Neuro Flashcards
Pediatric Differences
- cranial bones not ossified
- fontanels and suture lines
- immature nerves
- lack of mylenation
- head larger than body
Cognitive Function
controls behavior, communication, memory, LOC
Cerebellar Function
controls balance, coordination, fine and gross motor
Moro
startle
palmer/planter grasp
put finger in hand/foot and they will grab
tonic neck
fencing
rooting
if you touch their cheek their head will move towards it
Babinski
<n2 years old toes will fan out (+)
> 2 years old you want (-) babinski
(COULD MEAN STROKE)
Skull Fractures
Linear: most common, overlying hematoma
Depressed: more dangerous, bone fragments in the brain, hospitalizations
Basilar: fx at the base of the skull, increased risk for meningitis, NO NG TUBE (will snake into the brain)
Microcephaly: patho
Patho: small brain
- genetic disorder, destructive insult, viral infections
- intellectual disability
Hydrocephalus
Patho: problem w/ production and reabsorption of CSF
- COGNITIVE IMPAIRMENT COMMON
S/SX: enlarged ventricles, bulging fontanels, increased head circumference, signs of increased ICP (HA, N/V, LOC)
Dx: prenatally
Tx: remove obstruction, ventriculoperitoneal shunt
Myelomeningocele
Patho: protrusion of the meningeal sac that contains CSF, spinal cord, nerves
S/Sx: paralysis, weakness, sensory loss, neurogenic bladder (lack of bladder control)
Dx: prenatally elevated MSAFP
TX: surgical repair, braces for mobility (infection risk)
Prevention: folic acid during pregnancy
Positional Plagiocephaly
Patho: asymmetric flattening of the occiput “ABC campaign”
Tx: tummy time, torticollis-physical therapy, helmet wear
Cerebral Palsy
Patho: permanent disorders of mvt. + posture
MOST COMMON PERMANENT PHYSICAL DISABILITY
S/Sx: Abnormal muscle tone and lack of coordination, spasticity, seizures, milestones lagging, intellectual, vision, hearing, speech impairments
Tx: early recognition, therapy to reach childs fullest potential, feeding issue (G TUBE) , family support, socialization adapted educational opprtunities, meds
Guillan- barre Syndrome (GBS)
Patho: systemic weakness (nerve damage) w/progressive ascending paralysis
S/Sx: absent or diminished deep tendon reflexes
- ataxia= loss of muscle control
- within 6 wks of a gastro or flu - like illness
Tx: IV IG ( IV immunoglobulin )
Reye Syndrome
Patho: encephalitis (inflammation of the brain ) from ASA use after varicella and influenza
++ HIGH MORTALITY++
S/Sx: vomiting, mental status changes, seizures, unresponsive cerebral edema, fatty liver
Tx: supportive
Bacterial meningitis
Patho: inflammation of the meninges caused by bacteria or virus
S/Sx: brain swelling, increased ICP, fever shrill cry, lethargic, altered LOC, vomiting, HA w/ nuchal rigidity (chin to chest = neck pain), photophobia (light bothers the eyes), Kernig’s and Brudzinski signs
Dx: CBC, lumbar puncture, blood cultures, CT, MRI
Tx: anitbiotics (must cross BBB high dose IV), fever management, seizure precautions, isolation, treat contact prophylactically
What is status epilepticus
seizures that last for a long time or back to back seizures
- use LORAZEPAM to help
what is the post-ictal phase
phase after the seizure, last 30-60 mins, patient is really drowsy
What are the different types of seizures
- Partial or Focal= stares off
- Generalized= tonic-clonic
- Febrile= can get until age 5
- Epilepsy = common, abnormal firing of the brain
- Psychogenic nonepileptic seizure (PNES)= stress induced seizure ( not a true seizure but its real)
Seizure (patho, tx, and nursing)
Patho: abnormal electrical activity in the brain (involuntary mvt. , behavioral sensory alterations
Tx: cant cure only manage ( w/meds, surgery, or vagal nerve stimulation). Never stop meds abruptly, compliance is important, maintain therapeutic levels
Nursing:
1. seizure precautions (o2, padding, suction)
2. protect the airway, time the seizure, observe activity
3. never leave the pt, never put anything in mouth
4. recovery position after post ictal phase (lay on left side
Increased intracranial pressure (ICP): patho and s/sx
Patho: increased pressure due to infection, trauma, tumors
Early s/sx: HA, N/V, vision changes, high pitched cry, sunsetting eyes (eyes looked pushed down), buldging and tense fontanels
Late s/sx: decreased LOC, seizures, cushing triad, fixed/ dilated pupils, posturing (herniation), decerebrate (straight, rigid ) , decorticate (abonormal flexion)
Increased intracranial pressure (ICP): Dx and nursing
Dx: labs, EEG, CT, MRI
- Glascow coma scale: score <8= comatose (think about intubation)
- IF INCREASED ICP SUSPECTED, NO LUMBAR PUNCTURE
Nursing: treat the cause, maintain airway, maintain cerebral perfusion (dopamine), frequent neuro assessments, manage pain, position head midline, HOB 30 , seizure precautions (make sure they have gag reflex )
Traumatic Brain Injury (TBI): causes and s/sx
Causes: MVA, Falls, gun-related leads to brain swelling, and increased ICP
Mild s/sx: LOC, N/V, HA
Moderate s/sx: LOC 5-2 mins, HA, N/V
Severe S/sx: LOC> 10 min. will have s/sx of ICP
cushing triad, herniation, posturing, seizures
