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NURS254 Peds > Neuro > Flashcards

Neuro Flashcards

1
Q

what is meningitis

A
  • inflammation & swelling of the brain and spinal cord membranes
  • leading to increased ICP
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2
Q

what are the causes of meningitis

A
  • infection:
    bacterial: Group B strep, E. coli, neisseria meningitidis (meningococcal), streptococcus pneumoniae, Hib

viral: EBV, enterovirus, adenovirus + mumps

  • trauma
  • autoimmune diseases (i.e. lupus)

Bacterial think = Bad news (most contagious)

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3
Q

S/S of meningitis

A

H-H-H
- H: headache & photophobia
- H: hard stiff neck “nuchal rigidity”
- H: high temp “fever”

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4
Q

S/S of meningitis in newborns

A
  • high pitched or weak cry
  • refusal to feed, V/D
  • possible fever or hypothermia
  • late signs: bulging fontanelle & nuchal rigidity
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5
Q

S/S of meningitis in infants <2yrs old

A
  • high pitched cry
  • bulging fontanelles at rest (report to HCP)
  • irritability
  • vomiting & poor feeding
  • frequent seizures
  • sunset eyes: sclera visible above the iris

infant complication - hydrocephalus

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6
Q

S/S of meningitis in peds age 2 - adolescence

A
  • seizures (initial finding)
  • nuchal rigidity
  • positive Brudzinski’s sign (flexion of extremities with deliberate flexion of the child’s neck)
  • positive Kernig’s sign (resistance or pain to extension of the leg from a flexed position)
  • fever
  • headache
  • vomiting
  • irritability -> ALOC
  • petechiae: small round brown or purple colored spots (bacterial meningitis)
  • non-blanching rash (neisseria meningococcal)

Kernig think “Krinkled knees”
Brudzinski “beach chair ski”

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7
Q

if hydrocephalus isn’t corrected quickly, what can it lead to?

A
  • hearing & vision loss
  • learning disability
  • loss of coordination
  • brain damage
  • death

priority assessment is always fontanel

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8
Q

laboratory tests/diagnostics for meningitis

A
  • CT before lumbar puncture (can increase ICP)
  • test the CSF for infection
  • blood cultures

abx after blood cultures

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9
Q

compare viral vs. bacterial meningitis difference in CSF

A
  • viral: very clear
    normal glucose
  • bacterial: bad cloudy
    decreased glucose
    elevated protein

both: elevated WBC count with bacterial > viral

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10
Q

nursing actions to prepare for lumbar puncture

A
  • empty bladder
  • topical anesthetic cream 45mins - 1 hr prior
  • side-lying position with head flexed and knees drawn up to the chest
  • sedation: fentanyl & midazolam if required
  • pressure & elastic bandage applied to puncture site after needle removed
  • monitor insertion site dressing for clear fluid - report
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11
Q

contraindications for lumbar puncture

A
  • signs of increased ICP
  • coagulopathy or thrombocytopenia
  • local infection at puncture site
  • hemodynamic or resp instability
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12
Q

what type of precaution is meningitis placed on

A
  • droplet precautions: mask up & goggles
  • isolation for minimum 24hrs after initiation of antibiotic therapy
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13
Q

nursing care for meningitis

A
  • decrease environmental stimuli: minimize light & sound
  • comfort: position without pillow, elevate HOB 30 degrees
  • seizure precautions
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14
Q

what is the top priority for an infant <12 months old with meningitis

A
  • give antibiotics before any assessments
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15
Q

treatment for meningitis

A
  • correct fluid volume deficits then restrict until no evidence of increased ICP
  • IV abx
  • corticosteroids: dexamethasone (bacterial meningitis)
  • teaching to get Hib vax
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16
Q

what are signs of increased ICP secondary to meningitis

A
  • newborns and infants:
    builging fontanels
    increased head circumference high-pitched cry
    distended scalp veins bradycardia, resp changes
  • children:
    headache
    N/V
    diplopia
    seizures
    bradycardia, resp changes
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17
Q

