Neurological Alterations Pre-Recorded Lecture Flashcards

1
Q

Pediatric Nervous System

A

Central Nervous System (brain and spinal cord)
Peripheral Nervous System (pain and muscle control)
Autonomic nervous system (involuntary functions, heart ect)

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2
Q

Development of Neurological System

A

Rapid growth period
- 15-20 weeks of gestation (dramatic increase in the number of neurons, a really sensitive time for any kind of infection or injury that could cause brain damage. viruses especially)
- 30 weeks of gestation to 1 year of age (period of growth so again increased risk with viruses, hypoxia, or malnutrition)
- brain development continues after birth
- grey matter can be increased by proper stimulation in the first three years of life
Cerebral blood flow & O2 consumption is almost 2x that of adults -> reflects increased metabolic requirement consistent with G&D. resp rate is higher, O2 needs are higher, HR is higher
Brain and spinal cord are among 1st major organ systems to be recognized in embryo & one of last to finish significant development after birth

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3
Q

Brain growth achieved:

A

50% by 1 year
75% by 3 years
90% by 6 years

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4
Q

Other pediatric differences

A
  • cephalocaudal development
  • at birth the brain and head are 12% of entire body mass whereas adults are 2%
  • sensory pathways develop first (sense and feel pain) then motor pathways - obvious from child’s developing motor ability
  • this developing state of the young child’s cerebrum makes this a very sensitive period, but also a forgiving period
  • children can develop new pathways to overcome a neurological injury in the brain depending on the extent of the injury
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5
Q

Meninges

A

Dura mater (two spaces within this dura mater) - tough, outer meningeal membrane and inner periosteum of cranial bones)
- epidural space
- subdural space (between dura mater and arachnoid)
Arachnoid membrane (middle meningeal layer, delicate, avascular, weblike structure that loosely surrounds brain. Within that is the subdural space which is a potential space that prevents adhesion of the two layers. Has small vessels in it that can rupture during trauma and cause subdural hemorrhage.
- subarachnoid space: filled wth CSF; acts as cushion for brain tissue
- Pia mater: contains arteries & veins that supply brain: innermost covering, transparent membrane that adheres closely to the outer surface of the brain; includes arteries and veins of the brain.

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6
Q

ICP

A

very small amounts of blood increase their intercranial pressure very significantly

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7
Q

Cerebellum
Brain Stem

A

Cerebellum: so important in motor development and movement and a major area of concern for some children with neurological disorders
Brain Stem: cranial nerves - motor & sensory neurons travel through brainstem to allow for relay of signals b/n brain & spinal column; coordinates motor control signals from brain to body; controls life-supporting autonomic functions of peripheral nervous system

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8
Q

Autoregulation of Cerebral Blood Flow

A
  • intracranial pressure
  • cerebral arteries change their diameter in response to fluctuating cerebral perfusion
  • autoregulation is the brains protection of itself. it works to keep the pressure constant
  • CPP (cerebral perfusion pressure) = MAP-ICP
  • Brain gets the blood even in crisis
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9
Q

Oxygen

A

O2 needs alter with temperature
- increased temp = increased O2 needs
- decreased temp = decreased O2 needs
Sensitive to PaO2 and PaCO2 (ICP decreases with high CO2)
Blood brain barrier
- at birth is indiscriminate and allows passage of protein as well as oxygen and glucose
- children are more sensitive to medications
- a child, especially young child, is at a sensitive time

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10
Q

Neurological Assessment of Children - similar to adult, requires more observation and clinical data because children can’t communicate as well verbally

A

Behaviour
Cognitive status
Coordination and gait
Cranial nerves
Spinal nerves
Strength and power
Pupils - late sign

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11
Q

2 components of Level of Consciousness

A

Alertness and Cognitive power

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12
Q

Alertness

A

ability to react to stimuli

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13
Q

Cognitive power

A

ability to process & respond verbally or physically

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14
Q

Consciousness

A

implies awareness - ability to respond to sensory stimuli have subjective experiences

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15
Q

Unconsciousness

A

depressed cerebral function, or inability of brain to respond to stimuli

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16
Q

Levels of Deterioration

A

Confusion
Disorientation
Lethargy
Obtundation
Stupor
Coma
Persistent vegetative state
Going to wake up in the reverse order
child initially awake & alert. initial changes sublte; may become restless or fussy & actions that normally calm or soothe child only increase irritability. child may become drowsy but still respond to loud verbal commands. decorticate or decerebrate posturing

17
Q

Causes of decreased LOC

A

Hypoxia
Trauma
Infection
Poisoning
Seizures
Endocrine or metabolic disturbances
Electrolyte or biochemical imbalance
Acid-base imbalance
Cerebrovascular pathology
Congenital structural defect

18
Q

Lab Tests

A

blood chemistry
CBC
C+S
clotting factors
blood culture
toxicology of blood & urine
urinalysis with culture
LP
EEG
MRI
X-ray
Glasgow coma scale: modified for peds.

19
Q

Signs of increased ICP - infants

A

tense, bulging fontanels
separated cranial sutures
irritability & restlessness
drowsiness
high-pitched cry
increased fronto-occipital circumference
distended scalp veins
poor feeding
crying when disturbed
setting-sun sign

20
Q

Increased ICP - children

A

headache
nausea
forceful vomiting
diploplia, blurred vision
seizures
indifference, drowsiness
decline in school performance (slow)
diminished physical activity & motor performance
increased sleeping
inability to follow simple commands
lethargy

21
Q

late signs of increased ICP

A

bradycardia
decreased motor response to command
decreased response to painful stimuli
alterations in pupil size & reactivity
extension or flexion posturing: decerebrate, decorticate
cheyne-stokes respirations
papilledema
decreased consciousness
coma
Decorticate
Decerebrate

22
Q

GCS

A

15 is normal
< 8 coma
3 = deep coma or death

23
Q

Diagnostic Procedures

A
  • Lumbar puncture  meningitis. Spinal tap, into the subarachnoid space to collect CSF for culture. Between L3 and L4 or L4 and L5
  • EEC: electroencephalography – measures the electrical potential of the brain
  • CT – computerized tomography; pinpoint x-ray beam directed on horizontal & vertical plane to provide series of images that are fed into computer & assembled into an image
  • MRI – magnetic resonance imaging; radiofrequency emissions from elements that are converted to visual image
  • PET – positron emission tomography; IV injection of positron-emitting radionucleotide; local concentrations are detected & transformed into visual display; detects blood flow, metabolic activity and biochemical changes
  • Serum Blood Levels – imbalances of ions such as Na, K, Cl, Glucose and also of some medications used in treatment
  • Other
24
Q

Nursing management of the unconscious child

A

maintain patent airway
respiratory management
motor neurological status
pain management
ICP monitoring
Fluids and nutrition
Bowel elimination
Thermoregulation
medications
Routine care
Sensory stimulation
Family support
Discharge planning