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Module 5 (Pediatrics) > Neurological Dysfunction > Flashcards

Neurological Dysfunction Flashcards

1
Q

What family Hx do you need to know about during a neuro assessment?

A

Intellectual & Developmental Disabilities
Deaf/blind
Epilepsy
Stroke

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2
Q

What HEALTH Hx do you need to know about during a neuro assessment?

A

Injury with loss of consciousness
Febrile illness
Encounter with animal/insect - RABIES/WEST NILE
Ingestion of neurotoxic substance - FUEL/ANTIFREEZE
Past illness (recent – Meningitis or Green)

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3
Q

What are the neuro assessment PHYSICAL EXAM findings?

A

Size/shape of head – esp. infants
LOC Awake & alert/drowsy or lethargic
Activity – spontaneous or pain stimuli
Tone – tense, flaccid
Symmetry - equal
Facial features - Syndromes
High-pitched cry esp. in infants
Respiratory pattern – apnea, hyper vent
Muscular activity/coordination - ticks/twitch
Reflexes/strength

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4
Q

What neuro-assessment characteristic is the earliest sign of improvement or deterioration?

A

Level of Consciousness
- fully, lethargic, coma

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5
Q

The Glasgow Coma Scale is used to assess

A
  • LOC
  • impairments in infants to very young (<2 y/o) can be problematic
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6
Q

What is the standard system of evaluating and assessing LOC?

A

Glasgow Coma Scale

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7
Q

A Glasgow Coma scale in pediatrics is used for ages

A

< 2 y/o

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8
Q

During a Glasgow coma scale in pediatrics, what is a helpful strategy to fully evaluate the child

A

family member interactions with the child

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9
Q

What are the 3 parts of assessments for the Glasgow Coma scale?

A

eye-opening
verbal response
motor response - Best

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10
Q

What is the score range on a Galsgow Scale from lowest to highest?

A

3-15
- lowest = deep coma/death
- highest = awake and aware

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11
Q

What Glasgow score is generally accepted as coma?

A

less than or equal to 8

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12
Q

What Glasgow score does the patient need to be intubated?

A

less than 8; intubate

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13
Q

Glasgow scores for eye-opening responses (all ages)

A

4-spontaneous
3-to speech
2-to pain/pressure
1-none

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14
Q

Glasgow’s scores for verbal responses
>2 y/o

A

5: oriented
4: confused
3: inappropriate words
2: incomprehensible/sounds
1: no response
T: Endotracheal tube or Trach

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15
Q

Glasgow’s scores for verbal responses
<2 y/o

A

5: coos, babbles, smiles
4: irritable cry, consolable
3: inappropriate crying/screaming
2: moans/grunts
1:none

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16
Q

Glasgow’s scores for motor responses
< 2 y/o

A

6: spontaneous/purposeful
5: withdraws to touch
4: withdraws to pain
3: flexion abnormal
2: extension abnormal
1: none

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17
Q

Glasgow’s scores for motor responses
> 2 y/o

A

6: obeys commands
5: localizes pain
4: flexion withdrawal
3: flexion abnormal
2: extension abnormal
1: none

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18
Q

Neuro Assessment of Pupils uses what to measure them

A

Pupillometer (1-8mm)

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19
Q

What are the different reactions in a pupil assessment?

A

Brisk
Sluggish
No reaction
Eyes closed by swelling
Pinpoint, Dilated/fixed, Unequal

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20
Q

If the pupils are fixed or dilated for more than 5 minutes, what does this mean?

A

brain stem damage

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21
Q

Atropine

A

eye dilated

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22
Q

Pinpoint pupils reasons

A

medications
barbiturate poisoning

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23
Q

What is considered a neurologic emergency regarding pupils?

A

sudden appearance of a fixed/dilated pupil

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24
Q

When a child has a sudden appearance of dilated pupils, the nurse’s priority action is?

A

remain with the child

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25
Q

With atropine pupils, the child is at high risk for

A

respiratory arrest

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26
Q

Decorticate (flexion) position means what neurological problem?

A

dysfunction of the cerebral cortex/above brainstem

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27
Q

The decorticate (flexion) position looks like

A

flexion of the elbows onto the chest with adduction of the arms
extension of the legs
feet together

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28
Q

Decerebrate (extension) position means what neurological problem?

A

dysfunction at the midbrain/brainstem

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29
Q

The Decerebrate (extension) position looks like

A

Extremities rotate abduction of the arms and legs with inversion of the feet
Hands out and back

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30
Q

Will you see posturing if they are not stimulated?

A

no

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31
Q

How would you document posturing?

A

describe the appearance do not label it

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32
Q

Herniating

A

Posturing only on one side

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33
Q

Total Cranium vol for Intracranial Pressure percentages

A

Brain = 80%
CSF = 10%
Blood = 10%

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34
Q

If there is a chnage in 1 area of ICP, then the others will

A

compensate
- maintain constant vol and pressure

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35
Q

In cerebral swelling, what happens to the ICP?