nursing care for increased ICP secondary to meningitis

A
  • avoid coughing, straining
  • avoid bright lights & noise
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18
Q

differential diagnosis for meningitis

A
  • encephalitis: inflammation of the brain (similar symptoms)
  • sepsis
  • brain abscess
  • brain tumors
  • Kawasaki disease
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19
Q

what is Guilllain-Barre syndrome

A
  • immune system is trying to fight an infection
  • proteins on the pathogen resemble parts of the nerves, the immune system mistakenly attacks the nerves
  • immune system damages the myelin and axons
  • nerves can’t send signals properly
  • once immune attacks stops, nerves start to heal, however, axons may not completely recover
  • autoimmune disorder
  • acute inflammatory peripheral neuropathy & cranial nerves
  • bilateral motor weakness
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20
Q

what are possible infection sources for Guillain-Barre syndrome

A
  • infectious mononucleosis
  • measles, mumps
  • gastroenteritis
  • Lyme disease
  • EPV
  • H. pylori
  • cytomegalovirus
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21
Q

complications with Guillain-Barre syndrome

A
  • resp distress/failure
  • difficulty swalloing
  • paralysis
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22
Q

when might Guillain-Barre syndrome start after the primary infection

A

typically 10 days after primary infection

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23
Q

S/S of Guillain-Barre syndrome

A
  • bilateral muscle tenderness, paresthesia, cramps
  • paralysis ascending from lower extremities
  • diminished or absent deep tendon reflexes
  • autonomic dysfunction: change in HR, BP fluctuations, GI (constipation, difficulty controlling bladder), SOB, may need MV/intubation
  • cranial nerve involvement in severe cases: dysphagia, double vision, facial weakness
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24
Q

diagnostics for Guillain-Barre syndrome

A
  • lumbar puncture: CSF
    elevated protein
    normal glucose
    normal WBC
  • nerve conduction studies
  • electromyography (EMG)
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25
Q

Treatment for Guillain-Barre syndrome

A
  • plasmapheresis (plasma exchange): removes harmful antibodies from blood
  • IVIG: provides healthy antibodies from donor plasma to neutralize the harmful ones

No corticosteroids

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26
Q

nursing care for Guillain-Barre syndrome

A
  • resp support
  • pain management: gabapentin/pregabalin
  • nutritional support: feeding tube, NG tube
  • GI support: urine catheter, stool softner
  • DVT prophylaxis
  • passive ROM exercises
  • pressure ulcer prophylaxis
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27
Q

pathophysiology of seizures

A
  • abnormal, involuntary, excessive electrical discharges of neurons within the brain
  • altered ions (Na, K, Ca) or release or neurotransmitters
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28
Q

causes of seizures

A
  • anything that causes swelling or hypoxia: concussion, brain tumor, increased ICP
  • lead poisoning
  • tetanus, shigella, salmonella
  • hypoglycemia
  • fever
  • drug or alcohol withdrawal
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29
Q

generalized vs. focal seizures

A

generalized is the whole brain, focal is partial

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30
Q

what are the types of partial and generalized seizures

A
  • partial
    simple
    complex
  • generalized
    absence (petit mal)
    tonic-clonic (grand mal)
    myoclonic
    atonic
    infantile spasms (west syndrome)
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31
Q

describe what tonic and clonic phase do during a seizure

A
  • tonic phase:
    tight & tense
    piercing cry
    cyanosis
  • clonic phase:
    convulsions
    incontinence
    frothing
  • tonic-clonic: tight and convulsions

tonic-clonic seizure is also known as grand mal seizure

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32
Q

what are myoclonic seizures

A
  • brief contractions
  • involves only part of the body
  • no postictal state
  • might not lose consciousness
33
Q

what are atonic seizures

A
  • “drop attacks”
  • muscle tone lost suddenly -> fall
  • period of confusion follows
34
Q

what are absent seizures

A
  • “spaced out”
  • day-dreaming, starying off into space
  • brief interruptions of consciousness
35
Q

what are the 2 types of partial “focal” seizures and compare them

A
  • simple: fully conscious
  • complex: impaired or loss of consciousness
36
Q

what are typical signs of complex focal seizures

A
  • lip smacking, biting, picking
  • loss of consciousness
37
Q

what are infantile spasms (west syndrome)

