neuro peds Flashcards
retinal detachment
shaken baby syndrome
shaken baby
all get full body scan - also shows older injuries
early signs of head trauma
(don’t vomit too early)
can’t verbalize, vomiting, coordiation
late signs of head trauma - (late to the cushions)
- Increased systolic BP and widened pulse pressure * Bradycardia
- Irregular respirations
need a general knowledge
of vital signs for age ranges
sunsetting - head trauma - early or late sign?
(the sun sets at night)
late sign, eye is bulging out
assessments
how to do neuro assessment and glasgow
assessment - start with
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,
seizing
must have rescue meds available and ready, note time it started, what happened during and how long did it last.
seizure meds - how to give
rectal #1, IM #2
give meds if seizure is longer than
3 minutes
do head to toe
if possible after a seizure
know brudenski and kernig
(bruh, curl your head)
brudenski - lie flat and curl head up - we do it. kernig - leg up and when shortened it hurts
on test - after 24 hours can be
taken off droplet precautions
lumbar puncture - expected finding
clear straw colored - should not be blood
only give aspirin to children under 18 if
(aspirin kowaski)
they have kowasaki’s
cystica
more severe form of spinal bifida.
safety first -
then prevention of infection
spina bifida - temp regulated,
monitoring skin, moisturize skin, feeding issue, frequent turning
hydrocephaly - surgery
ventro-peritenial shunt (VP shunt) - neuro monitor before VP shunt surgery
Pediatric Differences - Infant Brain - – Develops rapidly until age
Infant Brain
– Develops rapidly until age 4
Infant and child differ from adults - and what about vertebrae?
Fontanels are not closed and cranial bones have yet to ossify
* Young infants have a proportionately large, heavy head
* Vertebrae are not completely ossified
Consciousness
responsiveness to or awareness of sensory stimuli
Unconsciousness
depressed cerebral function- inability to respond to stimuli
Intracranial Pressure
Force exerted by brain tissue, csf, & blood accumulating in cranial vault
* Decreased cerebral perfusion
Altered States of Consciousness Clinical Manifestations - ICP - early signs - what about pupils?
(I C with unequal pupils that your headache and vomiting is early)
Headache, visual disturbance, nausea/vomiting, pupils unequal or slow
Intracranial Pressure (ICP) - late signs
(I C your cushion is late)
Significant LOC decrease
CUSHING TRIAD
Pediatric Glasgow Coma Scale - what are the 3 parts? just start at the top
(eyes, mouth, arms)
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)
Lumbar Puncture - inserted into what space?
Insertion of spinal needle into subarachnoid space between the lower lumbar vertebrae.
Normal CSF - color
- Clear odorless
Abnormal CSF - color
*Turbid = cloudy
Nursing Management for decreased LOC
- Assessment
- Decrease stimuli
- Reduce light in room
- Quiet
- Restrict visitors
- Restrict visitors length of stay
Epilepsy
- Chronic Disorder
- Recurrent
- Unprovoked seizures
- Secondary to underlying brain abnormality
- Epilepsy is the most common childhood brain disorder in the United States
Status Epilepticus - more common in what age?
(your status is 5)
– Prolonged continuous
– More common in children less than 5 years
Status Epilepticus - etiology
- Acquired
- Familial
- Congenital
- Head trauma
- ICP
- Poisons
- Drug toxicity
- Cerebral infections
Febrile Seizures - what meds? and what ages?
- 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
Bacterial Meningitis
Acute inflammation of the meninges
* Sometimes fatal
* Decreased incidence following use of Hib vaccine (flu vaccine)
menigitis - bacterial - symptoms - you know these
Fever, lethargy, vomiting, headache – Nuchal rigidity, photophobia
menigitis - viral - symptoms
(viral rash)
– Lesser severity of symptoms – Fever, lethargy, irritability
– Malaise
– Maculopapular rash (flat and raised)
Bacterial Meningitis - what is the definitive test?
LP is the definitive diagnostic test
Bacterial Meningitis - meds - for how long?
- IV antibiotics 7-21 days
- Monitor ICP (may be initiated)
Encephalitis - caused by what virus?
