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Sophomore 1 Test 6 > Neuro > Flashcards

Neuro Flashcards

1
Q

Categories of Neurologic Disorders

A
  1. Structural
  2. Seizure
  3. Infectious
  4. Trauma
  5. Blood Flow
  6. Chronic
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2
Q

When does the brain and spinal cord develop from the neural tube?

A

3-4 weeks gestation

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3
Q

What is myelinization?

A

The formation of myelin, which covers and protects the nerves. In pediatrics, this formation is incomplete. The speed and accuracy of nerve impulses increases as myelinization increases. The process accounts for the acquisition of fine and gross motor movements and coordination.

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4
Q

In which direction does myelinization occur?

A

Myelinization proceeds in the cephalocaudal direction. For example, infants are able to control the head and neck before the trunk and extremities.

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5
Q

Deep tendon reflexes in the newborn

A

Are present at birth and are initially brisk and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality.

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6
Q

What is included in the neurological physical exam?

A
  1. LOC
  2. Vital signs
  3. Head, face, neck
  4. Cranial nerves
  5. Motor function
  6. Reflexes
  7. Sensory function
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7
Q

Level of Consciousness

A
  1. Full consciousness
  2. Confusion
  3. Obtunded (dulled to sensitivity)
  4. Stupor (state of near unconsciousness or insensibility)
  5. Coma
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8
Q

What can VS tell you during the neuro assesment?

A
  1. Can explain causes for altered LOC
  2. Tells you if oxygenation and circulation are adequate
    * * If there is a decrease in BP and O2 sat and an increased RR = problem
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9
Q

What is included in the neuro assessment of the head, face, and neck?

A
  1. Palpation of fontanels
  2. Inspect size/shape of head and facial symmetry
  3. Assess ROM of neck
  4. Measure head circumference
  5. Alternations in eye movements
  6. Sunsetting sign of increased ICP
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10
Q

Horizontal nystagmus

A

May indicate lesion in brainstem (or certain meds)

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11
Q

Vertical nystagmus

A

Indicates brainstem dysfunction

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12
Q

Pinpoint pupil size

A

Commonly observed in poisonings, brain stem dysfunction, and opiate use

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13
Q

Dilated but reactive pupils

A

Seen after seizures

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14
Q

Fixed and dilated pupils

A

Associated with brainstem herniation secondary to increased ICP

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15
Q

One dilated but reactive pupil

A

Associated with intracranial mass

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16
Q

What is included in the neuro assessment of motor response?

A
  1. Assess bilaterally
  2. Observe spontaneous activity and resting posture
  3. Examine for decorticate or decerebrate posturing
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17
Q

Decorticate posturing

A

Posturing in which there is rigid flexion of arms and extension of legs
- Indicates cerebral cortex damage

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18
Q

Decerebrate posturing

A

Posturing in which there is rigid extension and pronation of arms and legs
- Indicates brainstem damage

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19
Q

What is the Moro reflex?

A

To elicit this reflex, place the newborn on his or her back. Support the upper body weight of the supine newborn by the arms, using a lifting motion, without lifting the newborn off the surface. Then release the arms suddenly. The newborn willthrow the arms outward and flex the knees; the arms then return to the chest. The fingers also spread to form a C. The newborn initially appears startled and then relaxes to a normal resting position

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20
Q

When does the Moro reflex disappear?

A

Around 4 months

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21
Q

Tonic neck reflex

A

Test this reflex by having the newborn lie on the back. Turn the baby’s head to one side. The arm toward which the baby is facing should extend straight away from the body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly.

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22
Q

When does the tonic neck reflex disappear?

A

Around 4 months

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23
Q

Withdrawal/Babinski reflex

A

TheBabinski reflexshould be present at birth and disappears at approximately 1 year of age. It is elicited by stroking the lateral sole of the newborn’s foot from the heel toward and across the ball of the foot. The toes should fan out.

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24
Q

When does the withdrawal/babinski reflex disappear?

