Neurologic Disorders Flashcards
Sympathetic Nervous System
PNS –> Afferent (sensory) –> Somatic (voluntary)
Increased HR, BP, RR & temp; dilated pupils
Decreased peristalsis
Parasympathetic Nervous System
PNS –> efferent (motor) –> Automated (involuntary)
Decreased HR, BP, RR & temp; constricted pupils
Increased peristalsis
Epidural bleed
arterial bleed
b/t skin & dura
Subdural bleed
venous bleed
b/t dura & arachnoid
Subarachnoid bleed
bleed b/t arachnoid & pia
“Pop off vent”
fontanels in younger children allow for this but by 5-7 years of age the skull ossifies which leads to increased ICP
Concussion
an instantaneous loss of responsiveness; transient/reversible
Contusion
bruising of the brain, frequently the occipital, temporal or frontal lobes
Coup Contrecoup
brain suffers front to back to front injury
(shaken baby syndrome)
leads to retinal hemorrhage, brainstem injury & coma
ICP early signs
**High-pitched cry, headache, diplopia, change in LOC (MOST IMPORTANT PART OF NEURO EXAM!)
bulging fontanel, wide sutures, N/V, VS change (slight), photosensitivity
ICP Late signs
sunset eyes, significant decrease in LOC, cushing’s triad: increased systolic BP, widened pulse pressure, bradycardia & irregular respirations, decorticate posturing, fixed and dilated pupils
Decorticate posturing
arms and legs are brought to the core of the body
Decerebrate posturing
arms and legs are extended away from the body
worst of the 2 postures
Head injury care
monitor airway
assess injuries, immobilize neck
monitor VS and neuro function (widened PP & change LOC)
monitor for decreased responsiveness to pain (a significant sign of altered LOC); nonverbal pain!
initiate seizure precautions
NPO
no NGO w/ facial fx
HOB 15-30 degrees if not contraindicated
Position head midline, log roll pt, use minimal stimulation
Access drainage; CSF clear, + glucose
Suction through nares is CONTRAINDICATED
sedating meds withheld (other than codeine)
monitor for s/s of brainstem involvement
Epidural hematoma
EMERGENCY
monitor for asymmetric pupils
one dilated, unreactive pupil in a comatose child is a neurosurgical emergency
Cerebral perfusion pressure (CPP)
MAP - ICP = CPP
Severe head injury
Glasgow coma scale hypocapnia chemically paralyze and sedate artificially ventilate minimal stimulation prevent herniation and brain death
Autoregulation
a process of adjustment on the part of the brain’s arterioles that keeps cerebrovascular resistance constant.
Intervention of increased ICP
3% sodium chloride, mannitol, diuretics (Lasix)
redirect excess CSF
goal is to maintain CPP at more than 60
MAP below 65 puts at risk for insufficient blood flow to brain
MAP greater than 150 causes increased ICP
ICP monitoring discontinued when ICP remains normal for 48-72 hours or when PT starts following commands.
Glasgow coma scoring
Eye opening (4) Verbal response (5) Motor response (6)
Corneal reflex
cotton swab on cornea
no blink = + for brain death
Doll’s eyes
turn head left/right & eyes should follow
Eyes remain fixed = + for brain death
Calorics
irrigate ear canal with ice water & eyes should gaze toward affected ear
fixed eyes = + for brain death
Hydrocephalus
an imbalance of CSF r/t absorption or production, caused by malformations, tumors, hemorrhage, infections, or trauma that results in head enlargement and increased ICP.
