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2 Neuro Flashcards

1
Q

Layers of the brain (inner to outer)

A

Pia mater

Arachnoid

Dura

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2
Q

Nervous system is complete at birth but its what

A

Immature (waiting on myelinization)

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3
Q

Cranial bones and vertebrae are what

A

Not fully ossified

Immature muscles/ligaments (why we sit rearseated)

Risk for fx and head injuries

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4
Q

Peds neuro assessment
8

A

Health hx (birth hx)
Look before touching
Loc
Fontanel/suture assessment (until 3)
Head circumference measurement (until 3)
Pupil assessment
Movement/posture (primitive vs protective reflex)
-decorticate/decerebrate (also need to know reflexes
Signs of increased ICP

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5
Q

Peds GCS differences

A

For best response to auditory and verbal stimulus
There is seperate sections for over 2 and under 2

-under 2 is less verbal and more observations like crying

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6
Q

Decorticate vs decerebrate

A

Decorticate (toward the core you get more score on GCS) -not as bad
-flexed

Decerebrate:
-extention (worse)

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7
Q

Increased ICP
3 components
What causes it (5)

A

Increased pressure exerted by: brain/CSF/blood

Causes:
-brain tumor
-head trauma
-hematoma
-hydrocephalus
-infection

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8
Q

Increased ICP

Early signs

Non head related:9
Head related: 6

A

HA
Vomiting
Blurred/double vision
Dizziness
Decreased pulse
Increased BP
Irritable
Seizure activity
High pitched cry (sounds like a kitten)

Head related:
Bulging/tense fontanel
Wide sutures
Increased head circumference
Dilated scalp veins
Pupils sluggish/unequal
Sunset eyes

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9
Q

Increased ICP

Late signs (5)

A

Lowered loc
Bradycardia
Cheyne-stokes resp
Decerebrate/decorticate posturing
Fixed/dilated pupils

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10
Q

Cushings triad (increased ICP)

A

Bradycardia

Cheyne-stokes resp

Widening pulse pressures (systolic/dialstolic get further apart)

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11
Q

Is pulsating fontanel normally?

A

Yes

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12
Q

Increased ICP
Nursing management

A

ABC’s

Elevate HOB 30 minimum

Strict I/O, DW, fluid restrictions

Monitor electrolyte balance

Reduce agitation (less noise/visitors)

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13
Q

Increased ICP

Meds

A

Mannitol (osmotic diuretic)

3% hypertonic saline

These temporarily fix issue need to fix actual problem

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14
Q

Neural tube defects (anencephaly, encephalocele)

What is it
Causes (4)

A

Failure of neural tube to close by 4th week of gestation

Causes:
-folic acid deficiency
-previous neural tube defect
-drug use
-genetics

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15
Q

Neural tube defects (anencephaly, encephalocele)

Preventions

A

400 mcg folic acid daily

Higher dose for women with hx of neural tube defect

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16
Q

Anencephaly

-what does it look like
-born without what
-is it compatible with life?

A

Small or missing brain hemispheres, skull, scalp

Born without a forebrain and cerebrum

Remaining rain tissue may be exposed

Incompatible with life

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17
Q

Encephalocele

What does it look like

Prognosis depends on what

Often accompanied by (6)

A

Protrusion of the brain and meninges thru a skull deficit

Prgnosis depend on size of encephalocele and involvement of other brain structures

Accompanied by:
Craniofacial abnormalities
Hydrocephalus
Microcephaly
Visual problems
Developmental delay
Seizures

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18
Q

Encephalocele

Surgical repair

Nursing care

A

Sx:
-placement of tissue back into skull and removal of sac
-VP(ventriculoperitonial shunt) placed to correct hydrocephalus
-corrective repair of any craniofacial abnormalities

Nursing:
-monitor for hydrocephalus
-increased ICP

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19
Q

Hydrocephalus

A

Too much CSF on brain

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20
Q

Microcephaly

Define?
Congenital vs acquired

Results in?
Tx

A

Defined as hc greater than 3 standard deviations below the mean for the age and sex of the infant

Generally resuts in intellectual disability

No tx (just support)