A

absorb more CSF causing a low blood flow

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36
Q

Bulging fontanels if open means

A

more compensation

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37
Q

Increased ICP early S/S onset

A

subtle when more noticeable when pressure increases

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38
Q

What are the early s/s of increased ICP? SATA.
HA
Vomiting
Fatigue
Irritability
Dizziness
Personality changes

A

HA
Vomiting
Fatigue
Irritability
Personality changes

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39
Q

Increased ICP S/S in Infants

A

tense, bulging fontanels
separate cranial sutures
irritable/restless
drowsy
Increased sleep (no eating)
High-pitched cry
Increased head circumference
- distended scalp veins
Setting Sun Sign

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40
Q

What is the Setting Sun Sign?

A

eyes rotating downward with the white above the eyes exposed

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41
Q

What are some s/s of increased ICP in a 1-month-old infant? SATA.
Bulging fontanels with separate sutures
Seizures
Sleeping and not waking up to eat
Diplopia
Decreased head circumference
Setting Sun Syndrome

A

Bulging fontanels with separate sutures
Sleeping and not waking up to eat

Rationale: Seizures and Diplopia is seen in toddlers; not infants. They would have Increased FOC- head circumference and Setting Sun “Sign”; setting sun syndrome is in elderly patients becoming hyperactive at night.

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42
Q

Children s/s of increased ICP

A

HA (coughing, bending, sitting up)
Nausea
Forceful vomiting
Diplopia, blurred vision
Seizures
Indifference, drowsiness
Increased sleeping
Not following simple commands
Lethargy

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43
Q

What is the difference between infant and children s/s of increased ICP?

A

infants have more objective s/s
children are subjective s/s

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44
Q

What are late s/s of Increased ICP in infants and children?

A

Bradycardia
decreased motor response to a command
decreased sensory to painful stimuli
sluggish/fixed/dilated pupils
flexion/extension posturing
altered respiratory patterns
decreased LOC
coma

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45
Q

Why does the pediatric patient have bradycardia?

A

compensation has stopped in the circulatory system

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46
Q

Brain herniation is what type of bleed

A

epidural bleed = extra volume

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47
Q

Subalpine means what has occurred in the brain

A

midline shift

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48
Q

Trantenurial UNCAL

A

Downward brain mvmt

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49
Q

What are the indications for invasive ICP monitoring?

A

Glasgow less than = 8
Glasgow greater than 8 with respiratory assistance
Traumatic brain injury with abnormal CT
Deterioration of condition
Subjective neurosurgeon judgement

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50
Q

What are the different invasive ICP monitoring/drainage routes?

A

Subdural
Epidural
Subarachnoid
Intraparenchymal
Ventricular

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51
Q

What is the gold standard used for increased ICP with drainage systems?

A

Ventricular

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52
Q

What order will the nurse predict the neurosurgeon make regarding draining of fluid from the Intracranial space?

A

Sustained ICP > 20 then you can drain some of the fluid

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53
Q

What are some nursing interventions for a patient with an increase in ICP?

A

Familiar with the drainage/monitoring system and insertion procedure
- Readings and s/s
- all equipment and in working order
Mannitol, Sedation/Paraltics, Artificial Tears, Hypertonic Saline
Positioning, Pain control, Cool/Ice packs
Minimal Stimulation
- stool softeners, suction PRN,

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54
Q

Mannitol does what to the ICP

A

osmotic diuretic to lower ICP (1-5 min quickly carries lots Na and water)
- can cause hypovolemia

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55
Q

Hypertonic Saline

A

increased Na to pull fluid
- great use with hypovolemia or hypotonic
HTN

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56
Q

How should a patient with increased ICP be positioned for venous drainage?

A

Head elevated and midline
- venous drainage

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57
Q

What is a minimal stimulation environment?

A

dim lights
Pain mgmt
crowd control
quiet
calming effect with family
Only lay a hand on them do not rub

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58
Q

With a patient with increased ICP, other than a quiet zone what other way do you calm down the patient?

A

Sedate and Paralyze

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59
Q

In sedating and paralyzing a patient to prevent them from raising their ICP, what drugs would you use?

A

Midazolam - sedative
Fentanyl – sedative analgesic
Vecuronium - paralytic
ALSO, Artificial tears ointment for eye lubrication

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60
Q

Never use a paralytic without a

A

sedative

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61
Q

Midazolam

A
  • sedative
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62
Q

Fentanyl

A

– sedative analgesic

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63
Q

Vecuronium

A
  • paralytic
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64
Q

When do you suction a patient with High ICP?

A

only as needed
- due tot he stimulation of the activity

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65
Q

How do you thermoregulate an increased ICP patient?

A

Cooling or ice packs
- do not use antipyretics

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66
Q

With a patient with increased ICP you want to avoid constipation, so what will be used in conjunction with the other medications?

A

stool softeners to avoid constipation

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67
Q

Head injury is defined as

A

damage to the brain or surrounding structures due to mechanical force

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68
Q

What are the 1st to 3rd most common types of head injuries?

A

1st = falls
2nd = MV injuries
3rd = bicycle injuries

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69
Q

Infants and young children are prone to head injuries due to their

A

large head
immature neck muscles
thin skull bones
open fontanels

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70
Q

What are the secondary diagnoses due to a primary head injury?

