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Peds > Nursing care of the child with an alteration in intracranial regulation / neurologic disorder > Flashcards

Nursing care of the child with an alteration in intracranial regulation / neurologic disorder Flashcards

Exam 3

1
Q

Neurologic disorders:

What is intracranial regulation?

A

Intracranial regulation is the process that affects equilibrium within the brain, and therefore neurologic function.

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2
Q

Categories of neurologic disorders:

A

Structural

Seizure

Infectious:

Trauma

Blood flow disruption:

Chronic:

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3
Q

Categories of neurologic disorders:

Infectious:

A

Bacterial meningitis,

aseptic meningitis (viral),

encephalitis,

Reye Syndome

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4
Q

Categories of neurologic disorders:
Blood flow disruption:

A

stroke,

Periventricular and Intraventricular hemorrhage

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5
Q

Categories of neurologic disorders:
Chronic:

A

headaches,

breath holding

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6
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development: What is the central nervous system made up of?

A

Central Nervous system (CNS) is made up of brain and spinal cord

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7
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development: When does development occur?

A

Development occurs within 3-4 weeks of gestation from the neural tube

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8
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development:
What can occur?

A

Infection, trauma, teratogens (environmental substance that can cause physical defects in the developing embryo), and malnutrition

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9
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development: What are premature infants at greater risk for? Why?

A

Premature infants are a greater risk for bleeds due to the presence of more capillaries

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10
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development: How is the brain? What can that lead to?

A

Brain is highly vascular: increased risk for hemorrhage

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11
Q

Variations in pediatric anatomy and physiology:

Brain and Spinal Cord development: How is the brain flexible? Why is it flexible?

A

The sutures and the fontanels make the skull more flexible to accommodate for brain growth

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12
Q

Variations in pediatric anatomy and physiology:

Nervous System: How is the development of the nervous system at birth?

A

The development of the nervous system is complete but immature at birth

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13
Q

Variations in pediatric anatomy and physiology:

Nervous System: How are nerve cells at birth?

A

Born with all nerve cells

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14
Q

Variations in pediatric anatomy and physiology:

Nervous System: How is myelinization at birth?

A

Myelinization, formation of myelin, which covers and protects the nerves, is incomplete

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15
Q

Variations in pediatric anatomy and physiology:

Nervous System: As myelinization increases what happens?

A

Speed and accuracy of nerve impulses increases as myelinization increases

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16
Q

Variations in pediatric anatomy and physiology:

Nervous System: Speed and accuracy of nerve impulses leads to what?

A

Process accounts for acquisition of fine and gross motor movements and coordination

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17
Q

Variations in pediatric anatomy and physiology:

Nervous System: How does myelinization occur? (What direction)

A

Myelinization proceeds in the cephalocaudal direction (ex: infants able to control head and neck before the trunk and extremities)

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18
Q

Variations in pediatric anatomy and physiology:

Head size: How is the head size of infants and young children?

A

Head size in an infant and young child is large in proportion to the body.

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19
Q

Variations in pediatric anatomy and physiology:

Head size: The head grows until what age?

A

The head continues to grow until 5 years of age.

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20
Q

When does the brain have the most rapid growth? When is the second rapid growth?

A

Brain has most rapid growth at first year of life and second rapid growth at adolescent.

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21
Q

When can you start potty training a child?

A

When myelinization is complete, that is when we can start potty training.

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22
Q

Nursing process for the child with a neurologic disorder:

Health History: PMH

A

Prematurity, difficult birth, infection during pregnancy

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23
Q

Nursing process for the child with a neurologic disorder:

Health History: Family history

A

genetic disorders, seizure disorders, headaches

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24
Q

Nursing process for the child with a neurologic disorder

Health History: HPI

A

inquire about : nausea, vomiting, changes in gait, visual disturbances, headaches, recent trauma, changes in cognition, change or loss of consciousness, poor feeding, lethargy, increased irritability, fever, pain, altered muscle tonicity, delays in growth and development, ingestion or inhalation of neurotoxic substances or chemicals.

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25
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

A

Level of consciousness: 5 states:
Vital signs
Head, face, neck:
Cranial nerve function:
Motor function:
Reflexes
Sensory function:
Increased ICP

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26
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness

A

alertness and ability to respond to stimuli and show verbal or motor response.

