Neuro

Question 1

structural differences

Answer 1

larger heads, mobile spines, fontanelles fuse after brain growth slows, skull thickness increases with age, skull pliability decreases with age, vascular brain. develops rapidly in toddler years

Question 2

types of reflexes

Answer 2

step- 4-8whs, rooting- 3mo, suck- 2-5mo, moro and tonic neck- 4mo, palmar grasp- 4-6mo, plantar grasp- 9mo, babinski- 12mo

Question 3

neuro assessment

Answer 3

hx, observation of LOC, social interactions, cranial nerve function, motor function, tracking objects, VS, reflexes, sensory.

Question 4

nursing interventions for all

Answer 4

airway, oxygenation, hydration, nutrition, safety, skin integrity, neuro function, prevent infection, pain mx

Question 5

craniosynostosis

Answer 5

premature closure of cranial sutures, abnormal shape of skull. r/f genetics, AMA, male, teratogen exposure during pregnancy. either simple 1 suture or complex multiple sutures. sx increased ICP and head malformation. tx with surgery before 6mo and helmet after

Question 6

positional plagiocephaly

Answer 6

asymmetry and flattening of head from external forces. increased with back to sleep campaign. r/f are preterm, multiple gestation, low activity, torticollis. <right occiput can affect depth perception. tx with frequent positioning and helmet

Question 7

spina bifida

Answer 7

neural tube defect. occulta- malformation of vertebrae and absence of bone, see tuft of hair or dimple. mengigocele- pouch cyst containing meninges, may have neuro or musculoskeletal deficits. myelomeningocele- pouch sac containing meninges and spinal cord nerves, more severe deficits like hydrocephalus and paralysis.

Question 8

myelomeningocele mx

Answer 8

protect pouch with non adherent dressing and sterile, baby in prone position, hips flexed and abducted, open diaper, manage I&O/temp/nutrition/infection control, latex free sign, encourage parent bonding, pain mx. may require shunting for hydrocephalus, risk of uti, orthotics, promote growth and development

Question 9

encephalocele

Answer 9

neural tube defect, skull doesnt completely fuse at base of neck or face. brain is malformed with complete development, brain protrudes thru opening. often see hydrocephalus, neuro deficits, delays, vision problems, seizures.

Question 10

encephalocele tx

Answer 10

surgery to replace brain back into skull, wont correct neuro deficits. protect protrusion, neuro assessments, ICP monitoring, reflexes, seizure activity.

Question 11

anencephaly

Answer 11

neural tube defect where brain and skull dont form correctly, functional brainstem only no brain matter, most are fatal and need comfort measures.

Question 12

microcephaly

Answer 12

abnormally small head, primary is genetic and chromosomal, secondary is exposure during fetal development to radiation/infection/etoh. wide range of cognitive impairment, head circ >3 standard deviations below mean. no cure just supportive care

Question 13

hydrocephalus

Answer 13

buildup of csf in brain usually in ventricles. from increased csf production, decreased absorption, or flow obstruction.

Question 14

hydrocephalus sx

Answer 14

increased intracranial pressure, dilated scalp veins, bulging anterior fontanel, large head, sun setting eyes, apnea, irritability, ha, vomiting.

Question 15

hydrocephalus tx

Answer 15

ventriculoperitoneal shunt, prevent infection, monitor for patency by sx improving, may need replacement through lifetime.

Question 16

headaches

Answer 16

acute or chronic and mild to severe. rule out serious conditions like tumors, infections, increased ICP.

Question 17

ha sx

Answer 17

irritability, lethargy, head holding or banging, sensitivity to sound or light. red flags are progress in severity or frequency, awakes from sleep, worse upon arising, N/V, changes in gait, made worse by valsalva maneuver

Question 18

ha tx

Answer 18

relaxation, otc rx, migraines take triptans/antiemetics/analgesics, ha journal to find triggers (foods, related to hormones, weather, change in routine, stress, activity, sensory triggers)

Question 19

head injury

Answer 19

trauma resulting in injury to scalp, skull, brain, or blood vessels. primary from force and secondary from injury. accidental or nonaccidental. causes are falls, sports, mvc, abuse, infants at risk cause large head.

Question 20

head injury sx

Answer 20

ha, confussion, dizzy, vision change, lethargy, decreased loc, pupil change, sun setting eyes, retinal hemorrhage, raccoon eyes, gait change, seizure

Question 21

head injury tx

Answer 21

stabilize c spine, maintain airway, gsc score, avpu, observe posturing, monitor icp and map, monitor for hemorrhage.

Question 22

pediatric stroke

Answer 22

perinatal stroke is last few months of pregnancy to 1mo, childhood stroke is 1mo-18yr. similar mx to adult, nutrition and hydration.

Question 23

perinatal stroke

Answer 23

cause unknown. r/f congenital heart disease, placenta disorder, blood clot disorder, infections. sx are repetitive motions, twitching, apnea with staring, decreased mvmt, weakness on one side, hand preference before 1yr.

Question 24

childhood stroke

Answer 24

r/f are congenital heart disease, disease affecting brains arteries, infections, head trauma, sickle cell, autoimmune. sx are FAST, sudden ha, vomiting sleepy, weakness, numbness on one side, difficulty speaking, vision loss, dizzy. dont delay with tx

Question 25

neural fibral metosis

Answer 25

genetic, chromosomal, causes benign tumors to grow under skin and within eyes. associated with bone conditions, increased bp, learning difficulties, seizures. sx are lisch nodules in eyes, lumps on skin, cafe au lait spots, and skin fold freckles.

