Neuro Flashcards
What are DSM-5 criteria pieces of autism spectrum disorder?
What is a concern we have for safety with autism?
Lack of social skills
Repetitive behaviors
Interested in specific things only
Autistic individuals may try to self harm themselves due to impulsive behaviors
What are the core deficits in autism
Does everyone have the same level of deficits?
Deficits in:
social interaction
communication
behavior
No. Autism is on a spectrum. Some can be very high functioning. Others can have very severe deficits.
Which gender has more autism diagnosis?
How common is autism?
Males 4:1 ratio
1 in 68 kids will have it so pretty common
What is the patho of autism spectrum disorder? And how do we know?
Autosomal recessive inheritance.
We know this bc of twin studies.
- identical twins will both have autism
- fraternal twins hav no guarantee
When is autism usually diagnosed?
Around 2 years old so more delayed in diagnosis.
- higher functioning kids may take longer
You meet an autistic child. They don’t even look at you. Is this because they feel the need to be rude to you
No. They do not like eye contact.
They also have an inability to read social cues so they may not even know this is rude or that they’re supposed to look at you.
Physical symptom that is common with autism?
Constipation
- they can develop megacolon from dilation
How do autistic children eat?
Do they want you to hug them right away?
They are picky due to their sensory irritability.
No they do not like touch due to senses.
How do autistic kids respond to loud noise?
Those with autism do not like loud noises.
What should the family of an autistic child be educated on
Educate them on the need for routine.
Also not to fight them on what to eat.
Will early intervention for autism be a fix?
No. It may be helpful but this won’t just go away.
What two characteristics are found in ADHD?
Do they all have to be present?
Inattention
Hyperactivity w Impulsiveness
But you can have one or both.
What chemical imbalance drives adhd?
What other issue can be the driving force?
Imbalance of serotonin, norepinephrine, and dopamine.
Brain structure issue
When is adhd often diagnosed?
What is the tendency of the trait?
School age or when they begin to learn
Is familial so runs in families.
What do adhd pet scans look like compared to normal?
They have more brain activity going in
What type of approach is needed to manage adhd?
Multidisciplinary
- parents and teachers especially
- the more people observing behavior the better the diagnosis and treatment is too
Behavioral therapy but requires consistency
Medications to address neurotransmitter issue
Types of med classes used to treat adhd
Short acting
Long acting
Amphetamines
Non-stimulants
The most effective class of meds for adhd that needs to be taken twice a day
How do kids respond to these?
Short acting stimulants
- the taking it 2x a day can be hard for kids bc they feel like it makes them weird especially since they have to go see the nurse
- ritalin, focalin, dexedrine, daytrana
Drug class you take once a day that is effective but not the best
Long acting stimulants
- ritalin LA, Focalin XR, Daytrana, Concerta, Metadate, CD, Methylin ER
Drug class for adhd that Adderall falls under
Amphetamines
Side effects of stimulant drugs or amphetamine drugs for adhd
Headache
Stomach ache and decreased appetite which leads to weight loss
Tics Insomnia Behavior rebound Increase HR/BP Dependance
- Kids may even try not to take these meds if it is a side effect they don’t like.
How should providers and families approach adhd meds?
It is ok for them to try different ones out until they find one that works.
What are two non-stimulant drug for adhd that are effective?
Which one has a BBW of suicidal ideation?
Strattera - selective noriepi reuptake inhibitor . More school aged
Guanfacine - adrenergic agonist
Straterra can have risk for suicide. Need to tell parents with young children too bc young kids can commit suicide.
A child loses weight while taking a stimulant. Is this normal?
Can it affect how they grow?
It is expected.
But you can give the meds after the child eats so they remain hungry at least in the morning.
You should be monitoring their growth chart though bc it can cause development to slow.
A child with adhd reports having stomach pain and a headache. What is your assessment?
Ask or look in chart to see if they are taking stimulants.
If so, have them take meds after they eat.
Your adolescent patient has had to refill their adderall script 2 weeks before their next refill date for adhd. What do you do?
Discuss w parents that there could be abuse going on. And then have them monitor the medication.
How late can you give a stimulant for adhd?
5 hrs before bedtime to avoid insomnia
You see a parent give their child taking adhd stimulants a can of dr pepper. What do you do?
Suggest something like sprite or with no caffeine. The stimulant + caffeine can damage the heart .
You suggest that the child may need to go to therapy for adhd. What else do you suggest pertaining to the family?
The family may need to go to therapy too since they are having to cope with an affected child.