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27
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness: What are the five states

A

Full consciousness
Confusion:
Obtunded:
Stupor:
Coma:

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28
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness: Confusion

A

Confusion: disoriented, responds inappropriately to questions

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29
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness: Obtunded

A

limited responses and falls asleep if not stimulated

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30
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness: Stupor

A

responds to vigorous stimulation only

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31
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION:

Level of consciousness: Coma:

A

not arousable

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32
Q

Nursing process for the child with a neurologic disorder:

INSPECTION AND OBSERVATION: Head, face, neck:

A

size and shape of head, asymmetry, head circumference

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33
Q

Nursing process for the child with a neurologic disorder

Cranial nerve function:

A

doll’s eyes maneuver

nystagmus:

sunset eyes may be ICP as with hydrocephalus;

pupillary response is abnormal

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34
Q

Nursing process for the child with a neurologic disorder

Cranial nerve function: doll’s eyes maneuver

A

doll’s eyes maneuver for III, IV, VI;

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35
Q

Nursing process for the child with a neurologic disorder

Cranial nerve function:nystagmus:

A

vertical – brain stem dysfunction, horizontal – lesions or med (phenytoin);

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36
Q

Nursing process for the child with a neurologic disorder

Cranial nerve function: sunset eyes

A

sunset eyes may be ICP as with hydrocephalus; pupillary response is abnormal

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37
Q

Nursing process for the child with a neurologic disorder

Motor function:

A

observe spontaneous activity, posture, and balance; asymmetric movements; decorticate (flexed), decerebrate (flexed and pronated)

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38
Q

Nursing process for the child with a neurologic disorder

Sensory function:

A

Explain what you are doing! Distinguish between light touch, pain, vibration, heat and cold

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39
Q

Pediatric Glasgow Coma Scale:

Pediatric version

A

Pediatric version –> verbal & motor response related to the child’s age

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40
Q

Pediatric Glasgow Coma Scale:

Pediatric version: Higher the score indicates?

What is highest? What is 8 and below? What is 3?

A

Higher the score –> normal neurological function

15 highest score
8 or below –> definition of coma
3 (lowest score) indicates deep coma or death

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41
Q

Nursing process for the child with a neurologic disorder:

PALPATION AND AUSCULTATION

A

Palpation of newborn or infant skull and fontanels

Auscultation of intracranial bruits

42
Q

What is the number one health risk for children and leading cause of death in children greater than 1 year?

A

Unintentional injury is the number one health risk for children & leading cause of death in children greater than 1 year

43
Q

Head Injury:

Etiology?

A

Unintentional Falls
MVA

44
Q

Common Causes of Head Trauma in Children

A

Falls
Motor vehicle accidents
Sports injuries
Pedestrian and bicycle accidents
Child abuse

45
Q

Types of Closed Head Injuries (CHI) include:

A

Concussion
Contusion & laceration
Fractures
Other hemorrhagic lesions

46
Q

Types of Closed Head Injuries (CHI):

What are complications?

A

Epidural hematoma
Subdural hematoma

47
Q

Types of Closed Head Injuries (CHI): What are Other hemorrhagic lesions?

A

Cerebral edema

Sequelae of traumatic brain injury

48
Q

Types of Closed Head Injuries (CHI):

Sequelae of traumatic brain injury:

A

Post concussion syndrome
Posttraumatic headaches
Posttraumatic seizures
Hydrocephalus

49
Q

Causes of Non-accidental Head Trauma

A

Violent shaking: shaken baby syndrome (SBS)

Blows to the head

Intentional cranial impacts against the wall, furniture, or the floor

49
Q

Increased icp

A

CNS has a dynamic balance of fluid (called CSF) that bathes the brain and spinal cord at a specific pressure called intracranial pressure (ICP).

50
Q

Increased ICP: What is it a sign of?

A

Elevated ICP is a sign of a neurologic disorder.

51
Q

Early signs of ICP include?

