[Exam 4] Chapter 38 – Alteration in Intracranial Regulation/Neurologic Disorder Flashcards
Common Medical Txs: What is a shunt placement?
Catheterplaced in ventricle to pass the CSF to the peritoneal cavity, atrium of the heart, or pleural spaces.
Common Medical Txs: What is a external ventricular drainage?
Catheter is temporarily placed in the ventricle and CSF is drained in a closed system to a external resesrvoir
Common Medical Txs: What is a ventricular trap?
To reduce accumulation of CSF and decrease ICP
Common Medical Txs: What is a vagal nerve stimulator?
Nerve sitmulator is implanted and a lead wire running around skin. PRovides appropriate dose of sitmulation at preset intervals
Common Medical Txs, Physical Exam - LOC: WHat is obtunded?
State in which child has limited response to environment and falsl asleep unless stimulation provided
Common Medical Txs, Physical Exam - LOC: What is stupor?
exists when the child only responds to vigorous stimulation
Common Medical Txs, Physical Exam - LOC: What is a popular scale used to standardize degree of consciousnesss?
Pediatric Glasgow Coma Scale. Consists of eye opening, verbal response, and motor response
Common Medical Txs, Physical Exam - VS: What can cause changes in childs vital signs?
cerebral infections, increased ICP, coma, brain stem injury, or head injuries
Common Medical Txs, Physical Exam - Motor Function: When does decorticate posturing occur?
Damage to the cerebral cortex. Extremities flexed.
Common Medical Txs, Physical Exam - Motor Function: When does decerebrate posturing occur?
With damage at the level of the brain stem . Extremities extended and pronated
Common Medical Txs, Physical Exam - Increased ICP: This is a sign that may occur with what?
head trauma, birth trauma, hydrocephalus, infection and brain tumors.
Common Medical Txs, Physical Exam - Increased ICP: How is newborn positioned for lumbar puncture?
Newborn positioned upright with head flexed forward.
Common Medical Txs, Physical Exam - Increased ICP: How is child or older infant positioned for lumbar puncture?
Positioned on side with head flexed forward and knees flexed to abdomen
Seizures: Most seizures are caused by disorders outside the brain like?
high fever, infection, head trauma, hypoxia, toxins, or cardiac arrhythmias
Epilepsy: What is this?
Seizures are triggered recurrently from within the brain.
Epilepsy: What must happen for it to qualify as this?
Two or more unprovoked seizures more than 24 hrs apart.
One unorovoked seizure, after two unprovoked seizures happening over next 10 years
Diagnosis of epilepsy syndrome
Epilepsy - Patho: Why does this happen?
Result from a disruption of electrical communication among the neurons of the brain. Results from imbalance b/w excitatory and inhibitory mechanisms in brain.
Epilepsy - Patho: What are the three types of seziures?
Focal (known as partial before)
Generalized
Unknown seizures (epileptic spasms)
Epilepsy - Patho: Where fo focal seziures occur?
One hemisphere, while general involve all.
Epilepsy - Patho: Generalized seizures include what?
absence seizures, tonic, clonic, tonic-clonic seziures, myoclonic seizures and atonic seizures.
Epilepsy - Therapeutic Mx: Management focuses onw hat?
Controlling seizures or reducing their frequency.
Epilepsy - Therapeutic Mx: Primary mode of treatment?
The use of anticonvulsants.
Epilepsy - Therapeutic Mx: What happens if seizures remain uncontrolled?
Surgery. May be possible to remove the area that is responsible for the seizure activity or to interrupt the impulses from spreading, therefore stop or reduce the seizures
Epilepsy - Therapeutic Mx: Other nonpharmacologic treatments for this include?
keogenic idet or placement of vagal nerve stimulator
Epilepsy - Health Hx: Questions asking about seizure should include what
where id dit occur
Descript of childs behavior
How did they act afterwards?
Has the episode been recurrent?
Epilepsy - Health Hx: Risk factors for this?
family hx
Any complications during neonatal period
Changes in developmental status
Epilepsy - Health Hx: Difference between clonic and tonic seizures?
Clonic = Repeated jerking movement
Tonic = Stiffening of the muscles, typically the back, legs, and arms
Epilepsy - Health Hx: What is a myoclonic seizure?
Generlized seizure that includes sudden, brief, massive muscle jerks that may involve whole body or one body part
Epilepsy - Health Hx: What is a atonic seizure?
generalizes eizure known as drop attack . sudden loss of muscle tone
Epilepsy - Health Hx: What is a focal seizure without impairment of consciousenss?
