Neuro part 2 Flashcards
What are Neural Tube Defects?
How many types are there?
Incomplete closures of the vertebrae and neural tubes
3
Cause of Neural Tube Defects?
Unknown but could be genetic, from lack of folic acid, or viral organism.
Three types of Neural Tube Defects?
Spina Bifida
Meningocele
Myelomeningocele
Spina Bifida
A defect in development of spine and bone that can’t be seen other than a tuft of hair, dimple, but nothing obvious
- could go years without diagnoses
Meningocele
How is it repaired?
What part of the back do these occur most often?
Defect bulge in the vertebrae that is a little more obvious with pouching due to vertebrae not closing. No nerve tissue involved though.
Surgical repair is needed
Low back
Myelomineningocele
Repair?
What part of the back do these occur most often?
Defect of spine increases with the nerves being involved with the pouching.
Surgical repair here too
Diet reason for the three Neural tubal defects?
Foods with folic acid?
How do they make sure mom gets the folic acid?
Not getting enough folic acid
Breads, grain , cereals
Prenatal vitamins
Which neural tube defects have bulging/pouching?
What does the pouch pose a risk to?
First most foremost nursing goal for these?
Meningocele
Myelomineningocele
Infection risk bc the back is open
Nerve damage
Protect the sac!
What do you use to cover the sac pouch for neural tube defects like meningocele and myelomeningocele?
how to make sure you’re prepared?
wet/sterile dressing to maintain sterile and protect from infection
- this is especially important due to proximity of poop
- saline should be in warmer so it is ready
What positioning do we put infant in for meningocele and myelomeningocele?
Why does surgery take so long?
Prone position or on tummy to keep them from rolling onto the sac until recovered
Surgery can only happen 16-18 hours later bc they hav to to know the extension of the problem
- how much tissue, nerves, other defects (bc midline defects means other defects are likely)
When there is a neural tube defect going on , why do we check for other defects?
Bc if it is midline, there’s likely more defects.
With meningocele and myelomeningocele care what do we need to monitor for neurologically? And why?
Hydrocephalus and ICP due to spinal fluid not being able to drain from ventricles as it is supposed to or the fluid is being reabsorbed
- need to know which one tho in order to treat it
What allergy related to neural tube defects is common?
What education do we need to give?
Latex allergy
- although it is usually found before birth
No balloons or other forms of latex
After neural tube operation, what do we need to be careful about with the wound?
Be very gentle since the skin was pulled together to close the opening and it is tight
What post op position for neural tube defects does the infant need to be in ?
Prone positioning after surgery as well
Types of dressing changes to prevent infection post op neural tube operation?
What else can keep infection from occurring?
Sterile dressing changes
Maintain the skin’s integrity
Keep the diaper open
Monitor for infection signs
Why will a post op neural tube defect patient need a catheter? What to monitor for ?
They won’t be able to urinate
- this won’t go away btw so educate
Monitor for UTI
- due to catheter
What is the reason post op neural tube defect patients need PT?
Due to the lack of control below the defect and paralysis
- includes the bowl and bladder
What is Hydrocephalus?
Cerebrospinal fluid accumulating in brain from an imbalance between production and absorption
Classifications of Hydrocephalus?
How many types are there?
Congenital - neural tube defect or brain malformation
Acquired - infections and scarring
3 types and don’t confuse them with classification
Types of Hydrocephalus
What do all these cause?
Non-communicating
Communicating
Increased CSF production
Causes too much ICP from the fluid building up
Explain Non-communicating Hydrocephalus
Ventricles being obstructed
What is Communicating Hydropcephalus
Absorption problem in subarachnoid space
Increased CSF production cause of Hydrocephalus explanation
Rare tumor of choroid plexus causing increased production
What does Hydrocephalus affect?
Blood flow and thus oxygenation
Internal pressure ulcers and damage
How do they mainly treat and manage Hydrocephalus?
Surgical method
- Ventriculostomy
- Shunt
What is a Ventriculostomy surgery for Hydrocephalus?
Surgically perforating the wall of the third ventricle to drain CSF into interpenduncular cistern
Types of shunts they can do for surgical repair of Hydrocephalus?
Ventriculoperitoneal - located in the peritoneal cavity and most common bc of flexibility
Centriculoatrial - rt atrium location
Ventriculopleural - chest location
Lumbo-peritoneal - only for communicating hydropecephalus
Main concerns with the use of shunt for Hydrocephalus?