A

Headache

Vomiting (projectile)

Visual changes

Dizziness

Decreasing HR and respirations

Changes in pupil reactions

sunset eyes

Changes in LOC

Seizures

Bulging fontanel and increasing head circumference

51
Q

Late signs of ICP include?

A

Decreased LOC

Depressed motor sensory responses

Bradycardia

Irregular respirations

Cheyne- Strokes respirations

Decerebrate/decorticare postures

Fixed and dilated pupils

52
Q

Common Types of Structural Defects include

A

Neural tube defects:

Microcephaly

Arnold–Chiari malformation:

Hydrocephalus:

Intracranial Arteriovenous malformation:

Craniosynostosis

Positional Plagiocephaly:

52
Q

Increased ICP: What are possible causes?

A

head trauma,

birth trauma,

hydrocephalus,

infection,

brain tumors.

52
Q

Hydrocephalus- What is it caused by?

A

Caused by an imbalance in the production and absorption of CSF

53
Q

Hydrocephalus: What kind of signs may be seen?

A

May see signs of ICP including increase in head size and loss of developmental milestones or changes in personality in older children.

54
Q

Hydrocephalus: What may it require?

A

May require surgical intervention to relieve pressure with a ventricular shunt (temporary or permanent).

55
Q

Hydrocephalus: What is the surgical intervention that may be needed?

A

Ventriculoperitoneal (VP) Shunt

56
Q

Hydrocephalus:

What is included in Nursing Management?

A

Careful observation

Pre & postoperative care

Family Support

Long-term care

57
Q

Hydrocephalus:

What is included Careful Observation in Nursing Management?

A

Measurement of head circumference
Fontanels & suture line assessment
Behavioral changes
H/A, N/V, irritability

58
Q

Signs and Symptoms of Shunt Infection include:

A

Elevated vital signs

Poor feeding

Vomiting

Decreased responsiveness

Seizure activity

Signs of local inflammation along the shunt tract

59
Q

Types of seizures

A

Infantile spasms :

Absence:

Tonic:

Tonic-Clonic:

Myoclonic:

Atonic:

Focal seizure without impairment of consciousness:

Focal seizure with impaired consciousness:

Status epilepticus:

60
Q

Types of seizures:

Infantile spasms :

A

Spasm seen in infancy 3-12 months, occurs in series or clusters

61
Q

Types of seizures: (4 things to know)

Absence:

A

Type of generalized seizures,

uncommon before 5 years old,

not associated with post ictal state, numerous seizures per day.

May be staring, twitching

62
Q

Types of seizures:

Clonic:

A

Muscle will spam, jerk, and then relax

63
Q

Types of seizures:

Tonic:

A

Stiffening of the muscles, arms legs, back; consciousness preserved

64
Q

Types of seizures:

Tonic-Clonic:

A

combination of the above; a/w aura

65
Q

Types of seizures:

Myoclonic:

A

Sudden brief muscle jerks that may involve the entire body or one part, may lose consciousness

66
Q

Types of seizures:

Atonic:

A

Drop seizures, sudden loss of muscle tone, may lose consciousness

67
Q

Types of seizures:

Focal seizure without impairment of consciousness:

A

tonic and clonic movements, sensory, autonomic, psychic symptoms

68
Q

Types of seizures:

Focal seizure with impairment of consciousness:

A

Automatisms and complex purposeful movements

69
Q

Types of seizures:

Status epilepticus: What is it? How long does it last? What is a distinguishing quality of it?

A

neurologic emergency; seizure lasting longer than 5 minutes/2 or more within a 5min.

Period without returning to normal in between

70
Q

What is the most common type of seizure seen in children less than 5 years old?

A

Febrile seizures

Most common type of seizure seen in children less than 5 years old.

71
Q

Febrile seizures: What does it occur with?

A

Fever usually related to viral illness.

72
Q

Febrile seizures: What symptoms are associated with it?

A

Associated with rapid rise in core temperature to 102.2F or higher.

73
Q

Febrile seizures: What is the prognosis?

A

Excellent prognosis

74
Q

Febrile seizures: How long does it last? What accompanies it?

A

Generalized seizure lasting less than 15 minutes that occurs once in a 24 hour period and accompanied by a fever without any CNS infection present.