A

Disappears around 12 months

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25
Q

Laboratory and Diagnostic Testing in the Neuro Assessment

A
  1. Lumbar puncture
  2. Xrays of head/neck
  3. Cerebral angiography
  4. Ultrasound
  5. CT
  6. MRI
  7. EEG
  8. PET
  9. ICP monitoring
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26
Q

Lumbar Puncture

A
  1. Nurse assist with positioning (fetal or sitting for infant)
  2. Sedation as needed
  3. Topical anesthetic 1 hour before
  4. Space L3-L4 subarachnoid space
  5. Post-procedure care:
    - Lie flat for 30 minutes to an hour post procedure
    - Increase fluid intake for 24 hours after the procedure to decrease incidence of headache
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27
Q

Causes of ICP

A
  1. Traumatic head injury
  2. Hypoxemia (near drowning)
  3. Bleeding in brain
  4. Congenital or acquired defect (hydrocephaly)
  5. Infection (meningitis)
  6. Tumors or cysts
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28
Q

S/Sx of increased ICP in infants

A
  1. Poor feeding or vomiting (sucking increases ICP)
  2. Irritability or restlessness
  3. Lethargy
  4. High-pitched cry
  5. Tense bulging fontanels
  6. Increasing head circumference
  7. Separation of cranial sutures - may separate up to five years of age
  8. Seizures
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29
Q

S/Sx of increased ICP in children

A
  1. Severe headache
  2. Vomiting
  3. Change in LOC
  4. Confusion
  5. Sluggish pupils (or unequal or blown)
  6. Diplopia (double vision)
  7. Papilledema
  8. Changes in VS
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30
Q

Treatment for ICP

A
  1. Elevate HOB!!!
  2. Steroids
  3. Osmotic diuretics
  4. Keep oxygenated
  5. Keep head in midline
  6. Prevent straining
  7. Fluid restriction
  8. Skin care
  9. No sedatives or opioids
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31
Q

What is the purpose of giving steroids to a patient with increased ICP?

A

It decreases inflammation

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32
Q

What osmotic diuretic is given to patients with increased ICP?

A

Mannitol

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33
Q

How do you prevent a patient with increased ICP from straining?

A

Give stool softeners

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34
Q

What is a MAJOR complication of increased ICP?

A

Cushing’s Triad

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35
Q

What is Cushing’s triad?

A
  1. Widening pulse pressure (increasing systolic pressure)
  2. Bradycardia
  3. Respiratory changes
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36
Q

Diagnostic testing for epilepsy

A
  1. Blood work
  2. LP
  3. CT/MRI
  4. EEG
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37
Q

Why would blood work be done if epilepsy is suspected?

A

Blood work is done to rule out metabolic causes such as hypoglycemia and hypocalcemia

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38
Q

Why would a LP be done if epilepsy is suspected?

A

To analyze CSF to rule out meningitis or encephalitis

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39
Q

Why would a CT/MRI be done if epilepsy is suspected?

A

To identify abnormalities and intracranial bleeds and rule out tumors

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40
Q

Why would an EEG be done if epilepsy is suspected?

A

EEG findings may be noted with certain seizure types, but a normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. EEGs are useful in evaluating seizure type and assisting in medication selection. They can be useful in differentiating seizures from nonepileptic activity

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41
Q

If you observe seizure activity directly, a thorough description of the event is needed. What should be included in this description?

A
  1. Time of onset and length of seizure activity
  2. Changes in crying, facial expression, motor abilities, or sensory alterations before the seizure that may indicate an aura
  3. Precipitating factors such as fever, anxiety, just walking, or eating
  4. Description of movements and any progression
  5. Description of respiratory effort/apnea
  6. Changes in color
  7. Position of mouth, any injury to mouth or tongue, inability to swallow, or excessive salivation
  8. Loss of bladder or bowel control
  9. State of consciousness during and after seizure
  10. Duration of postictal state
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42
Q

General Epilepsy Treatment

A
  1. Aimed at controlling and reducing frequency
  2. Anticonvulsants
  3. Surgical intervention
  4. Family support and education
  5. Teach on care for seizing child
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43
Q

Surgical Intervention for Epilepsy

A

Depending on the area of the brain that is affected, it may be possible to remove the area that is responsible for the seizure activity or to interrupt the impulses from spreading, and therefore stop or reduce the seizures.