A

hypoxic
increased ICP
infection
cerebral edema

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71
Q

Minor head injury s/s

A

Possible LOC
temporary confusion
lethargy
drowsy
irritable
pallor
vomiting

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72
Q

S/S of progression to severe head injury

A

altered mental status
increased agitation
Tachycardia to Bradycardia

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73
Q

Severe head injury s/s

A

increased ICP s/s
bulging fontanels
retinal hemorrhage
pupil pinpoint
hyperthermia
unsteady gait
seizures
posturing (flexion and extension)
respiratory depression

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74
Q

Head Injury Dx

A

H&P (preexisting blood disorders, Hx matches injury, ABCD assessment, neuro, baseline VS)
X-Ray
CT
MRI (for structures)

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75
Q

What does ABCD mean in neuro?

A

Airway
Breathing
Circulation
Disability

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76
Q

When the brain strikes the skull, what are the medical terms for the impacts?

A

Coup and countercoup

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77
Q

Coup

A

point of impact

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78
Q

Countercoup

A

injury opposite from impact

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79
Q

Acceleration

A

the stationary head receives a blow

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80
Q

Deceleration

A

head in motion comes to an abrupt stop
- car crash, fall

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81
Q

With the skull receiving a blow, what increases from the head injury hit?

A

deformation of the skull increases ICP

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82
Q

Skull fractures occurs as a

A

direct blow/injury to skull associated with intracranial injury
- depressed, open

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83
Q

Which age range has the most flexible skull?

A

infants

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84
Q

Basilar Skull Fx

A

bones at the base of the skull fracture

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85
Q

What are the basilar bones?

A

Ethmoid
Sphenoid
Temporal
Occipital

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86
Q

Basilar Skull Fractures usually result in

A

dural tears

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87
Q

Why is the basilar skull fx a serious injury?

A

proximity to the brainstem

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88
Q

Basilar Skull Fx CONTRAINDICATED to have

A

NG Tube as it could go into the brain
- request OG Tube

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89
Q

With a basilar fx, the patient has a high risk of infection, so they need to have what vaccine hx or have it now?

A

Pneumovax

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90
Q

S/S of a Basilar Fx

A

SubQ bleeding on the mastoid behind the ear
Raccoon eyes
Red tympanic membrane
CSF leak from ears or nose

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91
Q

How do you detect CSF leakage?

A

HALO effect with a glucose dipstick test

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92
Q

Complications of Head Injuries

A

Hemorrhage
Infection
Edema
Herniation

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93
Q

How long should the head injury patient be monitored for swelling?

A

24-72 hours after injury

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94
Q

Epidural Hemorrhage Patho

A

Blood accumulates rapidly between the dura and skull
Hematoma
Forces brain tissue down and in

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95
Q

Classic S/S of Hemorrhage

A

momentary unconsciousness
normal period
altered lethargy or coma for hours

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96
Q

What is usually not evident in children with epidural hemorrhages?

A

classic s/s
- no unconscious period
normal period has (irritability, HA, vomiting, pale, and bulging fontanels)

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97
Q

Epidural Hemorrhage means

A

Brain bleed on top of the head
- in relation pushes the brain down and inward

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98
Q

How is the epidural hemorrhage diagnosed?

A

CT

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99
Q

Epidural hemorrhage causes tearing of what artery?

A

lower meningeal artery
- brain compresses rapidly on the artery causing the tear

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100
Q

Epidural hemorrhage with the lower meningeal tear is more common in what ages?

A

2+ y/o
because the artery has fully formed after 2 y/o

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101
Q

The lower meningeal artery is fully formed at what age?

A

2 y/o

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102
Q

Subdural Hemorrhage Patho

A

vascular injury
between the dura and cerebellum
spreads slowly through the dural space (around the side)

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103
Q

What type of bleed is a subdural hemorrhage?

A

venous

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104
Q

Venous bleeds are

A

slow

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105
Q

What is the difference between Basialr Fx, Epidural Hemorrhage, and Subdural Hemorrhage?

A

Basilar Fx = dural tear, Sub Q bleeding
Epidural = lower meningeal artery tear, bleeding btw dura and skull
Subdural = if also retinal bleed = child abuse, venous bleed, btw dura and cerebellum

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106
Q

Subdural Hemorrhage S/S

A

irritability
vomiting
Increased head circumference
lethary
coma
seizure

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107
Q

With an infant what is a sign of a subdural hemorrhage?

A

bulging anterior fontanel
- fontanels have not closed yet and will develop hemorrhagic shock before noticing

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108
Q

A child with a subdural hematoma and retinal hemorrhages needs to be evaluated for?

A

child abuse = Abusive Head Trauma or Shaken Baby Syndrome

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109
Q

What is the treatment for a Subdural Hematoma?

A

If small = observation
Butterfly subdural taps in infants
Subdural Drains with cath staying inside
Burr Hole
Surgical Evacuation of Hematoma

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110
Q

Tx for Mild Head Injuries

A

care and observe at home
family education

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111
Q

Tx for Severe Head Injuries

A

admit for possible surgery and observation
- Rehab

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112
Q

What do you give a head injury patient for a HA?

A

Acetaminophen

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113
Q

Comfort care and consults for head injuries are brought in for

A

palliative/spiritual with child life for siblings
when the damage is too severe and no possibility of survival

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114
Q

What painkiller do you not give to a head injury patient?

A

Morphine (alter mental status)

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115
Q

Submersion Injuries can occur where?

A

Bathtubs (infants)
Bucket (toddlers)
Swimming Pools (adolescents)
Lake, ponds, river, ocean
Anywhere with water

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116
Q

Bathtub submersions occur in what age?
Why?

