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PEDIATRICS > 37: Neuro-Cognitive-Psychosocial Disorders > Flashcards

37: Neuro-Cognitive-Psychosocial Disorders Flashcards

1
Q

Impaired movement and posture - resulting from abnormality in EXTRAPYRAMIDAL or PYRAMIDAL motor system.

A

Cerebral Palsy

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2
Q

Most common clinical type of Cerebral Palsy

A

Spastic: upper motor, neuron type of muscle weakness

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3
Q

Cerebral Palsy: Data Collection (7)

A
  1. extreme Irritability and Crying
  2. Feeding difficulties
  3. Abnml Motor
  4. Alt. muscle tone (stiff, rigid)
  5. Primitive Infantile Reflexes after 6 mos
  6. Abnml Posturing
  7. Seizures
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4
Q

Cerebral Palsy: Therapeutic Management (5)

A
  1. PT
  2. OT
  3. Speech therapy
  4. Education
  5. Recreation
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5
Q

Pathological result of - any mechanical force to the Skull, Scalp, Meninges, or Brain

A

Head Injury

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6
Q

Occurs when there is a - Fracture of the Skull, or Penetration of the Skull - by an object

A

Open Head Injury

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7
Q

Result of Blunt Trauma; can also be caused by Shaken Baby Syndrome

A

Closed Head Injury

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8
Q

A Closed head injury is more serious than Open head injury because ____

A

the chance of increased ICP, in a “closed” vault

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9
Q

2 Early signs of increased ICP

A

Slight change in

  1. Vital Signs
  2. LOC
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10
Q

INFANT: Early signs of increased ICP (7)

A
  1. Irritability
  2. High-pitched CRY
  3. Bulging FONTANEL
  4. Increased HEAD CIRC.
  5. Dilated SCALP VEINS
  6. MACEWEN Sign
  7. Setting-Sun Sign
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11
Q

“Cracked-pot” sound, on percussion of the Head

A

Macewen Sign

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12
Q

Sclera is visible above the iris

A

Setting-sun sign

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13
Q

CHILD: Early signs of increased ICP (4)

A
  1. Headache
  2. Nausea, Vomiting
  3. Diplopia
  4. Seizures
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14
Q

Late signs of increased ICP (8)

A
  1. decreased LOC
  2. BRADYcardia
  3. decreased MOTOR and SENSORY responses
  4. PUPIL size and reactivity
  5. DECORTICATE posturing
  6. DECEREBRATE posturing
  7. CHEYNE-STOKES respirations
  8. COMA
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15
Q

Flexion Posturing

A

Decorticate

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16
Q

Extension Posturing

A

Decerebrate

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17
Q

Earliest indication of an *improvement, or *deterioration of NEUROLOGICAL condition

A

child’s LOC

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18
Q

Immediate intervention/action after a Head Injury

A

IMMOBILIZE the Neck and Spine

*if cervical or other spinal injury is suspected

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19
Q

After spinal cord injury is ruled out, elevate the bed ____ degrees (if not contraindicated and as prescribed) to _____.

A
  1. elevate 15 - 30 degrees

2. to facilitate Venous Drainage

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20
Q

Head Injuries: A decreased response to pain is a significant sign of ___

A

altered LOC

21
Q

Head Injury: Position so HEAD is MIDLINE, to avoid ____.

A

jugular vein compression (which can increase ICP)

22
Q

Head Injury: Monitor IV FLUIDS to *AVOID ___, and to *MINIMIZE ____.

A
  1. avoid increasing any CEREBRAL EDEMA

2. minimize POSSIBLE OVERHYDRATION

23
Q

Head Injury: Monitor FLUID/ELECTROLYTE alterations because this could indicate _____

A

injury to the HYPOTHALAMUS or POSTERIOR PITUITARY

24
Q

Head Injury: Check for NOSE/EAR DRAINAGE which could indicate ____

A

leakage of CSF

*NOTIFY RN IMMEDIATELY!!!

