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XIO > neuro peds > Flashcards

neuro peds Flashcards

1
Q

retinal detachment

A

shaken baby syndrome

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2
Q

shaken baby

A

all get full body scan - also shows older injuries

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3
Q

early signs of head trauma

(don’t vomit too early)

A

can’t verbalize, vomiting, coordiation

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4
Q

late signs of head trauma - (late to the cushions)

A
  • Increased systolic BP and widened pulse pressure * Bradycardia
  • Irregular respirations
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5
Q

need a general knowledge

A

of vital signs for age ranges

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6
Q

sunsetting - head trauma - early or late sign?

(the sun sets at night)

A

late sign, eye is bulging out

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7
Q

assessments

A

how to do neuro assessment and glasgow

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8
Q

assessment - start with

A

fontanelle, eyes - open and moving - don’t shine light into eyes - do side approach, appropriate noises or talking, then glasgow - on test (check difference btwn adult and children) can’t assess orientation if pt is non-verbal,

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9
Q

seizing

A

must have rescue meds available and ready, note time it started, what happened during and how long did it last.

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10
Q

seizure meds - how to give

A

rectal #1, IM #2

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11
Q

give meds if seizure is longer than

A

3 minutes

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12
Q

do head to toe

A

if possible after a seizure

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13
Q

know brudenski and kernig

(bruh, curl your head)

A

brudenski - lie flat and curl head up - we do it. kernig - leg up and when shortened it hurts

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14
Q

on test - after 24 hours can be

A

taken off droplet precautions

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15
Q

lumbar puncture - expected finding

A

clear straw colored - should not be blood

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16
Q

only give aspirin to children under 18 if

(aspirin kowaski)

A

they have kowasaki’s

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17
Q

cystica

A

more severe form of spinal bifida.

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18
Q

safety first -

A

then prevention of infection

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19
Q

spina bifida - temp regulated,

A

monitoring skin, moisturize skin, feeding issue, frequent turning

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20
Q

hydrocephaly - surgery

A

ventro-peritenial shunt (VP shunt) - neuro monitor before VP shunt surgery

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21
Q

Pediatric Differences - Infant Brain - – Develops rapidly until age

A

Infant Brain
– Develops rapidly until age 4

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22
Q

Infant and child differ from adults - and what about vertebrae?

A

Fontanels are not closed and cranial bones have yet to ossify
* Young infants have a proportionately large, heavy head
* Vertebrae are not completely ossified

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23
Q

Consciousness

A

responsiveness to or awareness of sensory stimuli

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24
Q

Unconsciousness

A

depressed cerebral function- inability to respond to stimuli

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25
Q

Intracranial Pressure

A

Force exerted by brain tissue, csf, & blood accumulating in cranial vault
* Decreased cerebral perfusion

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26
Q

Altered States of Consciousness Clinical Manifestations - ICP - early signs - what about pupils?

(I C with unequal pupils that your headache and vomiting is early)

A

Headache, visual disturbance, nausea/vomiting, pupils unequal or slow

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27
Q

Intracranial Pressure (ICP) - late signs

(I C your cushion is late)

A

Significant LOC decrease
CUSHING TRIAD

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28
Q

Pediatric Glasgow Coma Scale - what are the 3 parts? just start at the top

(eyes, mouth, arms)

A

Three-part assessment 1. Eyes
2. Verbal response
3. Motor response
* Score of 15 = unaltered LOC
* Score of 3 = extremely decreased LOC
(worst possible score on the scale)

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29
Q

Lumbar Puncture - inserted into what space?

A

Insertion of spinal needle into subarachnoid space between the lower lumbar vertebrae.

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30
Q

Normal CSF - color

A
  • Clear odorless
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31
Q

Abnormal CSF - color

A

*Turbid = cloudy

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32
Q

Nursing Management for decreased LOC

A
  • Assessment
  • Decrease stimuli
  • Reduce light in room
  • Quiet
  • Restrict visitors
  • Restrict visitors length of stay
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33
Q

Epilepsy

A
  • Chronic Disorder
  • Recurrent
  • Unprovoked seizures
  • Secondary to underlying brain abnormality
  • Epilepsy is the most common childhood brain disorder in the United States
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34
Q

Status Epilepticus - more common in what age?