A

infants; left unobserved in the bathtub

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117
Q

Bucket submersions occur in what age?
Why?

A

Toddlers; top heavy

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118
Q

What measurement can cause submersion?

A

1 inch of water

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119
Q

Submersion Injuries are usually unintentional from what ages?

A

0-19 y/o
birth to 4 y/o having the highest rate

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120
Q

What are the items related to a Submersion Injury?

A

Hypoxia
Hypothermia
Aspiration

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121
Q

Hypoxia by Submersion happens within

A

minutes
Lack of O2 -> loss of consciousness -> progressive decrease of cardiac output ->apnea and cardiac arrest

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122
Q

Hypoxia by Submersion
Irreversible damage after

A

4-6 minutes

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123
Q

The heart and lungs can survive up to how long without O2

A

30 minutes

124
Q

What is the primary cause of death with submersion?

A

hypoxia

125
Q

What is the key to stopping hypoxia with a submersion injury?

A

early resuscitation

126
Q

Aspirated fluid is quickly absorbed in pulmonary circulation resulting in the following:

A

Pulmonary edema
Atelectasis
Airway Spasms

127
Q

Pulmonary edema, Atelectasis, and Airway Spasms aggravate what other factor of submersion?

A

Hypoxia

128
Q

What percentage of drowning victims die without aspirating fluid?

A

approximate 10%

129
Q

What children are at an increased risk of hypothermia?

A

large surface area
low sub Q fat
Limited Thermoregulation

130
Q

Diving Reflex activates when

A

cold water decreases metabolic demands

131
Q

Diving Reflex

A

blood shunts away from the periphery to vital organs
= cardiac arrest

132
Q

Hypothermia and aspiration occur from

A

submerged for lengthy period of time

133
Q

Priority Tx for submersion injury

A

Restore O2 delivery/prevent further damage
1st Airway
- spontaneous respiratory effort then O2
- no spontaneous effort then intubate with mechanical ventilation

134
Q

Treatment for Submersion Injury

A

Airway
ABGs
Rewarm (hypothermic)
Monitor for seizures
Blood glucose
IVF for electrolyte imbalances
Admit to PICU

135
Q

Submersion Injury Complications

A

respiratory compromise
cerebral edema
Aspiration pneumonia
- bronchospasm, gas exchange damage, atelectasis, abscess formation, acute RDS

136
Q

Respiratory compromise and cerebral edema occur when

A

4-8 hours
up to 24 hours after the incident

137
Q

Aspiration pneumonia can occur how many hours after the incident

A

48-72 hours

138
Q

The best prognosis for submersion injury is

A

submersion less than 5 minutes with
- sinus rhythm
- reactive pupils
- neurologic responsiveness at the scene

139
Q

The worst prognosis for submersion injury is

A

submersion greater than 10 minutes
- unresponsive to advanced life support within 25 minutes

140
Q

Children without _____________, ______________, and _______ ________ function 24 hours after submersion injury suffered severe neurologic deficits or death.

A

spontaneous, purposeful mvmt, and normal brainstem function

141
Q

Prevention of submersion injuries

A

Parental teachings
Adequate supervision
Pool covers, fencing, lifeguard
Basic CPR skills, water safety/survival training

142
Q

Intracranial Infections

A

Bacterial Meningitis
Aseptic (Viral) Meningitis
Reye Syndrome

143
Q

Bacterial Meningitis is the

A

inflammation of the membranes covering the brain and spinal cord

144
Q

Bacterial Meningitis is a medical

A

emergency

145
Q

Bacterial Meningitis PATHO

A

bacteria invades from a focus of infection (respiratory illness)
bacteria crosses the Blood Brain Barrier (BBB)
spreads into the CSF and subarachnoid space
Brain swells
Brain surface is covered with purulent exudate
infections spreads to ventricles
pus obstruct narrow passages
Obstruction of CSF flow
Cerebral edema an increased ICP

146
Q

Infants and young children s/s of bacterial meningitis

A

Fever/Hypothermia
Poor feeding
Vomiting
Marked irritability
Restlessness
Seizures
Bulging/tense fontanel
High-pitched cry

147
Q

older children/adolescents s/s of bacterial meningitis

A

Fever/Chills
Headache
Vomiting
Altered mental status
Lethargy
Irritability/agitation
Nuchal rigidity
Poor perfusion

148
Q

older children/adolescents may develop what from bacterial meningitis

A

seizures, photophobia, confusion, hallucinations, aggressive behavior, drowsiness, stupor, coma

149
Q

What type of temperature would Bacterial Meningitis present?

A

high or low (not normal)

150
Q

Bacterial Meningitis patients will have a history of this illness

A

URI

151
Q

Kernig Sign is tested by

A

supine
flex the knee
extend the leg at the knee
resistance or pain in the hamstring?

152
Q

Brudzinski Sign

A

flex head while in the supine position
knee or hip flex involuntary

153
Q

Bacterial Meningitis Dx

A

LP - spinal needle between L3-L4 or L4-L5 vertebral spaces into subarachnoid space

154
Q

Lumbar Puncture measures and collects

A

measures CSF pressure with stop cock and marks the point of ICP
- collect CSF sample

155
Q

What sedation medications might be done for LP?

A

possibly versed or fentanyl

156
Q

What are the contraindications for LP?

