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Pediatrics Exam 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

What is being tested in the Glasgow Coma Scale (GCS)?

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A
  • Eye opening (out of 4)
  • Motor response (out of 5)
  • Verbal response (out of 6)
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2
Q

Increased Intracranial Pressure (ICP)

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A

Excess of fluid (blood or CSF) or matter (brain) within the cranium causing pressure buildup due to proportional imbalance

Causes: tumor, infection, head injury, bleeding, CSF leak

Dx: ICP > 15

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3
Q

EARLY Signs & Symptoms of Increased ICP

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A
  • Headache
  • irritability
  • Visual disturbances
  • nausea / vomiting
  • pupils unequal or slow
  • changes in LOC
  • Posture (decerebrate, decorticate, flaccid)
  • changes in speech
  • seizures
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4
Q

Signs & Symptoms of increased ICP in infants

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A
  • bulging fontanelles
  • high pitched cry
  • suture separation
  • sunset eyes
  • increased head circumference
  • abnormal reflexes
  • prominent scalp veins
  • decreased PO intake
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5
Q

KEY late signs of increased ICP in children

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A

Cushing’s Triad

  • bradycardia
  • Irregular respirations
  • widened pulse pressure (systolic up & diastolic stays same)
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6
Q

ICP Measurement

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A

0 - 15 mmHg = NORMAL

  • 20 - 40 mmHg = slightly increased
  • > 40 mmHg = severely increased
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7
Q

Nursing Considerations for Increased ICP

A

Position
Respiratory
Elevated temperature
Systems to monitor
Straining activities avoided
Unconscious patient
Rx
Edema management

PRESSURE

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8
Q

Hydrocephalus

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A

Disturbance in the circulation of CSF that causes increased ICP

  • Overproduction of fluid
  • Obstruction preventing the normal flow of CSF through the ventricles
  • Impaired absorption in the subarachnoid space
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9
Q

What is a reservoir for hydrocephalus?

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A

Temporary treatment of hydrocephalus in neonates (specifically preemies) who aren’t big enough for a shunt placement
* typically tapped everyday by a physician

  • medications to reduce CSF
  • shunt
  • External Ventricular Drain (EVD) - drainage, position, neuro check
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10
Q

Closed head injury

A

Forcible collision of the brain & skull

Causes: abuse, MVA, fall

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11
Q

Signs & Symptoms of closed head injury

A

Minor:
* no loss of consciousness
* vomiting
* headache
* lethargy / confusion

SEVERE:
* increased ICP
* altered mental status
* gait changes
* elevated temperature
* eye changes (retinal hemorrhages, edema, pupils)

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12
Q

Closed head injury nursing considerations

A
  • Q1 neuro checks
  • ABCs
  • monitor / treat increased ICP
  • seizure precautions
  • dim / low lights
  • monitor drainage
  • education
  • no sports
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13
Q

A nurse is providing discharge teachign to the family of a child who just had a ventriculoperitoneal shunt placed. Which statements would indicate the parents understand the teaching?

a.) “There is no chance my child will have a seizure even if the shunt is functioning correctly.”
b.) “We should let our doctor know if the child complains of double vision.”
c.) “Our child does not need to be followed by any early-intervention programs, unless a problem develops.”
d.) “We will observe for symptoms of shunt malformation until our child has had the shunt for six months.”

A

b.) “We should let our doctor know if the child complains of double vision.”

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14
Q

What is Spina Bifida?

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A

Failure of the neural tube to close during fetal development
* no herniation, no opening, often hidden until later in life

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15
Q

Signs & Symptoms of Spina Bifida

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A
  • hair tuff or dimple above the sacrum
  • bowel / bladder dysfunction
  • gait abnormalities
  • tethered cord
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16
Q

What are the 2 different types of Spina Bifida?

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A

Meningocele: just fluid protruding from the back; no nerve root or spinal cord involvement
* uncommon to have significant neurologic dysfunction

Myelomingocele: nerve root & spinal involvement protruding from the back; nerve root & spinal involvement
* varying degree of neurological dysfunction
* paralysis below the level of the lesion

  • latex allergy risk
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17
Q

What is Meningocele Spina Bifida?

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A

NO nerve root or spinal cord involvement
* uncommon to have significant neurological dysfunction

18
Q

What is Myelomeningocele Spina Bifida?