44
Q

Educate parent of seizure patient to call EMS if:

A
  1. The child stops breathing
  2. Any injury has occurred
  3. Seizure lasts for more than 5 minutes
  4. This is the child’s first seizure
  5. Child is unresponsive to painful stimuli after seizure
45
Q

Status Epilepticus

A

Medical EMERGENCY

  1. Treat with diazepam or lorazepam
    • Dilute only with normal saline
    • Give in port closest to vein
  2. Follow up with continuous IV infusion of phenytoin or fosphenytoin
46
Q

Febrile Seizures

A
  1. Most common type in childhood
  2. Associated with fever usually related to a viral illness
  3. Need to make sure not due to infectious disease
  4. Usually seen in kids 6 months - 5 years old
47
Q

Neonatal Seizures

A
  1. Within first 4 weeks of life
  2. High age range for seizures due to immaturity of brain
  3. Can be due to metabolic causes (hypoglycemia or hypocalcemia), hemorrhage, hypoxic encephalopathy
    * * Phenobarbitol usually prescribed (dosage will look high)
    * * Increased risk of damage to the brain tissue
48
Q

Specific Nursing Care During a Seizure

A
  1. Maintain airway
  2. Place on side
  3. Protect from injury but don’t restrain
  4. Do NOT use tongue blade
  5. Suction set up and pulse ox
49
Q

Occulta

A

** Neural tube defect

Defect of the vertebral bodies without protrusion of spinal cord or meninges

50
Q

Meningocele

A

** Neural tube defect

Meninges herniate through a defect in the vertebra (less serious); spinal cord usually normal

51
Q

Myelomeningocele

A

** Neural tube defect

Spinal cord ends at defect - results in absent sensory and motor function

52
Q

Anencephaly

A

** Neural tube defect
Missing brain hemispheres, skull, and scalp
- Obvious and distinctive appearance

53
Q

Encephalocele

A

** Neural tube defect

Protrusion of brain and meninges through a skull defect

54
Q

Nursing Management of Anencephaly

A
  1. Supportive for family

2. Comfort measures

55
Q

Encephalocele Prognosis

A

Prognosis depends on size, location, and extent of cognitive defects

56
Q

Nursing Management of Encephalocele

A
  1. Supportive and symptomatic
  2. Pre and Post Op care (preventing rupture of sac, preventing infection, and providing adequate nutrition and hydration)
    * * Monitor for s/sx of increased ICP and head circumference
57
Q

Arnold Chiari Malformation

A

Usually associated with hydrocephalus and myelomeningocele. The deformity results from the cerebellum, the medulla oblongata, and the fourth ventricle displacing into the cervical canal, resulting in an obstruction of the CSF can causing hydrocephalus.

58
Q

Arnold Chiari Prognosis

A

Depends on the extent of the defect

59
Q

Arnold Chiari Treatment

A

Surgical decompression

60
Q

Hydrocephalus

A
  • Imbalance in production and absorption of CSF
  • Accumulates in ventricles
  • Congenital or acquired
  • Obstructive or non-obstructive
61
Q

Hydrocephalus Prognosis

A

Prognosis depends on the cause and if brain damage has occurred

62
Q

Obstructive Hydrocephalus

A

Occurs when the flow of CSF is blocked within the ventricular system

  • More common than non-obstructive
  • Also called noncommunicating hydrocephalus
    • Causes: Chiari, encephalocele, trauma, tumor, infection
63
Q

Non-obstructive Hydrocephalus

A

Occurs when the flow of CSF is blocked after it exits from the ventricles
** Causes: subarachnoid hemorrage

