neuro part 2 (3) Flashcards
what is inflammation of the meninges
meningitis
what 2 things cause meningitis?
bacteria or virus
why has incidence of meningitis decreased?
increased protection from several vaccines
patho of meningitis
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
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
12356
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
124567
describe nuchal rigidity
hallmark sign of meningitis, chin to shest, pain in back of neck
what is resistance to neck flexion?
nuchal rigidity
describe fevers in bacterial vs. viral meningitis
high fever = bacterial, low grade fever = viral
diagnostic tests of meningitis
CBC, elec, BUN/cr., LUMBAR PUNCTURE, positive brudzinski/kernig sign
which sign is characterized by:
-when you flex the neck, the hips and knees will flex
Brudzinski sign (indiciative of meningitis)
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
kernig sign (indicative of meningitis)
how long are antibiotics used for meningitis
7-21 days at the highest dose
what med is used for meningitis if the infant is older than 6 weeks
dexamthasone (decreases neuro damage)
what is always done prior to administering the first dose of antibiotics for meningitis
lumbar puncture
describe urinary output in peds
<=12 = 1ml/kg/he
>12 = 0.5ml/kg/hr
what is acute encephalopathy / cerebral dysfunction caused by toxic, inflammatory, or anoxic insult or injury that may result in permanent tissue damage
reye syndrome
what is associated with causing reye syndrome?
use of aspirin in influenza and varicella
what percentile head size classifies microcephaly
less than 3rd %ile
what is common with microcephaly
intellectual disability
causes of microcephaly
- genetics
- destructive insult during fetal life due to infection, metabolic disorder, hypoxia-ischemia
- maternal infection
what is an imbalance between the producation and absorption of CSF, there is inc. CSF and enlargement of ventricles
hydrocephalus
which kind of fluid imbalance is common with myelomeningocele
hydrocephalus
what can hydrocephalus be a complication of?
illness (meningitis/brain tumor)
injury
what is CSF produced by
choroid plexus within ventricles
where does CSF flow?
ventricles, brainstem, spinal cord, and surface of brain
is communicating hydrocephalus acquired or born with?
acquired
what is impaired in communicating hydrocephalus
asborption of CSF in sub-arachnoid spaceand arachnoid villi
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
non-communicating hydrocephalus
what are causes of non-communicating hydrocephalus
infection, hemorrhage, tumor, surgery or structural deformity
T/F?
in infants the predominant manifestation in hydrocephalus is rapidly increasing head circumference
true
what are some early clinical clinical manifestations of ↑ ICP
- 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
late clinical manifestations of increaced ICP
- 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
what are some signs of acquired hydrocephalus after closure of infant scalp sutures?
- 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
how is hydrocephalus diagnosed?
- head circumference
- clinical manifestations of ↑ ICP
- CT/MRI
- can be prenatal w/ US
treatment of hydrocephalus
- surgery to remove obstruction
- ventriculo-peritoneal shunt
what 4 things does a ventriculo-peritoneal shunt consist of?
- ventricular catheter
- pumping chamber
- one way pressure valve
- distal catheter
what are less serious complications of ventriculo-peritoneal shunt
- blockage
- kinking of tubing
- valve breakdown
what is the most serious complication of ventriculo-peritoneal shunt
infection (often within 3 months)
what happens if a VP shunt malfunctions?
revisions
post-op care after VP shunt for hydrocephalus
- 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
describe HOB elevation after VS shunt surgery for hydrocephalus
HOB flat initially to prevent rapid CSF drainage, then elevated over 1-2 days to promote drainage
what are other names for myelomeningocele?
myelodysplasia/spina bifida
what is a defect in one or more vertebrae through which spinal cord contents protrude
spina bifida
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
myelomeningocele
what are believed to be some causes of myelomeningocele
chemicals, meds, genetics, maternal health, gestational diabetes, folic acid deficiency, or maternal obesity
what is a very important influence on neural tube defects
folic acid
what kind of defect is spina bifida / myelomeningocele
neural tube defect
what is a defect in one or more vertebrae through which spinal cord contents protrude
spina bifida
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
myelomeningocele
what elevated serum test leads to suspicion of neural tube defect
prenatal maternal serum alpha-fetoprotein
when is surgery done for myelomeningocele
prior to 26 weeks
what kind of tests/assessments will a child with myelomeningocele have?
bladder/bowel testing, neurologic/motor/intellectual assessment
what kind of defecits will a child with myelomeningocele have?
motor/sensory defecit
what therapy will occur right after finding myelomeningocele?
surgical closure 24-48 hours after birth to prevent infection
preop nursing management of myelomeningocele
- 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
post-op care for myelomeningocele
- 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
what is usually present with myelomeningocele
hydrocephalus
What will be inserted in a second surgery a week after the myelomeningocele closure
VP shunt
Why is the risk for infection high after a VP shunt is put in?
