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PEDs Exam 3 > Neurological Alterations > Flashcards

Neurological Alterations Flashcards

1
Q

what is cerebral palsy?

A

non progressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (involuntary movements)

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2
Q

what are two associated problems that may occur with cerebral palsy?

A
  • intellectual disability

- seizures

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3
Q

what are 4 common causes of cerebral palsy?

A
  • low birthweight (major risk factor)
  • anoxic injury before, during, or after birth
  • maternal infections
  • kernicterus (brain damage that occurs in a newborn with severe jaundice)
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4
Q

Persistent neonatal reflexes (Moro, tonic neck) after six months maybe an indicator of what?

A

cerebral palsy

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5
Q

What are some common nursing assessments found with cerebral palsy?

A
  • delayed developmental milestones
  • apparent early preference for one hand
  • poor suck, tongue thrust
  • spasticity (may be described as “difficulty with diapering” by caregiver)
  • Involuntary movements
  • seizures
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6
Q

Scissoring of legs where the legs are extended and crossed over each other, feet or plantar-flexed, is a common characteristic of ________ cerebral palsy.

A

spastic

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7
Q

What are some nursing interventions for patients with cerebral palsy and their family?

A
  • support family through grief process at diagnosis and throughout the child’s life because caring for a severely affected child is very challenging
  • refer to community-based agencies
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8
Q

Identify cerebral palsy through follow-up of high-risk infants such as ________ infants.

A

premature

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9
Q

who are some specialists that need to be included in the care of patients who have cerebral palsy?

A
  • physical therapy
  • occupational therapy
  • speech therapist
  • nutritionist
  • orthopedic surgeon
  • neurologist
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10
Q

For patients who have cerebral palsy, administration of anticonvulsant medication such as ________ may be prescribed.

A

phenytoin (Dilantin)

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11
Q

For patients who have cerebral palsy, administration of _______ for muscle spasms may be prescribed.

A

diazepam (Valium)

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12
Q

When feeding an infant or child who has cerebral palsy using nursing interventions aimed at preventing _________ is a top priority.

A

aspiration

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13
Q

to prevent aspiration when feeding an infant or child who has cerebral palsy the nurse or caregiver should maintain the child in a(n) _________ position and support the _______ jaw.

A
  • upright

- lower

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14
Q

what are some sentence symptoms of increased intracranial pressure for infants?

A
  • poor feeding or vomiting
  • irritability or restlessness
  • lethargy
  • bulging fontanel(s)
  • high-pitched cry
  • increased head circumference
  • separation of cranial sutures
  • distended scalp veins
  • eyes deviated downward
  • increased or decreased pain response
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15
Q

what are some signs and symptoms of increased intracranial pressure for children?

A
  • headache
  • diplopia (double vision)
  • mood swings
  • slurred speech
  • Papilledema (swelling of the optic nerve)
  • altered LOC
  • nausea and vomiting, especially in the morning
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16
Q

What are some preoperative nursing interventions that are done for a patient who has spina bifida?

A
  • place infant in prone position
  • keep SAC free of stool and urine
  • position child on his/her abdomen , with legs abducted
  • measure head circumference every eight hours; Check fontanel
  • assess neurologic function
  • monitor for signs of infection
  • empty bladder using Crede’s method, or in and out catheterization
  • promote parent-infant bonding
  • maintain integrity of the sack (moist, sterile 4x4’s)
  • position the infant PRONE
  • infants had turned to one side for feeding
  • avoid contamination of sac area by urine or feces
  • avoid rectal temps
  • parents encouraged to stroke and talk to infant in prone position. Not allowed to hold, but may have infant in lap, prone, or on pillow
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17
Q

What are some postoperative nursing interventions are done for a patient who has spina bifida?

A
  • make same assessments as preoperatively
  • assess for signs of intracranial pressure (measure head circumference daily)
  • assess for signs of infection
  • prone or sideline
  • infant may be held upright avoiding pressure on surgical site
  • gentle range of motion exercises
  • assess incision for drainage and infection assess neurologic function
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18
Q

What are some long-term care teaching interventions that need to be done for a patient who has spina bifida?