64
Q

Nursing Management for Hydrocephalus

A
  1. Monitor vital signs
  2. Monitor neurological status
  3. Check perfusion (capillary refill, pulse ox)
  4. Intake and output
  5. Head circumference and fontanels in infants
65
Q

Treatment for Hydrocephalus

A

Ventriculoperitoneal shunt

66
Q

Post-Operative Care for Hydrocephalus

A
  1. Position off shunt
  2. Frequent vital signs
  3. Daily head circumference
  4. Monitor fontanels
  5. Watch for signs of ICP
  6. Watch for infection
  7. Antibiotics as ordered
  8. Educate parents
67
Q

S/Sx of shunt infection

A
  1. Elevated VS
  2. Poor feeding
  3. Vomiting
  4. Decreased responsiveness
  5. Seizure activity
  6. Signs of local inflammation along the shunt tract
68
Q

S/Sx of shunt malfunction

A
  1. Vomiting
  2. Drowsiness
  3. Headache
    * * S/sx of increased ICP can also be indicative of shunt complications
69
Q

Craniosynostosis

A

Craniosynostosis is a birth defect in which one or more of the fibrous joints between the bones of your baby’s skull (cranial sutures) close prematurely (fuse), before your baby’s brain is fully formed. Brain growth continues, giving the head a misshapen appearance.

70
Q

Streptococcus pneumoniae

A
  1. Causes 95% of meningitis cases
  2. Commonly follows otitis media
  3. Can be prevented with vaccines
    • Pneumovax protects against 23 strains
    • Prevnar used in ages under 5 years
71
Q

Neisseria meningitidis

A
  1. May kill within 12 hours
  2. Petechial rash is identifying finding
  3. Can cause loss of limbs
72
Q

Neisseria meningitis vaccine

A
  1. Menomune

2. Menatra

73
Q

S/Sx of Meningitis

A
  1. Fever/chills
  2. Changing LOC
  3. Seizures
  4. Irritability
  5. Lethargy
  6. Emesis
  7. Severe headache
  8. Photophobia
  9. Opisthotonic position
  10. Poor feeding
  11. N/V
  12. Nuchal rigidity in older children
74
Q

Kernig Sign

A

Is tested by flexing legs at the hip and knee, then extending the knee. A positive report of pain along the vertebral column and/or inability to extend knee is a positive sign and indicates irritation of the meninges

75
Q

Brudzinski Sign

A

Is tested by the child lying supine with the neck flexed. A positive sign occurs if resistance or pain is met. The child may also passively flex hip and knees in reaction, indicating meningeal irritation.

76
Q

Meningitis CSF Results

A
  1. Increased WBCs from infection
  2. Decreased glucose
  3. Increased protein
  4. Bacteria grows from culture
  5. Fluid is cloudy
  6. Pressure is elevated
77
Q

Nursing Management for Meningitis

A
  1. Antibiotics ASAP (after culture obtained)
  2. Droplet precautions for 24 hours on abx
  3. Corticosteroids
  4. Osmotherapy
  5. Fluid restriction PRN
  6. Anticonvulsants PRN
  7. Non-opioid analgesics
  8. Antipyretics
  9. Dark room PRN
  10. Quiet non-stimulating environment
78
Q

Osmotherapy for Meningitis

A
  1. Hypertonic IV fluids

2. Diuretics

79
Q

Complications of Meningitis

A
  1. SIADH (low sodium, high urine specific gravity)
  2. Brain damage (mental retardation or cerebral palsy)
  3. Blindness
  4. Deafness
  5. Hydrocephalus
  6. Waterhouse-Friderichsen Syndrome
  7. Sepsis/Death
80
Q

Waterhouse-Friderichsen Syndrome

A

Bleeding into the adrenal glands, caused by severe bacterial infection
- DIC

81
Q

Encephalitis

A

Inflammation of the brain

- Can be bacterial, viral, fungal

82
Q

The S/Sx of Encephalitis are similar to what other disease?

