A 4-month-old with significant head lag meets the criteria for ...

[tfester]

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child?
 
  a. Infant stimulation program
  b. Stretching exercises to decrease contractures
  c. Limited physical contact to minimize seizures
  d. Encouraging parents to have additional children

Question 2

A gravida 2, para 1 client is admitted to the labor and birth unit in labor. She states that she had a cesarean birth with her first pregnancy. The most critical information the nurse must obtain at this point is:
 
  a. the onset of contractions.
  b. her estimated date of birth.
  c. when the client ate last and what she consumed.
  d. the type of uterine incision with the first pregnancy.

[aadams68]

Answer to Question 1

ANS: A
Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). An infant stimulation program is essential. Frequent position changes, including changes in environment, provide the child with more physical contacts. Verbal, tactile, and auditory stimulation are also included. Contractures do not occur because of muscular atrophy. Sensation is normal in children with this disorder. Frequent touch is necessary as part of the stimulation. Werdnig-Hoffmann disease is inherited as an autosomal recessive trait. Parents should be referred for genetic counseling.

Answer to Question 2

ANS: D
A vertical incision creates a greater risk of uterine rupture in a subsequent labor than a transverse incision. The onset of labor is not the most important information that is needed at this point. This is important information to prepare for a fetus that may not be term. However, it is not the most critical question. If a cesarean birth is necessary this information is needed but not as critical as the type of previous incision.