Module 4 Care of the child with Neurological disorders Flashcards
The higher the injury is to the brain, the more
symptoms
In the Glasgow scale a 9-10 means
light coma
In the Glasgow scale a 6,7,8 score means
deep coma
under 3 in the glasgow scale means child is
totally unresponsive
for a child that has just sustained a head injury it is important for them not to
go to sleep
5 S&S of Increased Intracranial Pressure
Lethargy Shrill cry Poor muscle tone Seizures Poor appetite
What is the tx for Hydrocephalus
VP shunt
How does a VP shunt work
fluid goes from head to abdomen for liver to absorb so it can go back into circulation
Children with VP shunts have a tendency to be
unbalanced
In a child with a VP shunt how should you position them
un-operative side
Congenital embryonic neural tube defect - imperfect closure of spinal vertebrae
Spina Bifida
What decreases incidence of Spina Bifida?
Folic acid
Define Spina Bifida occulta and it’s manifestations
Minor variation - opening in spinal column small & no protrusion of structures
Tuft of hair or small dimple
Occurs at L5 or S1
Non congenital defect causing muscle weakness due to lack of oxygen at birth
Cerebral palsy
What actions are affected in cerebral palsy?
Impaired movement
Delayed milestones
Difficulty feeding
Type of CP that has slow and snake-like movement
Athetoid
Type of CP that shows no coordination
Ataxic
Type of CP where muscles don’t contract
Rigidity
Combination of other CP’s
Mixed
Altered neurological impulse causing rapid muscle contraction
Seizure
What can cause a seizure
Unknown
Fever
Trauma
Brain tumor
How long do seizures last and what can happen during and after a seizure has occurred?
30-90 seconds
Person becomes incontinent of urine
Person develops amnesia of the seizure event
Another name is tonic-clonic seizure
Gran-Mal
What causes Reye’s syndrome?
Viral infection
How does Reye’s syndrome present itself?
Vomiting Sluggish behavior Lethargic Seizures Stroke like symptoms
Inflammation of the meninges - meningitis can be caused by
A virus or a bacteria
What kind of isolation is used for meningitis and when is isolation constituted
Respiratory isolation and only if there’s + brudzinski sign
What decreases the risk of developing meningitis?
HIB vaccine
Signs and symptoms of meningitis
Severe headache, stiff neck (nuchal rigidity) irritability, fever, restlessness, petechia, vomiting & + brudzinski sign (when you put chin into chest, knees goes up involuntarily)
What is a lumbar puncture
Small amount of cerebral
Spinal fluid is extracted
What color should CSF be
Clear
What is encephalitis
Inflammation of the brain usually caused by a virus
What adverse effect is common if encephalitis is left untreated or undiagnosed?
Deafness
Positioning for lumbar puncture
Place child in lateral position
Hold neck and thighs to
Make a curve in the spine
Talk quietly to child for reassurance
Signs and symptoms of a head injury such as a concussion or a skull fracture
Increased ICP
Headache
Hypoxia
Change in LOC
Why do we not medicate for pain in head injuries
We do not want to mask symptoms. Symptoms tell us if condition is worsening
Describe decerbrate positioning in head injuries
Supine hands flexed back
Describe decorticate positioning in head injuries
Arms wrist and fingers flexed up
What is a neuroblastoma
Malignant tumor in the adrenal gland
When abdomen in palpated in neuroblastoma what will be found
Abdominal mass
Signs and symptoms of neuroblastoma
Abdominal mass
HTN
Tachycardia
Respiratory depression
Why is the prognosis poor in neuroblastoma
Metastasis of the tumor occurs before it is even discovered
Mental retardation - Intellectual disability/impairment definition
Below average mental functioning
Onset before 18 years old
Signs and symptoms of MR
Deficit in adaptive behavior
Affects memory mood and language
Treatment for MR
Early intervention
Emphasize strengths
Family support
AHRC
What is Down’s syndrome
Mild to severe form of MR
Characteristics of Down’s syndrome
Small head Round face Flat nose Protruding tongue Close set eyes Simian crease Short thick hands Congenital heart defects
Diagnosis of Spina Bifida pre natal
Alfa-fetal protein level at 13-15 weeks
Amniocentesis if indicated
What is one thing we must not let kid do after a head injury
Go to sleep
What does the b/p and the p do with increased ICP
B/p goes up and pulse goes down
If kid has bulging fontanels what position should we put them in and if they had sunken fontanels what position should we put them in
Bulging = sit them up Sunken = lay them down
Increased AFP shows suspicion of what