A

Symptoms are similar to meningitis but may be milder

83
Q

Encephalitis Diagnostics

A
  1. CSF may show increased protein and WBC with normal glucose
  2. MRI may be done
84
Q

What is Coup-Countrecoup?

A

When a child’s head hits an object so hard that the front of their skull fractures (coup)

  • Countrecoup (back of the skull fracture)
  • Coup-Countrecoup (both front and back)
    • Seen in babies that have been shaken and MVAs
85
Q

Raccoon Eyes

A

Indicative of a basal skull fracture

86
Q

Battle’s Sign

A

Is an indication of fracture of posterior cranial fossa of the skull

87
Q

Subdural Hematoma

A

Bleeding between the dura and the brain

  • Most common in children under 2
  • Symptoms may take 3-20 days to manifest
88
Q

Epidural Hematoma

A

Bleeding between the dura and the skull

- Rare in children

89
Q

Spina Bifida Occulta Nursing Management

A
  • Usually causes no defects so no immediate intervention is required
  • Management is usually aimed at education
90
Q

Meningocele Nursing Management

A
  • Keep the sac intact
  • Pre and post op care
  • Monitor neuro function and for complications if lesion increasing
91
Q

Myelomeningocele Nursing Management

A
  1. Prevent infection/KEEP CLEAN
  2. Protect sac until surgical intervention
  3. Prone positioning
  4. Attention to urinary/bowel elimination
  5. Promote adequate nutrition
  6. Avoid exposure to latex product to reduce risk of developing allergy
  7. Education
92
Q

Complications of Myelomeningocele

A
  1. Neurogenic bladder

2. Largely associated with hydrocephalus and type 2 Chiari defect in 80% of cases

93
Q

Muscular Dystrophy

A

Refers to a group of inherited conditions that result in progressive muscle weakness and wasting

  • Duchenne is most common type
  • Can see contractures, lordosis, and kyphosis
94
Q

The Gower Sign

A

Muscular Dystrophy

First the child must roll onto his hands and knees. Then he must bear weight my using his hands to support some of his weight, while raising his posterior. The boy then uses his hands to “walk” up his legs to assume an upright position.

95
Q

Muscular Dystrophy Nursing Management

A

Aimed at promoting mobility, maintaining cardiopulmonary function, preventing complications, and maximizing quality of life.

96
Q

Cerebral Palsy (CP)

A
  • Nonprogressive motor disorder of the CNS resulting in alteration in movement and posture
  • Alteration in voluntary muscular control is related to cerebral insult
97
Q

How is Cerebral Palsy (CP) Classified?

A

Classified by type of movement disturbance

  • Spastic
  • Athetoid
  • Ataxic
  • Rigid
  • Mixed
98
Q

Spastic CP

A

Most common type

  • Scissor gait
  • Toe walking
  • Jerky
  • Tense muscles
99
Q

Dyskinetic (athetoid) CP

A
  • Slow writhing uncontrolled movements

- Spasms

100
Q

Ataxic CP

A
  • Loss of coordination
  • Trouble with balance
  • “Clumsy”
101
Q

Nursing Management of Cerebral Palsy

A

Takes a “village” to take care of these patients

  • PT, OT, speech therapy, dietician, orthopedic, neuro
  • Medications: Baclofen
  • Surgery
  • Promote: mobility, nutrition, support, education
102
Q

Baclofen

A

Administered for cerebral palsy to manage spaticity

103
Q

When does the anterior fontanel close?

A

12-18 months

104
Q

When does the posterior fontanel close?

A

By 2 months

105
Q

Monroe-Kellie Hypothesis

A

The pressure-volume relationship between ICP, volume of CSF, blood, and brain tissue. When one of these increases in volume, the others must compensate by decreasing in volume (except brain tissue) up to 100 mL

106
Q

Ketogenic Diet

A

Believed to help with seizure control by inducing ketosis

- High protein, low carbohydrate

Sophomore 1 Test 6 (4 decks)

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