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A

Nerve root & spinal cord involvement
* varying degree of neurological dysfunction
* paralysis occurs below the level of the lesion

19
Q

Individuals with spina bifida are at risk for what allergy?

A

latex allergy

20
Q

Cerebral Palsy (CP)

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A

Non-progressive brain damage resulting from a defect in fetal development, trauma, or oxygen deprivation during or shortly after birth

  • can be hemiplegic, paraplegic, or quadriplegic

Dx: between 6-12 months; altered growth & development

Tx: PT/OT, adaptive equipment, medications, surgical interventions

21
Q

Signs & Symptoms of Cerebral Palsy (CP)

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A
  • altered development, movement, or posture
  • altered sensation, perception, communication, cognition, or behavior
  • abnormal muscle tone / poor coordination
22
Q

When do the posterior & anterior fontanelles close?

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A
  • Posterior Fontanelles: 2-3 months
  • Anterior Fontanelles: 12-18 months
23
Q

The brain continues to grow rapidly in children until what age?

24
Q

At what age will the suture lines between the skull bones ossify?

25
Q

What is decordicate posture?

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A

rigid/flexed posture; arms come into the core

  • associated with lesions above the brainstem
26
Q

What are seizures?

A

abnormal electrical discharge in the brain that causes involuntary movement & behavior

27
Q

Absence Seizure

A

May look like child is daydreaming or staring off into space

Sx: lip smacking, twitching, brief LOC

28
Q

Partial Seizure

A

Occurs in one hemisphere of the brain or cerebral cortex
* localized motor or sensory symtpoms
* usually has an aura

29
Q

Generalized Seizures

A

Due to diffiuse electrical activity that begins in both hemispheres simultaneously

  • spasms are b/l & symmetric with consciousness impaired
  • loss of consciousness, broad impairment, NO aura
30
Q

Febrile Seizures

A

Seizures that are triggered by a fever above 101 F (38.3 C)

  • occur mostly in kids 6 months - 5 years old
  • Usually last less than 1 minute though can last up to 15 minutes & rarely occur more than once in 24 hours
31
Q

Signs & Symptoms / Clinical Manifestations of a partial seizure

A
  • may have aura & may progress to generalized sizure
  • may be abrupt or start unprovoked
32
Q

What is a tonic clonic seizure?

A

A generalized seizure that begins in the tonic (muscle contraction) phase, followed by a clonic (extension) phase with rhythmic jerking

33
Q

What is status epilepticus? What needs to be monitored and when?

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A

An acute seizure that lasts over 30 minutes

  • need to check electrolytes, glucose, blood gases, temperature, & BP if seizure lasts longer than 15 minutes
34
Q

What is the post ictal period?

Know this!

A

Period after seizure activity

  • patient may have decreased level of consciousness
35
Q

Medications for Seizure Treatment

A
  • 1.) Benzodiazepines
  • antiepileptic drugs (AEDs) if no success with benzodiazepines
36
Q

Meningitis

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A

Inflammation of the meninges

  • bacterial
  • more virulent & can be fatal
  • infants at greatest risk
  • may occur secondary to other bacterial infections (otitis media or sinusitis)
  • viral
  • sx are same as bacterial meningitis, but child does not seem quite as ill
  • usually make full recovery
37
Q

Signs & Symptoms of Meningitis in children

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A
  • bulging or flat anterior fontanelles
  • hypothermia
  • appetite / feeding pattern changes
  • vomiting
  • diarrhea
  • confusion
  • noise or light sensitivity
38
Q

What is non-communicating hydrocephalus?

A

Blockage in the ventricular system that prevents CSF from entering the subarachnoid space

  • responsible for most cases in kids
39
Q

What is the main goal of treatment of hydrocephalus?

A

To reduce the intracranial pressure & preserve CNS function

40
Q

The nurse is completing a physical exam on a 6-month old Brian. Which of the following would be an abnormal finding suggestive of CP?

a.) Brian is able to hold onto the nurse’s hands while being pulled to a sitting position.
b.) Brian has no moro reflex.
c.) Brian has no tonic neck reflex.
d.) Brian has an obligatory tonic neck reflex.

A

d.) Brian has an obligatory tonic neck reflex

41
Q

Key motor signs of CP

KNOW THESE!!!!

A
  • Moro reflex (startle reflex) beyond 4 months old
  • Tonic Neck (fencing position - whatever way head turns, that arm goes out) beyond 6 months old

Pediatrics Exam 3 (4 decks)

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