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AN305 > 2 Neuro > Flashcards

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
Q

Hydrocephalus

What is it

Leads to what

A

Imbalance between production and absorption CSF

Leads to:
Increase in CSF circulating volume—>increased ICP

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26
Q

Hydrocephalus

Nonobstructive vs obstructive

A

Nonobstructive:
-flow of CSF blocked AFTER it exits the ventricles
-defective absorption

Obstructive:
-flow of CSF blocked WITHIN the ventricular system

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27
Q

Hydrocephalus
S/s

A

S/s of increased ICP:
Increased HC
Bulging fontanels/seperating sutures (when young)
Irritability/change loc
N/V/HA
Sunsetting eyes

Poor feeding

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28
Q

Hydrocephalus
Tx

A

Surgical correction of structural deformities

Remove or bypass obstruction

VP(ventroperitonel) or VA(ventriculoatrial) shunt

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29
Q

Hydrocephalus
Shunt care

A

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

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30
Q

Hydrocephalus
Shunt complications

A

Shunt malfunction: sx to replace shunt

Shunt infection:
-Sx to externalize shunt
-EVD: external ventricular drain
-IV abx

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31
Q

Where do we want the lazer on EVD?

Head Too high will cause what
Monitor how often

A

At the tragus of ear

Too high will drain too fast
Every hour

32
Q

Meningitis

What is it
Causes
Which is more life threatening

A

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
Q

Meningitis
S/s

3 unique
3 vague
Meningeal irritation signs (3)

A

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
Q

Brudzinskis sign
Vs
Kernigs sign

A

B:
-pull neck = involuntary flexing of knees and hips

K:
-hip at 90degree angle
-cant fully straighten leg

35
Q

Meningitis

Complications
(Clinical manifestations) what infection causes it

A

meningococcal:(bacterial)
-Petechiae/purpuric type rash

Pneumococcal:
-Chronic ear drainage

Meingococcal and Hib infection:
-Arthralgias

36
Q

Meningitis diagnotics

A

Blood culture
CBC (WBCs)
CRP/ESR (inflammation)
CT/MRI
CSF analysis via LP

37
Q

Meningitis

Bacterial vs viral CSF

Color
WBC
Proteins
Glucose
Gram stain

A

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
Q

Lumbar punctures for peds

Position
How to decrease pain
What to do after

A

Fetal lying position

Pain:
-topical numbing cream
-sucrose water, fetanyl, versed

Lay flat for several hours after to prevent spinal HA

39
Q

Meningitis tx

Precaution
Monitor what (3)
Assess (2)
Manage what
Decrease what

A

Droplet isolation

Monitor: VS, I/O (UOP), s/s of increased ICP

Assess: nuro status, pain

Manage fever
Decrease environmental stimuli

40
Q

Meningitis

Meds example
Antivirals?

A

Abx (up to 10days)
Corticosteroids: dexamethason

Antivirals:
-maybe before we know if its bacterial. But usually let viral meningitis run its course

41
Q

Reye syndrome

Affects who usually
Found to be a reaction that is triggered by what

Primarily affects what

A

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
Q

Reye syndrome

S/s (4)

Neuro s/s d/t liver d/t build up of ammonium

A

Severe Vomiting
Change in mental status (confusion/delirium)
Irritability/combativeness
Seizures

43
Q

Reye syndrome

Diagnostics
(5)

Wanna rule out what?

A

Elevated liver enzymes (ALT/AST)

Elevated blood ammonia levels

Coagulation times can prolong

Liver biopsy

LP: CSF analysis to rule out meningitis

44
Q

Reye syndrome
Tx

A

Hydrate whilte preventing cerebral edema

Decrease stimulants like increased ICP

Monitor/prevent bleeding episodes

Implement sz precautions

Meds:
Mannitol

45
Q

Head trauma: key terms

Concussion
Contusion
Laceration
Skull fractures

A

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
Q

Skull fracture types:

Linear
Depressed
Comminuted fractures
Basilar fractures

A

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
Q

Peds abusive head trauma:

