Ch 36: Peds Neuro

Question 1

Head Injury - early signs

Answer 1

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

Question 2

Macewen’s sign

Answer 2

cracked pot sound on percussion of the head

Question 3

setting sun sign

Answer 3

sclera visible above the iris

Question 4

Head Injury - late signs

Answer 4

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

Question 5

decorticate (flexion) posturing

Answer 5

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.

Question 6

decerebrate (extension) posturing

Answer 6

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

Question 7

CSF drainage

Answer 7

positive for glucose

Question 8

Communicating Hydrocephalus

Answer 8

occurs as a result of impaired absorption w/in the subarachnoid space
no interference of the CSF in the ventricular system

Question 9

Non communicating Hydrocephalus

Answer 9

Obstruction of CSF flow in the ventricular system DOES occur

Question 10

ventriculoparitoneal shunt

Answer 10

CSF drains into the peritoneal cavity from the lateral ventricle

Question 11

ventriculoatrial shunt

Answer 11

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)

Question 12

bacterial meningitis dx

Answer 12

lumbar puncture: CSF is cloudy with increased pressure, increased WBC count, elevated protein, and decreased glucose levels

Question 13

Kernig’s sign

Answer 13

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.

Question 14

Brudzinski’s sign

Answer 14

neck flexion causes adduction and flexion movements of the lower extremities
“flexion of the head causes flexion of the hips and knees”
Meningitis

Question 15

Meningitis interventions

Answer 15

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

Question 16

Reye’s syndrome

Answer 16

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

Question 17

Seizures

Answer 17

generalized
partial
unclassified

Question 18

Generalized seizures

Answer 18

tonic-clonic
absence
myoclonic
atonic

Question 19

Head Injury - Brainstem involvement

Answer 19

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.

Question 20

Spina Bifida

Answer 20

CNS defect that results from failure of the neural tube to close during embryonic development

Question 21

Spina bifida occulta

Answer 21

posterior vertebral arches fail to close in the lumbosacral area
spinal cord remains intact, not visible
meninges are not exposed
neurological deficits not present

Question 22

Spina bifida cystica

Answer 22

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

Question 23

Meningocele (spina bifida)

Answer 23

protrusion involves meninges and a sac like cyst that contains CSF in the midline of the back (lumbosacral area)
neurological deficits are evident

Question 24

absence seizures

Answer 24

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.

Question 25

myoclonic seizures

Answer 25

brief random contractions of a muscle group that can occur on one or both sides of the body

Question 26

simple partial seizures

Answer 26

consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or face or neck

Question 27

meningitis: classic signs

Answer 27

severe headache
fever
stiff neck
change in LOC

photophobia (may also be a prominent early sx, r/t meningeal irritation)

Question 28

transtentorial herniation

Answer 28

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.

Question 29

LOC obtunded

Answer 29

child sleeps unless aroused, once aroused has limited interaction w/ the environment.

Question 30

LOC confusion

Answer 30

ability to think clearly and rapidly is lost

Question 31

LOC disorientation

Answer 31

ability to recognize place or person is lost

Question 32

increased ICP, SIADH secretion

Answer 32

urine specific gravity > 1.020
weight gain
hypertension

Question 33

increased ICP, diabetes insipidus

Answer 33

high urine output

Question 34

post op infratentorial tumor

Answer 34

position the child flat

Question 35

post op supratentorial tumors

Answer 35

position the child with head up / elevated

Question 36

temporal lobe herniation (uncal herniation)

Answer 36

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

Question 37

Down Syndrome risk

Answer 37

increased risk for developing leukemia compared to the average child.

Question 38

decorticate to decerebrate progression

Answer 38

indicates a deteriorating neurological fxn

Question 39

newborn subdural hematoma s&sx

Answer 39

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.

Question 40

fragile X syndrome

Answer 40

common inherited cause of cognitive impairment.

Question 41

fragile X syndrome clinical manifestations

Answer 41

long, wide, and/or protruding ears
a long, narrow face w/ a prominent jaw
large protruding ears
large testes