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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
Q

Myelomeningocele Deficits

A

Sensory deficit below level of defect
Bowel and bladder dysfunction- Achieve bowel > bladder
Paralysis below level of defect

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26
Q

Craniosynostosis

A

Skull is malformed
Sutures close permanently
First 18-24 months
Unknown cause- possibly genetic

27
Q

Occipital Plagiocephaly

A

Flat heads

28
Q

Frontal Plagiocphaly

A

Most common form of Craniosynostosis

29
Q

Craniosynostosis Treatment

A

Surgical intervention for sutures fused

Helmet for under 12 months if not fused

30
Q

Non- accidental Trauma

A

Multiple injuries and admissions

Parent story changes

31
Q

Injury and Trauma

A

Falls, Sports, MVAs, Non-accidental trauma

32
Q

Mild Traumatic Brain Injury

A

Unconscious <15 minutes
GCS 13-15
Typical sports injury

33
Q

Moderate Traumatic Brain Injury

A

Unconscious >15 minutes

GCS 9 -12

34
Q

Severe Traumatic Brain Injury

A

Unconscious >6hr

GCS 3-8

35
Q

Diffuse CNS Infections

A

Meningitis- primary involvement of meninges

36
Q

Focal CNS Infections

A

Encephalitis - brain parenchymal involvement

37
Q

Bacterial Meningitis

A

Most potentially serious infections in infants and older children

38
Q

Bacterial Meningitis Signs and Symptoms

A 
HA, NV
Restlessness, irritability
Altered LOC
Fever, bulging fontanels 
Photophobia
Seizures 
Rash = serious!! Death in hours
SUDDEN ONSET
39
Q

Bacterial Meningitis Complications

A 
Cerebral Edema-- anorexia, vascular stasis, vasodialation
DIC
Shock
Elevated ICP
Brain Death
40
Q

Bacterial Meningitis Diagnosis

A

Lumbar puncture

Elevated cerebral spinal fluid, WBC, protein, glucose, cell count, differential, gram stain and culture

41
Q

Bacterial Meningitis Treatment

A 
IV ANTIBIOTICS-- 7 to 21 days
Corticosteriods-- reduce swelling
Fluid restriction 
Feeling better 2-3 days
Fever subsides around day 5
42
Q

Cerebral Palsy

A

Permanent disorders of the development of movement and posture

43
Q

Spastic Cerebral Palsy

A

Hypertonicity and most common
Diplegia- affects primarily the legs
Quadriplegia - all limbs
Hemiplegia - arm and leg on one side

44
Q

Dyskinetic Cerebral Palsy

A

All limbs and trunk
Choreform
Dystonic

45
Q

Ataxia Cerebral Palsy

A

Abnormal decrease in muscle tone

46
Q

Mixed Cerebral Palsy

A

Presence of more than one subtype

47
Q

Cerebral Palsy Clinical Manifestations

A

Motor, sensory, cognitive, visual and hearing impairment

Speech and feeding problems

48
Q

Cerebral Palsy Treatment

A

Multisystem - medical, surgical, neurophysiology
Multidimensional - PT, OT, Speech, Nutrition
MAXIMIZE POTENTIAL!
No cure

49
Q

Autism

A

More common in males
Males have a milder form
Peak 6-11 years
Early symptoms appearing 18-24 months

50
Q

Autism Symptoms

A

Impaired social interaction
All other levels of interaction
Eye contact

51
Q

Seizure

A

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
Q

Epilepsy

A

Syndrome

Unprovoked seizures that a recurrent

53
Q

Seizure Etiology- Inside Brain

A 
Cysts or tumors
Vascular malformations
Genetic Predisposition
Neuromuscular degenerative disorder 
Head trauma
54
Q

Seizure Etiology- Outside Brain

A

Fever

Infection

55
Q

Seizure Classifications

A

Febrile
Partial - Simple and Complex
Generalized - Absence, Tonic- Clonic, Myoclonic, Infantile Spasms
Psychogenic
Hold infants limb- if shaking continues = seizure

56
Q

Febrile Seizures

A 
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
Q

Partial Seizures

A

Some level of alertness

More subtle

58
Q

Generalized Seizures

A

Stiffness and jerking of the limbs

59
Q

Anti- Seizure Medication

A

NEVER STOP MEDS WO TITRATING

60
Q

Carbamazepine (Tegretol)

A

May decrease activity of contraceptives
Causes sedation, dizziness, aplastic anemia, urinary retention
Monitor of hepatic toxicity or hematologic disorders

61
Q

Phenytoin (Dilantin)

A

Gingival hyperplasia, hirsutism, blood dyscrasia, liver damage

62
Q

Gabopentin (Neurotin)

A

Do not withdraw medication abruptly

63
Q

Lorazepam (Ativan)

A

Significant respiratory depression or hypo-tension

NUR 440 Exam 2 (4 decks)

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