Noncommunicating hydrocephalus
obstruction of CSF flow within the ventricular system occurs
Communicating hydrocephalus
occurs as a result of impaired absorptions within the subarachnoid space. Interference of CSF within the ventricular system does not occur
Hydrocephalus assessment of infant
- increased head circumference
- bones of the head are thin and widely separated and produced a cracked-pot sound (Macewen’s sign) on percussion
- anterior fontanel tense, bulging, pulsating
- scalp veins dilated
- frontal bossing (frontal bone protrudes)
- sunset eyes (downward gaze)
Hydrocephalus assessment of child
- behavior changes such as irritability and lethargy (LOC changes)
- headache upon wakening
- N/V
- ataxia
- Nystagmus
Hydrocephalus signs: Late
high, shrill cry
seizure activity
Hydrocephalus Tx
-goal is to prevent further CSF accumulation by using shunts to bypass the blockage and drain the fluid from the ventricles to a location where it may be reabsorbed
Ventriculoperitoneal shunt (VP Shunt)
CSF drains into the peritoneal cavity from the lateral ventricle
Atrioventricular shunt (AV Shunt)
CSF drains into the right atrium of the heart from the lateral ventricle, bypassing the obstruction (used in older children and children with abdominal pathology)
Hydrocephalus postoperative care
- monitor VS
- position on unoperated side to prevent pressure on the shunt valve
- child kept flat as prescribed to avoid rapid reduction of ICF
- observe for increased ICP
- if increased ICP occurs, elevate HOB 15-30 degrees
- monitor for s/s of infection
- measure head circ.
- monitor I&O
- comfort measures
- instruct parents how to recognize shunt infection/malfunction
- in toddler, headache and lack of appetite are the earliest signs of shunt malfunction.
Spina bifida occulta
- posterior vertebral arches fail to close in lumbosacral area
- spinal cord remains intact and usually not visible
- neuro deficits not usually present
- no bowel, bladder complications, no hydrocephalus
Spina bifida cystica
- protrusion of spinal cord and/or its meninges
- sac-like protrusion in lumbar, sacral area, varying degrees of tissue involvement.
Meningocele
- protrusion involves meninges and a sac-like cyst that contains CSF in the midline of the back, usually in the lumbosacral area
- no involvement of spinal cord
- neuro deficits are usually not present
Myelomeningocele
- protrusion of meninges, CSF, nerve roots, portion of spinal cord
- sac (defect) is covered by thin membrane that is prone to leakage or rupture
- neuro deficits evident
- meningitis risk
Spina bifida assessment
- depends on spinal cord involvement
- visible spinal defect
- flaccid paralysis of the legs
- altered bladder and bowel function (cath)
- hip and joint dysplasia, clubbed feet
Spina bifida care
- evaluate sac and measure lesion
- perform neuro assessment; rectal tone
- monitor for increased ICP
- measure head circ.
- assess anterior fontanel for fullness
- protect sac; cover with sterile, moist (normal saline), nonadherent dressing
- change dressing every 2-4 hrs as prescribed and whenever soiled
- use aseptic technique to prevent infection
- place in prone position
- assess sac for redness, clear, purulent drainage, abrasions, irritation, s/s of infection
- administer antibiotics as prescribed to prevent infection within an hour of surgery
Meningitis
infectious process of the CNS caused by bacteria, fungus, and viruses
Meningitis assessment
S/s vary based on type, age of child, duration of illness
- headache
- fever/chills
- V/D
- poor feeding or anorexia
- nuchal rigidity
- poor or high-pitched cry
- altered LOC
- bulging anterior fontanel
- Kernig’s Brudzinski’s sign
- muscle joint pain
- petechial or purpuric rash RUN TO ER!! Sign of overwhelming sepsis that can lead to DIC with 90% mortality rate*
Seizure disorders
Tonic = stiffness Clonic = jerking Dilantin = seizure med; gum hyperplasia
Anacephaly
absence of brain above the stem. breathing & hr present
Microcephaly
small skull due to lack of brain growth
Megalocephaly
enlarged brain and skull
Craniostosis
absence of or premature fusion of 1 or more of the cranial sutures; facial & head anomlies
Guillain Barre
- idiopathic polyneuritis; nerve fibers undergo demyelination following a UTI or GI infection
- ascending flaccid paralysis; trouble walking; works from bottom-up
- diminished DTR, cranial nerve involvement, difficulty swallowing & RDS
- treatment is supportive (reduce inflammation of tissues); mechanical ventilation, plasmaphoresis (plasma separation), IVIG, Guillain barre rehab
