Neurological Disorders Flashcards
What are the aspects of a pediatric neuro assessment? (6)
- Vitals
- Skin
- Eyes
- Reflexes
- Motor
- Posture
Describe pediatric vital assessment considerations (3)
- Apical pulse assessed for 1 full min
- BP routinely assessed if > 3 years old
- Infants are nose breathers until 3 months old
RR of ______ indicates respiratory distress
< 60
What areas should be assessed for skin color? (5)
- Lips
- Nose
- External ear
- Hands
- Feet
When does the anterior fontanel close?
18 months
When does the posterior fontanel close?
3 months
Fontanels should be palpated until ______
1 year old
What can a bulging fontanel indicate? (2)
- ICP
- Meningitis
What can a sunken fontanel indicate?
Dehydration
Describe the age considerations for GCS use (2)
- Pediatric GCS for age < 2 (nonverbal)
- Standard GCS for age > 2 (verbal)
What aspects of GCS are assessed in infants? (3)
- Motor
- Muscle strength
- Response to stimuli
Describe assessment of eye movement (2)
- Normal = contralateral eye movement upon head rotation
- Abnormal = eyes remain fixed upon head rotation
Assessment of contralateral eye movement helps detect ______
Strabismus - eye misalignment
Describe the developmental considerations regarding reflexes (2)
- Infants are more reflexive
- Toddler become more coordinated and controlled
What are the major motor developmental milestones? (7)
- 4 months - head control
- 4 months hand-eye coordination
- 5 - 6 months - rolling over
- 6 months - palmer grasp
- 10 months - pincer grasp
- 12 months - walking
- 18 months - running
What are the major social / cognitive developmental milestones? (5)
- Infants (0 - 12 months) - trust vs. mistrust
- Toddlers (1 - 3 years) - autonomy vs. shame and doubt
- Pre-schoolers (3 - 5 years) - initiative vs. guilt
- School-age (6 - 12 years) - industry vs. inferiority
- Adolescents (13 - 18 years) - identity vs. role confusion
When does separation anxiety / stranger anxiety begin?
6 months old
What is hydrocephalus?
Excessive amount of CSF within the cerebral ventricles
What are the causes of hydrocephalus? (3)
- Impaired CSF production / absorption
- Blocked flow of CSF
- Congenital malformation
Describe the prognosis of hydrocephalus due to a neoplasm
Based on type / spread of tumor
Describe the prognosis of hydrocephalus due to trauma, infection, or hemorrhage
Based on amount of brain damage before treatment
What treatment significantly improves survival rate from hydrocephalus?
Shunt placement soon after diagnosis
What are the manifestations of hydrocephalus in infancy? (9)
- Rapid head growth
- Frontal enlargement
- Bulging fontanels
- Dilated scalp veins
- Thin skull bones
- Sunsetting eyes
- Sluggish pupils
- Lower extremity spasticity
- High-pitched cry
What clinical test of sound is used to assess for hydrocephalus?
Macewen sign
Describe Macewen sign (3)
- Resonant sound when tapping the skull near the junction of the frontal, temporal, and parietal bones
- Indicates separation of sutures due to intracranial pressure
- “Cracked pot sound”
What are the manifestations of hydrocephalus in older children? (6)
- No head enlargement
- Headache when awakening - improves after emesis / upright position
- Altered motor ability - ataxia, spasticity
- Decreased visual acuity
- Strabismus
- Papilledema
Describe the diagnosis of hydrocephalus in infancy
Evidenced by rapid head enlargement when compared to daily measurements of cranial circumference
What tests are used for diagnosis of hydrocephalus? (2)
- CT
- MRI
Describe the treatment of hydrocephalus (2)
- Surgical placement of ventriculoperitoneal (VP) shunt
- Valves open at a predetermined intraventricular pressure and close when pressure falls below that level
What are the complications associated with VP shunt placement for hydrocephalus? (2)
- Infection
- Malfunction - symptoms of ICP
Describe the post-op care associated with VP shunt placement (6)
- Position flat on non-operative side
- Assess for abdominal distention
- Assess for infection
- Neuro assessment
- NPO for 24 hours
- Antibiotics
Why is it important to position the patient flat on the non-operative side after placement of a VP shunt? (2)
- To prevent pressure on the shunt valve
- To prevent CSF from draining too quickly
Abdominal distention after placement of a VP shunt could indicate ______
Peritonitis
Most causes of seizure disorders originate …
Outside of the brain
Describe the pathophysiology of seizure disorders
Disruption of neuron communication causes abnormal firing
What factors influence manifestations of seizure disorders? (6)
- Age
- Genetics
- Brain injury
- Medications
- Sleep cycle
- Areas of the brain involved
What is a focal seizure?
Seizure activity in one cerebral hemisphere
What are the manifestations of a focal seizure? (5)
- May be aware, unaware, or unconscious
- Hallucinations - buzzing sounds, flashing lights
- Lip smacking
- Stiffness
- Jerking of one extremity
What is a generalized seizure?
Seizure activity in both cerebral hemispheres
What are the manifestations of a generalized seizure? (3)
- Loss of consciousness
- Stiffness
- Jerking
What is a febrile seizure?