A

increased ICF cause herniation from decreased pressure
CT with midline shift
seizures
bad respirations

157
Q

LP Pre-Op

A

Obtain consent(s)
Educate patient & family
EMLA?
Lidocaine

158
Q

What are the anatomical markers for LP

A

top of iliac crest and straight across
L3-L5 spaces
- below the spinal nerve for low risk of paralysis

159
Q

Positioning for an LP

A

Close to edge of exam table
Side-lying (infants & small children)
Bedside table (children & adolescents)
Head flexed
Knees drawn up toward chest
Immobilize child’s spine in flexed position

160
Q

CSF Analysis for a Bacterial infection

A

WBC elevated (increased neutrophils)
Elevated protein
low glucose
Positive gram stain
cloudy color
elevated pressure

161
Q

The lab has sent back the CSF Analysis. Which of these readings indicates a bacterial infection? SATA.
Elevated WBCs (esp. in neutrophils)
Negative Gram stain
Low Protein
High glucose

A

Elevated WBCs (esp. in neutrophils)

Rationale: The following are the correct results for a Bacterial infection.
WBC elevated (increased neutrophils)
Elevated protein
low glucose
Positive gram stain
cloudy color
elevated pressure

162
Q

What are the ACUTE complications of Bacterial Meningitis?

A

SIADH
Cerebral edema/herniation
Subdural effusion
Seizures
Septic Shock
Disseminated Intravascular Coagulation
Hydrocephalus

163
Q

What are the LONG-TERM complications of Bacterial Meningitis?

A

Deafness – most common
Hydrocephalus
Cerebral Palsy
Cognitive impairments
Learning disorders
ADHD
Seizures

164
Q

Half of the Bacterial Meningitis patients will have

A

long term complications

165
Q

Meningococcal Meningitis

A

peripheral rash
isolation grab

166
Q

Bacterial Meningitis Tx

A

Isolation
Broad Antibiotics
Hydration (little less than maintenance)
Airway and shock
Reduce ICP (midline and elevated HOB)
Seizure control
Thermal Regulation

167
Q

What isolation precaution is taken with a Bacterial Meningitis patient?

A

Droplet

168
Q

Tx of Bacterial Meningitis is needed quickly to avoid

A

long-term complications

169
Q

Nuchal Rigidity

A

arch their back with head back

170
Q

What nursing interventions would you perform in a Bacterial Meningitis patient?

A

Minimal stimulation
Comfort position
Pain mgmt
Safety Precautions
Family support due to sudden and severe outcomes

171
Q

Prognosis of Bacterial Meningitis depends on

A

time from onset to antibiotic therapy
type of organism
prolonged/complicated seizures
Low CSF glucose

172
Q

What is the highest mortality rate for meningitis and age?

A

Pneumococcal meningitis
infants less than 6 months

173
Q

What vaccination is used for the prevention of bacterial meningitis?

A

Haemophilus influenzae type b (Hib)
pneumococcal
meningococcal

174
Q

For Bacterial Meningitis, what are the patient outcome goals?

A

Early recognition
Antibiotics
Prevent cerebral edema
Isolation to prevent spreading
Manage symptoms
Prevent neurologic complications

175
Q

CSF Analysis of Viral (Aseptic) Meningitis

A

slight elevation of WBC (esp. lymphocytes)
normal (slight elevate) of protein
normal glucose
Negative gram stain
clear color
normal opening pressure

176
Q

Nonbacterial Meningitis aka

A

Aseptic, Viral

177
Q

What type of virus is aseptic meningitis?

A

entero viruses
- common in young

178
Q

S/S of Viral Meningitis

A

HA
Fever
Photophobia
Nuchal Rigidity

179
Q

What is used to dx and differentiate Meningitis

A

S/S
CSF Analysis

180
Q

Tx for Viral Meningitis

A

Primarily tx symptoms with
Acetaminophen
Hydration
Positioning for comfort
-Possible antibiotics/isolation until definitive dx

181
Q

Reye Syndrome is

A

acute illness causing encephalopathy and liver dysfunction
- cerebral edema
- fatty liver

182
Q

Reye Syndrome is characterized by

A

Fever
impaired consciousness
liver dysfunction

183
Q

Encephalopathy

A

cerebral edema

184
Q

What is used to dx reye syndrome?

A

liver Bx

185
Q

Reye Syndrome is caused by

A

viral (flu or varicella) aftermath
- salicylate = Pepto Bismol and aspirin in meds

186
Q

What are the nursing interventions for Reye Syndrome?

A

Manage ICP
Strict I&Os (no overload)
Labs (HIgh ammonia and coagulation)
Support/Teachings
- liver function works after

187
Q

Acute seizures aka

A

Nonrecurrent

188
Q

Chronic seizures

A

Recurrent

189
Q

What history do you need to know for seizures?

A

Anoxic (prenatal, perinatal, or postnatal)
Family Hx

190
Q

Triggers of seizures

A
191
Q

Postictal feelings and behaviors after seizures

A
192
Q

Dx of Seizures

A

LP r/o infection
CT/MRI r/o cerebral hemorrhages/structures in the brain
EEG - measures the electrical activity of cortex
Split-Screen EEG (24 hours)
- video with EEG

193
Q

EEG

A

Electroencephalography

194
Q

Neonatal Seizures are a clinical manifestation of

A

serious underlying disease

195
Q

Neonatal Seizures are usually due to what underlying disease?

