Neurological Disorders Flashcards
1
Q
What is the CNS
A
- Brain, spinal cord and the related nerves
2
Q
What are the different parts of the CNS?
A
- Cerebrum
a. Connected R and L hemispheres, top of the cranium
b. Responsible for the main activities of our body, behavior and cognition - Cerebellum
a. Under the cerebrum
b. Back of the cranial vault
c. Responsible for our bigger movements like posture, initiating and maintaining movement, balance - Brainstem
a. Base of the skull
b. Protected because it is made of midbrain, pons and medulla which are critical for our life (breathing and heart)
3
Q
Protection
A
- Skull, skin and 3 layers of meninges (see picture)
- Arachnoid (cobweb where fluid and blood to flow through
- Pia mater-thin and sensitive, right beside the brain
4
Q
Assessment
A
- LOC
a. Most important indicator of neurologic dysfunction
b. Describing LOC
i. Conscious vs unconscious
ii. Alertness-the ability to react to stimuli
iii. Cognitive power-processing of data. Can they answer questions, look at noises etc. - ICP
- Head circumference
- Vital signs
- Pediatric assessment is limited by the developmental stage of the child so we need help from family and friends
5
Q
Types of LOC
A
- Full consciousness
a. Patient alert to person, place and time if developmentally appropriate
b. Do they smile when a familiar face is present - Confusion
a. Disorientation to time, place or person - Delirium or obtundent
a. Characterized by confusion, fear, agitation, hyperactivity or anxiety
b. Some stimulation needed to stay awake - Stupor
a. Response to vigorous stimuli only
b. Loud noises, sternal rub - Coma
a. Severely diminished response
b. Not responding to vigorous stimuli
c. Part of our assessment needs to look at our posture
i. Decorticate where they are flexed and wrists and hands are turned in and feet are extended
ii. Deserigrit-extremities are extended and hands and feet are pronated
iii. See more often in longer coma
iv. PT/OT needs to do an assessment so they don’t have complications r/t their positioning - Bring in family member because we are going based on their reported baseline
6
Q
Intracerebral Pressure, cerebral spinal fluid
A
- Measured mmHg, created by the things in the skull (brain, blood and CSF)
- The pressure within the skull
- Normal CSF
a. Clear, odorless
b. Wbc 0-5
c. Protein 15-45
d. Glucose 50-80
e. Pressure 50-180 - Abnormal CSF
a. Turbid, cloud, bloody (infection or trauma)
b. WBC 1000-2000 esp. bacterial infection
c. Protein 100-500 (bacteria or blood)
d. Glucose lower than blood sugar esp. bacterial infection because the bacteria is ingesting the glucose
e. Pressure 180 or greater (tumor, trauma or infection)
6
Q
Pediatric Glasgow coma scale
A
- Designed as a standardized assessment of the patient with disturbed consciousness
- The lower the score at time of admission the poorer the outcome
- Takes into account the age of the child
- We look at their baseline and track changes as they occur
- Lowest score is 3 and highest is 15
7
Q
Common cause in change of LOC
A
- Trauma (head injury, car accident, poisoning)
- Most common is infection (meningitis and encephalitis)
- Seizure
- Hypoxia
8
Q
What may account for an increase in brain volume
A
- Edema
- Blood flow
- Bleed within the brain
- Tumor (cancerous or benign)
a. They grow and change the brain volume
9
Q
If we don’t catch changes in ICP fast enough
A
- Trauma to the brain causing brain tissue death and long-term outcomes
- Specific things that can happen from ICP
a. Brain can shift from edema
b. Injury to brain tissue, then necrosis (irreversible)
c. Older than 2 when there is no way to accommodate expansion is brain herniation that causes injury, ischemia and necrosis of the brain
10
Q
What to assess with an increased ICP
A
- LOC and pediatric Glasgow coma scale
- Head circumference under 2 years on admission and if hospitalized for something neuro BID, OD, q48h
- Known as Cushing’s triad (seen in response to ICP)
a. Hypertension
b. Bradycardia
c. Irregular respirations
d. The sympathetic NS is stimulated so vasoconstriction occurs and an increase in cardiac output so the baroreceptors are triggered and heart rate decreased
e. Pressure on the brain stem leads to irregular and slow respirations
11
Q
Vital signs tips
A
- Warm stethoscope
- Get the patient asleep when possible
- Start with RR and HR, then temperature calm them and BP
- RR and HR need to be done for a full minute
12
Q
Measure Head circumference
A
- Start just above ears to occipital prominence (largest part on the back of the head) and move around the front to the largest part (frontal prominence) and match the tape together
a. Front between the hairline and eyebrows
13
Q
Common Pediatric alterations in neurologic function
A
- Hydrocephalus
- Meningitis
- Encephalitis
- Seizures
- Traumatic brain injury
- Cerebral palsy
- Spinal cord injury/trauma
14
Q
Hydrocephalus
A
- Dilation of the ventricles
- Develops as a result of an imbalance between the production and absorption of CSF
- CSF builds up causing abnormal enlargement of the ventricles in the brain
- 1/500 children in Canada will develop this
- 2 primary causes
a. Congenital, uncommon. Means the infant or newborn is born with and it occurred in utero
b. Acquired through lesions, tumors, infection, intracranial bleed, myelomeningocele. Trauma during the birth process