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21
Q

Congential microcephaly

A

Abnormal development

Chromosomal abdnormalities

Exposure to infection (rubella, toxoplasmosis, CMV)

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22
Q

Acquired microcephaly

A

Severe malnutrition

Perinatal infections

Anoxic events in infancy

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23
Q

Positional plagiocephaly

What happens
Result of what (4)

A

Asymmetry in head shape without fused suture

Result of:
-cranial molding
-flattening of the occiput
-safe sleep position
-torticollis (neck muscles cause them turn to 1 side)

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24
Q

Positional plagiocephaly

Prevention

Tx

A

P:
-daily tummy time
-alternate head position during sleep

Tx:
PT
Customized helmet to reshape the skull

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25
Hydrocephalus What is it Leads to what
Imbalance between production and absorption CSF Leads to: Increase in CSF circulating volume—>increased ICP
26
Hydrocephalus Nonobstructive vs obstructive
Nonobstructive: -flow of CSF blocked AFTER it exits the ventricles -defective absorption Obstructive: -flow of CSF blocked WITHIN the ventricular system
27
Hydrocephalus S/s
S/s of increased ICP: Increased HC Bulging fontanels/seperating sutures (when young) Irritability/change loc N/V/HA Sunsetting eyes Poor feeding
28
Hydrocephalus Tx
Surgical correction of structural deformities Remove or bypass obstruction VP(ventroperitonel) or VA(ventriculoatrial) shunt
29
Hydrocephalus Shunt care
Place on opposite side of shunt incision Keep (clean/dry/intact) (no wet cloths=infection) *Keep flat to prevent rapid reduction of CSF* Monitor for shunt failure (doesnt work), infection
30
Hydrocephalus Shunt complications
Shunt malfunction: sx to replace shunt Shunt infection: -Sx to externalize shunt -EVD: external ventricular drain -IV abx
31
Where do we want the lazer on EVD? Head Too high will cause what Monitor how often
At the tragus of ear Too high will drain too fast Every hour
32
Meningitis What is it Causes Which is more life threatening
Inflammation of meninges (in brain/spinal cord) Bacterial or viral infection in CSF Viral: many types (CMV/HSV/enterovirus/HIV) Bacterial: meningococcal/pheumococcal/H. Flu (Hib), E.coli Bacterial is more life threatening
33
Meningitis S/s 3 unique 3 vague Meningeal irritation signs (3)
S/s of increased ICP :vomiting, HA, bulging font. Infant resting in opisthotonic position Irritability then progresses to drowsiness/stupor Fever Poor feeding (younger kids) photophobia (older kids can vocalize) Meningeal irritation: -nuchal rigidity -kernigs sign -brudzinskis sign
34
Brudzinskis sign Vs Kernigs sign
B: -pull neck = involuntary flexing of knees and hips K: -hip at 90degree angle -cant fully straighten leg
35
Meningitis Complications (Clinical manifestations) what infection causes it
meningococcal:(bacterial) -Petechiae/purpuric type rash Pneumococcal: -Chronic ear drainage Meingococcal and Hib infection: -Arthralgias
36
Meningitis diagnotics
Blood culture CBC (WBCs) CRP/ESR (inflammation) CT/MRI CSF analysis via LP
37
Meningitis Bacterial vs viral CSF Color WBC Proteins Glucose Gram stain
Bacterial: Color: cloudy WBC: elevated Proteins: elevated Glucose: decreased (bacteria eating it) Gram stain: positive Viral: Color: clear WBC: elevated Proteins: normal or elevated Glucose: normal Gram stain: negative
38
Lumbar punctures for peds Position How to decrease pain What to do after
Fetal lying position Pain: -topical numbing cream -sucrose water, fetanyl, versed Lay flat for several hours after to prevent spinal HA
39
Meningitis tx Precaution Monitor what (3) Assess (2) Manage what Decrease what
Droplet isolation Monitor: VS, I/O (UOP), s/s of increased ICP Assess: nuro status, pain Manage fever Decrease environmental stimuli
40
Meningitis Meds example Antivirals?
Abx (up to 10days) Corticosteroids: dexamethason Antivirals: -maybe before we know if its bacterial. But usually let viral meningitis run its course
41
Reye syndrome Affects who usually Found to be a reaction that is triggered by what Primarily affects what
