Neuro/ Respiratory Flashcards
1
Q
What is one of the first body system to form in uterus?
A
Nervous system-neural tube
2
Q
How much CSF do infants have?
A
50 mL
3
Q
Does the brain continue to grow throughout childhood?
A
Yes
4
Q
Are the pediatric brain and peripheral nerves fully developed at birth?
A
No
5
Q
Neurological Alterations
A
- IICP
- head injury
- hydrocephalus
- seizure disorders
- spina bifida
- cerebral palsy
- Reyes syndrome
6
Q
Causes of IICP
A
Space-occupying lesion- brain tumor, hematoma
Swelling- head trauma, infection, hypoxic episode
Overproduction of fluid
Malabsorption of fluid
Communication problem w/in
Aneurysms w/in the brain
Acute liver failure
7
Q
What is Hydrocephalus?
A
A condition in which fluid accumulates in the brain
Typically I young children
Enlarging the head
Sometimes causing brain damage
8
Q
What is Spina Bifida
A
A congenital neural tube defect(NTD)
Incomplete closure of the vertebrae and neural tube during fetal development
9
Q
What is Cerebral Palsy?
A
A chronic, non progressive disorder of posture and movement
Difficulty in controlling the muscles b/c of an abnormality in the extrapyramidal or pyramidal motor system
10
Q
What is Reye Syndrome
A
Exposure to a viral agent or toxin in at-risk children leads to liver cell damage w/rising serum ammonia levels
The toxic ammonia levels result in cerebral dysfunction (encephalopathy, cerebral edema), fluid and electrolyte and acid base imbalances, and coagulopathies
May be related to giving aspirin to children w/a viral disease
11
Q
Diagnostic testing for neurological alterations
A
CT-SCAN MRI Nuclear brain scan Angiography Echopencephalography (EEG) Lumbar puncture
12
Q
Lumbar puncture RN intervention
A
Keep child still (side-lying, knees to chin)
Monitor cardiorespiratory status
Help parents comfort child
13
Q
Lumbar puncture teaching points
A
EMLA cream used to numb the area(only form of pain management
Site will be cleansed w/cool antiseptic solution
Collection of CSF takes several minutes
Lie flat after procedure and encourage fluids
14
Q
S/S IICP infants
A
Bulging fontanel High- pitched cry Increased head circumference Eyes deviating downward(sun-setting) Altered response to pain(increased or decreased) Poor feeding/ vomiting Irritability Lethargy
15
Q
S/S of IICP in child
A
Headache
Altered LOC
Vomiting(esp. morning due to rising from laying position= shift in pressure)
Mood swings
Slurred speech
Changes in normal behavior(not acting like themselves)
16
Q
IICP nursing interventions
A
Elevate bed to 30 degrees
Medication: osmotic diuretic(mannitol), sedation, analgesics
Avoid aggressive use of passive ventilation (wind)
Monitor intraventricular catheter, if placed
Monitor LOC
17
Q
Posturing- DECORTICATE
A
Flexor
Arms are like a C
Moved inward (on chest)
PROBLEMS W/ CERVICAL SPINAL TRACT OR CEREBRAL HEMISPHERE
18
Q
Posturing- DECEREBRATE
A
Extensor
Arms are like E
Outward
PROBLEMS W/IN MIDBRAIN OR PONS
19
Q
Head injury- infant signs of skull fracture/trauma are…
A
Scalp hematoma and seizures
20
Q
Head injury assess
A
Airway
Respiratory function
Neurologic status
Other injuries
21
Q
Head injury nursing interventions
A
Maintain vital functions (adequate Oxygenation/perfusion)
Frequent neurological checks monitor for IICP
Encourage rest-NO SCHOOL OR TV OR VIDEO GAMES JUST SLEEP
22
Q
Mild head injury S/S EXPECTED
A
- Periods of confusion
- Behavior changes
- Irritability
- Vomiting
- Headache
- Sleepy
23
Q
Severe head injury S/S
CALL HCP
A
- Seizures
- Severe headache
- Severe/constant vomiting
- Blurred vision
- CSF (watery) or blood from ears/nose
- Hard to wake (decreased LOC)
- Slurred speech
- Unequal pupils or crossed-eyes
24
Q
Hydrocephalus infant early S/S
A
- Born w/ large head
- Rapid head growth
- Bulging anterior fontanel
- Irritability
- Poor feeding
25
Hydrocephalus infant late S/S
```
“Setting sun” sign
Vomiting
Difficulty feeding/swallowing
Increased BP
Decrease HR
Altered respiratory pattern
Shrill/high-pitched cry
Sluggish or unequal pupillary response to light
```
26
Hydrocephalus early S/S in children 12-18 months
