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Peds - Spring 2016 > Neurologic Dysfunction (Part 2) - Unit 3 > Flashcards

Neurologic Dysfunction (Part 2) - Unit 3 Flashcards

1
Q

What is hydrocephalus?

A

Water on the brain

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2
Q

What are the two types of hydrocephalus?

A

Obstructive/non communicating

Non-obstructive or communicating

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3
Q

What is obstructive/non communicative hydrocephalus?

A

Obstruction to the flow of CSF within ventricles - developmental, neoplasma, infection, trauma, etc.

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4
Q

What is non-obstructive or communicating hydrocephalus?

A

Impaired absorption or CSF within subarachnoid - LESS COMMON and same signs and symptoms.

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5
Q

What are some signs of hydrocephalus?

A

Abnormal head growth (OFC), bulging fontanels, separated sutures, setting sun expression (sclera above iris), dilated scalp veins, irritability, high pitched cry, signs of increased ICP

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6
Q

How do we manage hydrocephalus?

A

Ventricular-Peritoneal Shunt (VP Shunt) - a catheter that runs sub-cutaneously from a ventricle in the brain to the peritoneal cavity. It grows with the child because it curls, and it’s a one way valve so it keeps ICP at a normal level.

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7
Q

What should nurses do for kids with hydrocephalus?

A

Elevate HOB, keep pressure off shunt site, neuro checks, may start PO feeding as soon as awake!

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8
Q

What are complications of a VP shunt?

A

Malfunction, shunt infection (if happens, remove shunt, EVD, antibiotics), seizures

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9
Q

What percent of children have a seizure during childhood?

A

2-4%

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10
Q

What are seizures?

A

Periods of abnormal electrical discharge that cause involuntary movement, sensation, and/or behavior alterations.

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11
Q

What causes a seizure?

A

Caused by malfunctions of brain’s electrical system, fever, abnormal discharge cortical neuron cells.

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12
Q

What might trigger a seizure?

A

anxiety, fatigue, infection, metabolic disturbances, hypoxia, trauma.

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13
Q

Epilepsy - > or equal to __ “unprovoked” seizures.

A

2

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14
Q

Median age fro development of epilepsy is __ to __ years.

A

5-6

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15
Q

Idiopathic epilepsy - known cause. T/f?

A

FALSE

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16
Q

A seizure that is caused by abnormal electrical activity in one hemisphere or a specific area of the cerebral cortex is referred to as a ___ or ___ seizure.

A

Focal or partial.

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17
Q

A seizure that begins simultaneously in both hemispheres and spreads throughout is referred to as a ____ seizure.

A

Generalized.

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18
Q

What is a tonic clonic seizure?

A

Grand-mal - loss of consciousness then muscle involvement.

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19
Q

What is an absence (petit mal) seizure?

A

Staring spell/brief loss of consciousness - Can have 50-100 daily!

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20
Q

What is a myoclonic seizure?

A

No LOC, involuntary muscle jerks occur

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21
Q

What are infantile spasms?

A

Occur in clusters with developmental delays around 3 months

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22
Q

What are atonic seizures?

A

LOC, lose tone, falls to ground

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23
Q

What kind of diet can be used to manage myoclonic and absence seizures?

A

Ketogenic Diet - 90% fat + LOW carbs - Ketosis is thought to have anticonvulsant effects.

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24
Q

After a seizure, we should just let them go. T/F?

A

No, turn on side, maybe suction, etc.

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25
Q

Drug Therapy for seizures - multiple drugs are preferred. T/F?

A

Nope - it’s best to do monotherapy. If another is needed, we just lower Drug A and give drug B.

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26
Q

What is phenobarbital used for?

A

Febrile seizures, neonatal seizures

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27
Q

Phenobarbital - Front live IV choice is patient does not respond to diazepam. T/F?

High dose might require respiratory support. T/F?

A

True

True

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28
Q

Phenytoin (Dilantin) - slow or fast IV push?

precipitates when mixed with what?

