Exam 4 - Neuro Flashcards
autoregulation is aka
self regulation
what occurs during autoregulation
cerebral arteries change in diameter in response to changes in cerebral perfusion pressure
s/sx of IICP in an infant
poor feeding
vomiting
irritable/restless/lethargy
bulging fontanel
high-pitched cry
increased head circumference
separation of cranial sutures
distended scalp veins
eyes deviated downward (sun-setting)
increase or decrease pain response
s/sx of IICP in a child
HA
diplopia
mood swings
slurred speech
papilledema (after 48 hours)
altered LOC
N/V, esp in the AM
Cushing’s triad
low HR
irregular respirations
HTN
wide PP
AAO; interacts with environment
full consciousness
lacks ability to think clearly and rapidly
confused
impairment of reality with hallucinations possible
delirious
lacks ability to recognize place or person
disoriented
sleeps, once aroused, has limited interactions with environment
ex: someone you gave pain medicine to
obtunded
requires stimulation to arouse
stupor
vigorous stimulation produces no response
coma
awakens easily but exhibits limited responsiveness
lethargic
congenital neural tube defect (NTD) classified by incomplete closure of the vertebrae
spina bifida
what are the 2 categories of spina bifida
occulta
cystica
what are the 2 types of spina bifida cystica
meningocele
myelomeninogocele
what is spina bifida occulta
defective closure of laminae without herniation of spinal cord or meninges
skin depression, dimple, or tuft of hair at site
no neuro deficits
later life: develop foot weakness, decreased sensation
describe spina bifida cystica: meningocele
meninges protrude producing a sac-like cyst filled with CSF
little or no nerve damage
describe spina bifida cystica: myemeningocele
meninges protrude producing a cyst filled with fluid and nerve tissue
permanent neuro deficits
spina bifida pts can later develop what kind of allergy
latex
what to do with a baby who is born with spina bifida cystica
keep a sterile moist dressing of the sac
do not want the sac to rupture
how to prevent spina bifida
0.4 mg folic acid daily during child bearing years
hx of: 4 mg folic acid starting 1 month prior to conception and during first trimester
how to dx spina bifida
US
CVS
AFP: 16-18 weeks ONLY (false + if too early or late)
neurologic deficits r/t spina bifida cystica: myelomeningocele
hydrocephalus
Arnold Chiari type 2 malformation
tethered spinal cord
neurogenic bladder
bowel incontinence
seizures
orthopedic problems r/t spina bifida cystica: myelomeningocele
kyphosis
scoliosis
hip dislocation
foot, ankle deformities (clubfoot)
talipes varus vs. talipes valgus clubfoot
varus: inversion/bending inward
valgus: eversion/bending outwart
when is spina bifida sx performed
within 24 hours
prevent infection, trauma of exposed tissue, and stretching of other nerve roots
spina bifida positioning preop and postop
pre: prone
post: prone or side-lying
hips to be maintained in moderate abduction while prone
how often to change the sterile moist dressing with spina bifida
q2-4 hours
when can you give a bottle after surgery
while awake with active bowel sounds
this results as an imbalance of production and absorption of CVF
hydrocephalus
treatment for hydrocephalus consists of what
ventriculoperitoneal shunt
besides being congenital, what else can cause hydrocephalus
cancer
tumor
meningitis
what is macewen sign
“cracked pot” sound on percussion of the head
how soon can hydrocephalus be detected on an US
14-15 weeks
infancy dx of hydrocephalus is dx when
head circumference crosses 1+ percentile lines on the chart within a period of 2-4 weeks; progressive neurological signs
what ma be required for older infants and children who are having at CT performed
mild sedation
where to measure the head when hydrocephaus
largest point (occipitalfrontal circumference)
complications of ventriculoper. shunt are r/t
mechanical obstruction
–often r/t tissue or exudate within the ventricles
displacement from growth
–will present with s/sx of IICP
s/sx of ventriculoper. shunt infection
redness
tenderness
swelling
rubbing, pulling ears
fever
neck stiffness
the most common physical disability of childhood
cerebral palsy
chronic, nonprogressive disorder of posture and movement
damage to the motor centers and nerve pathways in the brain
cerebral palsy
CP comorbities
cognitive impairment
