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N353: Practice of Nursing II > Module 1 - PEDS Neuro > Flashcards

Module 1 - PEDS Neuro Flashcards

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1
Q

What are the pediatric differences of the head compared to an adult?

A
  1. Head is large, neck muscles underdeveloped
  2. Unfused suture
  3. highly vascular brain; less CSF cushion
  4. Cervical spine immature: Increased mobility
  5. Myelination incomplete at birth
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2
Q

What are children prone to with a large head and underdeveloped neck muscles?

A

head injury with falls

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3
Q

When are sutures unfused in peds patients?

A

< 18 months

this leads to being prone to fracture or brain injury - it requires time to solidify and become stronger

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4
Q

What does a highly vascular brain and less CSF lead Peds to be prone to?

A

hemorrhaging and trauma

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5
Q

When is myelination usually completed for children?

A

It matures by 4-5 years old but continues through and to late adolescence

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6
Q

Are pediatric seizures more common in children or infants?

A

Infants

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7
Q

How common are pediatric seizures in children

A

common

2-4 % of the peds population

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8
Q

How common are pediatric seizures in infants?

A

very common

1 in 1000 infants

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9
Q

What is the most common type of seizure in peds patients?

A

Febrile Seizure

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10
Q

Febrile Seizure

A

most common PEDS seizure

it is due to a sudden, rapid rise in temperature

could be hereditary with no other cause

Its incidence decreases with age

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11
Q

What causes the febrile seizure?

A

the rapid rise and fall, not the fever itself

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12
Q

What could help decrease a temperature gradually to prevent febrile seizure?

A

A tepid bath

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13
Q

Epilepsy

A

chronic Seizure disorder (sometimes in peds patients)

it occurs when you continue to have seizures with age

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14
Q

How does incidence of epilepsy and febrile seizure change with age?

A

Febrile seizure incidence decreases with age but epilepsy will continue with age

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15
Q

Medications that can treat pediatric seizures?

A

Dilantin

Phenobarbital

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16
Q

When is medication given for pediatric seizures?

A

with chronic disorders like epilepsy, but not for a single case febrile seizure

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17
Q

Why do you have to be careful when administering dilantin?

A

You have to give it with a straw to prevent gum dysplasia in epileptic children

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18
Q

Important types of seizure clinical manifestations?

A

Generalized

Partial

Absence

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19
Q

Generalized seizure clinical manifestations

A

Tonic Clonic

Loss of consciousness (grand mal/convulsive - widespread activity)

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20
Q

Partial seizure clinical manifestations

A

Simple, affect one hemisphere of the brain

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21
Q

Absence seizure clinical manifestations

A

may have non or minor motor movement

common

just a little out of it

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22
Q

Important infectious diseases that can cause neurological issues in children?

A

Bacterial Meningitis

Viral (Aseptic) meningitis

Reye’s Syndrome

Guillain-Barre Syndrome

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23
Q

Bacterial Meningitis

A

Bacterial etiology

Meninges infection / infection of the brain

somehow an infection crosses the blood brain barrier into CSF fluid

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24
Q

Who is at greatest risk for bacterial meningitis?

A

Infants (70% of cases) <5 years old

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25
Q

What may cause bacterial meningitis

A

May occur secondary to otitis media, sinusitis, pneumonia, brain trauma, neurosurgery, or many other things really

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26
Q

Meningococcal Meningitis has increased incidence in what population

A

College Age

so the vaccine is highly recommended for those living in dorms or highly populated living spaces

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27
Q

Rates of meningitis have declined with increased use of what?

A

HIB and pneumococcal vaccines

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28
Q

Clinical Manifestations of Meningitis in Infants

A

fever, change in feeding, vomiting, anterior fontanel BULGING, restless, lethargic, irritability

hard to consul even by the parent

piercing cry or lethargy/listless

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29
Q

What does a flat anterior fontanel indicate in infants?

A

dehydration

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30
Q

What does a bulging flat anterior fontanel indicate in infants?

A

Meningitis / brain infection with CSF buildup

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31
Q

Clinical manifestations of Meningitis in older children

A

Fever, irritability, lethargic, confused, combative, answering strangely, headache, back/neck pain, photophobia, nuchal rigidity

potential rash, petechiae, purpura (associated with meningococcal meningitis)

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32
Q

Nuchal Rigidity

A

back and neck pain by putting chin to chest

if there is pain in the neck or you cannot do it its a positive sign of meningitis

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33
Q

Opisthotonos Posturing

A

Awkward positioning more comfortable for infants and children with increased cranial pressure related to meningitis

condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with their head thrown backward. If a person with opisthotonos lies on their back, only the back of their head and heels touch the surface they are on.