Seizure triggered by high fever (100.4)
When are febrile seizures most common?
< 5 years old
Febrile seizures can cause body temperature to rise rapidly, reaching ______
102.2
What are the possible causes of febrile seizures? (3)
- Influenza
- Meningitis
- Viral infections
Describe simple febrile seizures (4)
- Affect the entire body
- Last < 15 minutes
- Once in 24 hours
- Full recovery in 1 hour
Describe complex febrile seizures (4)
- Affect one side of the body
- Last > 15 minutes
- Multiple in 24 hours
- Full recovery takes longer than 1 hour
What tests are used for diagnosis of seizure disorders? (3)
- CT
- MRI
- EEG
Describe the pharmacologic management of seizure disorders (2)
- Acute treatment - lorazepam, diazepam
- Maintenance - carbamazepine, valproic acid, phenytoin
What type of seizures can be treated using anti-epileptics?
Non-febrile seizures
Describe the nursing interventions associated with seizure disorders (2)
- Control temperature
- Consider physical growth and therapeutic drug monitoring
What factors are important to assess / monitor regarding seizure disorders? (6)
- Seizure duration
- Movement
- Behavior
- Face / eyes
- Respiratory effort
- Post-ictal observations
What is meningitis?
Infection of the meninges of the brain / spinal cord
What are the types of meningitis? (2)
- Bacterial (septic)
- Viral (aseptic)
Which type of meningitis has a higher mortality rate?
Bacterial
Bacterial meningitis is associated with what diseases? (4)
- Meningococcus
- Pneumococcus
- Streptococcus
- H. influenzae
Viral meningitis is associated with what diseases? (3)
- Measles
- Mumps
- Herpes
Describe the characteristics specific to viral meningitis (2)
- No exudate in CSF
- Self-limiting (lasts 7 - 10 days)
When is meningitis most common?
6 - 12 months old
How does meningitis reach the CNS? (2)
- Enters through the middle ear / nasopharynx / sinuses
- Travels through blood / lymph / CSF
Describe the pathophysiology of meningitis (2)
- Meningeal inflammation with release of purulent exudate
- Causes cerebral edema –> ICP –> necrosis of brain cells
What are the manifestations of meningitis? (8)
- Headache
- Photophobia
- Nuchal rigidity
- Back pain
- Seizures
- Petechiae
- Hyperthermia
- Chronic ear drainage
Petechiae associated with meningitis could indicate ______
Septic shock (bacterial meningitis)
What additional manifestations of meningitis may be present in infants? (2)
- Bulging fontanel
- High-pitched cry
What clinical tests of pain / resistance are used to assess for meningitis? (2)
- Kernig’s sign
- Brudzinski’s sign
Describe Kernig’s sign (3)
- Lay supine
- Extend leg and flex hip
- Cause pain / hamstring contraction
Describe Brudzinski’s sign (3)
- Lay supine
- Flex head
- Causes pain / hip flexion
Describe the diagnosis of meningitis (5)
- Lumbar puncture (CSF)
- Blood culture
- Urine culture
- Throat culture
- Nasal swab
What CSF analysis findings are associated with meningitis? (3)
- Low glucose
- Elevated WBCs
- Elevated protein
Describe the nursing interventions associated with meningitis (5)
- Broad-spectrum IV antibiotics (large dose)
- Anticonvulsants
- Audiometry testing
- Bedrest - dark, quiet room for headache / photophobia
- Prevent immobility
What type of isolation is needed for bacterial meningitis?
Droplet isolation for 24 - 48 hours after initiation of antibiotic therapy
Describe the education associated with meningitis (2)
- Rehabilitation program may be needed
- Prophylactic antibiotics for family members
What is a traumatic brain injury (TBI)?
Damage to skull / brain due to mechanical force
What is a primary TBI?
Occurs at the time of injury
What is a secondary TBI?
Occurs indirectly following injury
What are the early manifestations of a TBI? (4)
- Headache
- Photophobia
- Vertigo
- CSF leakage from the ears / nose
What additional early manifestations of a TBI may be present in infants? (2)
- Apnea
- Poor feeding
What are the late manifestations of a TBI? (6)
- ICP
- Hydrocephalus
- Seizures
- Posturing
- Unequal / non-reactive pupils
- Ecchymosis surrounding eyes / mastoid
What is a concussion?
Brain collides with skull due to shearing force
What are the hallmark manifestations of a concussion? (2)
- Confusion
- Amnesia
______ is not an accurate indicator of a concussion
Loss of consciousness
Concussions usually resolve within ______
7 - 10 days
How often should neuro checks be conducted for a patient with a concussion?
Every 4 hours
How often should the nurse assess a patient with a head injury for consciousness?
Every 2 hours
Describe the nursing interventions associated with head injury (4)
- GCS
- ABCs
- Assess for shock
- Assess for spinal cord injury
What tests are used for diagnosis of head injury? (2)
- CT
- MRI
What medication is used for head injury pain management?
Acetaminophen (NOT ibuprofen)
Why is ibuprofen not used for head injury?
NSAID - risk of bleeding
What complications are associated with concussions? (3)
- Contusion / laceration
- Epidural hematoma
- Subdural hematoma