hearing, speech impairment
visual impairment
seizures
CP: every case is the same or different
different
what are the 4 types of CP
spastic CP
dykinetic/athetoid
ataxic type
mixed type CP
most common type of CP
spastic
describe spastic CP
early: hypotonia
later: hypertonicity with poor control of posture, balance, motion; contracture and deformities may develop
describe dyskinetic/athetoid CP
deposits of bilirubin in the basal ganglia
involuntary movement of extremities, trunk, facial muscles, tongue, drooling and speech probs; movements aggravated by stress
contratures are rare
describe ataxic type CP
cerebral hypoplasia and severe neonatal hypoglycemia
wise-based, unsteady gait, disturbed coordination, rapid, repetitive movements performed poorly, hypotonic muscles
what is mixed type CP
combo of spastic and dyskinetic
many are severely disabled
CP is not usually dx until what age
2
CP: what is used with ambulation before balance is established
posture control walkers
facilitates thoracic extension
painful CP spasms are treated with ____
diazepam
___ is Rx for severe spasticity that interferes with ADLs and ambulation without side effects
baclofen
this can be injected in selected muscle groups to reduce CP spasticity
boxtox (botulinum A)
inhibits acetylcholine release
onset: 24-72 hours
duration: 3-6 months
concussions are transient which means they are ___
reversible
GSC for children
13-15: minor/mild. head injury
9-12: moderate
3-8: severe
how is a spinal cord injury dx
MRI
what med is given for spinal cord injury
solumedrol
excessive uncontrolled electrical discharge of a group of neurons in the brain
seizure
when is it considered epilepsy
seizures recur over a period of time in a discernible pattern
2+ unprovoked seizures
what are the 3 phases of a seizure
prodromal
ictal
postictal
what occurs during the prodromal phase of a seizure
right before occurence
aura
certain feeling or smell
behavior changes
what is the ictal phase of a seizure
beginning to end of seizure
whomever is with must know the start and end time
what is the postictal phase of a seizure
period immediately after
disoriented, confused, sleepy
tonic clonic seizure is aka
grand mal seizure
what occurs during a tonic clonic seizure
ctx of muscles
loss of consciousness
abrupt onset
1-2 minutes
certain cry during occurence
bite tongue
incontience
atonic seizure
“fall out”
lose support
injuries can occur
often during the day
myoclonic seizure
awake
can think during process
brief muscle ctx
do not have postical state
absence seizure
common in school aged
“zoned out” appearance
may act confused, daydreaming
focal seizure
one area of brain involved
involuntary movements of the mouth
usually drowsy afterwards
what labs must be assess with anticonvulsants
CBC
liver enzymes
med levels
what type of diet can help with seizures
ketogenic
low carb, high fat, high protein
3 main types of meningitis
bacterial
viral, aseptic
tuberuclosis
s/sx of meningitis in children > 2 y/o
high fever
HA (w/ poss vomiting)
nuchal rigidity
seizures
photophobia
change in LOC
Kernig, Brudzinski
opisthotonos
petechial, purpura rash (impending vascular collapse)
how is meningitis dx
lumbar puncture: culture, gram stain
meningitis precautions and for how long
droplet
at least 24 hours after abx
how long is someone on IV abx for meningitis
7-10 days
what is administered for meningitis besides abx
IV steriods
what baseline should be established upon meningitis admission
neuro status
VS
why should I&O be monitored with meningitis
possible development of DI or SIADH
which vaccines will help prevent meningitis
Hib
meningococcal
pneumonccocal
HOB for meningitis
15-30 degrees
what opioids can be used to relieve meningitis pain
acetaminophen with codeine
autoimmune neurologic disorder of the peripheral nervous system
Guillain-Barre syndrome
most common in males around 5 y/o
what can lead to GBS
viral infection or reaction to the flu vaccine
what is used to treat GBS
IVIG
how long until spontaneous recovery with GBS
2-4 weeks
4 neurological conditions that require critical care
encephalitis
Reye syndrome
botulism
tetanus (lockjaw)
encephalitis method of dx and treatment
dx: LP
tx causative agent
what occurs with Reye Syndrome
liver damage, increase ammonia levels
how can one contract botulism
improper sterilization of canned food
