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Mgmt PEDS > Neuro PPT > Flashcards

Neuro PPT Flashcards

1
Q

ways a child can sustain a neural or cerebral injury

A

prenatally - CP
acquired - trauma - Shaken Baby
genetics - fragile X syndrome - Rhett syndrome

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2
Q

persistence of rudimentary reflexes correlates to what disorder

A

Cerebral Palsy

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3
Q

Pediatric Glasgow Coma Scale looks at what 3 parameters

A

eyes
verbal
motor

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4
Q

what is the standardized assessment of child with altered LOC

A

PED Glasgow Coma Scale
pupil size/reactivity
LOC* - most sensitive indicator

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5
Q

Scoring of Glasgow Scale

A

15 - unaltered LOC

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6
Q

t or f, the lower the score of Glasgow at admission, the poorer the outcome

A

true

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7
Q

decorticate flexion correlates to an injury where?

A

cerebral cortex

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8
Q

what is decorticate flexion

A

arms/legs flexed to the core/mid-line

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9
Q

decerebrate extension correlates to an injury where?

A

mid-brain injury

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10
Q

what is anoxia

A

brain isn’t getting enough oxygen

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11
Q

fixed/dilated pupils on assessment is assoc with what?

A

anoxia; deficit of cranial nerve #3, hypothermia
use of eye drops - atropine medication causes dilation
death

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12
Q

what is atropine used for?

A

stimulate heart to go a little faster, check pupils first

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13
Q

AVPU method for assessment stands for

A

awake, verbal stimuli, painful stimuli, unresponsive

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14
Q

why is I/O an important assessment for neurological status

A

to assess cerebral edema - keep pt on dry side for prevention (salt/fluid restrictions)

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15
Q

to reduce increased metabolism r/t fever provide this type of therapy

A

anti-pyretic therapy - keep comfortable

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16
Q

do we want to mask s/s of head injury with pain mgmt

A

no

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17
Q

what should be avoided with neuro problems/head injury

A

narcotics - morphine

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18
Q

what is the recommended pain mgmt to avoid masking the effects of head injury

A

codeine

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19
Q

s/s of ICP in infants

A 
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)
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20
Q

what could happen as a result of increased ICP

A

herniate brain stem-death

head is a closed box

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21
Q

mgmt for ICP

A 
head circumference daily
prepare for CT or MRI
palpate fontanels
reflexes
LOC
keep head mid-line 15-30 degrees
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22
Q

those with spina bifida(myelomeningocele) have a high correlation with

A

hydrocephaly

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23
Q

communicating hydrocephalus

A

no break in system to plexus to villi

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24
Q

non-communicating hydrocephalus

A

tumor or stenosis is obstructing

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25
Q

assessment criteria/manifest. for hydrocephaly

A 
macewen sign (cracked-pot sound) - percussion on top of head
back arching (opthisotonus)
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26
Q

what is positive trans-illumination

A

assessment where a light source held against head - CSF trans-illuminates

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27
Q

in shunt placement for hydrocephaly does child need to undergo surgeries with growth spurts

A

no, shunt coils in peritoneum as child grows shunt will lengthen

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28
Q

what is the purpose of shunt placement for hydrocephaly

A

draw CSF from ventricle to peritoneum where it will be reabsorbed

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29
Q

what type of shunt is used in hydrocephaly

A

V-P Shunt

30
Q

pre-op care for shunt placement

A

head circumference

no s/s of infection

31
Q

post-op care after shunt placement

A 
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
32
Q

2 classic signs of shaken baby syndrome

A

retinal tears

intracranial bleeds

33
Q

consequence of shaken baby syndrome

A 
ID
seizures
CP
hydrocephalus
motor fxn disorders
blindness
34
Q

what will older kids w/bacterial meningitis complain of

A

the worst headache they ever had
nuchal rigidity/pain-stiff neck (touch chin to chest)
photophobia

35
Q

is bacterial meningitis spreadable?