A
  • teach family catheterization program when child is young
  • help older children to learn self-catheterization; May require Mitrofanoff
  • administer anticholinergics (oxybutynin) as prescribed for neurogenic bladder dysfunction
  • develop bowel program
  • assess skin condition frequently
  • assist with ROM exercises, ambulation, embracing, if patient is able
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19
Q

What are some bowel program interventions that can be initiated for a patient who has spina bifida?

A
  • high fiber diet
  • increased fluids
  • regular fluids
  • suppositories as needed
  • may require Chait/MACE tube for bowel irrigation
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20
Q

What is hydrocephalus?

A

condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain
-develops as a result of an imbalance between cerebrospinal fluid production and absorption , resulting in enlarged ventricles and an increase in intracranial pressure

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21
Q

Hydrocephalus is usually caused by an ___________ in the flow of CSF between the ventricles.

A

obstruction

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22
Q

Hydrocephalus is most often associated with what other neurological alteration?

A

spina bifida

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23
Q

Hydrocephalus can also be a complication of what type of infection?

A

meningitis

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24
Q

What are some early manifestations of hydrocephalus in an infant?

A
  • rapid head growth
  • full, bulging fontanel
  • irritability
  • poor feeding
  • Distended, prominent scalp veins
  • widely separated cranial structures
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25
Q

what are some late manifestations of hydrocephalus in infants?

A
  • “setting sun” sign (eyes appear driven downward)
  • frontal bone enlargement or bossing
  • vomiting, difficulty swallowing or feeding
  • hypertension
  • Bradycardia
  • altered respiratory pattern
  • shrill, high-pitched cry
  • sluggish or equal pupillary responses
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26
Q

what are some early manifestations of hydrocephalus in children?

A
  • strabismus
  • headache that occurs in the morning and is relieved by emesis or sitting upright
  • nausea and vomiting (maybe projectile)
  • diplopia
  • restlessness
  • behavior or personality changes
  • ataxia
  • sluggish or unequal pupillary responses
  • confusion
  • changes in school work
  • lethargy
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27
Q

what are some late manifestations of hydrocephalus in children?

A
  • seizures
  • hypertension
  • bradycardia
  • alterations in respiratory pattern
  • blindness from herniation of the optic disc
  • decerebrate rigidity
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28
Q

What are some nursing interventions that correspond with hydrocephalus?

A
  • prepare infant and family for diagnostic procedures
  • monitor for signs of increased intracranial pressure
  • maintain seizure professions
  • prepare parents for surgical procedure
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29
Q

what are the 2 surgical options for hydrocephalus?

A
  • VST: Ventriculoperitoneal Shunt
  • shunt is inserted into ventricle
  • tubing is tunneled through skin to peritoneum where it drains excess CSF
  • ETV: endoscopic third ventriculostomy
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30
Q

What are some postoperative interventions that we should watch for in infants who have received surgery for hydrocephalus?

A
  • changes in size, signs of bulging, tenseness , and separation in fontanels and suture lines
  • irritability, lethargy, or seizure activity
  • altered vital signs in feeding behavior
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31
Q

What are some postoperative interventions that we should watch for in older children who have received surgery for hydrocephalus, and we suspect that there may be an increase in intracranial pressure?

A
  • change in LOC
  • complaint of headache
  • changes in customary behavior (sleep patterns, developmental capabilities)
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32
Q

what are a couple general nursing interventions that need to be provided post-op for patients who have received surgery for hydrocephalus?

A
  • assess for signs of infection

- monitor I&O closely

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33
Q

what are some teaching interventions for home care programs for a patient who have received hydrocephalus surgery?

A
  • teach to watch for signs of increased intracranial pressure or infection
  • note the child will eventually outgrow shunt and show symptoms of difficulty
  • note that child will need shunt revision
  • provide anticipatory guidance for potential problems with growth and development
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34
Q

The signs of increase intracranial pressure are the opposite of those of _______.