Affects young children recovering from a viral illness Triggered by use of salicylates to treat viral infections (ASA) Affects: liver/brain -liver dysfunction -cerebral edema
42
Reye syndrome S/s (4) Neuro s/s d/t liver d/t build up of ammonium
Severe Vomiting Change in mental status (confusion/delirium) Irritability/combativeness Seizures
43
Reye syndrome Diagnostics (5) Wanna rule out what?
Elevated liver enzymes (ALT/AST) Elevated blood ammonia levels Coagulation times can prolong Liver biopsy LP: CSF analysis to rule out meningitis
44
Reye syndrome Tx
*Hydrate whilte preventing cerebral edema* Decrease stimulants like increased ICP Monitor/prevent bleeding episodes Implement sz precautions Meds: Mannitol
45
Head trauma: key terms Concussion Contusion Laceration Skull fractures
Concussion: -traumatic injury to the brain that alters the way the brain functions Contusion: -bruising of the cerebral tissue Laceration: -tearing of cerebral tissue Skull fractures: -direct trauma to skull (will cover types)
46
Skull fracture types: Linear Depressed Comminuted fractures Basilar fractures
Linear: most common - single fx at point of impact -do not cross suture lines Depressed: -broken bone fragment pushing inward -blunt trauma (hammer) Comminuted fractures: -more than one linear fx following intense impact Basilar fractures: -fracture of bones at base of skull
47
Peds abusive head trauma: More common in what gender Between what ages Risks
Males 3- 8 months Risks: -inconsolable/ crying child -male caregiver -unwanted pregnancy/child
48
Peds abusive head trauma: severe child abuse Caused by 3 Outcomes 6
Caused: -vigoreous shaking -intentional blow to head -intentional dropping Outcomes: -skull fx -intercranial bleeding -retinal hemorrhage -subdural hematoma -cerebral edema -if not death then may have long-term consequences
49
Head trauma clinical manifestation minor 6 Progressive 3 Severe 2
Loss of consciousness (need to know how long) Minor injury: -confusion, vomiting, pallor, irritability, lethary, drowsiness Progression of injury: -marked changes in vital, AMS, increased agitation Severe injury: -increased ICP, decorticate/decerebrate posturing
50
Head trauma: clinical manifestations Palpitation allows us to determine What do we see and feel? Depressed vs basilar skull fx Dont do what with fx
Depressed skull fx: Skull appears misshapen Basilar skull fx: Blood over mastoid process and/or around orbitis, leakage of CSF from nose. Dont put anything in nose if have a fx
51
Head trauma: Labs and diagnostics Think other causes to rule out neuro status
ABGs CBC: h&h, ply, RBC, reticulocytes Blood alcohol and toxicology screen Liver function test (bilirubin/ammonia) affects neuro Cervical spine x-ray CT/MRI EEG ICP measurement
52
Head injury : nursing care
Stabilize spine ABCs: airway, mechanical ventilation, sats 95%+ Through neuro assessment Monitor I&O, electrolyte balance Decrease stimulation Manage pain: analgesics Mannitol, antiepileptics
53
Complications: epidural hematoma Bleeding Typically
Bleeding between dura and skull typically arterial
54
Complications: epidural hematoma Clinical manifestations
Short period of unconsciousness followed by a normal period for several hours Lethargy/coma/vomiting due to compression of the brain
55
Complications: epidural hematoma Treatment
Removal of accuulated blood Ligation of torn artery
56
Complications: subdural hematoma Bleeding Typically Could be a result of what
Bleeding between the dura and the arachnoid membrane Typically venous Could be d/t: -birth trauma -falls -violent shaking
57
Complications: subdural hematoma Clinical manifestations Tx
CM: -irritability, anemia, sz -Increased HC -lethargy,coma, vomiting Tx: -self-resolving or drains/subdural tap (same as epidural hematoma)
58
Complications Cerebral edema Brain herniation -what is it -s/s 3
Cerebral edema: doesnt happen fast (worse before it gets better) -24-72 hours post trauma -increased ICP Brain herniation: -downward shift of brain tissue -loss of blink reflex, gag reflex -pupil dilated and fixed (big and dont react) -cushings triad (widen pulse pressure, bradycardia, irregular respirations)