What does inattention look like in adhd
disorganized
bored
noncompliant
What does easily frustrated look like in adhd
acting out
wanting to get what they want asap
What does hyperactivity look like in adhd
Fidgety
Talks your ear off
Doesn’t want to have to sit quietly
What does impulsivity look like in adhd
Interrupts a lot
Acts before even thinking
Nothing is confidential so they will spill your secrets
As a nurse, should you make a child with adhd go long periods without breaks
No they need lots of break in between
Who can you go to for consult in the hospital about a child with adhd
Child life specialist
If an adhd child is doing something undesirable, what should you do?
What if they do something good?
Either ignore it and don’t give them attention for it
or
Give them consequences
If they do something good then reinforce them about it and give them a reward
How should you set limits with a child with adhd
Set the limits, keep them, but also remind them of them
If a child with adhd does something impulsive, what should you teach them?
Help to teach them to see the relationship between their actions and the outcome
Scale to assess pediatric levels of consciousness?
Pediatric Glascow Coma Scale
- you want a score as close to 15 as possible. high is good
- if it is below 8, then it is abnormal
Best indicator for neurological conditions
Level of consciousness
Why might pupil reactions be altered with edema going on in the head?
If the pupils aren’t responding, this could be a sign of neurological edema. The edema puts pressure on the 3rd cranial nerve & so the pupil cannot respond.
Decorticate posture?
What does this mean?
Turned inwards to the core
Means there is an injury to the cerebral hemispheres
Decerebrate posture
What does this mean?
Turned outwards
injury to the midbrain and pons
Flaccid posture?
What does it mean?
No flexion of posture whatsoever.
Means there is an injury to the brain stem
What sign of vitals will you see with with a neurological issue from edema?
Cushings Triad
- increased systolic bp with a huge gap in between the systolic and diastolic
- slowed HR
- slowed breathing or irregular breathing like apnea
You check the head circumference of the infant. It is way bigger than what it was yesterday. What does this mean?
What if the head is smaller?
If the fontanels and sutures are closed and you are noticing changes in head size, this means there could be IOP
or Hydropcehalus or build up of fluid
If the head were smaller, it would be lack of hydration
Methods of screening to diagnose neurological conditions
Lumbar puncture CT scan Angiography Echoencephalography Electroencephlgoraphy MRI Nuclear brain scan
What is the Lumbar puncture diagnostic test
What is the nurses role when doing this diagnositc?
Obtains cerebral spinal fluid for testing
OR measures pressure in the spinal column
Nurses role is to support positioning and help them stay on their side and curved
OR
upright and curved forward (sort of like epidurals)
What does the CT scan do
It is faster thanMRI
Scans brain and spinal column
What does angiography do
Adds dye to get pictures of the vasculature
Echoencephalography does what
Gets sonogram of the head of infants
Electroencephlography does what
Looks at electrical waves of the brain to see if it is firing normally
What does MRI do
What will the nurse have to do during it?
Allows us to see slices across the tissues
It is a clear picture but it takes a lot longer than the CT scan
- need to lay still for around 30 minutes maybe
- no metal allowed
Nurse may have to monitor vitals and monitor the patient
- due to possible sedation
What does the Nuclear brain scan do
Nuclear brain scan uses isotopes to see brain activity and take photo
Signs of ICP in infants
Poor feeding & vomiting Irritability & restless High pitched crying & crying when held BULGING fontanel Large circumference Distended scalp veins Sunset sign or eyes down
Signs of ICP in older children
Headache due to no where for pressure to go now Diplopia Motor issues N/V Mood swings Altered LOC Seizures - put on precautions
Late signs of ICP
They may be tachycardic but once in bradycardia Apnea Cushings triad Posture changes Pupil reactivity lost Seizures Papilledema
How do we want to reduce the Cerebral spinal fluid with ICP?
If the pressure is built up, we need to drain it out with
- ventriculostomy of ventricles
- internal shunt
- extarnal shunt
Difference between the internal and external shunts?
Internal shunt is more permanent. It is brought out to surface, tunneled down the neck, and into thoracic or peritoneal cavity.
External is more temporary. End of tubing in ventricle but it drains into an external collection system that is external to the body.
Will measure pressures and adjust to level of drainage needed
When there is ICP how do we preserve metabolic needs
Limit activities using up O2 or provide them with more O2
Make sure they are perfusing correctly
Monitor ICP (normal is below 20)
Situations that increase ICP and that you should avoid doing as the nurse?
Suctioning, turning, bathing
Flexing or extending head away from the midline
Valsalvas Manuever
Fluids that can be used to decrease edema to the head?
Hypertonic fluids like mannitol or 3% saline.
- Their high solute being put in the blood makes the fluid in the head shift out of the head
Nursing responsibilities with an External shunt to decrease IOP
Make sure at level 0 at ear canal
Correct pressure. is set
Tubing/clamps/stopcocks open are open
Check the dressings and insertion sites
Why should the tubing of an internal shunt be looped?
For when the child grows