A

shock (tachycardia, hypotension)

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35
Q

LATE signs of increased intracranial pressure, include what?

A

Bradycardia and hypertension

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36
Q

What are seizures?

A

uncontrolled electrical discharges of neurons in the brain

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37
Q

Seizures are more common in children under the age of ___ years.

A

2

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38
Q

seizures can be associated with other things which include?

A
  • immaturity of CNS
  • fever
  • infection
  • neoplasms
  • cerebral anoxia
  • metabolic disorders
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39
Q

Generalized seizures include what type?

A
  • tonic-clonic
  • absence
  • myoclonic
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40
Q

what is a tonic-clonic seizure and the two phases of it?

A
  • loss of consciousness
  • tonic phase: general stiffness of entire body
  • clonic phase: Spasm followed by relaxation
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41
Q

how does an absence seizure present?

A

momentary loss of consciousness, posture is maintained; has minor face, eye, hand movements

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42
Q

how does a myoclonic seizure present?

A
  • sudden, brief contractures of a muscle or group of muscles, no POS tickle state; rapid jerking movements
  • may or may not be symmetrical or include loss of consciousness
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43
Q

Focal onset seizures (formally known as partial seizures) arise from a specific area in the brain an cause ______ symptoms.

A

limited

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44
Q

what are some S&S of tonic-clonic seizures and post seizure?

A
  • aura (a warning sign of impending seizure)
  • loss of consciousness
  • apnea, cyanosis
  • pupils dilated and non-reactive to light
  • incontinence
  • post seizure; disoriented, sleepy
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45
Q

what are some S&S of absence seizures?

A
  • last 5 to 10 seconds
  • child appears to be inattentive, daydreaming
  • poor performance in school
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46
Q

what age group is mostly affected by absent seizures?

A
  • 4 and 12 years of age

- preschool in school age

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47
Q

What is the most common cause of increased seizure activity?

A

medication noncompliance

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48
Q

what are some nursing interventions to consider with seizures?

A
  • maintain airway during seizure; Turn patient on side to aid ventilation
  • do not restrain patient
  • protect patient from injury during seizure and support head
  • avoid neck flexion
  • document seizure, noting all data in assessment
  • maintain seizure precautions
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49
Q

what are some key precautions to initiate for patients who have seizures?

A
  • reduce environmental stimuli
  • pad side rails or crib rails
  • have suction equipment and oxygen quickly assessable
  • have oral airway at bedside
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50
Q

What is bacterial meningitis?

A

disorder of the meninges that cover the brain and spinal cord

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51
Q

Meningitis is usually caused by what 3 infections?

A
  • Haemophilus influenza type B
  • Streptococcus pneumonia
  • Neisseria meningitides
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52
Q

What are the two common sources/entrance point of bacterial invasion?

A
  • Middle ear

- nasopharynx

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53
Q

Bacterial Meningitis can occur from what other sources of bacteria from wounds include?

A
  • fractures of the skull
  • lumbar punctures
  • shunts
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54
Q

what are the results of a lumbar puncture test show if a patient is positive for bacterial meningitis?

A
  • increased WBC
  • decreased glucose
  • elevated protein
  • increased ICP
  • positive culture for meningitis
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55
Q

what are the S&S for infants who is suspected to have bacterial meningitis?

A
  • absence of classic signs
  • ill, with general symptoms
  • poor feeding
  • vomiting
  • irritability
  • seizures
  • bulging fontanel (important sign)
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56
Q

what are the S&S for older children who we suspect have bacterial meningitis?

A
  • classic signs of increased ICP
  • fever, chills
  • neck stiffness
  • opisthotonos (spasm of muscles causing backward arching of the head, neck, and spine)
  • photophobia
  • positive Kernig sign (inability to extend leg when thigh is flexed anteriorly at hip)
  • positive Brudzinski sign (neck flexion causing adduction and flexion movement of lower extremities)
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57
Q

Patients who have bacterial meningitis should stay on droplet precautions for at least ____ hours.