Strabismus (cross-eyed appearance)
Morning frontal headache relieved by vomiting or sitting upright
Behavior/personality changes
Irritability
Sluggish or unequal pupillary response to light
Confusion
Lethargy
27
Hydrocephalus late S/S in children 12-18 months
- Seizures
- DECEREBRATE posturing and rigidity
- Increased BP
- Decreased HR
- Altered respiratory pattern
- Blindness (vision issues)
28
Causes of hydrocephalus
Head injury
Meningitis
Congenital defect
Tumor
Spina Bifida
29
Hydrocephalus nursing intervention
Monitoring the shunt to prevent further CSF accumulation and reducing disability and death
30
Hydrocephalus treatment
VP shunt (ventricular peritoneal shunt)
Permanent shunt from ventricle in brain to peritoneum
Drains CSF into abdomen where extra CSF can be absorbed, decreasing ICP
Internal system
31
Seizure disorder-febrile
- Children under 5 years old
- Caused by high and rapidly elevating temps
- Child at risk for additional febrile seizures
- Usually harmless and doesn’t cause other health problems
- ONLY TREATMENT IS GIVE ANTIPYRETICS
32
Neonatal seizure disorder
Birth to 4 weeks old (first month of life)
Subtle signs of seizures b/c immaturity of neonates nervous system
33
Neonatal seizure disorder causes
Underlying pathological process
- Drug withdrawal
- Hyperthermia
- Hypoglycemia
- IICP
- Intracranial hemorrhage
34
Neonatal seizure subtle signs of seizure activity
Staring
Rapid eye blinking
Rapid/constant lip smacking or sucking
35
Neonatal seizure disorder treatment
Medications during seizure activity and daily for 3-6 months
36
What is Epilepsy
Recurrent seizure activity that does not occur in association w/acute illness
37
Epilepsy treatment
Maintenance medication
For seizures lasting more than 5 minutes- give Dilantin (phenytoin) rescue drug RECTALLY AND KEEP THIS MEDICATION AT THE BEDSIDE
Ketogenic diet if medication doesn’t work! LAST RESORT (high fat, low/no carbs)
38
Seizure rn interventions
```
Place child on soft surface
Remove furniture/ objects from area
Turn gently to the side
Protect head
Stay w/child
Time and observe seizure
Do not restrain or put anything inside mouth
May need ketogenic diet if medications fail (high fat, low/no carbs)
```
39
Spina Bifida -occulta
Mild
Open vertebrae, nothing protruding
likely asymptomatic
40
Spina Bifida- cystica: meningocele
Moderate
Saclike protrusion containing meninges and CSF
41
Spina Bifida- cystica: myelomeningocele
Severe
- Saclike protrusion containing CSF, meninges, nerve roots and spinal cord
- Bowel/ bladder involvement
- Flaccid muscle tone
- respiratory issues
- paralysis of lower extremities
42
Treatment for Spina Bifida
- VP shunt
- Straight cath
- Leg braces
- Wheelchairs
- intrapartum-utero surgery
43
Complications of a VP shunt
Infection
Clog
Outgrow w/age
Migration
Breakage
44
Spina Bifida pts are at risk for...
```
Hydrocephalus and IICP
Cerebellum protrudes down top of spine causing CSF blockage-causing hydrocephalus
Respiratory apnea/cyanosis
GI dysfunction
Paralysis in lower extremities
Bowel ants bladder dysfunction
Club feet
```
45
Spina Bifida assessment
Lesion on back (dimple, hair tuft, saclike protrusion)
Flaccid lower extremities
Decreased sensation
Bowel/bladder incontinence
Improper positioning of hip, knee, plantar
46
Spina Bifida RN interventions
Prone position
Cover defect w/sterile, moist dressing prior to surgery
Latex precautions from birth due to repeated exposure to latex
Life long management of neurologic, orthopedic, and urinary problems
47
What is cerebral palsy?
- Chronic, non-progressive disorder of posture and movement.
- characterized by difficulty in controlling the muscles
- abnormality in the extrapyramidal or pyramidal motor system
48
Cerebral palsy co-mobidities
- cognitive impairments
- hearing impairments
- speech impairments
- visual impairments
- seizures
49
Risk factors
- being in a hot car
- shaking baby syndrome
- brain not going w/o oxygen during birth
- brain trauma
- maternal drug use intra-utero
50
How do we maximize a child with cerebral palsy’s abilities?