25
Head Injury: 2 Interventions if HYPOTHERMIA occurs
1. assist admin of TEPID SPONGE BATH | 2. Hypothermia BLANKET
26
Head Injury: Avoid suctioning through Nares because of ____
risk of SECONDARY INFECTION | *catheter might enter brain through a fracture
27
Head Injury: 4 areas to Assess/Monitor for BRAINSTEM INVOLVEMENT
1. Respiration (RAPID/DEEP or INTERMITTENT/GASP) 2. Pulse (wide FLUCT or SLOWING) 3. BP (widening PP or extreme FLUCT) 4. Pupils (sluggish, dilated, unequal)
28
Head Injury: Sign of EPIDURAL HEMATOMA
Asymmetrical Pupils (one dilated, nonreactive) *NOTIFY RN and HCP IMMEDIATELY!!!
29
Head Injury: If Epidural Hematoma occurs, a __ __ may be indicated to _____.
1. Neurosurgical EMERGENCY | 2. evacuate the hematoma!!
30
Head Injury: 5 Medications that may be administered
1. Acetaminophen (headache) 2. Anticonvulsant (seizure) 3. Antibiotic (if laceration present) 4. Tetanus Toxoid (prophylactic) 5. Corticosteriod or Osmotic Diuretic (reduce cerebral edema)
31
An IMBALANCE OF CSF absorption and production - caused by *malformations, *tumors, *hemorrhage, *infections, *trauma. Results in HEAD ENLARGEMENT and INCREASED ICP
Hydrocephalus
32
Hydrocephalus can be caused by (5)
1. Malformations 2. Tumors 3. Hemorrhage 4. Infections 5. Trauma
33
Hyrdocephalus results in (2)
1. Head enlargement | 2. Increased ICP
34
2 types of Hydrocephalus
1. Communicating | 2. Non-communicating
35
Type of Hydrocephalus that occurs as a result of - impaired absorption WITHIN THE SUBARACHNOID SPACE
Communicating Hydrocephalus
36
Type of Hydrocephalus that occurs with OBSTRUCTION of CSF flow in the VENTRICULAR SYSTEM
Non-Communicating Hydrocephalus
37
Hydrocephalus: 3 Surgical Interventions
1. Ventriculoperitoneal Shunt 2. Ventriculoatrial Shunt 3. Endoscopic Third Ventriculostomy
38
Hydrocephalus: Surgical Interventions used for Older Children or those with pathological conditions of the Abdomen
Ventriculoatrial Shunt
39
Hydrocephalus: Surgical Intervention that may not be appropriate for some types of hydrocephalus
Endoscopic Third Ventriculostomy
40
Hydrocephalus: A small opening is made in the floor of the third ventricle which allows CSF to bypass fourth ventricle, and return to circulation
Endoscopic Third Ventriculostomy
41
Hydrocephalus: Postoperative Positioning
``` on UNoperated SIDE (no pressure on shunt) and FLAT (avoid rapid reduction of fluid) ```
42
Hydrocephalus: INFANT Signs of shunt Infection/Malfunction
1. High, shrill CRY 2. Lethargy 3. Poor Feeding
43
Hydrocephalus: TODDLER Signs of shunt Infection/Malfunction
1. Headache | 2. Poor Appetite
44
Hydrocephalus: OLDER CHILD Signs of shunt Infection/Malfunction
Altered LOC
45
An infection process of the CNS - caused by bacteria and viruses
Meningitis
46
Meningitis may be acquired as a Primary Disease, or as a result of (4)
1. Complications of NEUROSURGERY 2. TRAUMA 3. INFECTION of the SINUSES/EARS 4. SYSTEMIC INFECTIONS
47
Diagnosis of Bacterial Meningitis is made by ____
testing CSF from Lumbar Puncture
48
Meningitis: CSF is CLOUDY, with (3)_____
1. Increased WBCs 2. Elevated PROTEIN 3. Decreased GLUCOSE levels

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