A

24

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58
Q

What two types of drugs should be administered for bacterial meningitis?

A
  • antibiotics

- antipyretics

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59
Q

what type of antibiotics can be given for bacterial meningitis?

A
  • penicillin
  • cephalosporins
  • aminoglycosides in patients who are <30days, so out of the newborn phase
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60
Q

what are some other nursing interventions that need to be provided for a patient who has bacterial meningitis?

A
  • monitor vital signs
  • monitor neurologic signs
  • keep environment quiet and dark to prevent overstimulation
  • implement seizure precautions
  • position for comfort: head of bed slightly elevated, with client on side if prescribed
  • measure head circumference daily in infants
  • monitor I&O closely
  • administer HIB vaccine to protect against H. influenza infection
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61
Q

with meningitis there may be inappropriate ____ secretions causing fluid retention (cerebral edema) and dilutional hyponatremia, so monitoring hydration status an IV therapy carefully is essential.

A

ADH (anti-diuretic hormone)

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62
Q

What is Reye syndrome?

A

acute, rapid progressing encephalopathy and hepatic dysfunction

  • in past, associated with aspirin (salicylates) being given during a viral illness such as varicella or influenza
  • fever, impaired consciousness, and disordered hepatic function-metabolic encephalopathy
  • cerebral edema and fatty changes to liver
  • diagnosed vis liver biopsy
  • early intervention and aggressive treatment necessary
  • may have prolonged bleeding times with liver involvement
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63
Q

what are some causes of Reye syndrome?

A

antecedente viral infections (influenza or Chickenpox)

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64
Q

occurrence of Reye syndrome is often associated with what drug use?

A

aspirin

65
Q

how is Reye syndrome staged, categorized?

A

according to the clinical manifestations to reflect the severity of the condition

66
Q

what are some S&S Reye syndrome?

A
  • vomiting
  • lethargy, rapidly progressing to deep coma with marked cerebral edema
  • elevated SGOT/AST , SCPT /ALT, lactase dehydrogenase, serum ammonium, decreased PT
  • hyperglycemia
67
Q

what age group is most affected by Reye syndrome?

A

school age children

68
Q

what are some nursing interventions that need to be done for Reye syndrome?

A
  • provide critical care early in syndrome
  • monitor neurologic status: frequent noninvasive assessments and invasive ICP monitoring
  • maintain ventilation
  • monitor cardiac parameters (invasive cardiac monitoring system)
  • administer mannitol, if prescribed, to increase blood osmolality
  • monitor I&O accurately
  • care for Foley catheter
  • provide family with emotional support
69
Q

What is the second most common cancer in children?

A

brain tumors

70
Q

most pediatric brain tumors are ___________, making them difficult to excise surgically.

A

infratentorial

71
Q

Tumors usually occur close to _______ structures.

A

vital

72
Q

________________ or low-grade gliomas are the most common childhood brain tumors.

A

Medulloblastomas

73
Q

What is the most common presenting symptom of brain tumors?

A

headaches an awakening

74
Q

what are some S&S of brain tumors?

A
  • headache
  • vomiting (usually in the morning), often without nausea
  • loss of concentration
  • change in behavior or personality
  • vision problems, tilting of head
75
Q

what are some S&S of brain tumors in infants?

A
  • widening sutures
  • increasing frontal occipital circumference
  • tense fontanel
76
Q

what are some nursing interventions to provide to a child who has a brain tumor in their family?

A
  • identify baseline neurologic function
  • support child and family during diagnostic work up in treatment
  • assess family’s response to the diagnosis and treat family appropriately
  • Monitor IV fluids and output carefully (overhydration can cause cerebral edema and increased ICP)
  • administer steroids and osmotic diuretics as prescribed
  • support child and family to promote optimum function postoperatively
77
Q

What are some preoperative teachings that need to be done if surgery is the treatment option for a brain tumor?