Question 26

neural fibral metosis mx

Answer 26

skin assessment, seizure mgmt, no tx,

Question 27

meningitis

Answer 27

infection of meninges, occurs any age,

Question 28

meningitis sx

Answer 28

fever, ha, irritable, nuchal rigity, photophobia, poor feeding, bulging fontanels, high pitch cry, rash, seizures, opisthotomos

Question 29

dx of meningitis

Answer 29

lumbar punct (cloudy, decreased glucose, positive gram stain is bacterial. clear, normal glucose and negative gram is viral), kernigs lay flat and bend hip and positive will have pain in body, brudzinskis lay flat and bend neck in and knees will bend up if positive

Question 30

meningitis tx

Answer 30

bacterial needs isolation, droplet precaution, abx. viral is self limiting and less severe. manage icp and monitor neuro status

Question 31

encephalitis

Answer 31

inflammation of brain tissue. from virus, toxins, bacteria, parasites, usually vector borne viruses. dx with lumbar punct and MRI

Question 32

sx of encephalitis

Answer 32

fever, ha, photophobia, altered loc, lethargy, drowsy, weak, seizures

Question 33

tx of encephalitis

Answer 33

seizure precaution, antiviral therapy, prevent with vaccines, mosquito and tick bite prevention.

Question 34

reyes syndrome

Answer 34

viral illness plus aspirin leads to mitochondrial damage then toxins released lead to increased ammonia and acute noninfla encephalitis and fatty degenerative liver failure.

Question 35

reyes sx

Answer 35

neuro changes, vomiting, drowsy, steatosis of liver, hypoglycemia, hepatomegaly, infection, coma, encephalopathy.

Question 36

tx of reyes

Answer 36

poor prognosis more severe the sx are, decrease ammonia levels like low protein and electrolytes/corticosteroids/diuretics.

Question 37

seizure disorders

Answer 37

electrical disturbance in brain. classified by location, severity, sx, frequency, duration, etiology. causes motor, sensory and cognitive changes.

Question 38

focal seizure

Answer 38

originates in one part or hemisphere of brain. aware vs impaired awareness. motor is clonic, tonic, atonic, myoclonic, lip smacking, stiff on one side. non motor is auditory/visual disturbance, tingling, anxiety, anger.

Question 39

generalized seizure

Answer 39

involves both hemispheres, usually impaired awareness. motor is tonic clonic, atonic, myoclonic. non motor is absence (behavior arrest), localized twitching

Question 40

epilepsy

Answer 40

recurrent unprovoked seizures, resolved if no seizure for >10yrs or off antiepileptics for >5yrs. dx with two unprovoked seizures more than 24hr apart, one unprovoked seizure with high probability of repetition, epileptic syndrome present.

Question 41

epilepsy tx

Answer 41

use vagal nerve stimulator, medications, safety interventions for during seizure.

Question 42

status epilepticus

Answer 42

emergency, seizure >5min or series without recovery in between. convulsive or nonconvulsive based on mvmt.

Question 43

timing during status epilepticus seizure

Answer 43

onset to 5 min- ABC's with cardio rr monitor, safety, IV access, blood glucose, benzodiazepine 5min- give one benzo (lorazepam, midazolam, diazepam) 10-15min- first dose of antiseizure rx (fosphenytoin, valproate, levetiracetam), eeg >15min- mechanical ventilation, transport to picu

Question 44

febrile seizure

Answer 44

acute seizure triggered by high fever in kids <7yrs, body temp >101.2, may develop epilepsy. eeg for dx. self limiting

Question 45

tx for seizure disorders

Answer 45

monotherapy preferred antiepileptic rx, consistency with rx, caregiver education on safety, medical alert bracelet, update school

Question 46

conjunctivits

Answer 46

pink eye, infla of conjunctiva, bacterial, viral, allergic.

Question 47

conjunctivits sx

Answer 47

redness of conjunctiva, itching, crusting of eyelids, purulent drainage bacterial, watery drainage viral

Question 48

conjunctivitis tx

Answer 48

highly contagious, cold or warm compress, clean eye from inner canthus out, abx, return to school when sx stop

Question 49

visual impairment

Answer 49

causes are genetic, infection, disorders. do vision screening, snellen, picture, tumbling E, peripheral vision, opthalmoscopic exam, misalignment testing with cover test or corneal light reflex, color vision screen with ishihara test.

Question 50

common visual impairment

Answer 50

myopia- nearsighted, see close objects hyperopia- farsight, see far astigmatism- curved cornea or lens, all distance blurry and star lights strabismus- cross eye

Question 51

otitis media

Answer 51

causes are anatomy, short eustachian tube with horizontal positioning, cant blow nose, drinking while laying flat, bacterial or viral spread from rr infection.

Question 52

sx otitis media

Answer 52

fever, ear pain, pulling at ear, fussy, crying when laying down, poor feeding, fluid drainage, opaque tympanic membrane, lympadenopathy.

Question 53

otitis media tx

Answer 53

analgesics, heat or cold packs, abx, ear plugs when swimming, pressure equalizing tubes

Question 54

hearing deficits

Answer 54

genetic, aquired, or unknown cause. suspected if absent startle reflex or no turn to noise at 6mo. will have speech delays or appear inattentive. needs hearing screenings.