A

SLOW -

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29
Q

What are some side effects of phenytoin?

A

Gingival hyperplasia, ataxia, rashes, acne, hirsutism, osteoprosis.

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30
Q

What’s the onset of phenytoin? How long does it last?

A

5-30 minutes - lasts 12-24 hours.

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31
Q

Fosphenytoin - may be given with __ or ___.
Rate up to __ mg/min.
Can be given __ or ___>

A

Given with saline or glucose.
rate up to 150mg/min.
IV or IM>

32
Q

Valproic acid - IV for what? What’s a side effect?

A

Status epilepticus. S/E = hepatotoxicity

33
Q

Diazepam (diastat rectal) - what’s this used for?

A

Choice of drug for status epilepticus.

34
Q

What’s the onset of diazepam?

A

3-10 minutes (short!)

35
Q

Concurrent loading of diazepam with phenytoin is preferred for sustained control of seizures. T/F?

A

True

36
Q

Ativan - may be preferable to diazepam, because….

A

longer duration of action, less respiratory distress in children older than 2 years, etc.

37
Q

Should we increase the dose as the child grows? Should we stop it suddenly?

A

Yes

Don’t stop suddenly! Decrease gradually if needed.

38
Q

When do we discontinue pharmacological management?

A

When seizure free for 2 years, normal EEG, avoid during stressful times (like puberty, or times of infection)

39
Q

After stopping meds, recurrence is possible within the first year. T/F?

A

True

40
Q

What are the big management steps for seizures?

A

Protect the airway (jaw thrusts), O2, protect form injury, control the seizure, monitor during post-ictal stage, teaching needs.

41
Q

What are febrile seizures?

A

Generalized, lasting less than 15 minutes, usually seen between 3 months and 5 years, caused by a rapid increase in temp above 39C, associated with an acute illness (not CNS infection), up to 50% will have another one.

42
Q

What is status epilepticus?

A

Continuous seizure lasting more than 30 minutes - it’s an emergency!

43
Q

How do we treat status epilepticus?

A

Diastat (rectal), IV lorazepCam, valproic acid, IV loading with phenytoin

44
Q

Why are CNS infections so bad?

A

CNS has limited response to injury and we can’t easily tell where it comes from.

45
Q

CNS infection - inflammation can affect meninges, brain, or spinal cord. T/F?

A

True

46
Q

What are the two types of meningitis?

A

Bacterial and viral!

47
Q

Nonbacterial/Aseptic Meningitis - cause? associated with? Onset quick or slow? manifestations?

A

Viruses cause it. Associated with measles, mumps, herpes, leukemia.
Onset is abrupt or gradual.
manifestations include headache, fever, malaise. Manage symptoms!

48
Q

Bacterial meningitis - acute inflammation of ____.

A

CNS.

49
Q

Bacterial meningitis - decreased incidence following use of “HIB” vaccine. T/F?

A

True

50
Q

What are some possible causative agents of bacterial meningitis?

A

Streptococcus pneumoniae, Group B streptococci, Escherichia coli

51
Q

How is bacterial meningitis transmitted?

A

Droplet infection from nasopharyngeal secretions - appears as extension of other bacterial infection, or from organisms that spread through CSF

52
Q

What’s the patho of bacterial meningitis? (4 steps!)

A

Inflammation —- exudation — wbc accumulation —- tissue damage

53
Q

What are some clinical manifestations of bacterial meningitis?

A

Increased ICP, stiff neck (nuchal rigidity), photophobia (unless super young and they can’t say that…)…it all just depends on the age of the child!

54
Q

What’s Kernig’s sign?

A

Inability to straighten the leg when the hip is flexed to 90 degrees - sign of meningitis.

55
Q

What is Brudzinski’s sign?

A

Patient’s hips and knees flex when the neck is flexed - sign of meningitis.

56
Q

What is an opisthotonic position?

A

Head back, arched back, on stomach - this helps the babies extend their heads - sign of meningitis!

