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Peds > neuro part 2 (3) > Flashcards

neuro part 2 (3) Flashcards

1
Q

what is inflammation of the meninges

A

meningitis

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2
Q

what 2 things cause meningitis?

A

bacteria or virus

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3
Q

why has incidence of meningitis decreased?

A

increased protection from several vaccines

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4
Q

patho of meningitis

A

bacteria in blood spreads to CNS, enters subarachnoid space → inflammatroy response occurs → bacterial endotoxins cause inflammation/edema in brain → cerebral edema / inc. ICP occur as a result of the presence of the endotoxins

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5
Q

which of the following are manifestations of an INFANT with meningitis
1. fever
2. poor feeding
3. anterior fonanel bulging
4. calms with rocking/cuddling
5. vomit/diarrhea
6. irritable/fussy

A

12356

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6
Q

which of the following are clinical manifestations of a CHILD with meningitis
1. irritable
2. lethargy
3. inc. appetite
4. frontal headache
5. photophobia
6. nuchal rigidity
7. fever

A

124567

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7
Q

describe nuchal rigidity

A

hallmark sign of meningitis, chin to shest, pain in back of neck

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8
Q

what is resistance to neck flexion?

A

nuchal rigidity

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9
Q

describe fevers in bacterial vs. viral meningitis

A

high fever = bacterial, low grade fever = viral

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10
Q

diagnostic tests of meningitis

A

CBC, elec, BUN/cr., LUMBAR PUNCTURE, positive brudzinski/kernig sign

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11
Q

which sign is characterized by:
-when you flex the neck, the hips and knees will flex

A

Brudzinski sign (indiciative of meningitis)

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12
Q

which sign is characterized by:
-when you flex the leg at the hip and knee, and then extend the knee, it will cause pain and increased resistance

A

kernig sign (indicative of meningitis)

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13
Q

how long are antibiotics used for meningitis

A

7-21 days at the highest dose

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14
Q

what med is used for meningitis if the infant is older than 6 weeks

A

dexamthasone (decreases neuro damage)

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15
Q

what is always done prior to administering the first dose of antibiotics for meningitis

A

lumbar puncture

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16
Q

describe urinary output in peds

A

<=12 = 1ml/kg/he
>12 = 0.5ml/kg/hr

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17
Q

what is acute encephalopathy / cerebral dysfunction caused by toxic, inflammatory, or anoxic insult or injury that may result in permanent tissue damage

A

reye syndrome

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18
Q

what is associated with causing reye syndrome?

A

use of aspirin in influenza and varicella

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19
Q

what percentile head size classifies microcephaly

A

less than 3rd %ile

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20
Q

what is common with microcephaly

A

intellectual disability

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21
Q

causes of microcephaly

A
  • genetics
  • destructive insult during fetal life due to infection, metabolic disorder, hypoxia-ischemia
  • maternal infection
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22
Q

what is an imbalance between the producation and absorption of CSF, there is inc. CSF and enlargement of ventricles

A

hydrocephalus

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23
Q

which kind of fluid imbalance is common with myelomeningocele

A

hydrocephalus

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24
Q

what can hydrocephalus be a complication of?

A

illness (meningitis/brain tumor)
injury

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25
Q

what is CSF produced by

A

choroid plexus within ventricles

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26
Q

where does CSF flow?

A

ventricles, brainstem, spinal cord, and surface of brain

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27
Q

is communicating hydrocephalus acquired or born with?

