Neurologic Flashcards
Meningitis
-infection: brain injury, sinus infection, breaking nose
-contact and droplet precautions
1. Viral (aseptic)-usually requires only supportive care for recovery
2. Bacterial (septic) -meningitis is a contagious infection, rash, no glucose in spinal fluid
-diagnosed with a lumbar puncture(spinal fluid)-put pt in a knee to chest position, empty bladder
-petechiae or a purpuric-type rash
Meningitis: expected findings
-photophobia- sensitivity to light
-nausea
-irritability
-headache
-crying
-rigid neck
Meningitis Infact to 2 yrs
-bulging fontanels
Meningitis 2 through adolescence
-Positive Brudzinski (flex neck and knees will move up) and Kernig’s sign (cant straighten legs when lifting)
Meningitis: labs
Send Blood cultures, CBC
CSF analysis indicative of meningitis:
BACTERIAL
-Cloudy color
-Elevated WBC count, elevated protein
-Decreased glucose content
-Positive Gram stain
VIRAL
-Clear color
-Slightly elevated WBC count
-Normal or slightly elevated protein content
-Normal glucose content
-Negative Gram stain
Medications for Meningitis
Antibiotics
-Administer IV antibiotics.
-Length of therapy is determined by the client’s -condition and CSF results.
-Therapy can last up to 10 days.
-Educate the family about the need to complete the entire course of medication
ICP - Intracranial pressure S/S
-bradypnea
-low BP
-bradycardia
normal ICP 0-20
Reye syndrome
-Primarily affects the liver and brain, causing dysfunction and cerebral edema.
-The cause of Reye syndrome is not understood.
-Peak incidence of Reye syndrome occurs when influenza is most common, typically January through March.
Reye Syndrome: Risk Factors
-There is a potential association between using aspirin (salicylate) products for treating fevers caused by viral infections.
-at risk to bleed, especially when given aspirin
Reye syndrome typically follows a viral illness
- Influenza
- Gastroenteritis
- Varicella
Reye Syndrome: Nursing Care
-Maintain hydration while preventing cerebral edema.
-Administer IV fluids as prescribed.
-Maintain accurate I&O.
-Insert indwelling urinary catheter as ordered.
-Position the client.
-Avoid extreme flexion, extension, or rotation.
-Maintain the head in a midline neutral position.
-Keep the head of the bed elevated at 30°.
Reye Syndrome: Medications
-Mannitol
-Vitamin K
Seizures
-Some seizures have no known etiology
-Febrile episode
-Cerebral edema
-Intracranial infection or hemorrhage
-Brain tumors or cysts
-Anoxia
-Toxins or drugs/Lead poisoning
-Tetanus, Shigella, or Salmonella
-Hypoglycemia, hypocalcemia, hyponatremia, hypernatremia, or hypomagnesemia
Seizures
-Some seizures have no known etiology
-Febrile episode
-Cerebral edema
-Intracranial infection or hemorrhage
-Brain tumors or cysts
-Anoxia
-Toxins or drugs/Lead poisoning
-Tetanus, Shigella, or Salmonella
-Hypoglycemia, hypocalcemia, hyponatremia, hypernatremia, or hypomagnesemia
Seizures: Nursing Care
-Protect from injury
-Maintain a position to provide a patent airway. (Turn head to the left side)
-Be prepared to suction oral secretions.
-Turn child to a side-lying position
-Loosen restrictive clothing.
-Do not attempt to restrain the child.
-Do not attempt to put anything in the child’s mouth.
-Administer oxygen
-Remain with the child, note onset, time, and characteristics of seizure.
Seizures: Medications
-phenytoin
Head Injury
-Concussion is a traumatic injury to the brain that alters the way the brain functions.
-Contusion is bruising of the cerebral tissue.
-Laceration is the tearing of the cerebral tissue.
-Fractures: linear, depressed, comminuted, basilar, open, or growing.