A
  • sudden, brief symmetric muscle contractions
  • possible eye deviation or nystagmus
  • possible cry or irritability
  • single event or clusters up to 150 seizures
38
Q

what is given to treat infantile spasms (west syndrome)

A

adrenocorticotropic hormone (ACTH)

39
Q

what are triggers for seizures

A
  • sleep
  • sleep deprived
  • strobe lights
  • stimulants
  • sugar or sodium low
40
Q

what are the 4 stages of seizures and describe each stage

A
  • prodromal phase: warning signs
    changes in mood, behavior, or physical sensations
  • aura phase: first symptoms of a seizure
    visual or auditory cues
    most likely a tonic-clonic seizure
  • ictal phase: seizure
  • postictal phase:
    confusion, disorientation
    headaches, sleepiness, tiredness
41
Q

what should you assess during the postictal phase of a seizure

A
  • assess LOC, neuro status, PERRLA, motor strength, sensation
  • identify cause
42
Q

what is status epilepticus? What is the priority?

A
  • seizures lasting 5mins +
  • repeated seizure in 30 mins
  • priority: stop the seizure with IV or rectal benzodiazepines

grand mal (generalized) seizures are at risk for status epilepticus

43
Q

what can untreated status epilepticus lead to

A
  • hypoxia
  • brain damage
  • hyperprexia: high fever
  • coma, death
44
Q

what is the first line of drug for seizures

A
  • IV or rectal benzodiazepine: lorazepam, diazepam
  • SL ativan
  • Intranasal midazolam
45
Q

what is the second line of drug for seizures

A

IV phenytoin

46
Q

diagnostics for seizures

A
  • electroencephalogram (EEG): records electrical activity and can identify the origin of seizures - electrodes on scalp
  • MRI/CT: structural issues
  • toxicology screening
  • LP: meningitis
47
Q

patient education to prepare an EEG

A
  • wash hair
  • no caffeine or stimulants
  • no seizure meds
  • no sleep
  • can eat before exam
48
Q

Frequency of seizures that would be considered epilepsy

A
  • at least 2 unprovoked seizures occuring greater than 24hrs apart
49
Q

what are the treatments for epilepsy

A
  • anti-seizure meds
  • sx for partial epilepsy
    focal resection, hemispherectomy (worst seizures), corpus callosotomy (separate the brain hemispheres)
  • implanted device: vagal nerve stimulator
  • ketogenic diet
50
Q

what are febrile seizures

A
  • sudden spike in temperature 38.9-40C
  • duration 15-20secs
51
Q

treatment for febrile seizures

A
  • give ibuprofen or acetaminophen q6hrs (can be interchangable)
  • cool damp compress on forehead

call 911 if seizure lasts more than 5 mins

52
Q

what is hydrocephalus

A
  • excessive CSF -> increased ICP
  • dilation of ventricles -> enlargement of skull
53
Q

what are the 2 types of hydrocephalus

A
  • communicating: impaired absorption of CSF
  • non-communicating: obstruction of CSF flow
54
Q

what are s/s of hydrocephalus in <2yrs old infant

A
  • high pitched cry
  • bulging fontanelles/eyeballs at rest
  • irritablity and ALOC
  • V/D & poor feeding
  • frequent seizures
  • sunset eyes “sclera visible above the iris”
  • headache
  • pupils sluggish - late
55
Q

what is the priority assessment for hydrocephalus

A
  • fontanel assessment
  • head circumference > chest
56
Q

what are the causes of hydrocephalus

A
  • meningitis & infections
  • tumors
  • trauma: bleeding in the brain
57
Q

diagnostics for hydrocephalus

A
  • CT
  • MRI
  • ultrasound
58
Q

treatment for hydrocephalus

meds another card

A
  • ventriculoperitoneal shunt (VP): drains into temporary device - external ventricular drain (EVD) by gravity
  • endoscopic third ventriculostomy: scope to create small hole in the floor of the third ventricle, hole allows CSF to flow into the subarachnoid space where it is reabsorbed naturally
59
Q

