neuro part 1 (3) Flashcards
when in gestation does the neural tube begin to form?
4th week
why is the brain and spinal cord at greater risk for injury in gestation?
they are formed really early on
describe CNS at birth
complete but immature
what cells enable receipt of nerve impulses
glial cells and dendrites
why does head circumference increase in infants and toddlers
brain growth
when does brain growth stop
12-15 years old
what is associated with the presence of infant refelxes?
a) lack of myelination
b) hypoxia
c) structural defects
d) infections
a) lack of myelination
what is the progressive covering of axons with layers of myelin or a lipid protein sheath is incomplete at birth
myelination
what accounts for progressive acquisition of fine and gross motor skills , coordination, and loss of infant reflexes in early childhood
myelination
what reflex has the baby extend the arms and fingers to form a C after being startled
moro
when does moro reflex disappear
6 months
which infant reflex is when you place a finger in the baby’s palm (not touching thumb). strong grip around finger
palmer grasp
when does the palmer grasp go away
3 months
What reflexes when you place a finger across the foot at the base of the toes, toes curl to grip the finger
plantar grasp
when does plantar grasp disappear
8months
What reflexes when you hold the infant erect and touch the top of one foot to the table or the chair, foot lifts as if to step onto the surface
placing reflex
When does the placing reflex disappear
several times
which reflexes when you hold the infant erect and touch the bottom of the foot on the surface, feet will lift in alternating pattern as if walking
stepping
When does the stepping reflex disappear
4-8 weeks
what reflexes when you place the infant supine and turn the head to one side, arm and leg on the face side extend an opposite arm and like flex, fencing position
tonic neck
When does the tonic neck reflex appear and disappear?
Appears at two months, disappears four to six months
what are spaces of connective tissue covering the brain at the junction of scroll bones which allow for brain growth
fontanels
what happens if the fontanels close prematurely?
It will not allow proper head growth
when does the posterior fontanelle close?
2-3 mo.
When does the anterior fontanel close?
12-18 mo.
Which fontanelle shows signs if there is increased intracranial pressure
anterior
brain growth continues until what age?
12-15
What is the most important indicator of neurologic dysfunction?
level of consciousness
What is the responsiveness of the minds to censor stimuli
consciousness
what are the two components of consciousness?
alertness
cognitive power
Which component of consciousness is the ability to react to stimuIi?
alertness
Which component of consciousness is the ability to process the data and respond either verbally or physically?
cognitive power
What can cause changes in level of consciousness? select all
1. inadequate folic acid
2. teratogens
3. infection
4. substance abuse
5. trauma
6. caffeine
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T/F?
Intracranial pressure is the force exerted by brain tissue, cerebrospinal fluid and blood within the cranial vault
true
symptoms of a decline in LOC would include? Select all.
1. Slight disorientation to time and place
2. restless and fussy
3. will respond to soft verbal commands
4. Lethergy
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early clinical manifestations of increased intracranial pressure would include? Select all.
1. Headache
2. nausea and vomiting
3. Slight change in vital signs
4. peoples not as reactive or unequal
5. oriented to person, place and time and situation
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What change in vital signs occur in the early stages of increased intracranial pressure?
tachycardia, Inc. temp with infection, increased in BP
Late signs of intracranial pressure include which of the following?
1. Significant decrease in level of consciousness
2. Increased systolic blood pressure, wide pulse pressure
3. bradycardia
4. Irregular respirations
5. Fixed and dilated pupils
6. tachycardia
7. seizures
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What are the symptoms of Cushing’s triad related to increased intracranial pressure
- increased systolic blood pressure, wide pulse pressure
- bradycardia
- irregular respirations
which tool is used in the assessment of coma in infants and children, it enables future comparison of improvement or deterioration
Glasgow coma scale
What diagnostic tests are done for alternative level of consciousness?
- CBC, electrolyte, blood culture
- toxicology, blood, urine
- lumbar puncture
- EEG
- CT
- MRI
Therapy for alter level of consciousness
find cause and treat
nursing management for altered level of consciousness
- Maintain airway
- assess/vitals
- mouth care
- integumentary
- nutrition
what are the immediate interventions for a jerking a seizure?
- airway assessment
- assess safety
- position on side
- suction available
- get help
- monitor seizure activity
- assess LOC
- vitals/assess after
- administer meds
How long is the loss of consciousness from a tonic clonic seizure?
1-2 mins
which tonic clinic phase Is where the body goes stiff and rigid due to muscle contraction
tonic
which phase of tonic clinic is rhythmic jerking motion of muscles
clonic
which seizure is a result of diffuse electrical activity that begins in both hemispheres of the brain simultaneously
tonic clonic
What kind of seizure is a tonic clonic seizure
generalized
what area of the brain does a tonic clinic seizure spread?
cortex/brainstem
Describe facial appearance of tonic clonic seizures?
eyes roll upward or deviate to the side, pupils dilate, drooling or foaming at the mouth due to secretions
describe airway, BMR, and urinary/bowel in tonic clonic seizures
- airway compromised
- BMR rise (Inc oxygen demand)
- urinary/bowel incontinence
What are the two types of seizures
focal/partial, generalized
what age do absence seizures occur?
4-10 years
describe absence seizures?
Brief loss of consciousness, rarely longer than 30 seconds, usually five to 10 seconds
How often do absence seizures occur?
can be 50-100/day or more
What kind of seizures is where there is no loss of consciousness, lasts less than 30 seconds
simple partial
What is another name for a simple partial seizure?
focal
What kind of partial seizure is where consciousness is impaired for 30 seconds to five minutes?
complex partial
What was the period following this season were a level of consciousness is decreased?
postictal phase
What is a prolonged continuous seizure of 15 minutes or intermittent seizures lasted more than 15 minutes without a full recovery between them?
status epilepticus
Which of the following is true about febrile seizures? Select all.
1. Rapid rising temperature
2. occurs between nine months and five years old
3. always needs treated long term
4. family history
5. increased risk of future febrile procedures if they have one
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when are febrile seizures treated?
when they are repeated, use anticonvulsants, not treated if it only occurred once
when can ibuprofen be used?
when older than 6 months
What diagnostic testing for seizures?
- CBC, elec
- urine/blood/lumbar puncture
- lead level, urine/blood toxicology
- inborn errors of metabolism
- medication blood levels
- EEG
- MRI/CT
what kind of drug therapy is preffered to treat seizures (decreases side effects)
mono-therapy (one drug)
how effective is mono-therapy for seizures, and when would a second med be added?
effective for 50% of new onset seizures, second med added if poor control
what classifies intractable seizures
continues to have seizures with 3+ meds
what are options of therapy for intractable seizures (3)
- surgery (resections)
- vagal nerve stimulator (pulse generator, regulate seizures)
- ketogenic diet (inc. fat, adequate protein, dec. carbs)
when will someone on seizure medications go under med withdraw attempt?
after being seizure free for 2 years or longer
what seizure med is teratogenic
valproic acid
T/F?
It is safe to place a tongue blade into a child’s mouth to prevent them biting their tongue while they are having a seizure?
false
what does oxygen need to be at during a seizure
> 95%
what meds are given during seizure
rectal diazepam