Caused by:
* West Nile virus * Virus
* Fungi
* Bacteria
* Parasite
Reye’s Syndrome
(reye has edema and low sugar in his liver)
Cerebral edema, hypoglycemia, enlarged, fatty, poorly functioning liver
Reye’s Syndrome - Always follows viral infection - what days for the rash?
chicken pox - Change on 4th/5th day of rash
– Nausea, vomiting, mental status changes – Seizures, progressive unresponsiveness
Hydrocephalus - nursing care - pre op - what about the neck?
- Preoperative
– Positioning – do not strain or stretch neck muscles – Providing skin care
– Meeting nutritional needs
– Providing emotional support
Hydrocephalus - commonly associated with
myelomeningocele
Hydrocephalus - symptoms
(water at sunset when crying)
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
Hydrocephalus -
nursing care - what position?
Postoperative
– Positioning - flat
– Assessing vital signs
– Antibiotics
– Providing incision care
– Monitoring for signs of shunt malfunction – Increased intracranial pressure
– Infection
Assessment of shunt
n Vomiting/nausea n Headache
n Irritability
n Drowsiness
n Fever
n Redness along shunt
line
n Fluid around shunt
valve
Neural Tube Defects - when do they occur?
Failure of the neural tube –
to close within the 1st 4 weeks of gestation
how much folic acid for spinal bifida
– Supplementation—0.4 mg/day
– If history of NTD—4 mg/day
Two types – neural tube defects
–Meningocele
–Myelodysplasia/Myelomeningocele- (Meningomyelocele/Spina Bifida)
neural tube defects- Clinical Manifestations
- Paralysis
- Weakness
- Sensory loss
- Bowel- and bladder-control issues * Hydrocephalus
- Ambulation difficulties
- Intellectual disability
- Visual impairment
Meningocele
- Sac contains meninges and spinal fluid but no neural elements
- No neurologic deficits
Spina Bifida
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
Myelomeningocele - Degree
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
head injury nursing care - what about HOB?
- 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
infant brain - ossified by age
– Suture lines between skull bones ossified by age 12
* Myelination
– Coordination – Motor skills
ICP - early signs in infants
(I c a bulge early)
increased head circumference, bulging fontanels
ICP - late signs - what about pupils? and RR?
- Irregular respirations
Fixed, dilated pupils
CUSHING’S TRIAD
(Increased systolic BP) widened pulse pressure, Bradycardia, irregular RR
normal CSF - WBC
- WBC’s 0–5
abnormal - *WBC’s 1000 – 2000
normal CSF - protein
(need protein at 15 and 45)
- Protein 15 to 45
abnormal = Protein 100 – 500
normal CSF - glucose
(need sugar at 50)
- Glucose 50 – 80
abnormal = Glucose lower than blood sugar
normal CSF - pressure
- Pressure 50 to 180
abnormal Pressure 180 or greater
status epilipiticus - risk factors
– Risks factors: Fever, infection, change in condition
– Increased demand for oxygen & glucose
– Neurons damaged & cerebral hypoxia
bacterial meningitis can be caused by
various bacterial agents
– Streptococcus pneumoniae
– Group β streptococci
– Escherichia coli
decorticate (de-core) posturing
rigid flexation - arms pulled up to core and feet flexed inward
deceberate posturing
brainstem - arms stretched and palms curled and out
what test for falls
CT
what test for seizures
EEG
what med for increased ICP?
mannitol (duiretic)
what type of seizures are febrile seizures?
- Generalized tonic-clonic
what meds for bacterial meningitis?
Ampicillin, ceftriaxone, penicillin G,
vancomycin
bacterial meningitis - Dexamethasone for what?
- Dexamethasone to decrease meningeal inflammation and hearing loss
spina bifida occulta
not serious one, just a few vertebrae missing - hair tuft
spina bifida cystica - 2 kinds
minigiocele and mylomenengicele
position for spina bifida
prone - on stomach
spina bifida - Below third sacral vertebra
*No motor impairment
* *Bladder and anal sphincter paralysis
HR range
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
RR range
Infant (0-12 months old): 30 to 60 breaths per minute. Toddler (1-3 years old): 24-40 breaths per minute
spina bifida - what vertebrae
L5-S1
head injury - moderate
– Five- to ten-minute loss of consciousness – Headache, nausea
– Glasgow Coma Scale: 9–12
head injury - severe
– Loss of consciousness of more than ten minutes
– Glasgow Coma Scale: less than 8
– Amnesia for more than 24 hours preinjury
– Coma
