[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.
Neural Tube Defects (NTDs) - Anencephaly, Nursing Mx: How to help parents with how their child appearS?
Use an infant cap , which wil allow them to feel more comfortable holding their infant
Neural Tube Defects (NTDs) - Encephalocele: What is this?
Protrusion of the brain and meninges through a skull defect. Caused by failure of anterior portion to close.
Neural Tube Defects (NTDs) - Encephalocele: What usually accompanies this?
Craniofacial abnormalities, microcephaly, ataxia, visual problems, and developmental delay
Neural Tube Defects (NTDs) - Encephalocele: Therapeutic MX consists of what?
surgical repair, including placement of tissue back into skull and removal of sac, and possible shunt placement.
Neural Tube Defects (NTDs) - Encephalocele, Nursing Assess: Initial assessment will reveal what?
Visible external sac protruding from skull area. Most common in occipital region.
Neural Tube Defects (NTDs) - Encephalocele, Nursing Assess: What will occur before surgical correction?
Infant will be examined to determine brain tissue involvement. CT, MRI, Ultrasound performed.
Neural Tube Defects (NTDs) - Encephalocele, Nursing Mx: This consists of what?
Preop and postop care, along with symptomatic and supportive care.
Neural Tube Defects (NTDs) - Encephalocele, Nursing Mx: Care should be taken to avoid what?
rupture of sac, preventing infection, and providing adequate nutrition and hydration.
Neural Tube Defects (NTDs) - Microcephaly: What is this?
Head circumference that is more than three standard deviations below the mean.
Neural Tube Defects (NTDs) - Microcephaly: This generally causes what in infant?
intellectual disability due to lack of brain tissue.
Neural Tube Defects (NTDs) - Microcephaly: What may cause this?
Abnormal development, or intrauterine infections such as rubella, toxoplasmosis, and cytomegalovirus.
Neural Tube Defects (NTDs) - Microcephaly: This can be aquired how?
severe malnutrition, perinatal infections or anoxia
Neural Tube Defects (NTDs) - Microcephaly, Nursing Assess: How will they present at bith?
With normal or reduced head size. AS they age, the head growth will fail. Will result in small head and large face.
Neural Tube Defects (NTDs) - Microcephaly, Nursing Mx: Nursing care will focus on
determining the extent of neurologic and cognitive deficits
Hydrocephalus: What is this?
CSF accumulates within the ventricular system and causes the ventricles to enlarge, and increases in ICP occurs.
Hydrocephalus: What causes congenital hydrocephalus?
Present at birth, and due to genetic predisposition or environmental influences. Includes abnormal intrauterine development.
Hydrocephalus: What causes acquired hydrocephalus to develop?
Can result form injury or disease such as trauma, hemorrhage in premature infants and neoplasms.
Hydrocephalus: Prognosis for this depends on what?
Whether brain damage has occured prior to recognition and treatment.
Hydrocephalus: THese kids are at increased risk for what
developmental disabilities, visual problems, abnormalities in memory and reduced intelligence
Hydrocephalus - Patho: When does hydrocephalus result on patho level?
When there is an obstruction in the ventricular system or obliteration or malfunction of the arachnoid villi. Results in impaired absorption of CSF
Hydrocephalus - Patho: When does obstructive or noncommunicating hydrocephalus occur?
When the flow of CSF is blocked within the ventricular system. Results form meningitis, trauma, or tumors.
Hydrocephalus - Patho: When does nonobstructive or communicting hydrocephalus occur?
When flow of CSF is blocked after it exits form the ventricles. Can still flwo in between. This includes subarachnoid hemorrhage.
Hydrocephalus - Therapeutic Mx: Treatment needs to start why?
To prevent brain tissue damage that can result from increased ICP that hydrocephalus creates.
Hydrocephalus - Therapeutic Mx: Goal of treatment?
relieving hydrocephalus, and managing complications associated with disorders, such as growth delay.
Hydrocephalus - Therapeutic Mx: How are most cases treated?
With placement of extracranial shunt, such as ventriculoperitoneal (VP) shunt
Hydrocephalus - Therapeutic Mx: Complications with VP shunt?
Infection, obstruction, and the need for revision as the child grows.
Hydrocephalus - Therapeutic Mx: Alternative to VP shunt?
Endoscopic third ventriculostomy
Hydrocephalus - Health Hx: Explore pregnancy hx for what?
intrauterine infections, meningitis, mumps
Hydrocephalus - Health Hx: Common signs child shows includes?
Irritability, lethargy, poor feeding, vomiting, complaints of headache
Hydrocephalus - Health Hx: Once admitted, what questions should be asked?