A

Hypoxic Ischemia Encephalopathy

196
Q

What are the s/s of neonatal seizures?

A

subtle
tongue sucking or eyes to the side
- frequent blinking
- smacking of tingue
- excessive sucking
- chewing mvmt
- Rare spasms/jerky tonic-clonic

197
Q

Tx of neonatal seizures

A

underlying cause
Respiratory support (apneic or hypoxic)
Medication-

198
Q

Infantile Spasms - Seizures

A

Sudden, brief, symmetric muscular contractions that occur in clusters – exaggerated startle
- possible altered consciousness

199
Q

Infantile spasms over time increase in

A

severity

200
Q

How does infantile spasms affect Growth and development?

A

regression of milestones

201
Q

Infantile Spasms are most common in

A

4-8 months of life
NOT after 2 y/o

202
Q

Febrile Seizures associated with

A

febrile illness without CNS infection

203
Q

Do infants with febrile seizures have a history of them?

A

No

204
Q

Febrile Seizures usually have a temperature of

A

38 C
100.4 F

205
Q

Febrile Seizures occur between these ages

A

6-60 months

206
Q

Febrile Seizures usually resolve

A

by themselves

207
Q

Parental Education for Febrile Seizures

A
208
Q

Febrile Seizures Tx

A

Ativan for mvmt
Alternate with Acetaminophen and Tylenol for fever

209
Q

Seizure Safety

A

If standing or sitting _ ease to the floor
Side-lying
Protect from injury (DO NOT RESTRAIN)
NPO
Do no try to forcibly stop seizures

210
Q

Seizure Precautions in the hospital

A

Side rails
Pads
Always someone in the room (family)
O2 Setup (flow meter, extension tubing, and mask)
Suction (suction unit, extension tubing, cath)

211
Q

Seizure Precautions in the home

A

Waterproof mattress or pad (incontience)
No hard objects and pad next to bed
Showers (bath if observed)
- submersion therapy
Swim with a friend
Protective Gear
Med ID

212
Q

Hydrocephalus

A

Imbalance in production & absorption of CSF in the ventricular system

213
Q

Hydrocephalus CAUSE

A

Congenital
associated with myelomeningocele

214
Q

Complications of illness Hydrocephalus

A

meningitis
brain tumor

215
Q

Complications of injury Hydrocephalus

A

intraventricular hemorrhage
brain injury

216
Q

Communicating/nonobstructive hydrocephalus

A

impaired absorption of CSF within subarachnoid space
- ventricles communicate

217
Q

Non-Communicating/obstructive hydrocephalus

A

obstruction to the flow of CSF within the ventricles
- no talking
development of malformation

218
Q

Hydrocephalus Dx Infants

A

head circumference increases one percentile line within 2-4 weeks at least
- progressive associated neurologic signs

219
Q

How do you dx hydrocephalus on older infants and children?

A

CT/MRI

220
Q

Hydrocephalus S/S WITH OPEN FONTANELS AND SUTURE LINES

A

Rapidly increasing head circumference
Tense, full, bulging fontanel
Bulging scalp veins
Shrill, high-pitched cry
Setting sun sign
Irritability or lethargy
Poor feeding
Vomiting
Change in level of consciousness

221
Q

Hydrocephalus S/S WITH CLOSED FONTANELS AND SUTURE LINES

A

Headache upon awakening
Irritability or lethargy
Poor appetite
Strabismus
Personality change, apathy
Alterations in motor skills
Confusion
Vomiting

222
Q

Tx of Hydrocephalus

A

remove obstruction
Ventriculoperitoneal (VP) shunt
Placement of reservoir

223
Q

Ventriculoperitoneal (VP) shunt consists of

A

ventricular catheter
flush pump
unidirectional flow valve (only 1 direction no backflow)
distal catheter – allows coiling as the child grows uncoils

224
Q

Placement of reservoir in a VP shunt

A

requires taping of the reservoir
not permanent

225
Q

Where is the reservoir of VP shunt in a premature infant?

A

bottom with no tubing
butterfly needle to pull off
Evaluation of long-term shunt placement

226
Q

Post-Op VP Shunt

A

Position on non-operative side
keep flat initially
Raise HOB when told by HCP
Assess for signs of increasing ICP
neuro checks
Monitor for infection
surgical sites & shunt tract
Pain management
FOC /head circumference
Abdominal assessment
Hypoactive or distension
Family support

227
Q

VP Shunt Malfunction Complication

A

Symptoms of increased ICP** - not draining
Kinking, plugging, separation, or migration of tubing
mechanical obstruction
particulate matter (tissue/exudate)
thrombosis
displacement because of growth
Requires shunt revision

228
Q

VP Shunt Infection Complication

A

Most serious complication
Generally the result of an infection before placement
Treatment - massive doses of IV antibiotics

229
Q

VP Shunt persistent infection

A

Shunt removal
Placement of External Ventricular Drain (EVD)
Continue IV antibiotics
Daily CSF cultures until infection clears
Replace VP shunt

230
Q

Shunt Alternatives for Hydrocephalus

A

External Ventricular Drain (EVD)
Endoscopic 3rd Ventriculostomy

231
Q

Out of the VP Shunt Complications, which is the most serious?
Malformation
Infection
Corrosion
Swelling

A

Infection
Rationale: Malformation and Infection are VP shunt complications; however infection is the most serious. Corrosion and swelling are not complications.

