Neurologic Conditions (10-15 questions)

Question 1

Amblyopia (lazy eye)

Answer 1

• patch healthy eye

- ID and treat before 6 yo (when eyesight matures)

Question 2

Cerebral Palsy

Answer 2

• not progressive
• most common in preemies
• intellectual disability only in < 1/2 kids

Question 3

Down Syndrome (Trisomy 21)

Answer 3

Hypotonia (protruding tongue, short stature, Simian crease (single crease along palm)

Due to small oral cavity – use small, straight handled spoon to push food toward side and back of mmouth

Communicate w/child based on mental age, not chronological

Question 4

Seizures

Answer 4

During - ABC’s, keep safe, observe/time/describe

Question 5

Seizures - treatment

Answer 5

• Antiepileptic drugs
• Ketogenic Diet - high fat, low carb – most have reduction in seizures, some have cessation; can be weaned off diet after 2 years w/reduction or cessation of meds; NO FLUIDS W/DEXTROSE

Surgical - brain surgery; VNS

Question 6

Febrile seizures

Answer 6

usually outgrow by age 3

Question 7

Intracranial Pressure (ICP) - s/s

Answer 7

infants - high-pitched cry; extreme irritability; bulging fontanel

Children - headache, vomiting, seizure, decreased LOC

Question 8

ICP interventions

Answer 8

• monitor neuro status
• limit fluids
• severe cases - osmotic diuretic; corticosteroid
• HOB 30 degrees
• Avoid: pain, seizures, fever, stress, crying, coughing, straining, non-therapeutic touch
• Keep a low stimulation environment; quiet

Question 9

Hydrocephalus

Answer 9

• observe full, bulging fontanel (increased ICP)

Treatment - VP shunt
Immediate post op: lay in supine (flat) for one day
- strict I/Os
- skin care for incision site
- monitor for s/s of infection, increased ICP

Question 10

Concussion

Answer 10

D/C teaching - BRAIN REST (no screen time, no contact sports, no deep concentration (homework, reading))

• GRADUALLY return to LEARN then PLAY
• If symptoms not completely resolved w/in 4-6 weeks - seek medical attention for s/s of a more severe TBI

Question 11

Neural Tube Defects - meningocele and myelomeningocele - preop assessment

Answer 11

• head circumference for baseline (high risk for hydrocephalus)
• monitor activity below sac (are legs moving?)
• monitor for leakage from sac
• s/s of CNS infection?
• lay prone
• • prevent sac from drying out – cover w/saline soaked sterile dressing **

Question 12

Neural Tube Defects - meningocele and myelomeningocele - post op assessment

Answer 12

• assess for neurogenic bladder (post void vol of >20 ml = insufficient emptying –> cath
• assess for movement (pain); paralysis?
• watch for s/s of ICP = measure head circumference

Question 13

Neural Tube Defects - meningocele and myelomeningocele - preop intervention

Answer 13

Teaching parents

• prevent constipation
• teach clean, intermittent cath (may still have wet diapers, but need to empty whole bladder or risk for kidney damage
• Avoid LATEX (pacifiers, nipples, elastic, chewing gum_
• Avoid high risk cross contamination foods: BANANA, AVOCADO, chestnut, kiwi
• mod risk: apple, carrot, celery, melons, papaya, potato, tomato
• older kids – avoid latex condoms

Question 14

Meningitis - symptoms

Answer 14

infants - high pitched cry, bulging fontanel, irritability

children - HA, stiff neck, vomiting, nuchal rigidity

Question 15

Meningitis - interventions

Answer 15

• abx therapy
• corticosteroids (severe cases)
• droplet and seizure prec
• neuro checks
• decrease stimuli
• monitor fluid status

Question 16

Lead poisoning screenings - when?

Answer 16

at 6 mos - questionnaire: live in a home built before 1978? Evidence of pica?

12 mos and 24 mos – SERUM SCREEN in high risk groups

Question 17

Lead poisoning - assessment

Answer 17

N/V
anemic = pallor = fatigue
anorexia
abd pain
tachy
neuro symptoms = behavior changes, distractibility, learning disabilities
stunted growth
hx of pica

Question 18

Lead poisoning - interventions

Answer 18

• administer PO, IM, and/or IV lead chelation
• BLL > 45 == oral or IV chelation (inpatient if symptomatic)
• BLL > 70 == IMMEDIATE HOSPITALIZATION FOR CHELATION THERAPY
• incr fluids to pee a lot
• monitor urine output for kidney function
• prevent further lead exposure – when on a chelator, you uptake lead more easily