Partial seizure that occurs in one part of brain. Motor activity characterized by clinic or tonic movements involving the face, neck, and extremities
Epilepsy - Health Hx: What is status epilepticus?
Neurologic emergency. Febrile seizure most common. Includes prolonged or clustered seizures where consciousness does not return between seizures.
Epilepsy - Health Hx, Physical Exam: Descriptions to include of seizure if witnessing one?
Time/Length of seziure
Alternations in behavior
Descripts of movements
Changes in color
State of consciousness
Epilepsy - Health Hx, Labs: Common labs include?
Serum glucose to rule out hypoglycemia
LP - Analyze CSF
Skull X-Ray
CT, MRI, EEGs, Video EEGs
Epilepsy - Nursing Mx, Managing Tx: Common cause of breakthrough seizures is?
medication noncompliance
Febrile Seizures: Where is this most common?
For children less than 5 years old, with peak between 12-18 months. .
Febrile Seizures: What is this associated with?
Fever that is not the result of an intracranial infection or metabolic imbalance. , and usually related to viral illness
Febrile Seizures: They can be an underlying sign of what?
meningitis or sepsis.
Febrile Seizures: Complications associated with this?
Status epilepticus, motor coordination deficits, intellectual disability and behavioral problems
Febrile Seizures, Therapeutic Mx: This includes what?
Determination and treatment of the cause of fever and interventions to control the fever.
Febrile Seizures, Therapeutic Mx: What is used to treat this?
Rectal diazepam. Buccal and intranasal midazolam has also been found to be effective
Febrile Seizures, Nursing Assess: What changes does this cause in body?
Rapid rise in core temp (>102.2).
Febrile Seizures, Nursing Assess: Simple febrile seziure defined as what?
generalized seizure lasting less than 15 minutes, and occurs once in 24 hour period and accompanied by a fever without any CNS infection
Febrile Seizures, Nursing Assess: RF for recurrence of febrile seizures includes what?
young age at first febrile seizure and family history of febrile seizures.
Febrile Seizures, Nursing Mx: What should the nurses do?
Provide parental csupport and education. Teach about controlling fever, and keeping child safe during seizure. Adminsiter rectal diazepam at onset.
Neonatal Seizures: When does this occur?
Within first 4 weeks of life and are most commonly seen within first 10 days.
Neonatal Seizures: Majority of seizures are associated with underlying causes such as
hypoxic ischemic encephalopathy, metabolic disorders (hypoglycemia), and neonatal infection (meningitis)
Neonatal Seizures, Therapeutic Mx: How should they be treated?
Aggressively. Focus on correcting metabolic disturbances, treating CNS infections, and ensuring adequate ventilation and cardiovascular support.
Neonatal Seizures, Therapeutic Mx: What medicine is given?
Phenobarbital used in initial management
Neonatal Seizures, Nursing Assess: How can this be recognized?
May be only through EEG changes.
Neonatal Seizures, Nursing Assess: What behaviors may they display during seizure?
stretching, sudden random movements, and random sucking movements.
Neonatal Seizures, Nursing Assess: Labs?
Serum testing (glucose, calcium, electrolytes), LP , cranial ultrasound.
Neonatal Seizures, Nursing Mx: Focuses on what?
Trying to cease seizure activity, monitoring neurologic status closely, recognizing seizures and preventing injury
Neural Tube Defects (NTDs): What is this?
Serious birth defects of spine and brain adn include disorders suh as s pina bifida occulta, anencephaly, and encephalocele.
Neural Tube Defects (NTDs): When does neural tube normally close
between the 3rd and 4th week in utero
Neural Tube Defects (NTDs): What should women take while pregnant to prevent this?
0.4 mg of folic acid daily.
Neural Tube Defects (NTDs) - Anencephaly: What is this?
Defect in brain development resulting in small or missing brain hemispheres, skull, and scalp. Occurs when the cephalic or upper end of the neural tube fail to close during 3rd-4th week of gestations.
Neural Tube Defects (NTDs) - Anencephaly: How are tehse infants born
without both a forebrain adn a cerebrum and the remaining brain tissue may be exposed.
Neural Tube Defects (NTDs) - Anencephaly, Nursing Assess: How will they appeaR?
Large defect noted in valut of skull.
Neural Tube Defects (NTDs) - Anencephaly, Nursing Assess: How long do they live for?
Will be born dead, or live only a few hours. Usually born blind, deaf, and unconscious.
Neural Tube Defects (NTDs) - Anencephaly, Nursing Mx: What can the nurse do?
Supportive in nature and focuses on comfort measures for dying infant.