232
Q

Hydrocephalus Discharge Teachings
Notify HCP immediately with

A
  • signs of shunt malfunction
  • signs of infection
  • seizures
233
Q

In car seat safety, the children should be placed where, regardless of age?

A

In the middle of the back seat facing the rear
esp. infants with large head and poor head control

234
Q

What referrals should be placed on a patient with and/or recovering from hydrocephalus?

A

helmet
- no contact sports

235
Q

What are the 2 congenital neuromuscular disorders included on the test?

A

Cerebral Palsy
Neural Tube Defects

236
Q

Cerebral Palsy is

A

non progressive impairment of motor function

237
Q

Cerebral Palsy affects what 3 motor function
categories?

A

muscle control (abnormal vision, speech, hearing)
coordination (seizure and cog impairment)
posture

238
Q

Leading cause of Cerebral Palsy

A

asphyxia at birth and prenatal abnormalities (maternal infection or substance abuse)

239
Q

Prenatal Causes of Cerebral Palsy

A

maternal infection or substance abuse

240
Q

Perinatal Causes of Cerebral Palsy

A

nuchal cord
ischemic stroke (hypoxia)

241
Q

Postnatal Causes of Cerebral Palsy

A

meningitis/encephalitis
motor vehicle crash
child abuse

242
Q

Highest risk for Cerebral Palsy occurs in what age

A

preterm with LBW

243
Q

An injury during this time can result in CP

A

Prenatal to 2 years

244
Q

What are the different types of CP?

A

Spastic (70-80%)
Dyskinetic
Ataxia

245
Q

Spastic Cerebral Palsy

A

HYPERTONICITY
muscle stiffness and permanent contractions

246
Q

Dyskinetic Cerebral Palsy

A

abnormal mvmt
uncontrolled, slow writhing

247
Q

Ataxic Cerebral Palsy

A

poor coordination, balance, posture

248
Q

Cerebral Palsy S/S

A

delayed gross motor
- Preschoolers, universal, symmetry/asymmetrical
-more noticeable as they grow
abnormal motor
- very early unilateral hand preference (6 months)
- stand/walk on toes
- uncoordinated/invol. mvmt
- poor suck and feeding
- persistent tongue thrust
altered muscle tone
- stiff/flaccid
- Opisthotonos posturing (arch)
- stiff when dressing
- hard diapering
- unbending hip/knee joints when sitting
Persistent primitive reflexes
scissoring and extension of legs when flexed in supine
- arms abducted at sides
- flexed elbows and fists
fail to meet milestones

249
Q

Hypertonicity

A

stiff

250
Q

Hypotonicity

A

flaccid

251
Q

Opisthotonos posturing

A

arching of the back

252
Q

What is a early sign of spasticity CP?

A

rigid and unbending hip/knee joints when pulled to sitting

253
Q

CP patients have a head lag and clenched fists after

A

3 mns of age

254
Q

CP Associated Disabilities

A

Seizures
Cog deficits
Behavior problems
Speech and sensory impairment (vision and hearing)

255
Q

Cerebral Palsy associated issues from s/s

A

feeding/Gastroesophageal reflux
orthopedic contractures
constipation
poor bladder and retention of urine
cavities, gingivitis
skin breakdown
chronic URI

256
Q

PO Medications for CP
HELP DECREASE SPASMS

A

dantrolene sodium
Baclofen (reduce spasticity)
Diazepam (spasms)
Gabapentin (neurologic neuropathy

257
Q

Injection Medications for CP

A

Botulism toxin A (reduce spasms)
- target upper and lower extremities

258
Q

What can be implanted into the CP patient and initially give a test dose?

A

Baclofen pump
- LP test for adverse effects
then Hockey puck with cath into intervertebral space

259
Q

dantrolene sodium

A

hepatotoxic

260
Q

Baclofen

A

-constipation and HTN

261
Q

Diazepam

A

reduces spasms

262
Q

Gabapentin

A

neuropathic neuropathy

263
Q

What other drug classes could be used for Cerebral Palsy?

A

antiepileptic drugs - Dilantin
drugs for dystonia
drugs for hyperkinetic mvmt disorders

264
Q

Treatment and Mobilization for Cerebral Palsy

A

Ankle-foot braces/orthotics
Wheelchairs
Surgery
Physical therapy

265
Q

Cerebral Palsy Nursing Interventions

A

Airway
Monitor for seizures
- Administer antiepileptic drugs (Dilantin)
Dental care (feeding tube)
Bowel and bladder care
Support Family

266
Q

With Dilantin, what is an adverse effect to watch for?

A

gum enlargement

267
Q

What is a great therapy for CP?

A

Hippotherapy (horses)
- increases core and cognitive

268
Q

Spina Bifida (Occulta and Cystica)

A

failure of neural tube to close during early development of embryo

269
Q

What multiple factors contribute to Spina Bifida?

A

genetic
environment (maternal drug use, radiation exposure, hot tub/sauna in pregnancy, antiepileptic drugs)
Syndromes

270
Q

Spina Bifida is associated with what deficiency

A

folic acid

271
Q

What is the recommended daily dose for the prevention of spinal bifida?