More common in what gender
Between what ages
Risks

A

Males
3- 8 months

Risks:
-inconsolable/ crying child
-male caregiver
-unwanted pregnancy/child

48
Q

Peds abusive head trauma: severe child abuse

Caused by 3

Outcomes 6

A

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
Q

Head trauma clinical manifestation
minor 6
Progressive 3
Severe 2

A

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
Q

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

A

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
Q

Head trauma: Labs and diagnostics
Think other causes to rule out neuro status

A

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
Q

Head injury : nursing care

A

Stabilize spine
ABCs: airway, mechanical ventilation, sats 95%+
Through neuro assessment
Monitor I&O, electrolyte balance
Decrease stimulation
Manage pain: analgesics
Mannitol, antiepileptics

53
Q

Complications: epidural hematoma

Bleeding
Typically

A

Bleeding between dura and skull

typically arterial

54
Q

Complications: epidural hematoma

Clinical manifestations

A

Short period of unconsciousness followed by a normal period for several hours

Lethargy/coma/vomiting due to compression of the brain

55
Q

Complications: epidural hematoma

Treatment

A

Removal of accuulated blood

Ligation of torn artery

56
Q

Complications: subdural hematoma

Bleeding
Typically
Could be a result of what

A

Bleeding between the dura and the arachnoid membrane

Typically venous

Could be d/t:
-birth trauma
-falls
-violent shaking

57
Q

Complications: subdural hematoma

Clinical manifestations

Tx

A

CM:
-irritability, anemia, sz
-Increased HC
-lethargy,coma, vomiting

Tx:
-self-resolving or drains/subdural tap
(same as epidural hematoma)

58
Q

Complications

Cerebral edema

Brain herniation
-what is it
-s/s 3

A

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
Q

Health promotion and disease prevention

A

Seat belts
Helmets
Shaken baby and child abuse prevention
Car seat compliance ( rear facing until 2 )

60
Q

Seizure: types

Unclassified
Generalized
Partial/focal

A

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
Q

Unclassified: febrile seizures

Associeted with what
Duration
Tx

A

Associated with sudden spike in temp as high as 102-104F

Duration: 15-20 seconds

Tx:
acetaminophen or ibuprofen
Light clothing
Tepid bath

62
Q

Unclassified: infantile spasms

Peak onset
S/s
How many events

A

Peak onset: 3-7 months

Sudden, brief, symmetric muscle contractions

Can occur as single event or in clusters

63
Q

Unclassified: neonatal seizures

Most times are what type
When your likely to get it

Associeted with underlying causes 4
Tx

A

Mostly focal
1st 4 weeks of life

Causes:
-hypoxic ischemic encephalopathy
-metabolic disorder
-infection/sepsis
-cerebral infarction

Tx: tx the cause

64
Q

Generalized: tonic-clonic

Most prevalent of all seizures

Onset is without what
Tonic phase duration
Clonic phase duration
State after all phases

A

Onset without warning

Tonic phase: 10-20 secs
Clonic phase: 30-50 secs (can last 30 min or longer)

Postictal phase

65
Q

Tonic phase
Clonic phase
Postictal state

A

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
Q

Generalized: absence

Aka
S/s
What is first indicator
Is there a postictal phase?

A

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
Q

Generalized: myoclonic

S/s:4
Postictal phase?

A

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
Q

Generalized: atonic

Aka
Onset what ages
S/s
If frequent child should do what.

A

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
Q

Partial : simple partial and complex partial

A

Simple partial: with motor manifestations

Simple partial with sensory manifestations

Complex partial

70
Q

Seizures: labs and diagnostics
9
6 unique
3 easy

A

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
Q

Seizure tx

During vs after

Suctioning

A

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
Q

Sz med types

A

Abortivet tx

Preventative/maintance meds

Miscellaneous tx

73
Q

Sz: abortive meds

A

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
Q

Sz preventative meds

What it does
Single med intitiated how
When can additional meds be added

A

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
Q

Sz preventative meds

Client education

When to take
Dosage when growing
What we need to monitor
Never stop how
Wean how

A

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
Q

Sz misc tx

A

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)

AN305 (15 decks)

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