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NUR 440 Exam 2 > Neurologic Disorders > Flashcards

Neurologic Disorders Flashcards

1
Q

Neurologic Assessment

A 
History
Level of consciousness
Coordination, Balance, gait, posture
Pupil reaction, reactivity to light
Motor strength
Speech
Fontanels and sutures
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2
Q

Level of Consciousness

A

Most important indicator of neurologic dysfunction and increasing intra-cranial pressure
Alertness and Cognition
1st and early sign

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3
Q

Bulging Fontanel

A

EMERGENCY
Late increase ICP. hydrocephalus
Meningitis, tumor, abuse
Not as common

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4
Q

Sunken Fontanel

A

Dehydration!

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5
Q

Decorticate

A

Laying flat

Arms on chest

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6
Q

Decerebrate

A

More concerning
Laying flat
Wrists flexed

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7
Q

Kernig’s Sign

A

Meningeal Irritation

Laying down, can’t fully extend the legs

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8
Q

Brudzinski Sign

A

Meningeal Irritation
Laying down
Lift the head and the legs come up

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9
Q

Inracranial Pressure

A

Brain- 80%
Blood- 10%
CSF- 10%
An increase in brain tissue–something has to go down!

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10
Q

Cerebral Perfusion Pressure

A

MAP- ICP = CPP
Minimal CPP- 40-50
Children should be >60

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11
Q

Mean Artiral Pressure

A

2x Diastolic + Systolic BP / 3

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12
Q

Early Signs of Increased ICP

A

HA, emesis, change in LOC, decreased glasgow, irritability, sunsetting (eyes sit low in the socket), decreased eye contact, pupil dysfunction, cranial nerve dysfunction, seizures

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13
Q

Late Signs of Increased ICP

A

Bulging fontanels
Decreased spontaneous movements, posturing, papilloedema, pupil dilation, irregular respiration, cushings triad (widening pulse pressure, irregular breathing and bradycardia)

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14
Q

Hydrocephalus

A

A condition as a result from impaired circulation, absorption or overproduction of CSF
Obstructive and Non-obstructive

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15
Q

Hydrocephalus Manifestations

A 
Bulging anterior fontanel, dilated cranial sutures
Dilated scalp veins
Irritability, decreased LOC
Sunset sign and Bossing of the skull
Morning headaches, NV
Personality changes
Ataxia and visual problems
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16
Q

Hydrocephalus Treatment

A

Surgical removal of obstruction or create a new flow path for CSF
VP shunt
Monitor for infection and pain
Amount of fluid pulled off by external drain is related to height of the device

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17
Q

Neural Tube Defects- Meningocele

A

Protrudes

Meningies and spinal fluid

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18
Q

Neural Tube Defects- Myelomeningocele

A

Protrudes
Meningies and spinal fluid and nerves
Can be covered with a layer of skin

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19
Q

Neural Tube Defects- Encephalocete

A

Bulging off the back of the head

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20
Q

Neural Tube Defects- Anencephaly

A

Head and neck bulging

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21
Q

Neural Tube Defects Etiology

A 
Unknown!
Folic Acid deficency
Excessive alcohol intake
Drugs - anticonvulsant medications, ance medication
Genetic
Malnutrition
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22
Q

Myelomeningocele

A

Protrusion of the meninges, spinal cord and nerve roots
Can occur along any point of the spinal column
Lumbar and Lumbosacral are most common
Skin may form over it

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23
Q

Myelomeningocele Treatment PREOP

A

Prone position
Sac covered with sterile saline dressing- if not covered with skin
Feed with head to side- NG tubes
Parents need to touch and cuddle infant!