(your status is 5)

A

– Prolonged continuous
– More common in children less than 5 years

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35
Q

Status Epilepticus - etiology

A
  • Acquired
  • Familial
  • Congenital
  • Head trauma
  • ICP
  • Poisons
  • Drug toxicity
  • Cerebral infections
36
Q

Febrile Seizures - what meds? and what ages?

A
  • Most common seizure in children
  • 6 months to 5 years
  • Occurs during rapid rise of fever
  • Child has illness or infection
  • Treat fever and illness
  • Treatment: if seizure conts – IV or rectal
    diazepam
  • For temperature - acetaminophen
37
Q

Bacterial Meningitis

A

Acute inflammation of the meninges
* Sometimes fatal
* Decreased incidence following use of Hib vaccine (flu vaccine)

38
Q

menigitis - bacterial - symptoms - you know these

A

Fever, lethargy, vomiting, headache – Nuchal rigidity, photophobia

39
Q

menigitis - viral - symptoms

(viral rash)

A

– Lesser severity of symptoms – Fever, lethargy, irritability
– Malaise
– Maculopapular rash (flat and raised)

40
Q

Bacterial Meningitis - what is the definitive test?

A

LP is the definitive diagnostic test

41
Q

Bacterial Meningitis - meds - for how long?

A
  • IV antibiotics 7-21 days
  • Monitor ICP (may be initiated)
42
Q

Encephalitis - caused by what virus?

A

Caused by:
* West Nile virus * Virus
* Fungi
* Bacteria
* Parasite

43
Q

Reye’s Syndrome

(reye has edema and low sugar in his liver)

A

Cerebral edema, hypoglycemia, enlarged, fatty, poorly functioning liver

44
Q

Reye’s Syndrome - Always follows viral infection - what days for the rash?

A

chicken pox - Change on 4th/5th day of rash
– Nausea, vomiting, mental status changes – Seizures, progressive unresponsiveness

45
Q

Hydrocephalus - nursing care - pre op - what about the neck?

A
  • Preoperative
    – Positioning – do not strain or stretch neck muscles – Providing skin care
    – Meeting nutritional needs
    – Providing emotional support
46
Q

Hydrocephalus - commonly associated with

A

myelomeningocele

47
Q

Hydrocephalus - symptoms

(water at sunset when crying)

A

Bulging anterior fontanel
Eyes deviated downward “Setting” Sun sign Increasing head circumference
Prominent scalp veins Irritability – high pitched cry
Poor feed
The older child will complain of headache

48
Q

Hydrocephalus -
nursing care - what position?

A

Postoperative
– Positioning - flat
– Assessing vital signs
– Antibiotics
– Providing incision care
– Monitoring for signs of shunt malfunction – Increased intracranial pressure
– Infection

49
Q

Assessment of shunt

A

n Vomiting/nausea n Headache
n Irritability
n Drowsiness
n Fever
n Redness along shunt
line
n Fluid around shunt
valve

50
Q

Neural Tube Defects - when do they occur?

A

Failure of the neural tube –
to close within the 1st 4 weeks of gestation

51
Q

how much folic acid for spinal bifida

A

– Supplementation—0.4 mg/day
– If history of NTD—4 mg/day

52
Q

Two types – neural tube defects

A

–Meningocele
–Myelodysplasia/Myelomeningocele- (Meningomyelocele/Spina Bifida)

53
Q

neural tube defects- Clinical Manifestations

A
  • Paralysis
  • Weakness
  • Sensory loss
  • Bowel- and bladder-control issues * Hydrocephalus
  • Ambulation difficulties
  • Intellectual disability
  • Visual impairment
54
Q

Meningocele

A
  • Sac contains meninges and spinal fluid but no neural elements
  • No neurologic deficits
55
Q

Spina Bifida

A

The sac
– May be fine membrane
* Prone to leakage of CSF; easily ruptured
– May be covered with dura, meninges, or skin
* Rapid epithelialization
* May be diagnosed prenatally or at birth * May be anywhere along the spinal column
– Lumbar and lumbosacral areas most common

56
Q

Myelomeningocele - Degree

A

Location and magnitude of defect determine nature and extent of impairment
– If defect is below second lumbar vertebra * Flaccid paralysis of lower extremities
* Sensory deficit
– Not necessarily uniform on both sides of defect

57
Q

head injury nursing care - what about HOB?

