Ch 36: Peds Neuro Flashcards
Head Injury - early signs
slight change in vital signs
slight change in LOC
infant: irritability, high pitched cry, bulging fontanel, increased head circumference, dilated scalp veins, Macewen’s sign, setting sun sign
Child: headache, nausea, vomiting, visual disturbances, seizures
Macewen’s sign
cracked pot sound on percussion of the head
setting sun sign
sclera visible above the iris
Head Injury - late signs
decrease in LOC bradycardia decreased motor and sensory responses alteration in pupil size and reactivity decorticate (flexion) posturing decerebrate (extension) posturing cheyne-stokes respirations coma
decorticate (flexion) posturing
adduction of the arms at the shoulders
arms are flexed on the chest w wrists flexed and the hands fisted
lower extremities are extended and adducted
*seen w severe dysfxn of cerebral cortex
* indicates a lesion in the cerebral hemisphere or disruption of the corticospinal tracts.
decerebrate (extension) posturing
rigid extension and pronation of the arms and the legs
- sign of dysfunction at the level of the midbrain
- indicates damage in the diencephalon, midbrain, or pons
CSF drainage
positive for glucose
Communicating Hydrocephalus
occurs as a result of impaired absorption w/in the subarachnoid space
no interference of the CSF in the ventricular system
Non communicating Hydrocephalus
Obstruction of CSF flow in the ventricular system DOES occur
ventriculoparitoneal shunt
CSF drains into the peritoneal cavity from the lateral ventricle
ventriculoatrial shunt
CSF drains into th eright atrium of the heart from the lateral ventricle, bypassing the obstruction (used in older children and in children w pathological conditions of the abdomen)
bacterial meningitis dx
lumbar puncture: CSF is cloudy with increased pressure, increased WBC count, elevated protein, and decreased glucose levels
Kernig’s sign
inability to extend the leg when the thigh is flexed at anteriorly at the hip.
Meningitis
to perform –> client’s leg is raised w/ the knee flexed and then extended at the knee.
positive if any pain or resistance is noted.
Brudzinski’s sign
neck flexion causes adduction and flexion movements of the lower extremities
“flexion of the head causes flexion of the hips and knees”
Meningitis
Meningitis interventions
respiratory isolation precautions maintained for at least 24 hrs after abx administered
administer abxs as soon as they are prescribed after lumbar puncture
*meds administed IV
Reye’s syndrome
acute encephalopathy that follows a viral illness (4-7 dys post).
characterized pathologically by cerebral edema and fatty changes in the liver.
liver biopsy = definitive dx
Acetaminophen = medicine of choice
Seizures
generalized
partial
unclassified
Generalized seizures
tonic-clonic
absence
myoclonic
atonic
Head Injury - Brainstem involvement
deep, rapid, or intermittent and gasping respirations
wide fluctuations or noticeable slowing of pulse
widening pulse pressure or extreme fluctuations in BP
sluggish, dilated, or unequal pupils
** notify physician immediately if these signs develop.
Spina Bifida
CNS defect that results from failure of the neural tube to close during embryonic development
Spina bifida occulta
posterior vertebral arches fail to close in the lumbosacral area
spinal cord remains intact, not visible
meninges are not exposed
neurological deficits not present
Spina bifida cystica
protrusion of the spinal cord or meninges or both
defect results in incomplete closure of the vertebral and neural tubes –> sac like protrusion in the lumbar or sacral area
can indlude: meningocele, myelomeningocele, lipomeningocele, and lipomeningomyelocele
Meningocele (spina bifida)
protrusion involves meninges and a sac like cyst that contains CSF in the midline of the back (lumbosacral area)
neurological deficits are evident
absence seizures
brief episodes of altered awareness or momentary loss of consciousness.
no muscle activity occurs except eyelid fluttering or twitching.
child has a blank facial expression.
last 5-10 seconds, may occur one after another several times a day.
myoclonic seizures
brief random contractions of a muscle group that can occur on one or both sides of the body
simple partial seizures
consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or face or neck
meningitis: classic signs
severe headache
fever
stiff neck
change in LOC
photophobia (may also be a prominent early sx, r/t meningeal irritation)
transtentorial herniation
occurs when part of the brain herniates downward and around the tentorium cerebelli.
can be unilateral or bilateral and may involve anterior or posterior portions of the brain.
if a large amt of tissue is involved, the risk of death is upped bc vital brain structures are compressed and become unable to perform their fxn.
LOC obtunded
child sleeps unless aroused, once aroused has limited interaction w/ the environment.
LOC confusion
ability to think clearly and rapidly is lost
LOC disorientation
ability to recognize place or person is lost
increased ICP, SIADH secretion
urine specific gravity > 1.020
weight gain
hypertension
increased ICP, diabetes insipidus
high urine output
post op infratentorial tumor
position the child flat
post op supratentorial tumors
position the child with head up / elevated
temporal lobe herniation (uncal herniation)
refers to a shifting of the temporal lobe laterally across the tentorial notch.
this produces compression of the third cranial nerve and ipsilateral pupil dilation.
if pressure continues up –> flaccid paralysis, pupil dilation, pupil fixation, and death will result
Down Syndrome risk
increased risk for developing leukemia compared to the average child.
decorticate to decerebrate progression
indicates a deteriorating neurological fxn
newborn subdural hematoma s&sx
subdural hematoma can cause pressure on a specific area of the cerebral tissue –> such pressure can cause changes in the stimuli responses in the extremities on the opposite side of the body.
fragile X syndrome
common inherited cause of cognitive impairment.
fragile X syndrome clinical manifestations
long, wide, and/or protruding ears
a long, narrow face w/ a prominent jaw
large protruding ears
large testes