A
  • explain that head will be shaved
  • describe ICU, dressings, IV lines
  • identify a child’s developmental level implant teaching accordingly
78
Q

what position is contraindicated for child to be placed in post operatively of a brain tumor?

A

Trendelenburg position is always contraindicated

79
Q

Most postoperative patients with __________ tumors or prescribed live flat or turn to either side.

A

infratentorial

80
Q

A large tumor may require that the child not be turned to the ________ side.

A

operative

81
Q

most postoperative patients with _________ tumors will have orders to maintain head above the level of the heart.

A

supratentorial

82
Q

Suctioning, coughing, straining, and turning can all cause an increased ______?

A

ICP

83
Q

What are the normal developmental milestones that a 3-month-old should obtain?

A
  • pushes up on arms

- holds head up

84
Q

What are some developmental warning signs for a 3-month-old infant?

A
  • unable to lift head
  • constantly fists hands
  • stiffens legs
  • arches body/head
  • uses only one side of body
85
Q

What are the normal developmental milestones that a 6-month-old should obtain?

A
  • sits with help
  • holds head up
  • holds back straight
86
Q

What are some developmental warning signs for a 6-month-old infant?

A
  • difficulty lifting head
  • rounded back
  • stiffens or cross his legs
  • stiffens body
  • holds arms back
87
Q

What are the normal developmental milestones that an 8-month-old should obtain?

A
  • sits by self

- reaches with arms

88
Q

What are some developmental warning signs for an 8-month-old infant?

A
  • rounded back, unable to sit
  • difficulty getting hands together
  • difficulty using arms to play
  • arches body back
  • stiffens legs, points toes
  • difficulty holding head up
  • unable to stand
89
Q

What are the normal developmental milestones that a 12-month-old should obtain?

A
  • pulls to stand

- crawl’s

90
Q

What are some developmental warning signs for a 12-month-old?

A
  • difficulty getting to stand
  • stiffens legs, points toes
  • uses only one side of body to crawl
  • can’t crawl on hands and knees
91
Q

What is the normal developmental milestones that a 15-month-old should obtain?

A

stands and walks

92
Q

What are some developmental warning signs for a 15-month-old?

A
  • walks on toes all the time
  • stiffens arms or legs
  • sits with body leaning to one side
  • uses only one hand for play
93
Q

What are the three types of spina bifida?

A
  • occulta
  • meningocele
  • myelomeningocele
94
Q

What is occulta spina bifida?

A
  • no herniation of the spinal cord or meninges; vertebral arches between L5 and S1 fail to fuse; may be noted as a dimple at the level of L5-S1
  • mildest, typically go about life without knowing that they have this type of spina bifida
95
Q

What is meningocele spina bifida?

A

-posterior vertebral arches fail to fuse; saclike protrusion containing meninges and cerebrospinal fluid at some point along the posterior vertebrae

96
Q

what is myelomeningocele spina bifida?

A

posterior vertebral arches fail to fuse; saclike herniation contains meninges, cerebral spinal fluid, and a portion of spinal cord or nerve roots

97
Q

how much folic acid should a woman be taken daily?

A

0.4 mg= 400 mcg

98
Q

What are some meticulous skin care for spina bifida?

A
  • no diapers
  • frequent change of pads under infant
  • constant stalling will need constant cleaning
  • placed on pressure reducing mattress
99
Q

What are some problems seen with spina bifida?

A
  • Chiari type 2 malformation
  • hydrocephalus
  • neurologic bladder
  • ineffective bowel function
  • loss of motor and sensory function below the level of the lesion
  • skin breakdown
100
Q

What are some pros and cons to using EVT (endoscopic third ventriculostomy) for patients who have hydrocephalus?

A
  • no hardware= no malfunctions
  • nothing in there that can cause an infection
  • outweigh risks and benefits because it doesn’t always work
101
Q

What are some nursing interventions that need to be done if a VP shunt is placed for patient who has hydrocephalus?

