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Pediatrics > Alterations in Neuro [seizure + LOC] > Flashcards

Alterations in Neuro [seizure + LOC] Flashcards

1
Q

myelination proceeds in ____ direction

A

cephalocaudal direction

head to fingers/toes

newborn reflex is fr lack of myelination

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2
Q

cerebral BF is maintained thru…

A

autoregulation

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3
Q

most important indicator of neuro dysfunction

A

states of consciousness

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4
Q

5 types of aletered levels of consciousness

A 
1 confusion
2 delirium
3 lethargy
4 stupor
5 coma
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5
Q

confusion

A

disoriented to person, place, time

-may still be able to answer simple questions

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6
Q

delirium

A
  • disoriented
  • fear, irritable, agitated
  • mental or motor excitement
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7
Q

lethargy

A
  • profound slumber

- limited speech + movement

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8
Q

stupor

A

deep sleep or unresponsiveness

-only aroused by vigorous stimuli

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9
Q

coma

A

unconscious

-cannot be aroused

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10
Q

altered states of consciousness often follows a predictable sequence

A 
1 slight disorentatn
2restlss + irrtbl
3 drowsy
4 non-purposeful response to pain
5 posturing, siezures, fixd pupils
***6*** crushing triad
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11
Q

cushing triad of altered states of consciousness

A
  • incr SBP w widened pulse pressure
  • bradycardia
  • irregular respirations
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12
Q

early signs of ICP

A
  • headache
  • slow reacting pupils
  • slight change in LOC
  • restlessness
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13
Q

early signs of ICP in infants are similar but with…

A
  • bulging fontanelle
  • high pitched cry

nonspecific to infants

  • headache
  • slow reacting pupils
  • slight change in LOC
  • restlessness
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14
Q

late signs of ICP

A

-significant change in LOC
-cushing triad
»incr SBP w widened pulse pressure
»bradycardia
»irreg RR

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15
Q

altered states of consciousness

treatment

A

AIRWAY> positioningm, intubation, bag-valve mask
BREATH>O2
CIRC> IV fluids, blood products

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16
Q

altered states of consciousness

is assessed with..

A

Glasgow Coma Scale
>eye opening
>verbal response
>motor response

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17
Q

altered states of consciousness

nursing mgmt

A

provide sensory stimultn
»encourage family to stroke + touch in soothing manner
repeated orientation
»bring familiar toys to bedside

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18
Q

Seizure Disorders

A

excessive neurons becoming overexcited

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19
Q

highest rate of onset of seizures

A

during first 12 months of life

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20
Q

possible causes of seizures

A

wide variety; many are unknown

  • brain injury
  • infection
  • electrolyte disturbance
  • toxins
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21
Q

Status Epilepticus

A

prolonged continuous seuzire lasting longer than 15 min
or
intermittent seizures longer than 15 min w/o full recovery bw each seizure

22
Q

seizures use up a lot of ___ +___

A

glucose + oxygen

23
Q

generalized seizures aka

A

tonic clonic

24
Q

generalized seizures/tonic clonic

manifestations

A

body becomes stiff + rigid

>followed by rhythmic jerking motions

25
Q

childhood absence epilepsy is caused by genetic predispotiion

A

touch does not interrupt seizures

26
Q

infantile spasms - genetic

A

abrupt spasms

>involves head nods + jackknife body contractions

27
Q

Phases of Seizure Disorders

A

Tonic
Clonic
Postictal

28
Q

Tonic

A
  • unconscious
  • continuous muscular contraction
  • sustained stiffness
29
Q

Clonic

A
  • alternating muscular contraction

- relaxation or rhythmic jerking

30
Q

Postictal

A

decreased LOC

31
Q

NEONATAL SEIZURES

findings

A
  • *subtle**
  • roving eye mvmt
  • repetitive blinking
  • sucking, lip smacking, tongue thrusting
  • leg pedaling mvmt
  • swimming mvmt of arms
  • apnea + tachycardia
32
Q

seizure disorder

maintaining safety

A
  • nothing in mouth
  • side-lying position
  • ensure rails have pads
  • move objects away
33
Q

seizure disorder

ABC’s

A

airway suctioning
supplt O2
bolus

34
Q

how to stop seizure

A

anticonvulsant + tx of cause

35
Q

post-seizure care

A

monitor postictal period (30 min-2hr)

get glucose + abg levels

36
Q

when starting new antiepileptic drugs, adolescents….

A

should NOT drive or do anything risky

-avoid ETOH

37
Q

MEDS for seizures

A 
benzos [diazepam, lorazepam/ativan]
fosphenytoin/cerebryx
levetiracetam/keppra
phenobarbital
valcroic acid/depakote
38
Q

benzos [diazepam, lorazepam/ativan]

A

monitor for
>hypotension
>tachycardia
>resp dprssn

*rectal or nasal form for home admin

39
Q

fosphenytoin/cerebryx

A

monitor for resp dprssn

40
Q

levetiracetam/keppra

A

monitor gait/coordinatn problems

41
Q

phenobarbital

A

monitor for excess sedation

42
Q

valcroic acid/depakote

A

can be given in sprinkle form

43
Q

Seizure Disorder

treatments

A
  • vagal nerve stimulator

- ketogenic diet

44
Q

vagal nerve stimulator

A

activated vagal nerve after AURA

-to reduce spread of seizure

45
Q

ketogenic diets must cut out

A

all glucose fr all sources

46
Q

a trial of antiseizure medication withdrawal

A

attempted after 2 years of no seizures

47
Q

seizure/anti epileptic meds are at risk for..

A

-depression
-anxiety
-behavioral problems
ADHD

48
Q

seizure education

A

nonadherence is common (esp w alcohol)
safety measures includes no bath, may need helmet, no playing around open flames, medical alert ID
*teach parents to focus on what they CAN do

49
Q

Febrile Seizures

A

usually w temp >39C in first 24 hr of illness

50
Q

SIMPLE Febrile Seizures duration

A

last less than 15 min

do no recur during the same illness

51
Q

SIMPLE Febrile Seizure

manifestations

A
  • generalized w tonic-clonic mvmt + eye rolling
  • brief postictal period
  • not tx w anticonvulsant
  • give antipyretic + education

Pediatrics (51 decks)

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