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34
Q

Lumbar Tap/Puncture

A

Test checking for meningitis

you stick a needle in the spinal area and draw out CSF for testing

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35
Q

What lab results may occur in CSF for a positive lumbar tap for meningitis?

A

Increased WBC

low glucose

increased protein

gram stain - positive (60-90%)

culture - positive

contagious !!!

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36
Q

What are the initial steps of clinical therapy for meningitis?

A

Check and find history, physical exams, and labs

Do a lumbar puncture to evaluate CSF

Administer antibiotics as soon as all culture specimens are obtained

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37
Q

Why do we administer antibiotics as soon as all culture specimens are obtained from a lumbar tap?

A

We assume the meningitis is bacterial since it can make a kid sicker than viral, so we do not want to wait to start antibiotics

We want to be proactive

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38
Q

Sequelae of Meningitis

A

neurologic damage
seizure
hearing loss
developmental delays
multisystem organ failure or death

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39
Q

If the meningitis is bacterial what will occur in culture?

A

it will grow, be contagious, and come out positive

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40
Q

Viral (Aseptic) Meningitis

A

Less intense than bacterial meningitis

an inflammatory process of the CSF still

Patient will not appear as ill, but treatment is still aggressive until the 48 hour cultures are negative for bacterial - so we still administer antibacterial to be proactive

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41
Q

What will occur for a culture of viral (aseptic) meningitis?

A

Culture will NOT GROW any bacteria

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42
Q

What levels are normal in CSF from a viral (aseptic) meningitis patient?

A

Glucose and protein levels in the CSF are normal

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43
Q

Reye’s Syndrome

A

Unclear etiology

Acute swelling of the brain caused by a toxin or injury - causing inflammation

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44
Q

What is associated with the cause of Reye’s Syndrome

A

Viral Illness

Use of Aspirin (before the advent of Tylenol) (mimics meningitis when due to aspirin)

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45
Q

Why is Reye’s Syndrome rare?

A

Nowadays acetaminophen and NSAIDS are used rather than Aspirin (ASA) and we educate parents now

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46
Q

Important Nursing Care steps for Meningitis Patients

A

ABCs

Cerebral Edema control

Seizure control

Antibiotics (if bacterial)

Steroid use

Put into semi fowler’s position to alleviate some pressure

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47
Q

Guillain Barre Syndrome

A

A post infectious polyneuritis (inflammation of nerves)

It is an autoimmune response to some infectious process that existed before (in the last few weeks)

It causes deteriorating motor function and paralysis in ascending pattern

Almost like progressive paralysis

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48
Q

What leads to the autoimmune response of Guillain-Barre Syndrome?

A

GI or Resp infection 2-3 weeks prior

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49
Q

How does deteriorating motor function occur in Guillain-Barre syndrome?

A

Ascending pattern

so bad motor function and paralysis begins at the lower extremities and works its way up

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50
Q

Treatment for Guillain Barre Syndrome?

A

Immunoglobulins

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51
Q

How fatal is Guillain Barre syndrome?

A

rarely fatal

BUT, respiratory difficulty may require ventilation and physical therapy assistance to overcome some paralysis and motor weakness

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52
Q

Special needs for children with disabilities you should consider when nursing?

A

Growth and development

body image and self esteem

autonomy

socialization and schooling

communication

family interactions and sibling needs

financial needs of the family

family interactions as well

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53
Q

What is important in assisting a chronically ill child’s transition to adult life?

A

An individualized transition plan including:

Adult oriented healthcare

alternate living arrangements

work skill assistance

54
Q

Cerebral palsy

A

A non progressive brain injury or malformation that effects movement, muscle tone, or posture

55
Q

What does non-progressive mean?

A

the disease does not necessarily get worse as long as we care and help (especially in moving the child in cerebral palsy)

56
Q

What may cerebral palsy be secondary to?

A

secondary to brain damage: congenital, hypoxic, or traumatic origin (like something in utero, during the birthing process, or something after)

57
Q

The most common chronic disorder in childhood is?