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24
Q

Myelomeningocele Treatment POSTOP

A 
Monitor for infection
VS, tissue perfusion and edema
Assess for ICP and development of hydrocephalus
Monitor bowel and bladder functions
Prone or side lying
Pain control
Emotional support
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25
Myelomeningocele Deficits
Sensory deficit below level of defect Bowel and bladder dysfunction- Achieve bowel > bladder Paralysis below level of defect
26
Craniosynostosis
Skull is malformed Sutures close permanently First 18-24 months Unknown cause- possibly genetic
27
Occipital Plagiocephaly
Flat heads
28
Frontal Plagiocphaly
Most common form of Craniosynostosis
29
Craniosynostosis Treatment
Surgical intervention for sutures fused | Helmet for under 12 months if not fused
30
Non- accidental Trauma
Multiple injuries and admissions | Parent story changes
31
Injury and Trauma
Falls, Sports, MVAs, Non-accidental trauma
32
Mild Traumatic Brain Injury
Unconscious <15 minutes GCS 13-15 Typical sports injury
33
Moderate Traumatic Brain Injury
Unconscious >15 minutes | GCS 9 -12
34
Severe Traumatic Brain Injury
Unconscious >6hr | GCS 3-8
35
Diffuse CNS Infections
Meningitis- primary involvement of meninges
36
Focal CNS Infections
Encephalitis - brain parenchymal involvement
37
Bacterial Meningitis
Most potentially serious infections in infants and older children
38
Bacterial Meningitis Signs and Symptoms
``` HA, NV Restlessness, irritability Altered LOC Fever, bulging fontanels Photophobia Seizures Rash = serious!! Death in hours SUDDEN ONSET ```
39
Bacterial Meningitis Complications
``` Cerebral Edema-- anorexia, vascular stasis, vasodialation DIC Shock Elevated ICP Brain Death ```
40
Bacterial Meningitis Diagnosis
Lumbar puncture | Elevated cerebral spinal fluid, WBC, protein, glucose, cell count, differential, gram stain and culture
41
Bacterial Meningitis Treatment
``` IV ANTIBIOTICS-- 7 to 21 days Corticosteriods-- reduce swelling Fluid restriction Feeling better 2-3 days Fever subsides around day 5 ```
42
Cerebral Palsy
Permanent disorders of the development of movement and posture
43
Spastic Cerebral Palsy
Hypertonicity and most common Diplegia- affects primarily the legs Quadriplegia - all limbs Hemiplegia - arm and leg on one side
44
Dyskinetic Cerebral Palsy
All limbs and trunk Choreform Dystonic
45
Ataxia Cerebral Palsy
Abnormal decrease in muscle tone
46
Mixed Cerebral Palsy
Presence of more than one subtype
47
Cerebral Palsy Clinical Manifestations
Motor, sensory, cognitive, visual and hearing impairment | Speech and feeding problems
48
Cerebral Palsy Treatment
Multisystem - medical, surgical, neurophysiology Multidimensional - PT, OT, Speech, Nutrition MAXIMIZE POTENTIAL! No cure
49
Autism
More common in males Males have a milder form Peak 6-11 years Early symptoms appearing 18-24 months
50
Autism Symptoms
Impaired social interaction All other levels of interaction Eye contact
51
Seizure
Time limited change in motor activity and or behavior that results from abnormal electrical discharge from neurons in the cerebral cortex Site of origination- in the brain and extent of abnormal neural activity determines the type and manifestation of the seizure
52
Epilepsy
Syndrome | Unprovoked seizures that a recurrent
53
Seizure Etiology- Inside Brain
``` Cysts or tumors Vascular malformations Genetic Predisposition Neuromuscular degenerative disorder Head trauma ```
54
Seizure Etiology- Outside Brain
Fever | Infection
55
Seizure Classifications
Febrile Partial - Simple and Complex Generalized - Absence, Tonic- Clonic, Myoclonic, Infantile Spasms Psychogenic Hold infants limb- if shaking continues = seizure
56
Febrile Seizures
``` Most common during childhood 3mo- 5years PEAKS at 17-24 months 4% of children Fam hx RAPID RISE OF CORE BODY TEMP Tonic Clonic movements for 15 minutes then a postical period 50% have recurrent seizures with later episodes of a fever ```
57
Partial Seizures
Some level of alertness | More subtle
58
Generalized Seizures
Stiffness and jerking of the limbs
59
Anti- Seizure Medication
NEVER STOP MEDS WO TITRATING
60
Carbamazepine (Tegretol)
May decrease activity of contraceptives Causes sedation, dizziness, aplastic anemia, urinary retention Monitor of hepatic toxicity or hematologic disorders
61
Phenytoin (Dilantin)
Gingival hyperplasia, hirsutism, blood dyscrasia, liver damage
62
Gabopentin (Neurotin)
Do not withdraw medication abruptly
63
Lorazepam (Ativan)
Significant respiratory depression or hypo-tension

NUR 440 Exam 2 (4 decks)

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