Spina Bifida
Spontaneous abortion or preterm birth can cause
amniocentesis
When should surgery be done for myelomeningocele
within 24-48 hrs
What can we do to repair damage the spinal cord
no fix for spinal cord yet
Which reflex is absent in myelomeningocele
babinsky reflex
Post op Spina bifida how should child be positioned
head slightly elevated
Shill cry could mean
increased ICP
what are two complications of post spina bifida surgery
chronic constipation
stool leakage
In cerebral palsy what is also affected as a result of lack of OXYGEN
muscle function
Spastic Cerebral Palsy is
Twitching
Adenoid Cerebral Palsy is
slow snake like movement
Ataxic Cerebral Palsy is
Lack of muscle control
Rigidity Cerebral Palsy is
unable to move muscles
Why do we perform ROM in Cerebral Palsy
to prevent contractions
Which population of kids are prone to seizures
Hydrocephalus
Head trauma, Rapid rise in Temp, Pressure in brain can cause a
Seizure
How long do seizures usually last
30-90 seconds
Not all seizures cause _______ however all _______ causes seizures
epilepsy
When do kids usually outgrow febrile fevers
By age 3
Infertile spasms usually are in _______ kids. They can have an overactive Moro which means they are _______
Myoclonic, they are jumpy
When giving anti-convulsants to kids it is important to tell parents that the drugs can cause
drowsiness
Reyes syndrome is linked to which drug use
aspirin
HIB vaccine for meningitis decreases risk for
Reyes syndrome
In reyes syndrome because of STROKE LIKE SYMPTOMS kid has increased risk for
bleeding in brain
HIM (Meningitis) which isolation do we place kid on
Resp isolation
A common symptom of meningitis is Nuchal head which is
stiff neck cant even pick it up
Which sign is specific to meningitis
Brudzinski sign
If lifting a child by the head and the child’s leg/knee comes up that is a positive sign of
Meningitis
What is a major risk when doing lumbar puncture
Paralysis / Spinal damage
Before lumbar puncture what is needed
informed consent
For lumbar puncture how do we treat parents
dont let them know whats going on, dont keep them in room. dont sedate child we need them with full LOC
What do we look for post meningitis / lumbar puncture
leakage
post meningitis / lumbar puncture child will be on resp isolation for how long
24-72 hours
encephalitis is usually caused by
Mosquito (West nile virus)
By the time we diagnose Nephroblastoma we have to tell parents what
prognosis is poor and it has already metastasized, child may not survive
What can a distended abdomen mean
malfunction in VP shunt
Spaces in the bones is referred to as
Spina bifida
Occulta is
Spina bifida
Post incontinence, or passing of urine can happen immediately after what
seizure episode
Persistent vomiting happens in what
Reyes Syndrome
Liver dysfunction can lead to
increased ammonia
What is a positive Brudzinski’s sign
Push head to chest, if legs come up on their own + sign
We elevate HOB for which condition
Hydrocephalus
We place child prone or side lying for which condition
Spina Bifida
A child with hydrocephalus has increased blood pressure, decreased pulse rate, and decreased respirations. The nurse suspects these symptoms indicate
Increased ICP
Infants with spina bifida commonly have an allergy to:
Latex
a protrusion of the membranes and cord through an opening in the spine
Meningomyelocele
Motor disability caused by a nonprogressive disturbance in brain development
Cerebral palsy
Complication that affects the liver and brain
Reyes syndrome
A practice that has helped us prevent mental retardation is
blood test at birth
Seizure where child cries out, falls on the floor, becomes rigid, and then has a convulsion
Grand-mal
he development of Reye’s syndrome has been associated with the use of aspirin while infected with
Meningitis
Which is not a characteristic of brain tumors in children
Decreased BP
Which is the most useful diagnostic procedure in diagnosing a seizure disorder
Electroencephalography
presence of blood in the anterior chamber of the eye
Hyphema
What 2 symptoms are early signs of Reyes syndrome
Vomiting and lethargy
Encephalitis can be secondary to what
Respiratory infection
two symptoms of meningitis
fever and irritability
inability to arouse the child is an early sign of
Increased ICP
Before surgical repair what position should you place the child in for Meningomyelocele
Prone, maintaining abduction with a pad between legs
Whens the best time to do EEG
When child is sleeping
Best diet for Seizures
Ketogenic diet (high fat low carb)
What is a spica cast
Cast from chest to lower extremities