A

Cerebral Palsy

58
Q

Classifications of Cerebral Palsy

A

Spastic
Dyskinetic
Ataxic
Mixed

59
Q

Spastic Cerebral Palsy

A

most common type of CP

can involve one or both sides of the body

involves persistent hypertonia - which is rigidity (including scissoring while walking), and exaggerated deep tendon reflexes; persistent primitive reflexes (like moro, and rooting) that do not go away

Issues lead to contractures and abnormal spinal curvatures

60
Q

Dyskinetic Cerebral Palsy

A

involves abnormal involuntary movements that disappear during sleep and increases with strength

they keep moving tongue, hands, etc non stop

they have bizarre twisting movements, tremors, exaggerated posturing, and inconsistent muscle tone

61
Q

Ataxic Cerebral Palsy

A

Lack of balance and position sense

muscular instability

gait disturbances

62
Q

Mixed type Cerebral palsy

A

combination of dyskinetic, ataxic, or spastic cerebral palsy

63
Q

The most common manifestation in all types of CP is …

A

delayed gross motor development

64
Q

What may be the first sign of cerebral palsy?

A

Failure to achieve milestones - know them as CP leads to delays (ex: reaching with only one arm, poor sucking/uncoordinated, etc)

65
Q

Manifestations of Cerebral Palsy

A

Delayed gross motor development

failure to achieve milestones

abnormal motor performance (early hand preference, poor sucking, etc)

alterations of muscle tone (ex: difficulty in diapering)

abnormal postures (ex: scissoring legs or persistence infantile posturing)

reflex abnormalities (persistent primitive reflexes or hyper reflexia)

mental impairment, seizures, ADHD, and sensory impairment sometimes

66
Q

When first coming into contact with a cerebral palsy patient…

A

NEVER assume they are disabled initially

DO NOT ASSUME they are mentally impaired as their brain may still be working and are completely “normal”

67
Q

The focus of clinical therapy for children is…

A

Helping them reach their maximum potential

Refer for evaluation if they have dev delays or bad reflexes

Refer to PT, OT, speech, special ed, ortho, hearing and vision assistance if they need it !

68
Q

Ways to help a cerebral palsy child reach maximum potential?

A

Prevent physical injury and deformity

Promote mobility

Ensure adequate nutrition

Foster relaxation and general health through rest periods

Administer Medications

Encourage self care and independence when possible (they may have normal intellect)

69
Q

A diet for cerebral palsy should involve…

A

high protein and high calorie since they have involuntary movements constantly occurring

also help get feeding devices as needs like G tubes

70
Q

Duchenne Muscular Dystrophy (DMD)

A

Most common and most severe form of muscular dystrophy

Progressive and leads to death!

71
Q

Muscular Dystrophy (MD)

A

disorder that causes progressive degeneration and weakness of skeletal muscles

72
Q

Why does Duchenne Muscular Dystrophy lead to death in adolescence?

A

It is progressive and often leads to infection or cardiopulmonary failure

73
Q

Half of DMD cases are …

A

X linked

74
Q

Pathophysiology of Duchenne Muscular Dystrophy

A
  1. Dystrophin (protein product in skeletal muscle) is absent in muscles
  2. there is gradual degeneration of muscle fibers
75
Q

When do MD symptoms begin?

A

between 2 and 6 years old (this is when they are noticeable but it begins at birth)

around 9-12 the calf muscles become fibrous and cardiac issues begin

76
Q

Initial signs and symptoms of MD

A

delays in further motor development

frequent falls, trouble getting up from sitting/lying position (may not want to run or ride bikes)

difficulties in running, riding a bike, and crawling up stairs/trouble climbing stairs

77
Q

Progressive Signs and symptoms of MD

A

abnormal gait becoming apparent

walking ability ceases between 9-12 years old due to calf muscle becoming fibrous

pseudohypertrophy of calf muscles (fatty/fibrous tissue)

cardiac problems (weakened heart muscles)

may start to be unable to eat or walk

78
Q

Nursing Management for PEDS patients with MD

A

Assess for signs of disorder progression and complications

maintain optimal physical mobility possible (don’t allow misuse)

compensate for disuse syndrome with positioning, skin care, fluids, chest PT, and a bowel routine

Support the child and family in coping with this progressive disorder

Refer family members to support agencies like the MDA

teach the family and child about diagnosis, treatment, devices, complications, and prognosis

79
Q

Neurological issues in PEDS patients because of Structural Defects

A

Hydrocephalus

Spina Bifida

Craniosynostosis

80
Q

Hydrocephalus

A

condition caused by an imbalance in the production and absorption of CSF in the ventricular system

Production exceeds absorption, so CSF accumulates, usually under pressure, producing dilation of the ventricles

81
Q

What can cause Hydrocephalus

A

congenital

(commonly) associated with spina bifida

could be from tumor, accident, or some issue leading to improper drainage and absorbing

82
Q

Congenital Hydrocephalus

A

born with absorption and drainage issues leading to deficits and hydrocephalus

83
Q

What is hydrocephalus most commonly associated with?

