alone can miss important anomalies, which will affect the outcome.

    Ultrafast fetal MRI is a more anatomically precise modality for prenatal neuroimaging.an MRI scan is obtained and interpreted by an experienced pediatric neuroradiologist to rule out any additional CNS anomalies. There is no apparent risk to the mother or fetus from the radiofrequency pulses or the magnetic field.

    Amniocentesis it can rule out most chromosomal problems. Some of the conditions that can cause hydrocephalus are caused by chromosomal abnormalities such as Down Syndrome (also known as Trisomy 21) or Trisomy 13 or 18 which are generally fatal.

    Fluorescence In Situ Hybridization. Results are faster compared to amniocentesis. These types of defects account for nearly 95% of all chromosomal abnormalities. It's not the full set of results, but it can rule out some of the biggies early in the process.

    Reference:

    2009 The Children's Hospital of Philadelphia. The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pa. 19104 http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81168

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for the question posted..

    Post  ara_portillo on Wed 12 Aug 2009, 8:20 pm

    >just like what we have in our face to face discussion, the amniocentesis is both a diagnostic and screening test.. so it will just suggest a possible neural tube defect... thanks Tina for that clarification.


    Last edited by ara_portillo on Wed 12 Aug 2009, 8:23 pm; edited 1 time in total

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:16 pm

    ara and for everyone as well, is amniocentesis specific, like, it will really detect if hydrocephalus is present or detect only the general problem and not go into specifics such as the manifestation, hydrocephalus?

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    no. 1.....

    Post  ara_portillo on Wed 12 Aug 2009, 8:09 pm

    For this case, the possible prenatal diagnostic tests that can be done are:

    > Amniocentensis: alpha-fetoprotein in amniotic fluid (by 14 weeks' gestation) suggests open neural tube defects.
    >Ultrasound: this readily diagnose the condition (as reflected in the case)
    > Fetal MRI: Useful when maternal habitus renders ultrasound studies suboptimal.
    Identifies associated anomalies, i.e., cerebral migration disorders,
    diastematomyelia, callosal anomalies. (van Zalen-Sprock et al., 1995).

    Laboratory Tests Prenatal:

    Prenatal:Maternal serum alpha-fetoprotein levels. Elevated alpha-fetoprotein level at 1618 weeks suggests fetal open neural tube defects, indicating further prenatal evaluation and genetic counseling.

    Reference: van Zalen-Sprock RM, van Vugt JM, van Geijn HP. First and early second
    trimester diagnosis of anomalies of the central nervous system. J Ultrasound Med 1995;14:603610. Electronic Version available at Medline.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 7:53 pm

    Hi! Good evening classmates! I'm Tina. I will be the moderator for tonight's discussion.

    For the discussion, everyone is free to speak out her mind regarding the topic. Please support your arguments with studies/literature. Please be guided by the rules on our previous meetings.

    For tonight, we will be discussing about adolescent pregnancy with congenital malformations and pregnant women at risk for preterm labor.

    CASE NO.1

    Adolescent pregnancy and congenital malformations


    A 16-year-old patient at one suburban obstetric clinic received upsetting news when an ultrasound exam revealed that her fetus had hydrocephalus; an abnormal accumulation of cerebrospinal fluid within the ventricles of the brain. The fluid build-up can raise intracranial pressure and enlarge the head, making normal passage of the fetus through the birth canal impossible. If persistently high, the pressure destroys white matter and cause mental retardation. Serial ultrasounds showed progressive build-up of fluid and moderate head enlargement. In addition, a lumbar meningomyelocele was identified. The gestational age of the fetus is 34 weeks.


    Questions:

    1. What other diagnostic/s test can the nurse practitioner suggest to detect the abnormalities?
    2. What do you think will be the best method of delivery in this case? Justify.
    3. What are the possible reactions of the mother to this situation considering her own her growth and development level?
    4. How would an understanding of Erik Eriksons psychosocial theory be applied in this situation?
    5. What nursing diagnoses will be relevant during the prenatal, intranatal, and postnatal period? How would you prioritize these nursing diagnoses?

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