57
Q

What are some diagnostic parts of meningitis treatment?

A

LP, isolation (droplet until 24 hours of antibiotics), hydration, regulation of increased ICP, control seizures

58
Q

CSF Analysis - what are the following like for bacterial meningitis?

WBC - 
Protein 10-30 - 
Glucose 40-80 - 
Gram Stain - 
Culture - 
Color -
A 
WBC - Increased - polymorphonuclear
Protein 10-30 - Increased
Glucose 40-80 - Decreased
Gram Stain - Positive
Culture - Positive
Color - Cloudy
59
Q

CSF Analysis - what are the following like for viral meningitis?

A 
WBC - slightly increased lymphocytes
Protein 10-30 - normal (slightly increased)
Glucose 40-80 - normal
Gram Stain - negative
Culture - negative
Color - clear
60
Q

What are some complications of meningitis?

A

Seizures, cerebral edema, hydrocephalus, deafness, visual defects, motor defects, meningiotoxemia - get a mask on, this shit is bad!

61
Q

A cerebral dysfunction caused by a toxin, inflammation, or injury is referred to as what?

A

Encephalopathy.

62
Q

What is Reye’s Syndrome?

A

An acute encephalopathy accompanied by liver dysfunction. Can cause cerebral edema and an enlarged fatty liver.

63
Q

To prevent Reye’s Syndrome, what should we do?

A

PREVENT KIDS FROM TAKING ASPIRIN!

64
Q

What are some manifestations of Reye’s Syndrome?

A

Nausea and vomiting, abrupt change in LOC, 5 stages of increasing cerebral edema/increased ICP, coagulation abnormalities (prolonged prothrombin time), increased liver enzymes, increased ammonia, decreased glucose.

65
Q

What are neuro tube defects?

A

Folic acid intake during pregnancy important for prevention - these are defects in the brain, spine, or spinal cord.

66
Q

What is anencephaly?

A

Most serious NTD - congenital malformation where both cerebral hemisphere s are absent. Usually causes the infant to be stillborn. :(

67
Q

Spina Bifida Occulta - what is it?

A

Midline defects of the vertebral bodies. Tuff of hair on back or discoloration of skin typical.

68
Q

What is a meningocele?

A

Meninges herniated through the defect, spinal cord is normal - typically asymptomatic but might leak CSF.

69
Q

What is a myelomeningocele?

A

Meninges, CSF, nerves herniated through defect. Usually has symptoms but depends on location. Associated with hydrocephalus - usually paralysis occurs but not always!

70
Q

How do we care preoperatively for a kid with a myelomeningocele?

A

Surgery within first 24 hours, keep infant warm, in prone position (on tummy), place moist/non-adhesive dressing over the sac, keep urine and stool off sac, measure OFC

71
Q

What are some long-term care needs for kids with a myelomeningocele?

A

Neurogenic bladder dysfunction issues, incontinence issues, ortho care, latex allergies!!!!!!!! (bananas can contain latex), Vp shunt complications.

72
Q

What is Cerebral Palsy?

A

Non-progressive motor disorder

73
Q

What are the 4 types of CP?

A

Spastic (tense, contracted muscles)
Athetoid (constant, uncontrolled motion of limbs)
Rigid (tight muscles that resist efforts to make them move)
Ataxic (poor sense of balance)
Tremor (uncontrolled shaking that interferes with coordination)

74
Q

What are some causes of CP?

A

Low birth weight, prematurity, prenatal cerebral insult, cardiorespiratory arrest

75
Q

What are some clinical findings of CP?

A

Motor delay, scissoring (walk like one leg is messed up), hyper-reflexia, communication issues, learning disabilities, behavioral disorders, failure to thrive, drooling, malocclusion, seizures, contractures.

76
Q

How do we manage/treat CP?

A

Directed toward maximizing functioning and preventing complications, master activities of daily living, multidisciplinary team, family support

Peds - Spring 2016 (29 decks)

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