A

0.4 mg

272
Q

Spina Bifida Occulta

A

not visible externally - closed skin
- spinal vertebrae does not completely encase cord

273
Q

Spina Bifida Cystica

A

visible externally
- meningocele
- myelomeningocele/meningomyelocele

274
Q

The skin is closed in which type of spina bifida?

A

Occulta

275
Q

Spina Bifida Occulta develops in what spinal areas?

A

Lumber
Sacral

276
Q

Spina Bifida Occulta looks like

A

dimple
tuft of hair
Port wine nevi (red rash)
depression of skin

277
Q

Meningocele

A

herniation of delicate sacs containing spinal fluid
protrudes outside the fluid
NOT associated with neurological deficits

278
Q

Myelomeningocele

A

herniation of delicate sac containing spinal fluid and spinal cord
- outside of the skin
**Neruo deficits occur in varying degrees
- 80% develop Type 2 Chiari malformation

279
Q

Type 2 Chiari malformation

A

Cerebellum and medulla oblongata

280
Q

Myelomeningocele Dx when

A

Ultrasound
Alpha-fetoprotein at 16-18 weeks gestation
Post: CT/MRI/Ultrasound S/S

281
Q

Myelomeningocele associated problems

A

Hydrocephalus
Pneumonia
Paralysis and/or orthopedic deformities
Neurogenic bladder
Bowel incontinence

282
Q

Myelomeningocele Pre-Op

A

Sterile, moist, nonadherent dressing
Soaked in normal saline
change every 2 – 4 hrs
Do not let to dry out
Incubator / warmer – balance with moist
Antibiotics - prophylactic
Early detection of hydrocephalus - FOC and CSF leakage
Prone with tactile stimulation
-No fecal contamination or rectal temps

283
Q

The myelomeningocele is treated when

A

12-24 hours of birth

284
Q

You should assess the myelomeningocele for what

A

Assess sac
leaks
abrasions
irritation
signs of infection

285
Q

Myelomeningocele Pre-Op positioning

A

Prone
hips slightly flexed
abduction with pad between knees
small roll under the ankles

286
Q

No rectal temperatures on a Myelomeningocele baby because

A

cause rectal prolapse

287
Q

Myelomeningocele - Postop

A

Routine postop care
Prone position initially
Monitor FOC for hydrocephalus
Encourage breastfeeding – positioning challenge
No rectal temps
High risk for latex allergies
Urinary/bowel independence
Clean INT cath at home

288
Q

What allergy is a Myelomeningocele baby/CP patient at high risk for

A

latex

289
Q

What does a spina bifida baby need for the remainder of life?

A

Multiple health care observations
- mobility, self-sufficience
Developmental focus
Optimal quality of life

290
Q

Anencephaly

A

absence of both cerebral hemispheres

291
Q

What is the most serious neural tube defect?

A

Anencephaly

292
Q

What is the Tx of Anencephaly for the survivors?

A

no specific tx (a portion of the brainstem) as most are stillborn
- able to maintain vital functions for few hours to several weeks
- temperature
- cardiac function
- respiratory function

293
Q

Guillain-Barré Syndrome is a

A

autoimmune disorder affecting the peripheral nervous system
- results in progressive and usually ascending flaccid paralysis (toes to nose)

294
Q

What is the hallmark symptom of Guillain-Barré Syndrome?

A

acute peripheral motor weakness

295
Q

Paralysis occurs when in Guillain-Barré Syndrome

A

10 days after a nonspecific viral infection

296
Q

Guillain-Barré Syndrome usually occurs in what age group?

A

4-7 y/o

297
Q

Guillain-Barré Syndrome is often associated with

A

rabies
polio
Menincoccl and Influenza vaccines

298
Q

Guillain-Barré Syndrome PATHO

A
  • viral/bacterial infection
  • inflammation and edema of the spinal cord and cranial nerves
  • rapid segmented demyelination and compression of nerve roots
  • impaired nerve conduction
  • ascending partial/complete muscle paralysis
299
Q

3 Phases of Guillain-Barré Syndrome

A

1) Acute (4 weeks)
- symptoms starts
- cont till new symptoms stop appearing
2) Plateau (few days to weeks)
- s/s constant
3) Recovery
- improvement begins
- progression to optimal recovery

300
Q

Guillain-Barré Syndrome Dx

A

ascending paralysis with symmetrical acute peripheral motor weakness
CSF Analysis
TENS
EMG findings

301
Q

Guillain-Barré Syndrome Tx

A

Airway support to temp. tracheostomy
IVIG – first 2 weeks
Plasmapheresis – replaces plasma, causes hypotension
Stool softeners - constipation
Gabapentin - neuropathic pain
Rehab – regain muscle strength and occupational strength

302
Q

Plasmapheresis causes

A

hypotension

303
Q

Does GBS affect with the brain or cognition?

A

no

304
Q

What is the best prognosis of GBS?

A

YOUNG
no mech vent
Tx with IVIG or plasmapheresis

305
Q

The recovery of GBS is

A

reverse order of onset
r/t degree of involvement

306
Q

CP referrals also infer with what other healthcare teams

A

SLP
Dentist
- brushing, fluoride, and flossing are vital at early age

307
Q

FOC means

A

Frontal occipital circumference

Module 5 (Pediatrics) (27 decks)

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