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Nursing Obstetrics & Pediatrics > Neural Tube Defects & Neuro Concerns > Flashcards

Neural Tube Defects & Neuro Concerns Flashcards

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1
Q

How much urine output is anticipated in an infant (0-12 months)

A

2mL/kg/hr

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2
Q

How much urine output is expected in a toddler?

A

1mL/kg/hr

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3
Q

How much urine output is expected in an adolescent?

A

0.5mL/kg/hr

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4
Q

what is the most common type of injury-related mortality for infants?

A

-suffocation

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5
Q

what is the most common type of injury-related mortality for those ages 1-24?

A

motor vehicle collisions

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6
Q

what is the most common type of injury-related mortality for those ages 25-69

A

suicide

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7
Q

what are unintentional causes of injury-related mortality?

A 
motor vehicle accidents
poisoning
drowning
suffocation
falls
fire
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8
Q

what are intentional causes of injury-related mortality?

A

suicide and homicide

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9
Q

what are some factors that make infants prone to head and neck injuries?

A
  • have a heavy head in proportion to body
  • neck muscles poorly developed
  • thin cranial bones, not well developed
  • unfused sutures in skull
  • excessive spinal mobility
  • immature musculature
  • joint capsule and ligaments of cervical spine are immature
  • incomplete ossification of vertebral bones
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10
Q

what type of spinal injury are infants at high risk of?

A

C1-C2 high cervical spin injuries

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11
Q

when are brain and spinal cord differentiated in fetal development?

A

at 3-4 weeks gestation

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12
Q

what can impact or alter brain and spinal cord development of a fetus?

A
  • infection
  • trauma
  • malnutrition
  • teratogen exposure
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13
Q

what are pediatric anatomical and physiological nervous system differences?

A
  • nervous system complete, but immature
  • maturation of nerve cells completes around age 4
  • glial cells and dendrites increase
  • mylenation process happens in cephalocaudal direction and is incomplete until 2 years of age
  • head is fastest growing body part until age 5
  • vertebrae are incompletely ossified until about age 9
  • dislocation at c1-c3 more common in children under 9
  • injury at c4-c6 more common in children over 9
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14
Q

what does confusion mean when assessing LOC?

A

-may be alert, but responses are inappropriate

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15
Q

what does obtundent mean when assessing LOC?

A

-patient has limited response, falls asleep unless stimulated

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16
Q

what does stuporous mean when assessing LOC?

A

-patient responds only to vigorous stimuli

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17
Q

what are some possible causes of altered level of conciousness in pediatric patients?

A
  • infection of the brain and/or meninges
  • increased intracranial pressure
  • trauma
  • hypoxia
  • poisoning
  • seizures
  • substance use/abuse
  • endocrine or metabolic disturbances
  • electrolyte imbalances
  • acid-base imbalances
  • stroke
  • brain tumor
  • congenital structural defect
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18
Q

what are the three elements that contribute to ICP

A

brain tissue
cerebrospinal fluid
blood

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19
Q

what causes spina bifida?

A

it is a neural tube defect

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20
Q

what is hydrocephalus

A
  • a build up of fluid in brain
  • causes pressure, which can lead to problems
  • causes abnormal enlargement of ventricles in brain
  • may be congenital or happen because of infection, trauma, stroke, tumor, brain bleed
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21
Q

what are the three most common types of spina bifida?

A

myelomeningocele
meningocele
occulta

22
Q

what is myelomeningocele?

A

a form of spina bifida where the spinal cord ends at the site of defect

  • motor and sensory function absent below defect
  • accounts for about 75% of cases of SB
  • has an increased risk associated with it of meningitis, hypoxia, hydrocephalus, and hemorrhage
23
Q

what are symptoms of myelomeningocele?

A
  • depend on location of defect
  • may have partial or complete paralysis of lower parts of body with partial or complete lack of sensation
  • may have loss of bladder and/or bowel control
  • hydrocephalus (about 90% of the time)
  • visible sac-like protrusion on the mid to lower back of a newborn
  • most serious form
24
Q

what is meningocele?

A

a form of spina bifida

  • spinal cord is usually normal, but meninges herniate through a defect in the vertebrae
  • typically there are no associated neurologic deficits
  • can be surgically corrected
25
Q

what is spina bifida occulta

A

a defect in lumbrosacral area

-generally no immediate intervention is require

26
Q

how can spina bifida be diagnosed before birth?

A
  • 85% of women carrying fetus with spina bifida show elevated serum alpha fetoprotein
  • ultrasound
  • amniocentesis
27
Q

what are some complications that can occur with surgical repair of spina bifida abnormalities?

A
  • increased ICP
  • shunt complications if shunt is inserted
  • infection
28
Q

what are signs and symptoms of hydrocephalus?

A

early signs:

  • unusually large head
  • rapid increase in head size
  • vomiting
  • distended scalp veins

late signs:

  • decreased LOC
  • bradycardia
  • sunsetting eyes
  • apnea
  • shrill cry
29
Q

what can cause hydrocephalus?

A
  • obstuctive causes (obstruction in ventricular system preventing CSF from flowing or communicating with the brain)
  • nonobstructive (problems with production or absorption of CSF)
  • GR2 malformation (structural defect)
30
Q

how is hydrocephalus treated?