A

acquired

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28
Q

what is impaired in communicating hydrocephalus

A

asborption of CSF in sub-arachnoid spaceand arachnoid villi

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29
Q

what is caused by a blockage in the ventricular system that prevents CSF from entering the subarachnoid space resulting in enlargement of one or more ventricles

A

non-communicating hydrocephalus

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30
Q

what are causes of non-communicating hydrocephalus

A

infection, hemorrhage, tumor, surgery or structural deformity

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31
Q

T/F?
in infants the predominant manifestation in hydrocephalus is rapidly increasing head circumference

A

true

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32
Q

what are some early clinical clinical manifestations of ↑ ICP

A
  • Rapidly increasing head circumference if under 18 months
  • Tense, full, or bulging anterior fontanel
  • Split sutures in an infant
  • Frontal bossing which is protrusion of the frontal area of the head
  • Difficulty holding head up
  • Macewen sign with percussion (cracked pot sound)
  • Prominent distended scalp veins
  • Increase tone or hyperreflexia, Babinski sign
  • Irritability or lethargy
  • Poor feeding, nausea and vomiting
  • Decline in level of consciousness
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33
Q

late clinical manifestations of increaced ICP

A
  • Cushings triad: Increased systolic BP with wide pulse pressure, bradycardia, irregular respirations
  • Shrill high pitched cry
  • Difficulty feeding, vomiting
  • Regression in milestones
  • Significant change in Level of consciousness
  • Fixed and dilated pupils
  • Seizures
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34
Q

what are some signs of acquired hydrocephalus after closure of infant scalp sutures?

A
  • Signs of increased intracranial pressure
  • Headache upon wakening with nausea and vomiting
  • Irritability or lethargy
  • Altered level of consciousness
  • Personality changes
  • Poor judgement, poor school performance, memory loss
  • Visual problems
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35
Q

how is hydrocephalus diagnosed?

A
  • head circumference
  • clinical manifestations of ↑ ICP
  • CT/MRI
  • can be prenatal w/ US
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36
Q

treatment of hydrocephalus

A
  • surgery to remove obstruction
  • ventriculo-peritoneal shunt
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37
Q

what 4 things does a ventriculo-peritoneal shunt consist of?

A
  • ventricular catheter
  • pumping chamber
  • one way pressure valve
  • distal catheter
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38
Q

what are less serious complications of ventriculo-peritoneal shunt

A
  • blockage
  • kinking of tubing
  • valve breakdown
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39
Q

what is the most serious complication of ventriculo-peritoneal shunt

A

infection (often within 3 months)

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40
Q

what happens if a VP shunt malfunctions?

A

revisions

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41
Q

post-op care after VP shunt for hydrocephalus

A
  • assess/vs
  • HOB flat initially (prevents rapid CSF drainage), then elevated over next 1-2 days to promote drainage
  • surgical site assessment
  • I&O
  • pain management
  • education of infection risk, sx of ↑ ICP from shunt failure
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42
Q

describe HOB elevation after VS shunt surgery for hydrocephalus

A

HOB flat initially to prevent rapid CSF drainage, then elevated over 1-2 days to promote drainage

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43
Q

what are other names for myelomeningocele?

A

myelodysplasia/spina bifida

44
Q

what is a defect in one or more vertebrae through which spinal cord contents protrude

A

spina bifida

45
Q

what is a type of spina bifida where there is a protrusion on a meningeal sac that contains CSF, a portion of the spinal cord and nerves through the vertebral defect

A

myelomeningocele

46
Q

what are believed to be some causes of myelomeningocele

A

chemicals, meds, genetics, maternal health, gestational diabetes, folic acid deficiency, or maternal obesity

47
Q

what is a very important influence on neural tube defects

A

folic acid

48
Q

what kind of defect is spina bifida / myelomeningocele

A

neural tube defect

49
Q

what is a defect in one or more vertebrae through which spinal cord contents protrude

A

spina bifida

50
Q

what is a type of spina bifida where there is a protrusion of a meningeal sac that contains cerebral spinal fluid, a portion of the spinal cord and nerves through the vertebral defect

A

myelomeningocele

51
Q

what elevated serum test leads to suspicion of neural tube defect

A

prenatal maternal serum alpha-fetoprotein

52
Q

when is surgery done for myelomeningocele

A

prior to 26 weeks

53
Q

what kind of tests/assessments will a child with myelomeningocele have?

A

bladder/bowel testing, neurologic/motor/intellectual assessment

54
Q

what kind of defecits will a child with myelomeningocele have?