A
  • positioned flat, on the non-operative side
  • assess for signs of increase intracranial pressure
  • observe surgical site closely for leakage (suspected drainage test positive for glucose if it is CSF)
  • assess for abdominal distention (all the extra fluid is going from the brain to the peritoneal cavity)
  • monitor closely for signs of infection
  • administer antibiotics as ordered
  • reposition every two hours
102
Q

What is our first line treatment for neurogenic bladder?

A

frequent, clean, straight catheterization is preferred method of management; Maintain home schedule as much as possible

103
Q

what medication is used for neurogenic bladder?

A

oxybutynin

104
Q

What are some nursing considerations when using oxybutynin for neurogenic bladder?

A
  • do not take with antihistamines because it could increase the effects of oxybutynin
  • careful monitoring with the digoxin because oxybutynin can increase the effects of digoxin
105
Q

What are some side effects of oxybutynin?

A
  • Constipation
  • dry mouth
  • decrease sweating
  • drowsiness
106
Q

What are some other treatment options besides straight catheterization for neurogenic bladder?

A
  • vesicostomy

- mitrofanoff

107
Q

What type of allergy is common in children with spina bifida? children with chronic renal failure are also at high risk of developing this type of allergy.

A
  • latex allergy

- avoid bananas, avocado, kiwi, chestnuts

108
Q

What are some other problems that a child might be prone to if they have spina bifida?

A
  • clubfoot
  • dislocated hip(s)
  • scoliosis
  • precocious puberty
  • cognitive impairment
  • learned helplessness (when we are doing everything for the pt…we want them to be as mobile and independent as possible)
109
Q

What are the three major neurological assessments that are done in Pediatrics?

A
  • patients baseline
  • developmental level
  • post operative baseline
110
Q

levels of consciousness

Full?

A

awake, alert, oriented, interacts with environment

111
Q

levels of consciousness

Confused?

A

lacks ability to think clearly and rapidly

112
Q

levels of consciousness

Disoriented?

A

lacks ability to recognize place or person

113
Q

levels of consciousness

Lethargic?

A

awakens easily but exhibits limited responsiveness

114
Q

levels of consciousness

Obtunded?

A

sleeps unless aroused; Once aroused, has limited interaction with environment

115
Q

levels of consciousness

Stupor?

A

requires considerable stimulation to rouse

116
Q

levels of consciousness

Coma?

A

vigorous stimulation produces no motor or verbal response

117
Q

Head Injury in Children using the Glasgow Coma Scale

Minimal?

A

score of 15, no loss of consciousness

118
Q

Head Injury in Children using the Glasgow Coma Scale

Mild?

A

score of 14/15, brief loss of consciousness

119
Q

Head Injury in Children using the Glasgow Coma Scale

Moderate?

A

score of 9-13, loss of consciousness greater than five minutes

120
Q

Head Injury in Children using the Glasgow Coma Scale

Severe?

A

score of 5-8

121
Q

Head Injury in Children using the Glasgow Coma Scale

Critical?

A

score of 3-4

122
Q

what type of vital sign assessment needs to be documented during a neurological check?

A
  • heart rate= rapid or slow and bounding
  • respirations= slow, deep, irregular
  • blood pressure= an increase in the BP and a slowing of the pulse (called the Cushing’s response) is rare in children, and if occurs means impending brainstem herniation
  • temperature= hypothalamus damage
123
Q

What are some types of neurological assessments that need to be done with the eyes?

A
  • pupil dilation occurs on the same side as the pressure
  • papilledema (swelling of the optic disc)
  • pre-retinal hemorrhages (may suspect abuse, shaken baby syndrome OR subdural hematoma)
124
Q

What are some late signs of increase intracranial pressure in infants and children?

A
  • posturing
  • bradycardia
  • increase BP
  • alterations in pupil size and reactivity
  • Cheyne-stokes respirations
  • decrease consciousness
  • coma (1-8)
125
Q

What are some neurologic emergencies?

