Neuro PPT Flashcards
ways a child can sustain a neural or cerebral injury
prenatally - CP
acquired - trauma - Shaken Baby
genetics - fragile X syndrome - Rhett syndrome
persistence of rudimentary reflexes correlates to what disorder
Cerebral Palsy
Pediatric Glasgow Coma Scale looks at what 3 parameters
eyes
verbal
motor
what is the standardized assessment of child with altered LOC
PED Glasgow Coma Scale
pupil size/reactivity
LOC* - most sensitive indicator
Scoring of Glasgow Scale
15 - unaltered LOC
t or f, the lower the score of Glasgow at admission, the poorer the outcome
true
decorticate flexion correlates to an injury where?
cerebral cortex
what is decorticate flexion
arms/legs flexed to the core/mid-line
decerebrate extension correlates to an injury where?
mid-brain injury
what is anoxia
brain isn’t getting enough oxygen
fixed/dilated pupils on assessment is assoc with what?
anoxia; deficit of cranial nerve #3, hypothermia
use of eye drops - atropine medication causes dilation
death
what is atropine used for?
stimulate heart to go a little faster, check pupils first
AVPU method for assessment stands for
awake, verbal stimuli, painful stimuli, unresponsive
why is I/O an important assessment for neurological status
to assess cerebral edema - keep pt on dry side for prevention (salt/fluid restrictions)
to reduce increased metabolism r/t fever provide this type of therapy
anti-pyretic therapy - keep comfortable
do we want to mask s/s of head injury with pain mgmt
no
what should be avoided with neuro problems/head injury
narcotics - morphine
what is the recommended pain mgmt to avoid masking the effects of head injury
codeine
s/s of ICP in infants
bulging fontanels increased head circumference sunset eyes prominent scalp veins vomiting with or without nausea assess for seizures high-pitched cry headache (older kids) diplopia -double/blurry vision (older kids)
what could happen as a result of increased ICP
herniate brain stem-death
head is a closed box
mgmt for ICP
head circumference daily prepare for CT or MRI palpate fontanels reflexes LOC keep head mid-line 15-30 degrees
those with spina bifida(myelomeningocele) have a high correlation with
hydrocephaly
communicating hydrocephalus
no break in system to plexus to villi
non-communicating hydrocephalus
tumor or stenosis is obstructing
assessment criteria/manifest. for hydrocephaly
macewen sign (cracked-pot sound) - percussion on top of head back arching (opthisotonus)
what is positive trans-illumination
assessment where a light source held against head - CSF trans-illuminates
in shunt placement for hydrocephaly does child need to undergo surgeries with growth spurts
no, shunt coils in peritoneum as child grows shunt will lengthen
what is the purpose of shunt placement for hydrocephaly
draw CSF from ventricle to peritoneum where it will be reabsorbed
what type of shunt is used in hydrocephaly
V-P Shunt
pre-op care for shunt placement
head circumference
no s/s of infection
post-op care after shunt placement
flat on un-operative side wound care (sterile q-tip w/anti-biotic ointment) behind ear monitor for s/s of infection (high temp) GI status watch for ICP
2 classic signs of shaken baby syndrome
retinal tears
intracranial bleeds
consequence of shaken baby syndrome
ID seizures CP hydrocephalus motor fxn disorders blindness
what will older kids w/bacterial meningitis complain of
the worst headache they ever had
nuchal rigidity/pain-stiff neck (touch chin to chest)
photophobia
is bacterial meningitis spreadable?
yes - even during ruling out
put on **droplet precautions - at least 24hrs of anti-biotic therapy
what causes a child to have bacterial meningitis
strep pneumoniae (pneumococcal)
meningococcal
HIB
are you at high risk of developing meningitis if you have a local infection
yes - can become a systemic infection
Assessment technique to confirm bacterial meningitis
+ kernig and brudzinski sign
what is a kernig sign*
lift leg - child complains of pain in back of neck
what is a brudzinski sign*
lift back of neck - child lifts legs
severe form of bacterial meningitis is called
meningococcemia - medical emergency
manifestations of meningococcemia
purpuric or petechial rash - ominous sign
how do we dx bacterial meningitis
LP - lumbar puncture done at L3-L4
preparation of infants for LP-lumbar puncture
side lying knee-chest position - press on fontanel to expedite CSF drops
signs of bacterial meningitis in CSF
cloudy, turbid fluid WBC (1000-2000) Protein (100-500) *Glucose lower than blood sugar (bacteria needs glucose to grow) positive culture pressures are elevated
draw a venous specimen a half hour before lumbar tap, t or f
true
bacteria needs glucose to grow which is why glucose is lower than blood sugar in CSF for bacterial meningitis, t or f
true
nurs interventions for bacterial meningitis
isolation (droplet precautions) timely iv anti-biotic admin neuro checks/fontanelo pain mgmt quiet environment min. maint. fluids
is aseptic meningitis bacterial in nature
no - may be caused by a virus
antibiotics are not indicated - supportive therapy (hydration,rest)
not as lethal
will children with aseptic meningitis complain of the same things as bacterial meningitis
yes - headache, stiff neck, photophobia, n/v
what will cerebral spinal fluid show in aseptic meningitis
elevated lymphocytes
how should we position patient with spina bifida (myelomeningocele)
prone to prevent pressure or tears in the sack
what would happen if sack breaks its integrity
infection
is somebody has myelomeningocele there is a high incidence of
arnold chiari malformation - a form of hydrocephaly
assoc problems with myelomeningocele/spina bifida
paralysis of lwr extremities
issues w/bowel-bladder control (bowel training/urinary cath)
hip dysplasia
trt for spina bifida
surgery - to prevent infection/further problems
multi-disciplinary approach to care/trt
post op care for spina bifida surgery
pin diaper below suture line to ensure no contamination
bowel/bladder routines (GI/GU)
**correlation between latex allergy and spina bifida t or f
true
what are the plastic pieces worn for anatomical alignment for children with CP
MAFO - molded ankle foot orthotics
never put plastic next to the skin
assessment for CP
failure to achieve milestones (dx at 6-12 mos)
persistence of rudimentary reflexes
what are children at high risk for with CP
contractures
scoliosis (assess)
hearing and eye problems
seizures/spastic issues
what should we teach parents for children with CP
passive range of motion exercises
do children with CP typically have some form of ID
yes - from profoundly MR to cognitive fxn
trt for CP
early detection/trt MAFO's PT and ROM dental care modify environment good nutrition
more frequent type of CP seen
spastic
medications used to trt CP
baclofen - implanted in abdomen - intrathecal space
anti-epileptics
what clinical behaviors are expected in infant w/meningitis
poor feeding irritability high-pitched cry lethargy bulging fontanel nuchal rigidity
definitive meningitis is based on what test
LP - lumbar puncture
why low-level of fluids for pt with meningitis
cerebral edema leading to ICP
can meningitis be prevented
yes - HIB vaccine