ICP due to occlusion
Infection from foreign object
What is an extra ventricular drain?
Risks?
But why use it?
External shunt
infection risk and make sure you know how stopcocks work so you don’t turn the wrong way
keep ports covered d
It measures pressure. Levels with trachea and cartilage.
What is Meningitis?
CNS infection (viral, bacterial , TB) - the type of organism will drive the treatment
Cause of Meningitis?
1) Vascular dissemination or travels through blood from somewhere else in the body
- most common
2) Implantation after trauma
3) Anatomic abnormality
What does the Meningitis cause?
Inflammation, edema, ICP and damage to brain tissue
Treatment for meningitis?
Depends on the agent
Viral: supportive
Bacterial : treatable with med s
Neonate so 1 month old meningitis symptoms
Poor feeding & sucking Vomiting / diarrhea Poot muscle tone Hyper or Hypothermia Jaundice Irritability Seizures Full fontanel as late sign
3mo-2 years old Meningitis
Fever Bulging fontanel Poor feeding Seizures Headache Irritability
2 years and up Meningitis
Fever Irritability Headache Opisthotonus Positive Brudzinksi & Kernings
Clotting issues leading petichae and purpura
Arching back due to the inflammation and to release tension (nucchal rigidity )
Brudzinski sign
Flexing of the hip the knee when neck is flared and is painful when there is meningitis
Kernels sign
90 degree angle and raised leg that causes pain and occurs with meningitis
What will happen to glucose and protein if it is bacterial meningitis?
What else will they culture?
Testing?
Glucose will drop
Protein rises if the cause was bacterial
Will culture blood and urine
Rapid antigen testing
What is a PCR diagnostic test for meningitis?
Polymerase Chain Reaction
- Can tell you if it is viral or bacterial
- if bacterial, give antibiotics
What if the wbc shift is small?
What if the wbc is large?
Means viral meningitis
Means bacterial meningitis
What if the meningitis is suspected of being disseminated intravascular coagulation (DIC)?
Coagulation panel
What do we do with someone who is suspected of meningitis?
We isolate them and we get treatment for anyone who has been in contact with them.
What treatment do we start out with if meningitis is suspected?
Next?
Broad spectrum IV antibiotics first but then narrow it down after lumbar puncture is done and we know the organism
- lumbar puncture being cloudy is not god
What position do we keep those wit meningitis in?
Elevated to help drain the fluid from the head
What precautions will someone with meningitis be on? meds?
Isolated but also seizure precautions with anti-seizure meds
- headache may be present too
With antibiotics administration what do we want to give before? Why?
Steroids like dexamethasone as to avoid inflammation and ICP from Cytokine Cascade
The antibiotics may break down the cell wall and allow fragments of the membrane to to cause inflammation
How can we prevent meningitis?
How can meningitis effect the elderly?
Vaccinate
- especially young and elderly
They’re already at risk from reduced motor skills, hearing, and cognition issues. We don’t want any secondary effects occurring from the meningitis.
What is Encephalitis?
Examples of causes?
Inflammation of brain from viral illness
Herpes, Respiratory infection
Signs of Encephalitis?
Treatment of Encephalitis?
Alteration in short term memory like not being able to remember names
IV antivirals that shorten the illness
Reyes Syndrome defintion
What can make this worse?
Encephalopathy characterized by viral infection that can lead to hepatic, metabolic, neuro failure
Using aspirin - so don’t give this to kids. Salicylates
What is Guillain Barre’ ?
Progressive motor weakness that travels upwards due to infection from the nerves being affected
- bottom peripheral and distal affected first like legs
Major concerns with Guillain Baree?
Respiratory depression bc it affects breathing muscles
Fall risk bc it starts from bottom and goes up
What is recommended for Guillain Barre patients?
When is another Time Guillain barre can also happen?
PT to learn how to use muscles again
Post pregnancy due to hormones shifting
What is the major thing to remember about treating head injuries?
We aren’t treating the head injury but we are preventing the secondary injury
T/F
Having a seizure means you have epilepsy
False. To be an epileptic, you must have 2 or more seizures that are not caused by anything else
- bc you can have seizures
Classifications of seizures
Focal : Limited area in the brain with abnormal firing but there are seizures taking place . Motor response is not always involved though so may not even see it and can be simple with motor signs, sensory signs, impaired awareness.