59
Health promotion and disease prevention
Seat belts Helmets Shaken baby and child abuse prevention Car seat compliance ( rear facing until 2 )
60
Seizure: types Unclassified Generalized Partial/focal
Unclassified: -febrile, infantile spasms, neonatal seziures Generalized: (not specific part of brain) -tonic-clonic, absence , myoclonic, atonic Partial/focal: (specific part of brain) Simple partial with either motor or sensory manifestations complex partial.
61
Unclassified: febrile seizures Associeted with what Duration Tx
Associated with sudden spike in temp as high as 102-104F Duration: 15-20 seconds Tx: acetaminophen or ibuprofen Light clothing Tepid bath
62
Unclassified: infantile spasms Peak onset S/s How many events
Peak onset: 3-7 months Sudden, brief, symmetric muscle contractions Can occur as single event or in clusters
63
Unclassified: neonatal seizures Most times are what type When your likely to get it Associeted with underlying causes 4 Tx
Mostly focal 1st 4 weeks of life Causes: -hypoxic ischemic encephalopathy -metabolic disorder -infection/sepsis -cerebral infarction Tx: tx the cause
64
Generalized: tonic-clonic Most prevalent of all seizures Onset is without what Tonic phase duration Clonic phase duration State after all phases
Onset without warning Tonic phase: 10-20 secs Clonic phase: 30-50 secs (can last 30 min or longer) Postictal phase
65
Tonic phase Clonic phase Postictal state
T: Piercing cry, pallor Stiffening of body and limbs (back arching) C: Salivary frothing Eye blinking Clonic jerks of limbs, body, and head P: Limbs and body limp
66
Generalized: absence Aka S/s What is first indicator Is there a postictal phase?
Aka: petit mal Affects schoolwork 1st indication S/s: -abrupt onset/offset -blank stare, motionless -can drop items being held -unable to call (come out of it on their own) No postictal phase (come back as if nothing happened)
67
Generalized: myoclonic S/s:4 Postictal phase?
S/s -Symmetric or asymmetric ( one sided or both) -Brief contractions of muscle groups -Can involve only the face and trunk or one or more extremities -may lose consciousness No postictal phase
68
Generalized: atonic Aka Onset what ages S/s If frequent child should do what.
Aka: drop attacks Onset at age 2-5 y/o S/s: -loss of tone which can cause a fall -period of confusion follows If frequent: child should wear helmet
69
Partial : simple partial and complex partial
Simple partial: with motor manifestations Simple partial with sensory manifestations Complex partial
70
Seizures: labs and diagnostics 9 6 unique 3 easy
Lead level: blood levels Blood glucose (r/o low sugar) Metabolic panel Chromosomal analysis Toxicology screen Lumbar puncture (r/o meningitis) WBC EEG CT/MRI
71
Seizure tx During vs after Suctioning
Sz Precautions During: Nurse worried about safety/their head/ timing event/ watch CR monitor/ recovery position Post sz: Monitor/notify provider Can suction around mouth but not in mouth during sz
72
Sz med types
Abortivet tx Preventative/maintance meds Miscellaneous tx
73
Sz: abortive meds
Lorazepam (ativan): -1st line drug -route: IV Midazolam (versed) -route: IV or intranasal (good when dont have a IV) Diazepam (diastat) -route: rectal Home med (good for taking home by parents)
74
Sz preventative meds What it does Single med intitiated how When can additional meds be added
Decrease incidence and severity of sz Single med intitially at: Low dose Gradually increased until sz are controlled Additional meds can be added to achieve control
75
Sz preventative meds Client education When to take Dosage when growing What we need to monitor Never stop how Wean how
Take med at same time everyday Dosage will need to be increased as the child grows Therapeutic drug levels need to be monitored Never stop taking abruptly Wean very slow
76
Sz misc tx
Ketogenic diet: -high fat, protien/low carbs Vagal nerve stimulation (stim. Stops sz) Removal of tumor/lesion Focal resection (remove specific tissue causing issue) Hemispherectomy (remove whole hemisphere) Corpus callostomy (separate te the 2 hemispheres)

N305 (17 decks)

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