Chapter 13 - Neurological and Sensory Disorders Flashcards
West Nile Virus can cause:
encephalitis.
What is the central component of the Nervous System?
Neuron
the smallest part, the Nerve Cell
What is Dandy-Walker syndrome/malformation?
it is a malformation of the Cerebellum and fluid-filled spaces around it.
Congenital brain malformation.
Dystonia is:
muscle contraction and twisting movements of muscle groups; abnormal posture
What are two other AKAs for Spina Bifida?
- Myelomeningocele
2. Neural Tube Defect
What is Meningocele?
Membrane around the SC (spinal cord) is enlarged, creating a mass.
Root word: mening/i/o = meninges (membranes of the CNS)
suffix cele = protrusion of; hernia; swelling
4 types of nonviral causes of Encephalitis are:
- Bacteria
- Parasites
- Fungi
- Rickettsiae
Anticonvulsant medications for seizure disorder are:
Valproic acid (depakene) Phenytoin (dilantin)
Diagnostic evaluation of Reye Syndrome includes:
6 items
- history, revealing recovery from a recent viral disease
- sudden onset of vomiting and mental confusion
- Elevated Liver enzymes
- Below normal Blood Glucose
- Elevated Ammonia levels
- Prolonged partial thromboplastin time
Name 4 kinds of Movement Disorders in children.
- Tics
- Tremors
- Dystonia
- Chorea
What is a petit mal seizure?
staring seizure, or absence seizure, a brief loss of awareness.
What is agenesis of the Corpus Callosum?
Absence of the structure that connects the 2 hemispheres. Congenital brain malformation
Meningitis is a precursor to:
Encephalitis.
Febrile Seizures are due to:
fever, in young children.
Alterations in the firing of neurons in the brain are:
seizures
What is the most common cause of acute paralysis in children?
Gullain Barre Syndrome
GBS
Hydrochephalus occurs as a result of:
an IMBALANCE between CSF production and absorption.
A complete loss of tendon reflexes occurs with G_____ B_____ Syndrome
Gullain Barre
3 signs of Cushing’s Triad
- Bradycardia (tachycardia that leads to bradycardia)
- Irregular respiratory pattern
- Systolic hypertension with WIDE pulse
pressure.
List 3 kinds of Infectious Neurologic health problems:
- Meningitis
- Encephalitis
- Reye Syndrome
If a child has meningitis, it is treated as a:
medical emergency
The most common reason for a shunt revision is:
a child’s growth
List 7 symptoms of Meningitis
- Severe headache
- Stiff neck
- Sudden high fever
- Bulging fontanels (infants)
- Altered mental status
- Depending on age: irritability or sleepiness
- May have a RASH, with certain bacterial infection
The general public often mistake tics to be:
voluntary.
Tics are involuntary. It can cause a child to be disciplined even though it is a medical condition.
Generalized seizures have what type of body movements associated with it?
(2 items)
Tonic (rigid)
Clonic (jerking)
Two classification of Meningitis is:
- Viral
2. Bacterial (strep pneumonia)
It is important for the nurse to teach the family with a child who has epilepsy to:
- medication effects and side effects
- obtain a med alert bracelet for child to wear
- find alternatives for contact sports
- avoid swimming or climbing along
Children with SB (spina bifida) have a 50% chance of having what type of allergy?
Latex allergy
Vertebrae are completely ossified at birth.
True or False
False
What are LATE signs of Hydrocephalus in an older child?
there are 6 signs
Late signs of Hydrocephalus in an older child:
- Seizures
- BP increased
- Blindness from herniated of Optic disc
- Decerebrate rigidity
- Heart rate decreased
- Respiratory pattern altered
Chorea resembles:
dancing movements.
muscle contractions result in quick, rhythmic movements.
If there is malformation or damage to any area of the CNS, what is the result?
Some form of IMPAIRMENT
Damage/Malformation = impairment
What are 2 primary ways to diagnosis an infant/child with Cerebral Palsy?