A

yes - even during ruling out

put on **droplet precautions - at least 24hrs of anti-biotic therapy

36
Q

what causes a child to have bacterial meningitis

A

strep pneumoniae (pneumococcal)
meningococcal
HIB

37
Q

are you at high risk of developing meningitis if you have a local infection

A

yes - can become a systemic infection

38
Q

Assessment technique to confirm bacterial meningitis

A

+ kernig and brudzinski sign

39
Q

what is a kernig sign*

A

lift leg - child complains of pain in back of neck

40
Q

what is a brudzinski sign*

A

lift back of neck - child lifts legs

41
Q

severe form of bacterial meningitis is called

A

meningococcemia - medical emergency

42
Q

manifestations of meningococcemia

A

purpuric or petechial rash - ominous sign

43
Q

how do we dx bacterial meningitis

A

LP - lumbar puncture done at L3-L4

44
Q

preparation of infants for LP-lumbar puncture

A

side lying knee-chest position - press on fontanel to expedite CSF drops

45
Q

signs of bacterial meningitis in CSF

A 
cloudy, turbid fluid
WBC (1000-2000)
Protein (100-500)
*Glucose lower than blood sugar (bacteria needs glucose to grow)
positive culture
pressures are elevated
46
Q

draw a venous specimen a half hour before lumbar tap, t or f

A

true

47
Q

bacteria needs glucose to grow which is why glucose is lower than blood sugar in CSF for bacterial meningitis, t or f

A

true

48
Q

nurs interventions for bacterial meningitis

A 
isolation (droplet precautions)
timely iv anti-biotic admin
neuro checks/fontanelo
pain mgmt
quiet environment
min. maint. fluids
49
Q

is aseptic meningitis bacterial in nature

A

no - may be caused by a virus
antibiotics are not indicated - supportive therapy (hydration,rest)
not as lethal

50
Q

will children with aseptic meningitis complain of the same things as bacterial meningitis

A

yes - headache, stiff neck, photophobia, n/v

51
Q

what will cerebral spinal fluid show in aseptic meningitis

A

elevated lymphocytes

52
Q

how should we position patient with spina bifida (myelomeningocele)

A

prone to prevent pressure or tears in the sack

53
Q

what would happen if sack breaks its integrity

A

infection

54
Q

is somebody has myelomeningocele there is a high incidence of

A

arnold chiari malformation - a form of hydrocephaly

55
Q

assoc problems with myelomeningocele/spina bifida

A

paralysis of lwr extremities
issues w/bowel-bladder control (bowel training/urinary cath)
hip dysplasia

56
Q

trt for spina bifida

A

surgery - to prevent infection/further problems

multi-disciplinary approach to care/trt

57
Q

post op care for spina bifida surgery

A

pin diaper below suture line to ensure no contamination

bowel/bladder routines (GI/GU)

58
Q

**correlation between latex allergy and spina bifida t or f

A

true

59
Q

what are the plastic pieces worn for anatomical alignment for children with CP

A

MAFO - molded ankle foot orthotics

never put plastic next to the skin

60
Q

assessment for CP

A

failure to achieve milestones (dx at 6-12 mos)

persistence of rudimentary reflexes

61
Q

what are children at high risk for with CP

A

contractures
scoliosis (assess)
hearing and eye problems
seizures/spastic issues

62
Q

what should we teach parents for children with CP

A

passive range of motion exercises

63
Q

do children with CP typically have some form of ID

A

yes - from profoundly MR to cognitive fxn

64
Q

trt for CP

A 
early detection/trt
MAFO's
PT and ROM
dental care
modify environment 
good nutrition
65
Q

more frequent type of CP seen

A

spastic

66
Q

medications used to trt CP

A

baclofen - implanted in abdomen - intrathecal space

anti-epileptics

67
Q

what clinical behaviors are expected in infant w/meningitis

A 
poor feeding
irritability
high-pitched cry
lethargy
bulging fontanel
nuchal rigidity
68
Q

definitive meningitis is based on what test

A

LP - lumbar puncture

69
Q

why low-level of fluids for pt with meningitis

A

cerebral edema leading to ICP

70
Q

can meningitis be prevented

A

yes - HIB vaccine

Mgmt PEDS (21 decks)

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