A
  • asymmetric pupils
  • one dilated, unreactive pupil
  • widening pulse pressure
  • deep, periodic or grasping respirations
  • slowing pulse
  • brainstem involvement
126
Q

What are some interventions for unconscious children with increase intracranial pressure?

A
  • ABC’s
  • patient positioning
  • avoid activities that may increase ICP
  • treat pain
  • IV administration of fluids and parenteral nutrition
  • very strict monitoring of I&O’s
  • altered pituitary secretions= SIADH or DI
127
Q

what are some things that can cause increased intracranial pressure?

A
  • suctioning
  • Valsalva maneuver
  • agitation
  • stimulation/startle, especially after sleep
  • gentle, slow ROM exercises
  • later begin gastric feeding via NG or GT
  • patient may continue to have risk of aspiration
  • family support
128
Q

what are some signs and symptoms of diabetes insipidus?

A
  • dehydration
  • hypernatremia
  • increased urination
  • increased thirst
  • low specific gravity (<1.005)
129
Q

what are some signs and symptoms of SIADH?

A
  • fluid retention
  • hyponatremia
  • decrease urination
  • hypertension
  • weight gain
  • high specific gravity (>1.030)
130
Q

What is a concussion and what are the three key features?

A

a trauma induced alteration in mental status that may or may not be associated with loss of consciousness

1) confusion
2) loss of memory
3) reduce speed of information processing

131
Q

what is post-concussion syndrome?

A
  • symptoms develop within days of injury

- resolve in about 3 months

132
Q

what are some signs and symptoms of post-concussion syndrome?

A

headache, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration, memory impairment

133
Q

when should the health care provider been notified if the patient is diagnosed with post-concussion syndrome?

A
  • signs of ICP:

- vomiting , vision disturbances, loss of consciousness

134
Q

what are three main types of meningitis?

A
  • bacterial
  • aseptic (viral/nonbacterial)
  • tuberculous
135
Q

what is the leading cause of bacterial meningitis?

A
  • transmitted by droplets via nasal pharyngeal secretions
  • neonates= Group B streptococcus
  • children 3 months to 11 years= streptococcus pneumoniae
  • children between 11 and 17 years= Neisseria meningitidis
136
Q

What are some clinical manifestations of bacterial meningitis?

A
  • infant: fever or hypothermia, poor feeling, and bulging anterior fontanel
  • children: fever, headache, irritability (vomiting)
137
Q

What are some initial managements of bacterial meningitis?

A
  • isolate
  • ABC’s
  • obtain IV access and blood work
  • assist with lumbar puncture for obtaining CSF
  • start first dose of antibiotics: penicillin, Cephalosporins
  • monitor for ICP changes
  • temperature control
  • treat complications
138
Q

What are some diagnostic testings that are done for bacterial meningitis?

A
  • lumbar puncture (definitive)
  • blood culture
  • nose and throat cultures
139
Q

what are some therapeutic and nursing managements for bacterial meningitis?

A
  • neuro checks every four hours
  • strict I&O
  • monitor electrolytes and hydrate
  • promote comfort
  • monitor for complications
  • hearing screen after discharge
140
Q

what are some complications of bacterial meningitis?

A
  • meningococcal sepsis(meningococcemia): Waterhouse-Friderichsen syndrome
  • SIADH
  • cerebral edema
  • subdural effusions
  • hydrocephalus
  • seizures
  • brain damage, hearing loss, vision loss, learning disabilities
  • paresis (muscular weakness caused by nerve damage or disease; partial paralysis)
141
Q

What is the most dramatic and serious complication ( that needs immediate emergency treatment) of bacterial meningitis?

A
  • Meningococcemia
  • Waterhouse-Friderichsen syndrome
  • septic shock
  • disseminated intravascular coagulation (DIC)
  • bilateral adrenal hemorrhage
  • purpura
142
Q

What are some preventative vaccinations for bacterial meningitis?

A
  • HIB (H. influenza type B) vaccine at 2,4,6 months with booster at 12-15 months
  • Pneumococcal vaccine at 2,4,6 months with booster at 12-15 months
  • Meningococcal conjugate vaccine at 11-12 years with booster at 16 years old
143
Q

Nonbacterial (aseptic) meningitis: what is it and treatment?