Early recognition and intervention
OT/PT
51
What is the main test for a lumbar puncture?
Meningitis
52
Strabismus
Cross-eyed appearance
53
Cerebral palsy assessment
- delayed gross motor development
- spastic or uncontrolled movements in extremities
- gait disturbances
- seizures
- sensory impairment
- primitive reflexes
- abnormal muscle tone
- lack of progression thru developmental milestones
- speech and swallowing impairments
54
How to prevent Reye syndrome?
Vaccinations of MMR, VARICELLA,FLU...
don’t give aspirin
55
S/S of Reye Syndrome
- prior viral infection
- progressive neurological decline
- malaise
- N/V
- elevated ammonia levels
- liver dysfunction
- low blood sugar
- bleeding issues
- IICP w/ respiratory dysfunctions
56
What two organs does Reye syndrome attack?
Liver
Brain
57
Monitoring w/ Reye syndrome
- Neurological status
- IICP
- hydration
- acid-base balance
- cardiorespiratory status
58
Treatment for Reye syndrome
- manage symptoms caused by virus
- IV Fluid to regulate glucose and electrolyte levels
- mannitol or IICP
59
Considerations for Reye syndrome
- Can cause permanent neurological damage (brain damage)
| - can’t be fatal w/in days if not treated
60
What is Otitis Media?
Fluid or infection in the middle ear
61
What risk factors for otitis media
- Infants and small children d/t their Eustachian tube is not as slanted and is shorter
- daycare
- smoking in home
- supine position while being bottle fed
- pacifier users
- 6-24 months
62
S/S of otitis media
- bulging, red,opaque tympanic membrane(MD)
- earache,pulling ears
- fever
- V/D
- sleep disturbances
- hearing & speech problems
- yellow/green foul smelling drainage(indicates perforated tympanic membrane (not common)
63
Treatment of otitis media
- watch and wait 3-4 days to see if it resolves itself before giving antibiotics
- antibiotics
- tympanostomy tubes
64
What is tympanostomy tubes?
- surgical placement on tubes into the ear canal
| - treatment of otitis media
65
What is croup
- Viral infection
- upper airway
- let it run its course
66
S/S of croup
- sore throat
- INSPIRATORY STRIDOR
- RESPIRATORY DISTRESS
- fever
- BARKY COUGH (worse at night)
67
Croup treatment
- COOL MIST/ HUMIDIFICATION (#1)
- apply oxygen depends on vitals
- breathing treatments (respiratory therapy)
- manage symptoms
- may be treated at home or in the hospital
68
What is Pharyngitis
Inflammation or infection of the throat
| Usually strep
69
S/S of pharyngitis & treatment
- sore throat
- redness/inflammation -throat
- fever
- cough
- runny nose
- hoarseness voice
TREATMENT-antibiotics, pain/ symptoms managed
70
S/S of tonsillitis
- Sore throat
- redness/inflammation of tonsils
- difficulty swallowing
- decreased appetite
- decreased thirst
- WHITE EXUDATE ON TONSILS
- fever
- UNPLEASANT MOUTH ODOR
- often present w/ pharyngitis
71
Treatment of tonsillitis
- antibiotics
| - tonsillectomy if recurrent
72
RN interventions for tonsillitis
```
ASSESS FOR BLEEDING
-excessive swallowing
-bloody drainage
-bloody vomitus
-restlessness associated w/ pain
-high/low BP
-high HR
MAINTAIN HYDRATION
SCHEDULED PAIN MEDS
FLUIDS ORALLY
```
73
Epiglottis is
Inflammation of the flat that closes the opening of the windpipe when swollen.
EMERGENCY SITUATION!!!!!