75
Q

Bacterial meningitis

A

Infection of the meninges, the lining that surrounds the brain and spinal cord.

76
Q

Bacterial meningitis: What can it lead to?

A

Serious illness that can lead to brain damage, nerve damage, deafness, stroke and even death.

77
Q

Bacterial meningitis: What does it cause? (Symptom-wise)

A

Causes inflammation, swelling, purulent exudates, tissue damage to the brain. Can occur secondary to sinus or ear infections.

78
Q

Bacterial meningitis: How are symptoms for most children?

A

Most children have sudden onset headache, fever, vomiting & severe headache with irritability

79
Q

Bacterial meningitis:

How are symptoms of infants?

A

Infants may have fever or hypothermia, poor feeding & bulging fontanel

80
Q

Bacterial meningitis:

Physical Assessment: How would babies rest? How are older children? What else?

A

May rest in opisthotonic position, older child may complain of neck pain, bulging fontanel in infant late sign.

81
Q

Bacterial meningitis:

What can indicate irritation of the meninges?

A

Positive Kernig and Brudzinski signs can indicate irritation of the meninges.

82
Q

Bacterial meningitis:

What should you inspect children for?

A

Inspect child for rash; a petechial, vesicular, or macular rash may be seen (abrupt eruption could be meningococcemia).

83
Q

Common Laboratory and Diagnostic Tests

A

Lumbar puncture (LP), CSF analysis

Intracranial pressure (ICP) measurements

Electroencephalogram (EEG)

Head and neck radiograph

Ultrasound

Fluoroscopy:

MRI:

Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography, uses radio isotopes (PET), and single photon emission computed tomography, used to detect brain death (SPECT)

84
Q

Other Procedures and Treatments for Neurologic Disorders:

A

Ventricular shunt placement

Hyperventilation

Physical, Occupational, or Speech Therapies (PT/OT/ST)

External ventricular drainage (EVD)

Ventricular tap

Vagal nerve stimulator

Ketogenic diet

85
Q

Medications Used to Treat Neurologic Disorders

A

Antibiotics
Anticonvulsants
Benzodiazepines
Analgesics
Osmotic diuretics
Corticosteroids

86
Q

Acute Stroke in Children: What are the types?

A

Ischemic or hemorrhagic types.

87
Q

Acute Stroke in Children:

How are the risk factors compared to adults? How are signs and symptoms compared to adults?

A

Risk factors in children are different than in adults.

Will see same signs and symptoms as in adults.

88
Q

Acute Stroke in Children:

What are the signs and symptoms of stroke in children (which are the same in adults)?

A

Weakness on one side or hemiplegia

Facial droop

Slurred speech

Speech deficits

89
Q

Managing Disturbed Sensory Perception:

What should be assessed?

A

Assess for changes in sensory perception.

90
Q

Managing Disturbed Sensory Perception

When should you monitor providers?

A

Notify physician or nurse practitioner of changes in sensory perception.

91
Q

Managing Disturbed Sensory Perception

What should be monitored?

A

Monitor child for risk of injury secondary to changes in sensory perception.

92
Q

Managing Disturbed Sensory Perception:

What should you assist with?

A

Assist child to learn to use adaptive methods to live with permanent changes in sensory perception (i.e., use of eyeglasses) and maximize the use of intact senses.

93
Q

Managing Disturbed Sensory Perception:

What should you provide?

A

Provide familiar sounds (voices, music).

94
Q

Closed Head Injuries:

How are brain injuries graded?

A

Brain injury graded on severity (mild, moderate, severe) based on symptoms.

95
Q

Closed Head Injuries:

How may it occur?

A

May occur with an accident or intentional injury.

96
Q

Closed Head Injuries:

What is it?>

A

Non-penetrating injury to head.

97
Q

Closed Head Injuries:

How is consciousness?

A

Normal behavior before the injury, may or may not lose consciousness.

98
Q

Promoting Child and Family Teaching

A

Assess child’s and family’s willingness to learn.

Provide family with time to adjust to diagnosis.

Repeat information.

Teach in short sessions.

Gear teaching to a level of understanding of the child and family.

Provide reinforcement and rewards.

Use multiple modes of learning involving many senses.

Peds (15 decks)

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