Module 1 - PEDS Neuro Flashcards
What are the pediatric differences of the head compared to an adult?
- Head is large, neck muscles underdeveloped
- Unfused suture
- highly vascular brain; less CSF cushion
- Cervical spine immature: Increased mobility
- Myelination incomplete at birth
What are children prone to with a large head and underdeveloped neck muscles?
head injury with falls
When are sutures unfused in peds patients?
< 18 months
this leads to being prone to fracture or brain injury - it requires time to solidify and become stronger
What does a highly vascular brain and less CSF lead Peds to be prone to?
hemorrhaging and trauma
When is myelination usually completed for children?
It matures by 4-5 years old but continues through and to late adolescence
Are pediatric seizures more common in children or infants?
Infants
How common are pediatric seizures in children
common
2-4 % of the peds population
How common are pediatric seizures in infants?
very common
1 in 1000 infants
What is the most common type of seizure in peds patients?
Febrile Seizure
Febrile Seizure
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
What causes the febrile seizure?
the rapid rise and fall, not the fever itself
What could help decrease a temperature gradually to prevent febrile seizure?
A tepid bath
Epilepsy
chronic Seizure disorder (sometimes in peds patients)
it occurs when you continue to have seizures with age
How does incidence of epilepsy and febrile seizure change with age?
Febrile seizure incidence decreases with age but epilepsy will continue with age
Medications that can treat pediatric seizures?
Dilantin
Phenobarbital
When is medication given for pediatric seizures?
with chronic disorders like epilepsy, but not for a single case febrile seizure
Why do you have to be careful when administering dilantin?
You have to give it with a straw to prevent gum dysplasia in epileptic children
Important types of seizure clinical manifestations?
Generalized
Partial
Absence
Generalized seizure clinical manifestations
Tonic Clonic
Loss of consciousness (grand mal/convulsive - widespread activity)
Partial seizure clinical manifestations
Simple, affect one hemisphere of the brain
Absence seizure clinical manifestations
may have non or minor motor movement
common
just a little out of it
Important infectious diseases that can cause neurological issues in children?
Bacterial Meningitis
Viral (Aseptic) meningitis
Reye’s Syndrome
Guillain-Barre Syndrome
Bacterial Meningitis
Bacterial etiology
Meninges infection / infection of the brain
somehow an infection crosses the blood brain barrier into CSF fluid
Who is at greatest risk for bacterial meningitis?
Infants (70% of cases) <5 years old
What may cause bacterial meningitis
May occur secondary to otitis media, sinusitis, pneumonia, brain trauma, neurosurgery, or many other things really
Meningococcal Meningitis has increased incidence in what population
College Age
so the vaccine is highly recommended for those living in dorms or highly populated living spaces
Rates of meningitis have declined with increased use of what?
HIB and pneumococcal vaccines
Clinical Manifestations of Meningitis in Infants
fever, change in feeding, vomiting, anterior fontanel BULGING, restless, lethargic, irritability
hard to consul even by the parent
piercing cry or lethargy/listless
What does a flat anterior fontanel indicate in infants?
dehydration
What does a bulging flat anterior fontanel indicate in infants?
Meningitis / brain infection with CSF buildup
Clinical manifestations of Meningitis in older children
Fever, irritability, lethargic, confused, combative, answering strangely, headache, back/neck pain, photophobia, nuchal rigidity
potential rash, petechiae, purpura (associated with meningococcal meningitis)
Nuchal Rigidity
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
Opisthotonos Posturing
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.
Lumbar Tap/Puncture
Test checking for meningitis
you stick a needle in the spinal area and draw out CSF for testing
What lab results may occur in CSF for a positive lumbar tap for meningitis?
Increased WBC
low glucose
increased protein
gram stain - positive (60-90%)
culture - positive
contagious !!!
What are the initial steps of clinical therapy for meningitis?
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
Why do we administer antibiotics as soon as all culture specimens are obtained from a lumbar tap?
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
Sequelae of Meningitis
neurologic damage
seizure
hearing loss
developmental delays
multisystem organ failure or death
If the meningitis is bacterial what will occur in culture?
it will grow, be contagious, and come out positive
Viral (Aseptic) Meningitis
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
What will occur for a culture of viral (aseptic) meningitis?
Culture will NOT GROW any bacteria
What levels are normal in CSF from a viral (aseptic) meningitis patient?
Glucose and protein levels in the CSF are normal
Reye’s Syndrome
Unclear etiology
Acute swelling of the brain caused by a toxin or injury - causing inflammation
What is associated with the cause of Reye’s Syndrome
Viral Illness
Use of Aspirin (before the advent of Tylenol) (mimics meningitis when due to aspirin)
Why is Reye’s Syndrome rare?
Nowadays acetaminophen and NSAIDS are used rather than Aspirin (ASA) and we educate parents now
Important Nursing Care steps for Meningitis Patients
ABCs
Cerebral Edema control
Seizure control
Antibiotics (if bacterial)
Steroid use
Put into semi fowler’s position to alleviate some pressure
Guillain Barre Syndrome
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
What leads to the autoimmune response of Guillain-Barre Syndrome?
GI or Resp infection 2-3 weeks prior
How does deteriorating motor function occur in Guillain-Barre syndrome?
Ascending pattern
so bad motor function and paralysis begins at the lower extremities and works its way up
Treatment for Guillain Barre Syndrome?
Immunoglobulins
How fatal is Guillain Barre syndrome?
rarely fatal
BUT, respiratory difficulty may require ventilation and physical therapy assistance to overcome some paralysis and motor weakness
Special needs for children with disabilities you should consider when nursing?
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