Neurologic status (LOC)
Complaints of headache
Vomiting
Visual Disturbances
Hydrocephalus - Health Hx, Observation: What should you pay particular attention to?
Shape of skull and size.
Hydrocephalus - Health Hx, Observation: What is the most common sign seen in infant and older child?
Infant: Rapid increase in head circumference
Older Child: Loss of development and changes in personality
Hydrocephalus - Health Hx, Observation: What labs may be done?
Skull X-Ray, CT, MRI
Hydrocephalus - Nursing Mx:
This will focus on what?
Maintaining cerebral perfusion, minimizing neurologic complications, and maintaining adequat enutrition.
Hydrocephalus - Nursing Mx, Preventing and Recognize Shunt Infection/Malfunction: Signs of shunt infection include?
Elevated VS, poor feeding, vomiting, decreased responsiveness, seizurea ctivity and signs of local inflammation.
Hydrocephalus - Nursing Mx, Preventing and Recognize Shunt Infection/Malfunction: signs of shunt malfunction includes?
vomiting, drowsiness, and headache.
Hydrocephalus - Nursing Mx, Preventing and Recognize Shunt Infection/Malfunction: When is infection most common and treated how?
1-2 months after placement.
Tx with IV antibiotics and if it persists, shunt will be removed.
Hydrocephalus - Nursing Mx, Preventing and Recognize Shunt Infection/Malfunction: Malfunction of shunt commonly due to what?
Kinking, clogging, or separation of tubing.
Bacterial Meningitis: What is this?
Infection of the meninges, the lining that surrounds the brain and spinal cord.
Bacterial Meningitis: What does this elad to
brain damage, nerve damage, deafness, storke, and even death.
Bacterial Meningitis: What has caused a significant decrease in this?
Hib Vaccine
Bacterial Meningitis - Patho: What does this cause in body?
Inflammation, swelling, purulent exudates, and tissue damage to the brain. Can occur as secondary infection to URI.
Bacterial Meningitis - Patho: What can cause this to occur?
LP, skull fracture, neurosurgical intervention.
Bacterial Meningitis - Therapeutic Mx: What should be done if this is suscepted?
Prompt hospitalization and treatment. Deterioration may occur in less than 24 hours.
Bacterial Meningitis - Therapeutic Mx: What treatment will be done?
IV Antibiotics immediately after LP.
Bacterial Meningitis - Therapeutic Mx: Why would corticosteroids be ordered?
To help reduce the inflammatory process.
Bacterial Meningitis - Nursing Assess: Signs reported may include?
Sudden onset of symptoms. Respiratory illnes or sore throat.
Fever, Chills
Headache, Vomoting
Photophobia
Stiff Neck
Bacterial Meningitis - Nursing Assess: Symptoms in infant?
Pooro sucking and feeding
Weak cry
LEthargy
Vomiting
Bacterial Meningitis - Nursing Assess: RF include?
Young age, any fever during pregnancy
Exposure to ill person or TB.
Travel Hx.
Recent neurosurgical procedure.
Bacterial Meningitis - Physical Exam: What position will infant rests in?
Opisthotonic position, Head and neck hyperextended backwards.
Bacterial Meningitis - Physical Exam: What will older children complain of
neck pain.
Bacterial Meningitis - Physical Exam: What test may indicate irritation of meninges?
Positive Kernig and Brudzinski signs.
Bacterial Meningitis - Physical Exam: Abrupt eruption of a petechial or purplish rash can be indiciatve of what
miningococcemia.
Bacterial Meningitis - Labs: Labs include what?
LP (will reveal elevated CSF and WBC)
CBC
Blood, urine, nasopharyngeal culture
Bacterial Meningitis - Nursing Mx: What should be done after cultures obtained?
Prescribe antibiotics.
Bacterial Meningitis - Nursing Mx: Quickly initiate supporitve measures to ensure what
proper ventilation, reduce inflamamtory response and help prevent injury to the brain.
Bacterial Meningitis - Nursing Mx: Interventions are aimed at doing what
reducing ICP and maintaining cerebral perfusion along with treating fluid volume deficit.
Bacterial Meningitis - Nursing Mx: What precautiosn will be placed?
Droplet isolation until 24 hours after antibiotics have been recieved.
Bacterial Meningitis - Nursing Mx, Reducing Fever: What may be present due to the fever?
Hyperthermia, increaed metabolic rate, and dehydration
Bacterial Meningitis - Nursing Mx, Reducing Fever: What is given to reduce this?
