Neuro Flashcards
Excess production, impaired absorption or block in the flow of the CSF that results in an excess amount of CSF w/in the cerebral ventricles
Hydrocephalus
Increased intracranial pressure vs shock
SHOCK: ^P, decr. BP
IIP: ^BP, decr. P
Hydrocephalus tx
VP shunts
VA shunts (to L atrium)
EVD
VP Shunts
Placed asap to prevent further damage
Revised due to growth
Can get infected and need to be externalized= EVD
NTD w/protrusion of meninges, CSF and spinal cord
Myelomeningocele
Cause of Myelomeningocele
Low folic acid intake= vitamin B12 deficiency
Myelomeningocele sx
Lower extremities may be partially or totally paralyzed Bowel/bladder problems Orthopedic problems If high, may have resp. distress Loss of sensation below level of lesion Hydrocephalus
Myelomeningocele diagnosis
Prenatal U.S.
Amniocentesis shows ^ AFP
Myelomeningocele tx
Surgery
Myelomeningocele positioning pre op
Prone, to keep stool/urine away from lesion
4 point restrain= Bradford Frame
Myelomeningocele mgmt
Family support Prevent infection Assess for hydrocephalus** Teach how to straight cath/May Crede Bowel program/high fiber/suppositories
Feeding in the prone position
Difficult
Inflammation of meninges
Meningitis
Is Meningitis bacterial or viral?
Can be both
Cause of Meningitis
Infection (otitis, sinusitis, cellulitis, pneumonia)
Penetrating trauma
Nero intervention
How does Meningitis occur?
Bacteria enter bl. supply-> disseminated thru body->into CSF and spread thru subarachnoid space-> inflammatory response->WBC cover brain->brain is edematous-> II
Meningitis sx
Fever Feeding alterations Bulging anterior fontanels Seizures N/V Photophobia Opisthotonic pos. Nuchal rigidity HA
If a rash is present w/Meningitis, what could this be?
Meningococcemia
Positive Kernigs sign
Have child lie supine w/ hips flexed. If Kernigs sign is present, child will resist having legs extended
Brudzinski’s sign
The child should be supine. If there is meningeal irritation, when the child’s head is flexed forward, the child will flex hips and knees
Meningitis diagnosis
Hx Contact w/ sick ind. Rash Sz. Fever Behavior changes Labs Lumbar puncture
Meningitis labs
CBC
Culture of CSF
Serum el./ Osmo (hydration and clotting)
CSF levels
50 mm for non crying baby
85 mm for child
> 180 mm = meningitis
> 100 WBC = meningitis
CSF sx
Cloudy
Glucose is decr. / protein ^
CSF diagnosis
Urine culture
Meningitis tx
Cardioresp. monitor O2 Shock= fl. and drug support Antibiotics Steroids
Meningitis mgmt
Isolation; for 24 hr p antibiotics have been started Asses neuro status freq. Adm. antibiotics Keep child comfortable/ env. dark Maintain temp.
Life threatening encephalopathy w/accompanying microvascular fatty deposits in the liver and kidney
Reyes
Causes of Reyes
ASA
Influenza
Chicken pox
What does Reyes lead to?
Enlarged liver Depleted glucose stores Enzyme reduction (convert ammonia to urea) Changes in liver enzymes Cerebral edema w/IIP
Reyes liver enzymes
SGOT (AST) SGPT (ALT) LDH Serum ammonia Decr. PT
Reyes sx
Of a mild infection Vomiting Behavior changes Decr. LOC Comatose-> death w/in 2-3 days of sx
Reyes diagnosis
CBC Chemistries CSF Clotting times Bun Bl. gases Amylase Liver fctn studies Liver biopsy Urinalysis
Reyes tx
ICU
Paralyzed= vent.
Sz. tx
Indwelling cath.
Reyes mgmt
Monitor vitals, neuro
Family support
