CPN Exam Neurologic Conditions Flashcards
Cerebral Palsy
A non-progressive neuromuscular disorder that affects movement and posture
Most common in preemies
Disability with CP
Abnormal muscle coordination and tone
Vision, hearing, speech disturbances
Seizures
Intellectual disability
CP Management
Speech, occupational, and physical therapy
Adaptive equipment (bracing, splinting, crutches, walkers)
Age-appropriate cognitive activities and incentives for motor development
Down Syndrome (Trisomy 21)
Congenital condition characterized by intellectual disability, dysmorphic facial features, and other defects (e.g. congenital heart defects)
CP Assessment
Intellectual Disability
Flat, broad forehead
Low-set ears
Hypotonia
Protruding tongue
Short stature
Simian Crease
CP Management
Developmentally appropriate play and activities
Small, straight handled spoon to push food back toward side and back of mouth
Seizures
A sudden, episodic involuntary alteration in consciousness, motor activity, behavior, sensation, or autonomic function
Seizure disorder/Epilepsy
A condition characterized by two or more unprovoked seizures
Seizure Disorder Treatment
Antiepileptic Drugs
Ketogenic Diet
Vagal nerve stimulation
Febrile Seizures
Seizure in association with a febrile illness in the absence of a central nervous system infection or acute electrolyte imbalance in children older than 1 month of age without prior afebrile seizures
Febrile Seizure Age
6 mo - 3 years
uncommon > 5 years
Febrile Seizure Management
Age susceptibility to seizure induced by fever (usually > 38.8oC
No anti-epileptic therapy
Emotional support and reinforce the benign nature of the febrile seizure
Concussion
Transient state of neurologic dysfunction caused by jarring of the brain
May or may not be accompanied by loss of consciousness
Classified as a mild traumatic brain injury (TBI)
Most common TBI
Second Impact Syndrome
Rapid brain swelling which can occur with resuming physical activities before healed
Concussion Symptoms
Headache
Dizziness
Vision problems
Changes in emotions or behaviors
Sleep disturbances
Difficulty remembering
Vomiting
Concussion Discharge Teaching
Brain Rest
Gradually return to learn, then play
Increased Intracranial Pressure (ICP)
Occurs when compensation is not possible
A persistent increase destroys healthy brain tissue and alters mental function
ICP Infant Assessment
High-pitched cry
Extreme Irritability
Bulging fontanel
ICP Children Assessment
Headache
Vomiting
Seizure
Decreased LOC
ICP Management
Monitor neuro status
Limit fluids
Administer osmotic diuretic/corticosteroid
Elevate head of bed 30 degrees
Hydrocephalus
A syndrome resulting from a disturbance in the dynamics of cerebral spinal fluid (CSF)
Hydrocephalus Assessment
Measure head circumstances
Observe full, tense fontanel
Note signs of increased ICP
Hydrocephalus Management
Surgical placement of a VP shunt – Drains CSF from the ventricles to the peritoneum
Hydrocephalus Post Op
Position on non-affected side or back
Measurement of head circumference
Strict I & O with fluid restrictions
Skin care of incision site
Monitor for signs of infection and increased ICP
Neural Tube Defects
Group of related CNS birth defects caused by the incomplete closure of the embryonic neural tube including: anencephaly, encephalocele, meningocele, myelomeningocele
Meningocele
Hernial protrusion of saclike cyst containing meninges but no spinal cord
Myelomeningocele
Protruding sac containing CSF, meninges, and a portion of the spinal cord
Spina Bifida Pre-Op Assessment
Leakage from sac
infection around sac
Motor activity below sac
Head circumference
Spina Bifida Post-Op Assessment
Position child on abdomen
Avoid contamination of sac
Cover sac with saline soaked dressing
Not leg movement
Assess for paralysis
Assess for neurogenic bladder
Neurogenic Bladder
Intermittent urinary catheterization prevents infection and kidney damage due to increased bladder pressure
Spina Bifida - Avoid
Pacifiers
Feeding nipples
Elastic
Chewing gum
Banana, Avocado, Chestnut, Kiwi
Condoms (Trojan or ya know… the other brands I guess)
Meningitis
An inflammation of the meninges of the brain and spinal cord
Sudden onset– Serious illness within 24 hours
Meningitis Assessment
Infant: High pitched cry
Bulging fontanel
Irritability
Children: Headache
Stiff Neck
Vomiting
Nuchal rigidity
Meningitis Diagnosis
Lumbar Puncture: cloudy color, Increased WBC, Increased protein, decreased glucose level
Meningitis Interventions
Antibiotics
Corticosteroids
Droplet Precautions
Neuro assessment
Monitor fluid status
Lead Poisoning (plumbism)
Questionnaire - beginning at 6 months for all primary care visits
Does the child live in a home built before 1978?
Is there evidence of PICA?
Serum screen - 12 months and 24 months in high-risk groups