A

Spina Bifida

84
Q

Acquired hydrocephalus

A

usually results from space occupying lesions, hemorrhage, intracranial infections, or dormant developmental deficits

85
Q

Communicating Hydrocephalus

A

CSF flows freely but has IMPAIRED ABSORPTION within the arachnoid space

86
Q

Non Communicating Hydrocephalus

A

OBSTRUCTION TO THE FLOW of CSF through the ventricular system

More common kind of hydrocephalus

87
Q

Clinical Manifestations of Hydrocephalus in infants

A

First sign is BULGING FONTANELS, irritability, then head enlargement, sutures become palpably separated

frontal protrusion or bossing

Setting Sun Sign

pupils may be sluggish with unequal response to light

88
Q

What is the first sign of hydrocephalus in infants?

A

Bulging Fontanels

89
Q

Bossing

A

Frontal protrusion

front of the forehead comes out and moves forward

90
Q

Setting Sun Sign / Sunset Eyes

A

sclera visible greatly/ more so than normal above the pupil with the eyes moved downward and pupils are sluggish to light

91
Q

Clinical Manifestations of Hydrocephalus in Older Children

A

Different from infants since the closure of cranial sutures already occurred

There is NO bossing

morning vomiting, headache, confusion, apathy, ataxia, visual deficits/defects

Overall, signs of increased intercranial pressure

92
Q

The key symptom of hydrocephalus in a brain scan is…

A

ventricular enlagement

93
Q

What is absent in hydrocephalus in older children compared to infants?

A

No bossing / frontal protrusion since the sutures are closed in the skull

94
Q

Treatment for Hydrocephalus

A

Ventriculoperitoneal (VP) Shunt

Infection prevention

95
Q

VP Shunt (Ventriculoperitoneal)

A

A path for excess CSF from the ventricles to the peritoneum through a hose/tube for reabsorption

Must be replaced as the child grows

it can be blocked, kinked, or cause infection

comes back behind the ear and you may feel it back there when palpating

96
Q

What does Malfunction of the VP shunt cause?

A

recurrent signs of increased ICP

Infection (a more serious complication)

97
Q

Neural Tube Defects

A

the neural tube is a structure that develops into the brain and spinal cord as well as tissue that surround it for a baby

If it does not develop or close properly in the 3rd or 4th week of gestation then there will be defects in the spinal cord or nerves

98
Q

The main neural tube defect is …

A

Spina Bifida

99
Q

Encephalocele

A

Opening along the spine or in the facial area where the brain is

they are protrusions/sacs that stick out in these areas

Facial reconstruction can occur for the children

100
Q

3 Types of Spina Bifida

A

SB Occulta

Meningocele

Myelomeningocele

101
Q

Spina Bifida Occulta

A

SB that does not usually affect the spinal cord

External signs include a dimple or hair patch in the area of the spin

small gap or indent occurs but no opening is present for the spinal cord

102
Q

Meningocele

A

Spina Bifida type

a fluid filled sac that protrudes outside the vertebrae

The spinal cord and root are OK where and where they should be

103
Q

Myelomeningocele

A

Spina Bifida Type (worst kind)

fluid filled sac also containing the spinal cord and nerve routes protruding from the back

possible muscle weakness, paralysis, urinary bowel problems, joint and bone deformities (nerve issues mean they have trouble moving too)

104
Q

As you get higher up the spinal column with spina bifida…

A

the worse the signs and symptoms will be

105
Q

How does Spina Bifida related back to Hydrocephalus

A

Outpouching causes CSF flow issues so it may block movement and lead to hydrocephalus

106
Q

Spina Bifida and ____ often go together

A

Hydrocephalus

107
Q

Treatment for SB Occulta

A

no treatment unless neurologic damage or it opens (sinus needs to be closed)

keep the area clean

108
Q

Treatment for Meningocele

A

requires closure as soon after birth as possible

the child should be monitored for hydrocephalus, meningitis, and spinal cord dysfunction

location is very important in determining treatment

109
Q

Treatment for Myelomeningocele

A

requires a multidisciplinary approach (ex: neurology, neurosurgery, pediatrics, urology, orthopedics, rehabilitation, nursing, etc)

Closure needs to be done 2-3 days after birth to minimize infection and prevent further damage to the spinal cord and roots

Shunting is performed for hydrocephalus and antibiotics are initiated to prevent infection

the child will need correction of musculoskeletal deformities and management of urologic and bowel control problems

110
Q

How to prevent infection and injury for the surgical closure of a meningocele or myelomeningocele within 24-48 hours of birth?