A

motor/sensory defecit

55
Q

what therapy will occur right after finding myelomeningocele?

A

surgical closure 24-48 hours after birth to prevent infection

56
Q

preop nursing management of myelomeningocele

A
  • monitor integrity of sac and leakage of CSF
  • assess/vs (infection, leak)
  • cover sac with sterile saline dressing
  • prone, hips slightly flexed and legs abducted to minimize tension on sac
  • feed with head to side
  • comfort with touch
57
Q

post-op care for myelomeningocele

A
  • vs/wound assess
  • pain management
  • I&O
  • prone/side lying
  • diaper away from surgical site (poop and peepee can cause infection)
  • ROM to prevent contractions and atrophy
  • intermittent catheterization
  • fam/emotional support
  • education
58
Q

what is usually present with myelomeningocele

A

hydrocephalus

59
Q

What will be inserted in a second surgery a week after the myelomeningocele closure

A

VP shunt

60
Q

Why is the risk for infection high after a VP shunt is put in?

A

seconf surgery involving brain

61
Q

describe bladder and urination of a kid with myelomeningocele

A

They have a neurogenic bladder, they are labeled to have complete emptying of the urine. They will never be potty trained. Need to be catheterized every three to four hours

62
Q

Describe intermittent catheterization in kids/infants with myelomeningocele

A

need it every 3-4 hours, once at night for infants

63
Q

what kind of medication is used to treat bladder sphincter hyperreflexia in myelomeningocele

A

anticholinergic

64
Q

What procedure for myelomeningocele is when the appendix is used to create a conduit between the abdominal wall and bladder

A

mitrofanoff procedure

65
Q

why is a mitrofanoff done?

A

this replaces catheterizing the urethra, empties bladder

66
Q

What is injected into the external bladder sphincter to improve continence with myelomeningocele

A

botulinum toxin type a

67
Q

What kind of gastrointestinal deficit is when foul control can generally be achieved with diet modifications and regular toileting habits

A

lower defecit

68
Q

What are the diet in toilet modifications that need to be made with lower deficit? (GI)

A

High fiber diet, supplements, sit on the toilet ten minutes after meals

69
Q

what kind of gastrointestinal deficit requires fiber supplements, laxatives, suppositories and enemas to assist regular bowel function?

A

higher defecit

70
Q

What kind of GI deficit is a Malone stoma usually used for?

A

higher defecit

71
Q

What is a pathway bringing the appendix to the umbilicus, allows for enema administration and increased bowel continence

A

malone stoma

72
Q

if the appendix is already being used for catheterization, what is used instead of a malone stoma?

A

A special flap from the colon is made (appendicostomy), can give the enema to themselves for stool evacuation

73
Q

What assistive devices will children with myelomeningocele use when they are older

A

braes, splints, crutches, walkers, wheelchairs

74
Q

How is myelomeningocele cared for in the community?

A

pediatric spina bifida clinics

75
Q

What is a permanent disorder of movement and posture with non-progressive disturbances of the developing fetal or infant brain. There is a major physical disability that affects functional development in children

A

cerebral palsy

76
Q

what kind of disorder is cerebral palsy primarily?

A

motor

76
Q

What areas are also affected by cerebral palsy?

A

hearing, sensation, perception, cognition, communication, and behavior

77
Q

how many types of cerebral palsy are there?

A

4

78
Q

what is cerebral palsy mostly caused by?

A

prenatal insult (prematurity comp., teratogens, viral infections, genetic)

79
Q

What are clinical manifestations of cerebral palsy?

A
  • Abnormal muscle tone and lack of coordination with spasticity
  • Spasticity most common manifestation and causes muscle weakness that interferes with gross motor activities
  • Delayed in meeting developmental milestones
  • All have motor impairment; some may have intellectual disabilities, vision impairments, hearing loss, speech and language impairments or seizures
80
Q

What will make a provider suspect cerebral palsy?