Head Injury: Prevention
-Wear helmets
-Wear seat belts when driving or riding in a car
-Avoid dangerous activities (riding a bicycle at night without a light, driving faster than the speed limit, or while under the influence of alcohol or controlled substances).
-Never shake a baby.
Head Injury: Assessment Findings
Severe injury: Increased ICP
INFANTS:
-Bulging fontanel/Separation of cranial sutures
-Irritability, restlessness, increased sleeping
-High-pitched cry, poor feeding, distended scalp veins
CHILDREN:
-Nausea, headache, forceful vomiting
-Blurred vision, increased sleeping, inability to follow simple commands
-Decline in school performance/Seizures
Head Injury: Nursing Care
ICP management is the same as adults
Medications
-Mannitol
-Antiepileptics
-Antibiotics: with CSF leakage, lacerations, or penetrating injuries
-Analgesics (acetaminophen)
Therapeutic Procedures
-Transfontanel percutaneous aspiration
-Subdural drains/Burr hole
-Craniotomy (removing skull)
Down Syndrome
-Most common chromosomal abnormality
-Trisomy 21 is seen in 97% of cases
-Many medical conditions accompany Down syndrome
-Congenital heart malformation, hypotonicity, dysfunction of the immune system, thyroid dysfunction, leukemia.
Risk Factors:
-Might be multicausal in nature.
-Maternal age greater than 35 years
-Paternal age greater than 55 years
Fractures
-Bone healing and remodeling is faster in children than in adults
-Epiphyseal plate injuries can result in altered bone growth.
-Radiographic evidence of previous fractures in various stages of healing or in infants can be the result of physical abuse or osteogenesis imperfecta.
Nursing Care of Fractures
-cast care
-traction care
-assessment from compartment syndrome
Clubfoot
-A complex deformity of the ankle and foot.
-Can affect one or both feet, occur as an isolated defect, or in association with other disorders such as cerebral palsy and spinal bifida
-Categorized as positional clubfoot (occurs from intrauterine crowding)
-Syndromic (occurs in association with other syndromes)
-congenital (idiopathic)
Clubfoot
-A complex deformity of the ankle and foot.
-Can affect one or both feet, occur as an isolated defect, or in association with other disorders such as cerebral palsy and spinal bifida
-Categorized as positional clubfoot (occurs from intrauterine crowding)
-Syndromic (occurs in association with other syndromes)
-congenital (idiopathic)
Developmental Dysplasia of the Hip
-A variety of disorders resulting in abnormal development of the hip structures that can affect infants or children.
-Asymmetry of gluteal and thigh folds
-Limited hip abduction
-Shortening of the femur
-Widened perineum
-Positive Ortolani test (hip is reduced by abduction)
-Positive Barlow test (hip is dislocated by adduction)
Developmental Dysplasia of the Hip
-A variety of disorders resulting in abnormal development of the hip structures that can affect infants or children.
-Asymmetry of gluteal and thigh folds
-Limited hip abduction
-Shortening of the femur
-Widened perineum
-Positive Ortolani test (hip is reduced by abduction)
-Positive Barlow test (hip is dislocated by adduction)
Cerebral Palsy
-A nonprogressive impairment of motor function, muscle control, coordination, and posture.
-CP can cause abnormal perception and sensation; visual, hearing, and speech impairments; seizures; and cognitive disabilities.
-CP manifests differently in each child.
-Developmental outcomes vary and are dependent on the severity of the injury.
Spinal Bifida
-Failure of the osseous spine to close.
-Neural tube defects (NTDs) are present at birth and affect the CNS and osseous spine.
-Meningocele: The sac contains spinal fluid and meninges.
-Myelomeningocele: The sac contains spinal fluid, meninges, and nerves.
-No movement below the spinal closure
-prone the pt, may have a wet dressing or open to air
Spinal Bifida Complications
-Skin Ulcerations
-Latex Allergy
-Increased intracranial pressure
—-Caused by shunt malfunction or hydrocephalus.
-Bladder Issues
-Orthopedic Issues