- Neural exam
2. Health history (neural)
List 3 clinical manifestations of Battle Sign
- leakage of CSF from nose or ears
- Raccoon eyes, periorbital ecchymosis.
- Bruising behind the ears
5 Behavioral signs of Cerebral Palsy are:
- extreme irritability or crying
- does not smile by 3 months old
- feeding difficulties
- persistent gagging or choking when fed
- persistent extrusion reflex after 6 months old.
Ominous sign for the eyes is?
Pupils are dilated and fixed.
a nerve is compressed (Oculomotor nerve)
What are the 2 early Signs of Hydrocephalus: in an older child with Hydrocephalus, compared to symptom for an infant with Hydrocephalus?
Older child = headache + strabismus
Infant = head size increase + fontanel bulging.
Which type of muscular dystrophy is more common in boys?
Duchenne’s muscular dystrophy
What type of DME may assist a child with Cerebral Palsy?
Splints,
Braces,
Adaptive feeding devices.
Tethered Cord Syndrome is:
limited spinal cord movement inside the spinal column
What is the nonprogressive motor disorder of the CNS called?
Cerebral Palsy
What type of headaches do most children experience?
2 types
Tension headache,
Migraine
What is Meningitis?
You should know this by now.
itis = inflammation mening = meninges (membrane of the CNS)
Assessing Level of Consciousness using
the Glasgow Coma Scale (GCS).
List 4 general things about the GCS
- Nurse uses the scale to apply a value from 1-15
- Provides clues to neurological status
- Categories: eye opening, motor response and verbal response
- 0-3 is Deep Coma
List 7 items in a General Assessment of the Pediatric Nervous System
- gather History (of pregnancy and Family hx) [Listen]
- LOC and Glasgow Coma Scale (level of consciousness)
- Ht and Wt (measure)
- Head (circumference, suture lines and anterior fontanel)
- Developmental Milestones
- Assess behavior, (and describe it), interactions and general appearance.
- VS, for baseline. (vital signs)
Cyclic vomiting is treated with:
antidepressant,
amitriptyline
Neurological Assessments
identify 6 assessment items
Assess:
- EYES (eg. response, size, funduScopic exam)
- Cranial nerves
- Coordination (is there any?, eg. throwing a ball)
- Mental Status (for school-age & adolescents)
- Motor Fxn (eg. strength, tone, smooth, purposeful movement)
- Sensory Fxn (eg. deep tendon reflexes & other appropriate reflexes)
It is a common skull fracture that occurs with children.
Battle sign
What type of diuretic would you administer to a child with ICP?
Mannitol,
it is an osmotic diurectic.
List 3 general concepts about Assessment of the Pediatric Nervous System
- Children under the age of 2: require special evaluation
- Most info is gained through OBSERVING spontaneous and elicited REFLEX RESPONSES.
- Red Flags = Delay or deviation from expected milestones, OR, re-appears of primitive reflexes
A priority nursing consideration pre-surgery for a child with Spina Bifida is:
maintain skin integrity of the sac.
__% of childhood seizures are idiopathic.
50%
Half!
Symptoms of Hydrocephalus in older children:
there are 8 signs
- HeadACHE
- Blurred vision, or, double vision
- Balance problems
- Lethargy
- New urinary incontinence
- Papilledema (swollen optic disc)
- Sunsetting Eyes
- Vomitting
A seizure that lasts 30 minutes or more is:
a pediatric emergency, aka status epilepticus
Anencephaly is:
a congenital malformation, where both cerebral hemispheres are ABSENT.
Stillborn infants have this defect. so sad!!!
What are the 3 diagnostic tests help verify Meningitis?
- Lumbar puncture
- Blood cultures
- Nose and throat cultures
What is Post concussion Syndrome?
Child may become easily upset and may be irritable if tired or stressed.
Memory problems are common.
Double vision, dizziness, headaches, may last for months.