Generalized : Abnormal firing in a large area such as a whole hemisphere of the brain and there is a muscle response that can be seen that result in Tonic or Clonic responses.
Tonic Generalized Seizure
Clonic Generalized Seizure
Stiffening up for 10-20
Stiffening with jerky movement
What is meant by Post stage seizure?
Stage where the effects go on
Focal seizure that is partial with motor signs
A seizure of the a limited area of the brain due to it being focal
And Small response like lip smacking or hand smacking. and it appears on one side
Focal seizure that is simple partial with sensory signs
Limited area of the brain seizure that produces sensory issues like numbness, paresthesia, or pain in one area of the body.
Posture change from muscle relaxation and visual sensations
Focal seizure with impaired awareness
What will you have?
Period of altered behavior
Can have auras and impaired consciousness.
You won’t remember it.
T/F
Generalized seizures or seizures that happen in large areas are always either tonic or clonic.
False!
It can be both called a Tonic-Clonic generalized seizure and be followed be a postictal phase
In a tonic clonic seizure, how long does each portion last
Tonic for 10-20 seconds
- stiffening contractions and often may fall to the ground
Clonic for at least 30 seconds but can last half or longer
- you will see violent jerking movement from rhythmic
Explain the tonic phase
Immediate loss of consciousness, falls to ground even.
Eyes roll upward
Not breathing, apnea
Increases salivation not swallowing
Explain the clonic phase
Violent jerking
Foaming at mouth
Incontinent urine and feces
Postical phase
Appears relaxed, but is semiconscious or confused with poor coordination.
- not out of the woods
- very sleepy
What are generalized absence seizures?
When do they go away?
How often can these happen?
Unrecognizable seizures almost that happen to kids 4-12 years old that is mistaken for inattentiveness or daydreaming
- the seizure Vetter discussed
Go away with puberty
Absence seizures can happen multiple times throughout the day 20 or more
What are Atonic and Akinetic generalized seizures
When do these happen a lot tho?
Can you outgrow these?
Sudden abrupt momentary loss of muscle tone
You fall without the ability to break the fall essentially and can happen anytime in the day
Can happen shortly after being awake
Yes they can be outgrown
What are Generalized Myoclonic seizures? Important thing to differentiate?
Is there a postictal state with Myoclonic seizures?
Do you lose consciousness with Myoclonic seizures?
Is it symmetric?
Sudden brief contractures of muscle that can be once or continuous.
- not a jerky movement but a contraction
No postictal state
You can or can’t be unconscious
It can or can’t be symmetric
Where do they start with diagnosis of seizures?
A very thorough history and physical
- can even include prenatal care
When a skilled observation of a seizure is happening (usually to help dx) what is needed?
Full description of what is happening , location, consciousness level, type, and how long it lasts
- document carefully
What is the most useful tool for diagnosing seizures?
EEG
- confirms abnormal electrical discharges
- helps focus in on what type of seizure
Why is the keto genie diet recommended for seizures?
The high fat, low carbs, and low protein induces keto to keep seizures at bay
What is surgery like for seizure treatment?
Remove any area that interferes with electrical firing of brain or separate hemispheres; removal of epileptic foci
How are vagal nerve stimulator a good option for management of seizures?
Programing?
The stimulator goes in the chest/collarbone, wires wrap around legs and vagal nerve, and then the single overrides the seizure
Programming can be continuous for 30 sec every 5 minutes or activated for demand of the seizure
Vagal nerve stimulator complications?
Coughing, swallowing hoarseness
Infection
Tingling
All from excessive stimulation
Larzepam use?
Most common seizure med and used in emergencies
Diazepam use?
route?
What do we need to do for this med so it work properly?
Can be given rectally for seizures
Make sure to dilute with saline tho bc it can sticking interact to plastic
Seizure meds that start with a P?
Phenytonin
Phenobarbital
What can seizure meds interact with?
Liver issues
Bone marrow
- RBC/WBC development
What are Febrile seizures?
What age group is this most common in?
Seizure activity related to fever above 100.4-102
Infant - 5 years
Management for seizures including febrile?
Put the child on their side
Do not try to put anything in the mouth or restrain the child
When to seek medical attention with febrile seizures?
If seizures are repetitive
Last longer than 5 minutes
Child is difficult to arouse after the seizure
- the child may be tired but you should be able to arouse them
What to educate parents about febrile seizures
The temp is causing it and to pay attention to whether they are recurrent, lasting longer than 5 minutes, and can’t arise the child.
