Families exam 4 - neurosensory and neuromuscular Flashcards
When would a positive kernig’s sign and positive brudzinski’s sign be seen with meningitis?
2 years - adolescence
When would a weak cry vs. a high-pitched cry be seen with meningitis?
- weak: newborn
- high pitched: 3 months - 2 years
When is photophobia seen?
meningitis
When are bulging fontanels seen with meningitis?
3 months - 2 years
What assessments need to be done for meningitis?
- neuro
- pain
- fluid status
- urine output
- VS
What needs to be monitored for newborns and infants with meningitis?
- head circumference
- fontanels
What precautions are necessary for meningitis?
- seizure
- droplet
What type of medications can be used for meningitis?
- antibiotics
- corticosteroids (not for viral)
- analgesics
What position should a child be in for a lumbar puncture?
side-lying with their knees drawn up and their head flexed
What does bacterial CSF look like?
- cloudy
- increased WBC
- increased protein
- decreased glucose
- positive gram stain
What does viral CSF look like?
- clear
- increased WBC
- norm/increased protein
- normal glucose
- negative gram stain
When would a supple neck vs. a stiff neck be seen with meningitis?
- supple: newborn
- stiff: 2 years- adolescense
What happens to the fontanels of a baby with increased ICP?
bulging
What happens to the cranial sutures of a baby with increased ICP?
they separate
What happens to the head circumference of a baby with increased ICP?
it increases
What happens to the HR of a baby with increased ICP?
bradycardia
What types of respirations characterize increased ICP?
cheyne-stokes
What vision changes can occur with increased ICP?
double or blurred vision
What are priority assessments for increased ICP?
- LOC
- pupils
- VS
- ICP
- motor activity
- sensory
- verbal responses
How can ICP be decreased?
- raise HOB to 30
- keep head midline
- avoid hip flexion/extension
- minimize suctioning
- avoid coughing, blowing nose, straining
What can be signs of brain herniation?
- loss of blinking and gag reflex
- pupils not reacting to light
- systemic HTN
- bradycardia
- coma
- respiratory arrest
What can it mean if CSF or blood drains from the ears or nose?
basilar fractures
What does a VP shunt treat?
hydrocephalus
What s/sx might occur if shunt malfunction/failure occurs with a VP shunt?
signs of increased ICP
- vomiting
- poor appetite
- high-pitched cry
- bulging fontanels
What s/sx might occur if shunt infection occurs with a VP shunt?
- changes in responsiveness
- low-grade fever
- diminished appetite
- sleep disturbances
- signs of increased ICP
What are some risk factors for seizures?
- cerebral edema
- intracranial infection/hemorrhage
- brain tumor/cyst
- toxins/drugs
- hypoglycemia
- electrolyte imbalances
How long does the tonic phase of a seizure last?
10-30 seconds
What happens during the tonic phase of a seizure?
- loss of consciousness
- contraction of the entire body (flexed arms, extended legs/head/neck)
- stiffening of muscles
What increases during the tonic part of a seizure?
- salivation
- BP
- HR
How long does the clonic phase of a seizure last?
30-50 seconds
What happens during the clonic phase of a seizure?
- violent jerking movements
- foaming at the mouth
- incontinence
How long does the postictal phase of a seizure last?
30 mins
What happens during the postictal phase of a seizure?
- confusion, no recollection of the seizure
- sleepy
- impaired movements/coordination/vision/speech
- sore
- HA
- possibly vomiting
What position should the patient be in during a seizure?
side-lying
What should you avoid doing during a seizure?
- restraining
- opening the jaw
- putting anything in their mouth
What should be noted during a seizure?
- onset
- time
- duration
- characteristics
What is the first thing you should do after a seizure?
check for injuries
What assessments should be done after a seizure?
- neuro status
- vitals
What should be maintained after a seizure?
- seizure precautions
- side-lying position
When should EMS be called for a seizure?
- if the child stops breathing
- if the seizure lasts longer than 5 minutes
- pupils are unequal post-seizure
- child vomits continuously 30 minutes post-seizure
- child is unresponsive to pain or cannot be awakened
- the seizure occurs in water
- this is the child’s first seizure
What is myopia?
near-sightedness
What is hyperopia?
far-sightedness
What is astigmatism?
uneven vision (can only see parts of letters on a page)
What is esotropia?
inward deviation of the eye
What is exotropia?
outward deviation of the eye
What is strabismus?
when both eyes do not line up in the same direction
What is amblyopia?
lazy eye
What are cataracts?
decreased ability to see clearly
What is glaucoma?
loss of peripheral vision
What assistive devices can be used for visual impairments?
- braille
- audiotapes
- special computers
What can be used for testing visual acuity?
- snellen chart
- tumbling E
- picture chart
How far away does the child stand for a vision test?
10 ft
How many characters have to be identified correctly to go to the next line?
4/6
What is partial visual impairment?
20/70 to 20/200
What is legal blindness?
- 20/200 or worse
- a visual field of 20 degrees or less in the better eye
How can you tell if an infant has hearing impairment?
- lack of startle reflex
- failure to respond to noise/spoken words
- absence of vocalizing by 7 months old
How can you tell if a child has hearing impairment?
- using gestures rather than talking after 15 months
- failure to develop understood speech by 24 months
- yelling
- irritability due to inability to gain attention
- shy/withdrawn
- speaking in monotone
- inattentive
What can help with communication in a patient with hearing impairment?
- lip reading
- use of cued speech
- hand gestures with verbal communication
- flashing lights when the doorbell or phone rings
- telecommunication devices
- closed captioning on the TV
- sign language or interpreter
- hearing aids