A
  • re-establishment of balance between CSF production and reabsorption
  • shunt insertion
31
Q

what are some complications that can occur with shunts?

A
  • mechanical failure
  • infection
  • blockage
32
Q

what kinds of mechanical failure can occur with a shunt?

A
  • under or over drainage
  • blockage
  • failure of the valve system

highest incidence of failure is within first few months of surgery

33
Q

what kinds of infections commonly infect shunts?

A

40% are staphylococcus epidermus
20% staphylococcus aureus
streptococci and gram negative organisms also common

34
Q

what is normal intracranial pressure

A

1-10 mmHg

35
Q

how can intracranial pressure be measured?

A
  • by lumbar puncture

- by intraventricular catheter inserted into anterior fontanelle

36
Q

how should the glasco coma scale be modified for infants?

A
  • eye opening to loud noise instead of verbal stimuli
  • verbal response - not r/t orientation, instead r/t normal response to stimuli like cooing or smiling.
  • motor response - spontaneous instead of obeys commands
37
Q

what are the normal characteristics of cerebrospinal fluid ?

A
  • clear
  • odorless
  • WBCs 0-5
  • Protein 15-45
  • Glucose 50-80
  • Pressure 50-180
38
Q

what are characteristics of abnormal cerebrospinal fluid?

A
  • turbid, cloudy
  • elevated WBCs, protein
  • Glucose level lower than blood sugar
  • pressure greater than 180
39
Q

what are some nursing diagnoses related to increased ICP?

A
  • pain r/t increased pressure
  • altered LOC
  • risk for imbalanced nutrition
  • risk for altered sleep
  • risk for seizures
  • impaired mobility
  • risk for ineffective cerebral tissue perfusion
  • potential for fluid volume deficit
40
Q

what are some nursing interventions for elevated ICP?

A
  • monitor ins and outs
  • monitoring LOC
  • monitor for signs of increased ICP
  • monitor for signs of infection
  • manage pain
  • measure head circumference and monitor fontanelles
41
Q

when an external shunt is installed, what are some care precautions?

A
  • need to clamp shunt everytime child is picked up
  • head must remain at same level as body
  • sterile technique used when assessing shunt for specimens
  • measure CSF output Q1H
42
Q

what are early signs of dehydration?

A
  • up to 5% weight loss
  • increased thirst
  • reduced urine output
43
Q

what are moderate signs of dehydration?

A
  • 6-9% weight loss
  • lethargy
  • irritability
  • moderate thirst
  • dry appearance
  • sunken fontanelle(s)
  • decreased capillary refill
  • decreased urine output (less than 1ml/kg/hr for an infant)
  • lightheadedness relieved by laying down
44
Q

what are signs of severe dehydration?

A
  • 10% or more weight loss
  • altered behavior (confusion, anxiety, unable to stay awake)
  • rapid pulse
  • weak pulse
  • faintness
  • cold, clammy skin or hot, dry skin
  • little or no urine
  • loss of consciousness
  • poor skin turgor
  • low/decreased BP
45
Q

how do isotonic fluids work in the body

A
  • have a concentration of dissolved particles equal to intracellular pressure (osmotic pressure is the same)
  • they do not promote a shift in fluids into or out of cells, but will help to rehydrate and bring up BP
  • ringers lactate and normal saline (0.9% saline) are both isotonic solutions
46
Q

how to hypertonic solutions work in the body?

A
  • hypertonic means they have more dissolved particles than the bodies cells, so they draw fluid out
  • shrink cells, expand extracellular space. bring fluid into vascular space
  • 3% saline, 5% saline, D5W, D5NS, D10W, TPN, albumin are hypertonic solutions
47
Q

how do hypotonic solutions work in the body?

A
  • have less dissolved particles than cells, so they cause fluid to go into cells and swell them
  • should be given with caution
  • examples are 0.33% NS and D2.5W
48
Q

what is one way spina bifida can be prevented?

A

-women of childbearing age taking folic acid at a dose of 400mcg/day

49
Q

what are some risk factors for a fetus developing spina bifida?

A
  • woman with no folic acid supplementation and inadequate dietary intake
  • woman who takes anti-seizure medication
  • family or personal history of neural tube disorders
  • previous pregnancy affected by ntd
  • clinically diagnosed obesity
50
Q

why are latex precautions used with patients with spina bifida?

A
  • because they often have many procedures

- especially if needing constant catheterization, are always exposed and have increased risk of developing sensitivity

51
Q

what are some points to be discussed before discharge?

A

 Discharge information is important part of RN role with these patients
 Signs of infection
 Signs of increased ICP
 Need to know how to self-catheterize/catheterize child
 Education r/t how shunt may need to be replaced or lengthened
 May need to have guidance about what kind of sports or activities they can participate in
 Medic-alert bracelet
 Children with spina bifida are at higher risk of obesity/becoming overweight for a number of reasons
 Genetic counselling
 Diet: high fiber
o May need to be disimpacted, may need stool softeners depending on damage to spinal cord that they have
 antibiotics

Nursing Obstetrics & Pediatrics (26 decks)

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