ANtipyretics like acetaminophen and NSAIDS like ibuprofen.
Bacterial Meningitis - Nursing Mx, Reducing Fever: What nonpharmacologic measures can be done?
Cooling blankets, fans, cold compreses, and tepid baths.
Bacterial Meningitis - Nursing Mx, Preventing Bacterial Meningitis: How is this transmisted?
By direct close contact with respiratory droplets from nose or throat.
Bacterial Meningitis - Nursing Mx, Preventing Bacterial Meningitis: What may be effective to prevent htis?
Postexposure prophylaxis and postexposure immuniztion
Bacterial Meningitis - Nursing Mx, Preventing Bacterial Meningitis: If pregnant woman positive with group b streptococcus, what is given
intrapartal antibiotics.
Bacterial Meningitis - Nursing Mx, Preventing Bacterial Meningitis: What was proven to cause a dramatic increase of transmission of this in the 90s?
Living in close quarters, sleeping less than usual, and sharing personal items like drinking glasses.
Aseptic Meningitis: What is this?
Most common type of meningitis, and affected children are younger than 5.
Aseptic Meningitis, Therapeutic Mx: How is this treated?
Treated aggressively. Antibiotics adminsitered. If viral, antiviral agenets bmay be started and lasts 3-10 days.
Aseptic Meningitis, Therapeutic Mx: Common signs include?
Fever General Malaise Headache Photophobiai Poor Feeding Neck Pain
Aseptic Meningitis, Nursing Mx: Nursing care will focus on what?
Comfort measures to reduce pain and fever.
Encephalitis: What is this?
Inflammation of the brain that may also include an inflammation of the meninges.
Encephalitis: Common organisms that cause this include
Herpes, Poliovirus, and vector-borne viruses.
Encephalitis: Complications can include?
severe neurologic damage with residual effects.
Encephalitis, Nursing Assess - Health Hx: Signs include?
Fever
Flu-Like Symptoms
Altered LOC
HEadache
Encephalitis, Nursing Assess - Health Hx: Risk factors inlude?
Recent travel
Recreational activites
Animal contacts
Encephalitis, Nursing Assess - Physical Exam: Neurologic exam will reveal changes where?
In sensorium and focial neurologic changes.
Encephalitis, Nursing Assess - Labs: Labs include
LP
MRI, CT< EEG
Encephalitis, Nursing Assess - Nursing Mx: What will be used for disease caused by herpes?
Specific antiviral therapy.
Encephalitis, Nursing Assess - Nursing Mx: This can result from complicatiosn such as ?
measles, mumps, chickenpox.
Encephalitis, Nursing Assess - Nursing Mx: PReventivie measures include?
Using insect repellent, wearing clothing that covers arms, and controlling mosquito population
Reye Syndrome: What is this?
Affects those younger than 15 years who are recovering from viral illness. Triggeered by use of salicylates or salicylate-containing products to treat infection
Reye Syndrome: What does this reaction cause?
braiin swelling, liver failure, and death in hours.
Reye Syndrome: What contains salicylate?
Aspirin
Reye Syndrome: Signs may include?
Several continual vomiting Changes in mental status Lethargy Irritability Confusion Hyperreflexia
Reye Syndrome: RF for this?
Prodromal viral illness like chicken pox , croup, flu
Infestion of aspirin within 3 weeks of start of virus
Reye Syndrome: Tests for this?
Elevated liver function tests and elevated serum ammonia levels confirm this
Reye Syndrome , Nursing Mx: Mx is aimed t what?
Maintaining cerebral perfusion, mxing and preventing increased ICP, providing safety measures, and monitoring fluid status.
Reye Syndrome , Nursing Mx: Salicylates are found in what products?
Alka-Seltzer and Pepto-Bismol
When compared with adults, why are infants and children at an increased risk of head trauma?
The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. The development of the nervous system is complete at birth but remains immature. The spine is very immobile in infants and young children. The skull is more flexible due to the presence of sutures and fontanels.
The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.
At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds
narrow sutures sunken fontanels a rapid increase in head circumference increase in weight since last visit
a rapid increase in head circumference
A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention related to prevention of injury?
Remove the child from his bed. Place a tongue blade in the child’s mouth. Restrain the child. Place the child on his side and opening his airway.
Place the child on his side and opening his airway.
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:
Educate the family on ways to prevent bacterial meningitis. Initiate appropriate isolation precautions and begin intravenous antibiotics. Assess the infant’s fontanels. Encourage the mother to hold the infant and feed her.
Initiate appropriate isolation precautions and begin intravenous antibiotics.