A
  1. Preoperative apply a MOIST sterile dressing to the lesion constantly having it moist
  2. Maintain a sterile damp dressing before and after, examine for leakage, avoid placing a diaper or other covering directly over the lesion (as it could cause fecal contamination), monitor for signs of local infection and meningitis (fever, irritability, poor feeding)
  3. Position in a prone or side lying position to prevent contamination by stool or urine
111
Q

Position for a SB Patient to prevent stool/urine contamination

A

Prone or Side Lying Position

112
Q

How can we prevent the development of neural tube defects?

A

Encourage women of childbearing age to get 0.4 mg of folic acid daily during preconceptual period

The women should consult their primary care provider or pharmacist to ensure that their multivitamin contain this amount of folic acid

113
Q

Craniosynostosis

A

premature closure of the cranial sutures that can lead to skull deformities

can palpate over riding of the suture

brain will continue to grow but the skull is sealed now

114
Q

When should reconstructive surgery be done for craniosynostosis for best outcome?

A

before age 1

115
Q

When does the anterior fontanelle usually close when not diagnosed with craniosynostosis?

A

closes at 18 months old

116
Q

Lead Poisoning

A

one of the most common pediatric problems in the US leading to neurological problems

117
Q

When is the highest incidence for Lead Poisoning?

A

late infancy and toddlerhood

118
Q

Etiology of Lead Poisonin

A
  1. Child exposed by eating contaminated food or nonfood, breathing contaminated air, or drinking contaminated water
  2. Lead dust from pain chips, paint powder, gasoline, unglazed ceramic containers, lead crystal, water from lead pipes, batteries, folk remedies, fishing weights, furniture refinishing supplies, art supplies, cosmetics, pool cue chalk, and even certain industrial pollutants
119
Q

Why are children at greater risk for lead poisoning?

A

they absorb and retain more lead in proportion to their weight

120
Q

What kind of problems with normal cell function does lead poisoning cause?

A

Nervous System - irreversible damage to developing brain

Blood - displace iron, which decreases heme production - causes Anemia

Kidneys - excreted through kidneys

Adverse affect on vitamin D and calcium metabolism - statute issues causing bone growth issue and decreased height

121
Q

3 routes of Absorption for Lead

A

GI

Inhalation

Transplacental (in utero)

122
Q

Clinical manifestations of Lead Poisoning

A

Decreased IQ Scores

cognitive deficits (affects ability to learn leading to learning disabilities and cognitive deficits)

Loss of hearing

growth delays

Anemia (offer multi vitamins)

Urine Abnormalities

acute crampy abdominal pain, vomiting, constipation, anorexia

short statue and lead lines in bones on x ray

123
Q

How does low dose lead exposure cause neurologic manifestations?

A

behavioral changes like distractibility

hyperactivity

impulsivity

learning problems

hearing impairment

mild intellectual deficits

124
Q

How does high dose lead exposure cause neurologic manifestations?

A

lead encephalopathy manifested by seizures, mental deficits, paralysis, blindness, coma, and even death

125
Q

Important assessment findings for Lead Poisoning?

A

History of Pica?

Inquire as to housing conditions

126
Q

How to diagnose/test Lead Poisoning?

A

Lead lab test revealing serum lead levels exceeding 10 mcg/dL is considered positive for lead poisoning

127
Q

___ mcg/dL is an amount positive for lead poisoning?

A

10 mcg/dL

128
Q

Treatment for Lead Poisoning?

A

Chelation therapy treatment is the blood lead levels is greater than 4 ug/dL through used of EDTA

129
Q

EDTA

A

medicine that binds with lead to be excreted in urine as part of chelation therapy

130
Q

What to teach the child and family to prevent lead poisoning?

A

assure they don’t have access to peeling paint or chewable surfaces coated in lead based paint

wash and dry Childs hands frequently

if the soil is likely contaminated plant grass or other ground coverings

if remodeling an old home, follow proper procedures

use only cold water from tap for consumption especially when preparing formula

have water and soil tested

do not store food in open cans

do no use inadequately fired ceramic ware or pottery for food or drink

do not store food or drink in lead crystal

avoid folk remedies or cosmetics that may contain lead

avoid home exposure to lead from occupations or hobbies

make sure that the child eats regular meals and consume adequate amounts of iron and calcium

N353: Practice of Nursing II (14 decks)

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