A

clinical findings including delayed development and increased or decreased muscle tone

81
Q

Why is cerebral palsy difficult to diagnose in the young infant?

A

need to r/o other neuro probs

82
Q

what are the diagnostic tests used to determine the cause of cerebral palsy?

A

CT, MRI, ultrasound

83
Q

What does clinical therapy for cerebral palsy focus on?

A

It focuses on helping the child develop to maximum level of independence and maximum performance of activities and daily living.

84
Q

What kind of devices promote range of motion, skeletal alignment, stability, control of involuntary movement, and prevents contractures in cerebral palsy?

A

braces, splints, serial casting devices

85
Q

What is done to improve function, balance muscle power, stabilize uncontrollable joints, and other benefits in cerebral palsy?

A

orthopedic surgery

86
Q

What medications for cerebral palsy affect brain control of muscle tone to help control spasticity and rigidity?

A

oral diazepam, lorazepam, clonazepam

87
Q

what medication for cerebral palsy inhibits muscle contraction, skeletal muscle relaxant, antispasmodic

A

oral dantrolene

88
Q

What medication for cerebral palsy inhibits motor nerve conduction at level of spinal cord, is used in a pump for continuous low doses

A

oral/intrathecal baclofen

89
Q

What medication for cerebral palsy treats spasticity for three months?

A

IV botulinum toxin type a

90
Q

Why are there feeding difficulties in cerebral palsy?

A

due to spasticity or hypotonia, poor suck, poor swallowing coordination

91
Q

What dietary adaptions are necessary for cerebral palsy?

A
  • High calorie diet and supplements; High fiber diet
  • Small amounts of food due to difficulty with chewing and swallowing
  • Utensils with large padded handles and adaptive cups
  • Adequate fluids
  • Gastrostomy tube
92
Q

How is skin integrity maintained in cerebral palsy

A

protect baby prominence, monitor splints and braces, proper body alignment

93
Q

What is blank force to the head or penetrating injury that disrupts normal brain function?

A

traumatic brain injury

94
Q

what are the most common neuro injuries in children

A

TBI

95
Q

what is the most effective strategy to prevent traumatic brain injury?

A

helmets

96
Q

Describe chronic sorrow from my parents of children with neuro probs

A
  • recurrent episodes of sorrow at childhood milestones
  • they are reminded that their hild is not normally developing
97
Q

what is a coping mechanism that allows parents to. Breathe the child who has a diagnosis that is permanent, progressive, and recurring in nature?

A

chronic sorrow

98
Q

what is another term for chronic sorrow

A

cyclical sadness

99
Q

how should children with disabilits be addressed

A

“people first”
“a girl WITH cerebral palsy”

100
Q

A blockage in the flow of cerebral spinal fluid results in what condition?
a) Myelomeningocele
b) Hydrocephalus
c)Cerebral palsy
d) Meningitis

A

b) Hydrocephalus

101
Q

The anterior fontanel in an infant with increased intracranial pressure would be ?
a) Soft and flat
b) Sunken
c) Bulging

A

c) Bulging

102
Q

Nursing interventions after surgical placement of a ventriculo-peritoneal shunt would include which of the following. Choose all that apply.
a) Intake and output
b) Pain medication
c) Head of bed elevated 30-45 degrees immediately after surgery
d) Wound assessment

A

A, B, and D

103
Q

A child with myelomeningocele has a neurogenic bladder. What are the implications of a neurogenic bladder? Choose all that apply.
a) They will have complete bladder emptying as they grow
b) They will never have complete emptying of their bladder
c) They may get a Mitrofanoff procedure
d) They may get a Malone stoma

A

B and C

104
Q

What medications may be used with a child with Cerebral Palsy? Choose all that apply.
a) Intrathecal baclofen
b) Oral diazepam
c) Oral ibuprofen
d) IV botulinum toxin type A

A

A, B, and D

105
Q

True or False.

Bike helmets are one of the best ways to prevent head injuries in children?

A

true

Peds (30 decks)

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