States of Consciousness in a patient
Lists 5 states of consciousness
- Alert
- Lethargy
- Obtundation
- Stupor
- Coma
Narcolepsy is:
extreme tendency to fall asleep, at inapropriate times
Hypersomnia is:
excessive sleepiness, sleeping at inapropriate times
Name 4 common neuromuscular disorders.
- Cerebral palsy
- Muscular dystrophy
- Myasthenia gravis
- Spinal muscle atrophy
Performing a Lumbar Puncture
List 6 things to consider while performing a Lumbar Puncture.
- Instruct child to lie on side
- Instruct child to bend knees, until knees touch chin
- Wash back ( cool liquid)
- Tell child, will feel a “pinch” or “sting”
- Check CardioPulmonary status
- Support client and family
Encephalitis is usually caused by a:
Virus
List 3 important Nursing Interventions for Meningitis.
- Isolation
- Monitor Neurologic Status (LOC)
- Monitor IV fluids
Other Nursing Interventions:
monitor Cardiorespiratory status (frequent VS)
have emergency airway equipment in room/bedside
provide env’t that will minimize ICP
monitor for cerebral edema
Doctor’s orders: antipyretics, administer as ordered
monitor for complications such as seizure, hearing loss, visual alterations
Identify 4 Nursing Intervention for Teaching Parents to care for child with a Head Injury:
- Ice (to child’s head)
- Rest (for the child)
- Limit foods, if child vomits
- Watch for 2 full days. Awaken child at parent’s bedtime and again 4 hours later to make sure child is alert and can answer your questions appropriately
When to call the physician immediately for a head injury:
the list is long, 10 items
- bleeding that does not stop after putting pressure for 10 minutes on area.
- needs sutures
- under 1 yr old
- Unconscious or confused
- Severe headache, vomitting
- Slurred speech, blurred vision
- Blood or watery fluid coming from ear or nose
- Unequal pupils or crossed eyes
- Difficulty walking or crawling, or weakness in the arms.
- Other symptoms that concern you.
What is Lissencephaly?
Absence of folds, grooves and fissures of the brain.
Congenital brain malformation.
Is transient neonatal Myasthenia Gravis a real thing?
yes.
Gullain Barre Syndrome requires a ___________ assessment. Deaths are due to __________ failure.
Respiratory,
respiratory
(yes, same word twice for fill in the blanks).
List 9 Diagnostic tests of the NS (Nervous System)
- CT scan
- AngioGraphy
- EchoEncephaloGraphy
- ElectroEnchephaloGraphy (electrodes)
- Lumbar Puncture
- MRI (head is restrained)
- Nuclear Brain Scan
- Subdural Tap
- Ventricular Puncture
Becker’s muscular dystrophy is:
- progressive weakness in the pelvis and legs (over time)
- Symptoms begin around age 12
- Weakness in the heart muscles can occur
__________ rarely occurs in infancy.
Papilledema (mass of blown out blood vessels are the Optic Nerve)
Neural tube forms the anterior end (the brain) and the posterior end (spinal cord).
If there are defects, what is the result?
result is defects in the brain and Spinal cord.
AKA, neural tube defects.
What are the affects of Sleep Disorders have on children?
list 6 items
- affect rest
- affect learning and behavior
- disruptive to family (parents/siblings)
- problems with insomnia
- problems with sleep arousal
- problems with early-morning awakenings
What is the most commong infection of the CNS?
Meningitis
The main goal for all children with Cerebral Palsy is:
Self-care.
Myoclonic seizures are:
sudden brief jerks of muscle groups with possible loss of consciousness.
List 3 kinds of Head Injuries
- Shaken Baby Syndrome
- Battle Sign
- Near Drowning
Neuropathy is a condition in which __________ nerves are damaged.
peripheral
What is the difference between a headaches caused from a primary or secondary cause?
Primary headache occurs spontaneously, NOT due to trauma, or any other problem.
Secondary headaches are due to trauma, illness, tumors.
An infant’s head is ___% of an Adult’s head.
66%