Neuro Disorders Flashcards
3 forms of spina bifida
Spina bifida occulta
Meningocele
Myelomeningocele
Type of spina bifida:
‣ tuft of hair present, dimpling at base of spine
‣ no protrusion of spinal nerves, but missing bone
oculta
Type of spina bifida:
Protrusion containing meninges and spinal fluid ,,, NO nerves
Meningocele
Type of spina bifida,,,
Protrusion containing meninges, spinal fluid, and nerves
Myelomeningocele
What is the general name for the disorder that causes neural tube defects affecting g the CNS
Spina bifida
Spina bifida increases risk of what allergy?
Latex!
*can be life threatening allergic reaction
Spina bifida increases risk of what disorder that requires shunting at it?
Hydrocephalus
Bladder and bowel issues/paralysis with which types of spina bifida?
Meningocele and Myelomeningocele
Can we take rectal temps on spina bifida patients?
Heck no!
What kind of dressing goes over lower back of spina bifida patient?
Sterile moist dressing initially, change ever 2 hours
What position do we place new born spina bifida patient in?
Prone
Avoid pressure on sac
What kind of hold is recommended for spina bifida newborn?
Football hold — avoid pressure on sac
Can spina bifida babes be born vaginally?
No! C section
When is surgery done to repair spina bifida site after birth?
Within 24-48 hours of birth
Long term considerations for spina bifida
risk for ineffective ADL/ impaired elimination/ mobility
◦ education: in and out every 4 hours
◦ OT to help with bowel training
◦ ROM exercises
Is hydrocephalus common in spina bifida patients?
Yes! 90-95% have it
This disorder is an imbalance in the PRODUCTION and/or ABSORPTION of the CSF
Hydrocephalus
What does hydrocephalus do to fontanel?
Accumulation of blood in ventricles causes bulging of the fontanels
Post op consideration for VP (ventricular peritoneal) Shunt (think: positioning)
position change follows Dr. orders
‣ do not elevate too fast –> fluid drain too quickly –> injury to brain
‣ lay child flat on his or her nonsurgical side to prevent rapid reduction in intracranial fluid
S/s if increased icp in infant
◦ bulging fontanel ◦ increase in head circumference ◦ high pitched cry ◦ lethargic ◦ vomiting ◦ widening of cranial suture lines
S/s of increase ICP IN CHILD
◦ headache ◦ lethargic ◦ n/v ◦ double vision ◦ decreased LOC ◦ seizure
Disorder causing movement, muscle control, and posture deficits caused by hypoxia to the brain
Cerebral palsy
Most common disability of childhood to effect the movement
Cerebral palsy
4 types of cerebral palsy
Spastic
Dyskinentic
Ataxic
Mixed
Type of CP: hypertonicity- muscles tight, increased reflexes, clonus, poor control with balance/ posture/movement, fine/gross motor difficulties, pyramidal, crouched gait with scissoring motion of legs, Babinski reflex
Spastic
Type of CP:
involuntary jerking, slow worm like movements, non-spastic, extrapyramidal, slow twisting movements, drooling and speech impairment
Dyskinetic CP
Type of CP:
wide based gait, difficulty with coordination, can’t do repetitive motions well, difficulty with purposeful movement like reaching for an object
Ataxic CP
When is CP diagnosed
• diagnosed in infancy when child fails to meet milestones of development
Interventions for CP
◦ no cure but can use OT/PT/ surgery/equipment/meds like anti anxiety/seizure meds to manage it
• Safety : protective equipment- helmet/pads, safe toys preventing aspiration, position child upright with feeding, educate parents
Most common type of seizure in pedes? What causes it?
Febrile — temp >104
Safety considerations for seizure
◦ suction/oxygen
◦ bed free of things that can injure them
◦ pad side rails
◦ position on side during seizure –> prevent aspiration of secretions
◦ bed locked and low
◦ loosen restrictive clothing
◦ do not try to restain/put anything in mouth
◦ stay with child
◦ note onset/characteristics
What is meningitis?
Infection of the nervous system
•Affects covering of the brain and spinal cord (meninges)
•Medical emergency – life threatening infection
Is meningitis chill or like a big deal?
Medical emergency= life threatening!
Tonic phase of seizure =
Stiffening 10-20 seconds
Clonic phase of seizure =
Jerking, 30-50 seconds
Postictal phase of seizure
Limp body, semiconscious, after tonic and clonic, lasts 30 min
2 weird types of seizure disorders from ATI
West syndrome- onset 3-7 mont, tested with ACTH, single sudden seizure of cluster of up to 150
Lennox- gastaut syndrome- mixture of seizure with cognitive deficits
S/s of meningitis in infant/child
• infant= low temp, not feeding, lethargy, bulging fontanels
• Severe headache
• stiff neck
• older kids =sudden high fever
• photosensitivity
• altered mental status
• rash = specific type of bacteria- can die within hours! very serious
•Kernig’s sign
◦ Flex hip and knee 90° - positive if child cannot extend knee from pain
•Brudzinski’s sign
◦ Flexion of neck causes involuntary flexion of knee and hip
Re: meningitis sign
◦ Flexion of neck causes involuntary flexion of knee and hip
Brudzinski’s sign
Re meningitis sign:
◦ Flex hip and knee 90° - positive if child cannot extend knee from pain
Kernigs sign
2 types of meningitis
Viral ( aseptic) and bacterial ( septic)
Which type of meningitis is highly contagious and requires droplet precautions
Bacterial
When do we give Abx in relation to lumbar puncture?
Before LP!
Worst kind of meningitis?
Bacterial
Positioning for lumbar puncture - during and after
◦ Proper positioning – hips and knees flexed
‣ Infant – chin to chest and knees to abdomen- check resp. status in this position
◦ Flat in bed after procedure
Need to differentiate meningitis from ______ ______
Reye’s syndrome
Can cause liver and neuro and looks like meningitis
Reye’s syndrome occurs when….
You use aspirin with viral infection
Exception=COME BACK TO THIS. WE JUST LEARNED ABOUT IT
Signs of increase ICP re: head injury
◦ Slow, sluggish pupil response, increased sleeping ◦ Infant – bulging fontanels ◦ Bradycardia (late sign) ◦ irritable, fussy ◦ emesis ◦ changes in mental status/LOC/ coma
Education re head injuries
• Preventative education is key: helmets, seat belt, shaken baby syndrome