74
S/S of epiglottis
-abrupt onset and gets worse very quickly
- the 4 D’S
-drooling
-dysphasia
-dyphonia
-distressed inspiratory efforts
(trouble breathing)
-tripod position
-HIGH FEVER
-Gasping for air
75
Treatment for epiglottis
- Antibiotics (IV until extubated)
- antipyretics (IV or rectal)
- USUALLY INTUBATED/ maintain patent airway
76
What vaccine can prevent epiglottis
HIB
77
RN intervention for epiglottis
- stay w/ child
- continually assess for respiratory distress
- have intubation equipment at the bedside
- radiographs at the bedside
- keep child and parents calm and quiet
78
What is the most important intervention for a pt w/ epiglottis
DO NOT PUT ANYTHING IN PTS MOUTH
DO NOT SWAB THROAT UNTIL READY W/ INTUBATION EQUIPMENT
SWABBING WILL INCREASE IRRITATION AND INFLAMMATION CAUSING COMPLETE AIRWAY OBSTRUCTION
79
What is Bronchiolitis
Inflammation and edema causing constriction of the bronchioles (lower airway)
CAUSED BY THE VIRUS RSV
80
S/S of bronchiolitis
- Sneezing
- A LOT OF CLEAR NASAL DRAINAGE
- ALTERED LUNG SOUNDS(crackles,wheezes, rhonchi)
- respiratory distress
- LOW GRADE FEVER
81
When to suction a pt w/ bronchiolitis(RSV)
Hospital or home
ESPECIALLY BEFORE FEEDING AND AT BEDTIME
82
When can a pt go home with bronchiolitis
When secretions can be controlled with a bulb suction
83
RN interventions for bronchiolitis
- suction
- apply cool humidified O2
- respiratory therapy
- IV fluids if necessary
- MAINTAIN HOB 30-40 degrees w/ Neck slightly extended
- TEACHING RSV PREVENTION IS MOST IMPORTANT
84
What is asthma?
Spasms in the bronchi of the lungs causing difficulty breathing
Usually caused by allergic reaction or hypersensitivity to stimulus
85
S/S of asthma
- Retraction
- nonproductive cough
- stridor
- respiratory distress
- apprehension, restlessness, diaphoresis
- abdominal pain
- SOB
- chest tightness followed by dry cough, wheezing, and suspend
- symptoms worsening at night
86
Triggers for asthma attack
- pet dander
- mold
- dust
- perfumes
- air fresheners
- tobacco smoke
87
How to treat asthma
- remove carper/curtains
- avoid allergens
- inhalers and nose spray SPACERS OR FACE MASKS ARE BETTER FOR KIDS TO INHALE MEDICATION
- rescue inhaler
88
What is cystic fibrosis
Chronic, genetic, multi system disorder affecting exocrine glands (bronchioles, small interesting, pancreatic and bile ducts) produces abnormally thick mucous causing obstruction of small passageways
89
What organs are affected w/ cystic fibrosis?
- Sinuses
- lungs (thick, sticky, mucus buildup, pneumonia, widened airway)
- skin(salty sweat)
- liver(blocked bile ducts)
- pancreas(blocked pancreatic ducts)
- intestines (cannot absorb nutrients)
- reproductive organs
90
How is cystic fibrosis dx
Newborn screening
Sweat test
91
First sign of cystic fibrosis?
Lack of meconium (meconium ileum)
Difficult for infant to have their first poop
92
What system does cystic fibrosis affect first
Digestive!
Then the respiratory develop later
93
S/S of cystic fibrosis
- Lack of meconium
- loose, bulky, fat stool
- diminished lung sounds
- hoarse voice
- wheezing(b/c of mucus)
- recurrent infection (like pneumonia)
- they are thin/ small for their age due to malabsorption
94
Treatment for cystic fibrosis
- give pancreatic enzymes w/food to aid in nutrient digestion and absorption
- chest percussion therapy (usually a vest)
- breathing treatments
- medications
- lung transplant is an option but not for all kids.
95
What is Apnea
The absence of breathing for 20 seconds or longer
Or
shorter period but w/ bradycardia or cyanosis present
96
S/S of apnea
Absence of breathing
Low HR
Cyanosis
Low O2 sat
97
What’s is important to observe ina pt w/ apnea
Observe for cause!!!
Like sleeping or feeding or pooping
98
RN interventions for apnea
- Monitor HR and respiratory continuously
- keep resuscitative equipment available at all times
- record time, duration, color change, HR, O2 sat during an episode
- what the pt was doing during the episode
99
What to do during an episode of apnea
Rub their
- back
- feet
- chest
100
What is most important for parents and care givers to do for apnea pts
CPR training!
101
What is SIDS
Sudden infant death syndrome
Sudden and unexplained death in infants
102
What age are they no longer at risk usually
6- 12 months depending if they can roll then the risk decreases
103
Risk factors for SIDS
- male gender
- prematurity
- prenatal exposure to alcohol or smoke
104
S/S of SIDS
Death
Child may be found in ANY POSITION AND MAY BE CLUTCHING BEDDING
105
Diagnosis of SIDS
Autopsy
106
Interventions or avoid SIDS
- no bed sharing! Sleep alone
- used ONLY firm mattress
- no loose bedding blankets or bumpers
- use sleepwear designed to keep baby warm
- do not put baby in car seat, carrier, or swing to sleep
- remove cigarette smoke
