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OR Nurse:
doi: 10.1097/01.ORN.0000428350.85726.6b
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Restoring function for children with brachial plexus birth palsy

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INSTRUCTIONS Restoring function for children with brachial plexus birth palsy


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Restoring function for children with brachial plexus birth palsy

GENERAL PURPOSE: To provide an overview of brachial plexus injury, including surgical intervention and nursing implications. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Describe the incidence, pathophysiology, and treatment of brachial plexus birth palsy. 2. Outline a plan of care for the patient undergoing surgical repair of brachial plexus birth palsy.

1. The condition in which a nerve is torn but still attached to the spinal cord is termed a(n)

a. avulsion.

b. rupture.

c. neuroma.

d. neurapraxia.

2. The best method for evaluation of brachial plexus birth palsy is

a. MRI within the first 72 hours of birth.

b. using the AMS assessment tool.

c. computed tomography scans at regular intervals.

d. serial physical exams.

3. The assessment tool that quantifies upper extremity function using a 0 to 10 scale is the

a. Toronto Score.

b. Mallet Classification.

c. AMS.

d. Narakas Classification.

4. In Narakas I and II injuries, the rate of spontaneous recovery of function in the upper extremity is reported to be

a. 9%.

b. 27%.

c. 64%.

d. 72%.

5. By observation, the best indication of a good outcome after brachial plexus injury is

a. the level of involvement according to the Narakas Classification.

b. strength of shoulder function as it recovers first.

c. how quickly the triceps muscle begins to function against gravity.

d. how quickly the biceps muscle begins to function against gravity.

6. Injuries concurrent with brachial plexus injury might include all of the following except

a. humerus fracture.

b. intervertebral disk herniation.

c. clavicle fracture.

d. shoulder dislocation.

7. At what age can physical therapy begin?

a. 1 to 2 weeks

b. 4 to 6 weeks

c. 8 weeks

d. 12 weeks

8. Chest ultrasound is performed preoperatively to

a. assess for respiratory infection or underlying respiratory disorder.

b. measure baseline lung function.

c. determine the location of the spinal accessory nerve.

d. determine if the phrenic nerve has been injured.

9. The preoperative briefing and immediate preparation for brachial plexus repair should always include

a. determining which side of the mouth to secure the endotracheal tube.

b. positioning the patient supine with the head turned to the operative side.

c. informing parents that the surgery will likely last less than 3 hours.

d. administering neuromuscular blocking agents.

10. When the intraneural architecture of a nerve is severely damaged but the nerve isn't severed into two separate parts, the lesion is termed

a. avulsed.

b. axonotmetic.

c. neurapraxic.

d. a neuroma-in-continuity.

11. Phrenic nerve injury generally resolves within

a. 6 months with post-op nerve stimulation.

b. 1 year post-op without intervention.

c. 1 year post-op with physical therapy.

d. 2 to 3 years post-op.

12. The nerve typically used for grafting in brachial plexus injury repair is the

a. phrenic nerve.

b. sural nerve.

c. peroneal nerve.

d. tibial sensory nerve.

13. Which statement about nerve transfers is accurate?

a. They can't be used in cases of nerve root avulsions.

b. They are indirect motor-to-motor neural connections.

c. They are direct motor-to-motor neural connections.

d. They don't target specific muscle groups.

14. Postoperatively, the affected arm is positioned

a. abducted and flexed for 1 to 2 days.

b. abducted and flexed in a soft cast for 2 to 3 weeks.

c. adducted and extended lateral against the torso.

d. adducted and flexed against the anterior chest.

15. Which concern takes the highest priority immediately following brachial plexus repair?

a. function of the affected extremity

b. complications with the donor site

c. diaphragm function

d. incisional care

16. Return of function to the affected extremity is first evidenced by improvement in

a. biceps function.

b. shoulder movement.

c. extension and flexion of the wrist.

d. movement of the fingers.

17. After surgery, families should be advised that improvements in function may be seen for up to

a. 6 to 9 months.

b. 1 to 2 years.

c. 3 to 4 years.

d. 5 years.

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