A
  • Elevate head of bed if no neck injury
  • Provide nutrition – with enteral feeding if child is unable to eat
  • Reduce light in room
  • Keep room quiet
  • Oralcare
  • Preventphysicaldeformities
  • Restrict visitors & length of stay
58
Q

infant brain - ossified by age

A

– Suture lines between skull bones ossified by age 12
* Myelination
– Coordination – Motor skills

59
Q

ICP - early signs in infants

(I c a bulge early)

A

increased head circumference, bulging fontanels

60
Q

ICP - late signs - what about pupils? and RR?

A
  • Irregular respirations
    Fixed, dilated pupils
61
Q

CUSHING’S TRIAD

A

(Increased systolic BP) widened pulse pressure, Bradycardia, irregular RR

62
Q

normal CSF - WBC

A
  • WBC’s 0–5
    abnormal - *WBC’s 1000 – 2000
63
Q

normal CSF - protein

(need protein at 15 and 45)

A
  • Protein 15 to 45
    abnormal = Protein 100 – 500
64
Q

normal CSF - glucose

(need sugar at 50)

A
  • Glucose 50 – 80
    abnormal = Glucose lower than blood sugar
65
Q

normal CSF - pressure

A
  • Pressure 50 to 180
    abnormal Pressure 180 or greater
66
Q

status epilipiticus - risk factors

A

– Risks factors: Fever, infection, change in condition
– Increased demand for oxygen & glucose
– Neurons damaged & cerebral hypoxia

67
Q

bacterial meningitis can be caused by

A

various bacterial agents
– Streptococcus pneumoniae
– Group β streptococci
– Escherichia coli

68
Q

decorticate (de-core) posturing

A

rigid flexation - arms pulled up to core and feet flexed inward

69
Q

deceberate posturing

A

brainstem - arms stretched and palms curled and out

70
Q

what test for falls

A

CT

71
Q

what test for seizures

A

EEG

72
Q

what med for increased ICP?

A

mannitol (duiretic)

73
Q

what type of seizures are febrile seizures?

A
  • Generalized tonic-clonic
74
Q

what meds for bacterial meningitis?

A

Ampicillin, ceftriaxone, penicillin G,
vancomycin

75
Q

bacterial meningitis - Dexamethasone for what?

A
  • Dexamethasone to decrease meningeal inflammation and hearing loss
76
Q

spina bifida occulta

A

not serious one, just a few vertebrae missing - hair tuft

77
Q

spina bifida cystica - 2 kinds

A

minigiocele and mylomenengicele

78
Q

position for spina bifida

A

prone - on stomach

79
Q

spina bifida - Below third sacral vertebra

A

*No motor impairment
* *Bladder and anal sphincter paralysis

80
Q

HR range

A

babies (birth to 3 months of age): 100–150 beats per minute. kids 1–3 years old: 70–110 beats per minute. kids by age 12: 55–85 beats per minute

81
Q

RR range

A

Infant (0-12 months old): 30 to 60 breaths per minute. Toddler (1-3 years old): 24-40 breaths per minute

82
Q

spina bifida - what vertebrae

A

L5-S1

83
Q

head injury - moderate

A

– Five- to ten-minute loss of consciousness – Headache, nausea
– Glasgow Coma Scale: 9–12

84
Q

head injury - severe

A

– Loss of consciousness of more than ten minutes
– Glasgow Coma Scale: less than 8
– Amnesia for more than 24 hours preinjury
– Coma

85
Q
A

XIO (372 decks)

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