A
  • viral
  • variations in CSF between bacterial/viral meningitis
  • diagnosis based on clinical features and CSF
  • asymptomatic treatment= supportive care, hydration, no antibiotics
144
Q

tuberculosis meningitis: what is it and treatment?

A

clinical manifestations: meningeal signs, fever, change in LOC, cranial nerve involvement, seizures and neuro deficits

145
Q

What are some diagnostic evaluations for seizures and epilepsy?

A
  • history and assessment

- testing: EEG, sleep study, video

146
Q

what are some therapeutic managements for seizures and epilepsy?

A
  • control seizure, reduce frequency and severity

- drug therapy

147
Q

what are some nursing considerations for seizures?

A
  • observe for presents and length of apnea
  • note if the mouth has any deviation the one side or the other, teeth clenched, tongue bitten, frothy at mouth, and/or flecks of blood or bleeding
  • note duration of postictal period; level of consciousness; orientation in time, person, in place; any alteration in motor ability or speech
148
Q

Types of nursing management for seizures?

A
  • seizure precautions, prevent injury
  • long term care and support to child and family
  • education in anticipatory guidance
  • medication compliance and administration
  • prevention of triggers
  • nutritional support (vitamin D and folic acid)
  • school plans to ensure safety and medication
149
Q

what should you do if a patient is actively seizing?

A
  • turn to side
  • remove surrounding objects
  • put on monitor if not already
150
Q

what are some nursing considerations for anticonvulsants?

A
  • use with caution in clients taking anticoagulants, aspirin, sulfonamides, cimetidine, or antipsychotics
  • absorption is decreased with the use of milk products, antacids, calcium preparations, and antineoplastic medications
  • monitor liver and renal function
  • monitor therapeutic levels of drug
151
Q

what are two major adverse effects that should be monitored for if a patient is taking anticonvulsants?

A
  • Stevens Johnson syndrome

- toxic epidermal necrolysis

152
Q

What is a ketogenic diet in why is it used for patients who have seizures?

A
  • high fat, severely restricted carbs , adequate protein diet
  • forces body does shift from using logos his primary energy source to using fat, thus developing a state of ketosis
  • used as an adjunct to anticonvulsant medications in controlling intractable seizures or in cases of resistance to medications or drugs toxicity
  • these patients cannot have any oral suspension medications because of the sugar content= must get PO medication that can be crushed
153
Q

what are some side effects of a ketogenic diet?

A
  • Constipation
  • weight loss
  • lethargy
  • kidney stones
  • poor bone mineral density exacerbated
  • diet is deficient in vitamins and minerals= vitamin supplementations is necessary
154
Q

what are some treatment options for seizures?

A
  • Vagus nerve stimulation: implantable device

- surgical therapy: focal resections, corpus callostomy, lobectomy

155
Q

What is status epilepticus and nursing care managements for it?

A
  • seizure lasting greater than 30 minutes
  • maintain patent airway
  • ensure safety
  • assessment, documentation
  • diazepam administration (buccal, nasal, rectal, IV)
  • support family
156
Q

What are some key considerations for diazepam?

A
  • incompatible with many drugs and allegiance
  • can give slowly and directly into the vein without dilution as close as possible to the vein insertion
  • can be diluted in NS, D5W, or LR in a 1:20 dilution for 6-8 hour stability (1:15 dilution results in the immediate precipitation)
157
Q

Flurazepam has a longer duration of action than diazepam and causes less _____________ depression in children over ___ years of age.

A
  • respiratory

- 2

158
Q

what is a febrile seizure?

A
  • occur in a child age six months to five years (this is unique to the pediatric population)
  • seizure occurs during the temperature rise at rapid rate
  • absence of CNS infection
  • antipyretics do not prevent the seizure
  • no antiepileptic prophylaxis is needed

PEDs Exam 3 (3 decks)

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