seconf surgery involving brain
describe bladder and urination of a kid with myelomeningocele
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
Describe intermittent catheterization in kids/infants with myelomeningocele
need it every 3-4 hours, once at night for infants
what kind of medication is used to treat bladder sphincter hyperreflexia in myelomeningocele
anticholinergic
What procedure for myelomeningocele is when the appendix is used to create a conduit between the abdominal wall and bladder
mitrofanoff procedure
why is a mitrofanoff done?
this replaces catheterizing the urethra, empties bladder
What is injected into the external bladder sphincter to improve continence with myelomeningocele
botulinum toxin type a
What kind of gastrointestinal deficit is when foul control can generally be achieved with diet modifications and regular toileting habits
lower defecit
What are the diet in toilet modifications that need to be made with lower deficit? (GI)
High fiber diet, supplements, sit on the toilet ten minutes after meals
what kind of gastrointestinal deficit requires fiber supplements, laxatives, suppositories and enemas to assist regular bowel function?
higher defecit
What kind of GI deficit is a Malone stoma usually used for?
higher defecit
What is a pathway bringing the appendix to the umbilicus, allows for enema administration and increased bowel continence
malone stoma
if the appendix is already being used for catheterization, what is used instead of a malone stoma?
A special flap from the colon is made (appendicostomy), can give the enema to themselves for stool evacuation
What assistive devices will children with myelomeningocele use when they are older
braes, splints, crutches, walkers, wheelchairs
How is myelomeningocele cared for in the community?
pediatric spina bifida clinics
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
cerebral palsy
what kind of disorder is cerebral palsy primarily?
motor
What areas are also affected by cerebral palsy?
hearing, sensation, perception, cognition, communication, and behavior
how many types of cerebral palsy are there?
4
what is cerebral palsy mostly caused by?
prenatal insult (prematurity comp., teratogens, viral infections, genetic)
What are clinical manifestations of cerebral palsy?
- 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
What will make a provider suspect cerebral palsy?
clinical findings including delayed development and increased or decreased muscle tone
Why is cerebral palsy difficult to diagnose in the young infant?
need to r/o other neuro probs
what are the diagnostic tests used to determine the cause of cerebral palsy?
CT, MRI, ultrasound
What does clinical therapy for cerebral palsy focus on?
It focuses on helping the child develop to maximum level of independence and maximum performance of activities and daily living.
What kind of devices promote range of motion, skeletal alignment, stability, control of involuntary movement, and prevents contractures in cerebral palsy?
braces, splints, serial casting devices
What is done to improve function, balance muscle power, stabilize uncontrollable joints, and other benefits in cerebral palsy?
orthopedic surgery
What medications for cerebral palsy affect brain control of muscle tone to help control spasticity and rigidity?
oral diazepam, lorazepam, clonazepam
what medication for cerebral palsy inhibits muscle contraction, skeletal muscle relaxant, antispasmodic
oral dantrolene
What medication for cerebral palsy inhibits motor nerve conduction at level of spinal cord, is used in a pump for continuous low doses
oral/intrathecal baclofen
What medication for cerebral palsy treats spasticity for three months?
IV botulinum toxin type a
Why are there feeding difficulties in cerebral palsy?
due to spasticity or hypotonia, poor suck, poor swallowing coordination
What dietary adaptions are necessary for cerebral palsy?
- 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
How is skin integrity maintained in cerebral palsy
protect baby prominence, monitor splints and braces, proper body alignment
What is blank force to the head or penetrating injury that disrupts normal brain function?
traumatic brain injury
what are the most common neuro injuries in children
TBI
what is the most effective strategy to prevent traumatic brain injury?
helmets
Describe chronic sorrow from my parents of children with neuro probs
- recurrent episodes of sorrow at childhood milestones
- they are reminded that their hild is not normally developing
what is a coping mechanism that allows parents to. Breathe the child who has a diagnosis that is permanent, progressive, and recurring in nature?
chronic sorrow
what is another term for chronic sorrow
cyclical sadness
how should children with disabilits be addressed
“people first”
“a girl WITH cerebral palsy”
A blockage in the flow of cerebral spinal fluid results in what condition?
a) Myelomeningocele
b) Hydrocephalus
c)Cerebral palsy
d) Meningitis
b) Hydrocephalus
The anterior fontanel in an infant with increased intracranial pressure would be ?
a) Soft and flat
b) Sunken
c) Bulging
c) Bulging
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, B, and D
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
B and C
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, B, and D
True or False.
Bike helmets are one of the best ways to prevent head injuries in children?
true