what is important to watch for after VP shunt

A
  • mechanical obstructions of shunt
  • infection: sepsis, wound infection, meningitis (first couple of months)
  • abx
60
Q

medications for hydrocephalus/increased ICP

A
  • seizures: phenytoin
  • diuretics: mannitol
  • swelling: dexamethasone, phenobarbital (sedation vacation, allow brain to rest)
61
Q

what is crucial to monitor before and after sx from hydrocephalus

A

head circumference

62
Q

what are nursing interventions for increased ICP for hydrocephalus

A
  • I: immobilize head “C-spine”
  • C: CO2 low (dilates vessels)
  • P: flat first -> positioning 30-35 degrees of higher,
    no flexion & bending of extremities
    no sneezing, coughing, blowing nose
    no valsalva maneuvers

hyperventilate (increase RR) pts to lower ICP

63
Q

At what GCS score do you intube, what is considered good or bad score

A
  • score ranges from 3-15
  • 3: lowest score, 15: highest score
  • less than 8 we intubate

any decrease in score should be reported

64
Q

what is spina bifida

A
  • infant’s spinal cord fails to develop properly
  • neural tubes fail to fuse
  • failure in formation of the vertebral neural archs
65
Q

what are the 2 types of spina bifida

A
  1. spina bifida occulta: not visible
  2. spina bifida cystica: sac protrusion
    types: meningocele, myelomeningocele
66
Q

what is meningocele vs. myelomeningocele

A
  • meningocele: meninges & spinal fluid
  • myelomeningocele: meninges, spinal fluid, and nerves
67
Q

s/s of spina bifida occulta

A
  1. small tuft of hair at the base of the spine
  2. saccral dimple or nevus birthmark
68
Q

what are s/s of spina bifida

A
  • sensory deficits
  • neuro-muscular deficits: bowel/bladder function, paralysis
  • extreme: vital changes
69
Q

nursing actions for myelomeningocele pre-op

A
  • cover area with moist sterile dressing
  • use aseptic technique
  • prone position
  • I/Os
  • neuro/motor assessments

reduce change of infection and damage to nerves, leakage of CSF

70
Q

diagnostics for spina bifida

A
  • amniocentesis: alpha-fetoprotein (AFP) test
  • MRI/CT, ultrasound
71
Q

risk factors for spina bifida

A
  • maternal malnutrition: vitamin B-9 deficits (folic acid)
  • genetics
  • radiation
  • anti-seizure meds: valproic acid, carbamazepine
72
Q

treatment for spina bifida

A
  • prenatal sx: reduces risk of further nerve damage; can lead to premature birth
  • sx first 72hrs of life: close sac
73
Q

what are good sources of folic acid for mothers

A
  • green leafy vegetables
  • black beans & rice
  • peanut butter
  • fortified cereals
  • enriched bread
74
Q

what is cerebral palsy

A
  • permanent disorder of movement due to abnormal brain development
  • random muscle spasms
75
Q

what are the effects of random muscle spasms from cerebral palsy

A
  • stiff muscle tones
  • tremors
  • involuntary motions with abnormal posturing
  • lack of coordination
  • difficulty speaking, talking, swallowing
  • seizures, different cognitive function
  • change in hearing/vision
76
Q

what are early warning signs of cerebral palsy in infant/children

A
  • no head control over 6 months old
  • rigid muscles
  • positive babinski sign (big toe up, other toes fan out) over 2 years old
77
Q

management of cerebral palsy

A
  • PT, braces, wheelchair, helmets
  • speech therapy
  • nutrition support
  • seizure, spasm med
  • ortho surgery
78
Q

meds for cerebral palsy

A
  • baclofen

NURS254 Peds (6 decks)

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