Alterations in Neuro 2 Flashcards
Bacterial Meningitis
inflammation of meninges
>causes cerebral edema + trigger SIADH
»»monitor UO + spec gravity
Bacterial Meningitis
findings in young infants
bulging fontanelle (late finding) opsthotonic position (head is hyperextended)
Bacterial Meningitis
findings in older children
- petechiae that changes to purpura or large necrotic patches
- nuchal rigidity
- kernig sign
- brudzinski sign
Kernig Sign
-sign of bact meningitis
-raise legs w knee flexed then extend legs at knee
»>resistance + pain is POSITIVE
Brudzinski Sign
flex head while in supine
|»_space;>knees or hips flex involuntarily is POSITIVE
Bacterial Meningitis
definitive diagnostic
Lumbar puncture
- incr WBC
- incr protein
- decr glucose
- incr CSF pressure
- cloudy
Bacterial Meningitis
complications
- cerebral edema
- siadh
- disseminated intravascular coag
- hearing loss (common)
Viral/Aseptic Meningitis
less severe
symptoms usually resolve spontaneously
do not give aspirin to children bc
Reyes syndrome
bad liver
Reyes syndrome
care + prognosis
supportive care
high mortality rate
dont give aspirin!!
Guillain-Barre Syndrome
rare in kids compared to adults
-paralysis fr feet up
Guillain-Barre Syndrome
signs of impending resp failure
- difficulty swallowing
- bilateral facial nerve weakness
types of headaches
1 Migraine Headaches
2 Tension Headaches
3 Medication Overuse Headaches
Migraine Headaches
triggered by stress, foods w nitrates, glutamates, caffeine, tyramine, sale, menses, fatigue, hunger
Tension Headaches
asoc w stress r/t school, anxiety, fasting, inadeq sleep
Medication Overuse Headaches
w freq use (2-3x/wk) of NSAIDS, decongestants, opioids
Migraine
manifestations
pulsatile throbbing pain
-lasts hours to days
visual or motor aura
Tension
manifestaions
feels like pressure or tightening instead of pulsing
Rebound or Med Oversure Migraine
manifestations
bandlike over entire head
crushing
Microcephaly
small brain w head circumference below 3rd percentile
-usually w intellectual diasbility
Hydrocephalus
commonly assoc w myelomeningoceles
Noncommunicating Hydrocephalus
impaired flow
*most common in kids
hydrocephalus that is acquired after closure of sutures
no head enlargement
Hydrocephalus
early signs
bulding fontanelle
irritability
lethargy
Hydrocephalus
late signs
sunsetting eyes
apnea spells
shrill, high pitched cry
Hydrocephalus
treatment
ventriculoperitoneal shunt system > moves blood fr ventricles to peritoneum
-often placed at 3-4 months of age
*freq measurement of head necessary
>may decr 1-2cm initially
-head growth should occur no sooner than 2-4 months
-often needs revision as they grow
4 Types of Neural Tube Defects
1 Anencephaly
2 Encephalocele
3 Spina Bifida Occulta
4 Spina Bifida Cystica
Anencephaly Neural Tube Defects
no development above brainstem
-fatal
Encephalocele Neural Tube Defects
protrusion of meningeal tissue or brain thru a defect in skull
Spina Bifida Occulta Neural Tube Defects
vertebral defect w vertebral arches fail to fuse
>spinal cord + meninges contained in vertebral canal are not present
Spina Bifida Cystica Neural Tube Defects
vertebral arch defect w protrusion of meninges thru bony spine
Types of Spina Bifida/Myelodysplasia
both are protrusion of meningeal sac w CSF
Meningocele> no abnormalities in spinal cord
Myelomeningocele> parts of spinal cord + nerves thru vertebral defect
main risk factor of Spina Bifida/Myelodysplasia
folic acid deficiency
Spina Bifida/Myelodysplasia
manifestations at THORACIC LEVEL
- paralysis of legs
- weakness + sensory loss at trunk + lower body
Spina Bifida/Myelodysplasia
manifestations at LUMBA LEVEL
- varying levels of hip involvement
- may move knees + toes
Spina Bifida/Myelodysplasia
manifestations at SACRAL LEVEL
mild weakness in ankles + toes
Spina Bifida/Myelodysplasia commonly have what allergy
latex
Spina Bifida/Myelodysplasia often have __ and may need ___
neurogenic bladder (intermittend catherization Q3-4 hr)
Mitrofanoff procedure
Spina Bifida/Myelodysplasia
nursing mgmt
prone position w hips slightly flexed + legs abducted
Neonatal Abstinence Syndrome
initial signs
excessive high pitched crying
Neonatal Abstinence Syndrome
screening
meconium screening provides info on drug use by mom for last half of pregnancy
why is breastmilk encouraged w Neonatal Abstinence Syndrome
minimal amt of drugs can cross over into milk
