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Pedi Neuro Flashcards

1
Q

Aside from what you already know, what else can cause increased ICP?

A
  • Hydrocephalus
  • Infx (ie: viral or bacterial meningitis)
  • Brain tumor
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2
Q

What might increased head circumference indicate?

A

Early sign of increased ICP

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3
Q

Aside from abx, what other drug class are you going to give for bacterial meningitis?

A

Corticosteroids
(Ie: Dexamethasone)

  • To decrease the severe inflammation in the brain and spinal cord associated with the infx.
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4
Q

Vaccines that may prevent meningitis?

A

PCV, HiB, Meningococcal

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5
Q

A child that has suffered a submersion injury and has survived for at least 24 hours refers to _______-__________.

A

Near-drowning, AKA non-fatal drowning.

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6
Q

Tonic refers to:

A

Stiffening of the muscles (Think muscle tone)

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7
Q

Clonic means:

A

Repetitive jerking movements. Muscles will spasm, jerk, and then relax.

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8
Q

Atonic, or “drop attacks”, refers to:

A

Sudden loss of muscle tone.

-May include a sudden drop of the head with return to consciousness typically < 1 min

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9
Q

Consciousness is usually preserved in tonic or clonic seizures?

A

Tonic

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10
Q

Myoclonic seizures are a type of absence seizure, characterized by jerking or twitching of the?

A

Shoulders, arms, eyelids, eyebrows, mouth.
(So upper body)

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11
Q

What is the primary difference between simple partial and complex partial seizures?

A

Whether or not consciousness/awareness is retained.

Simple: Retains consciousness
Complex: Impaired consciousness/awareness

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12
Q

Simple partial seizures, AKA Focal seizures, include clonic or tonic movements that are isolated to one area of the body, such as the face, neck, and extremities. Why?

A

The seizure occurs in one part of the brain. So the symptoms seen will depend on what part of the brain is affected. Child remains conscious and may be able to verbalize during the seizure.

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13
Q

Complex partial seizures involve impaired awareness. In infants and children, it typically involves some type of complex, purposeful movement. Like what?

A

Infants: Lip-smacking, chewing, swallowing, excessive salivation. Difficult to distinguish from normal infant activity.

Children/teenagers: Picking or pulling at bed sheets or clothing, rubbing objects, or running or walking in a non-directive and repetitive fashion. Will seem pretty out of it/non-verbal during this activity.

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14
Q

Status epilepticus

A

No return of consciousness between seizures.

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15
Q

Status epilepticus drugs? (Hint: The usual, plus 1 new one. And no one seems to use Versed lol)

A

Lorazepam, Diazepam, and Fosphenytoin.

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16
Q

For long-term control of seizures, you should monitor what type of labs, both for therapeutic effects and for possible vitamin deficiencies? Vitamin supplementation can also alleviate side effects.

A

Serum levels of the drug, plus serum levels of Vitamin D, B complex vitamins, folate, calcium, and mag.

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17
Q

Long term use of Phenobarbital in children can cause what?

A

Gingival hyperplasia

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18
Q

In young children, the spinal cord is mobile and the head is larger in relation to the body. This increases their risk for what type of injury?

A

Cervical spine injury

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19
Q

Eye opening and best motor response are easy to still assess in an infant for GCS. But for best response to auditory or verbal stimulus, what changes?

(For memory purposes- Infants and younger toddlers can’t speak or communicate. So you will need other ways to judge their baseline and normal responses)

A
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20
Q

A child that is looking downward continuously, the lower lid covering the iris and upper lid retracting, is experiencing what? What is this associated with? Early or late sign?

A

-Sunset eyes. (Iris looks like the setting sun)
-Associated with increased ICP
-Early

21
Q

Head circumference should be monitored in the infant that is being monitored for? Why are you monitoring this specifically over any of the other signs?

A
  • Increased ICP
  • Increasing head circumference is an early sign of increasing ICP
22
Q

What is hydrocephalus? Why does it cause increased ICP?

A

-Imbalance in the production and absorption of CSF.
-Accumulation of CSF in the ventricles, causing them to expand and increase ICP

23
Q

List some changes in the child that might have acute onset of hydrocephalus

A
  • Mental status change
    -Personality changes (older children)
    -Headache
    -Irritability
    -Vomiting
    -Poor feeding
    -Visual disturbances
    -Bulging, tense, full fontanels
24
Q

What scans will diagnose hydrocephalus?

25
If VP shunt is removed because of infx and an external ventricular drainage device is placed, how should you manage it?
- Label all lines as EVD - Clamp the drain if the child needs to be moved - Dress the entry site into the skull with a sterile occlusive dressing. Change when soiled -Chid will be on prophylactic abx
26
Management of the Ventriculoperitoneal shunt?
- Monitor signs of inflammation along the tract (small incision behind ear where it enters the brain, and the end point on the abdomen. This one won’t be visible after healed). All portions of tract are underneath the skin. - Infx of shunt will be treated w/ IV abx -Keep peritoneal sx incision free of urine or feces -Intrathecal abx may be admin by physician or NP
27
Signs of infected VP shunt?
- V/S obvi - Poor feeding and vomiting -Seizures -Decreased mental status -Local inflammation along the shunt tract
28
When is it common for children to acquire infections of their VP shunt?
1-2 months after placement
29
Cushing’s triad consists of what 3 signs of ICP? Are these early or late signs?
-Bradycardia -Hypertension (Trying desperately to perfuse the brain) -Irregular respirations
30
-Bradycardia -Hypertension (Trying desperately to perfuse the brain) -Irregular respirations
31
Early signs of increased ICP?
-Headache, projectile vomiting, AMS -Seizures -Sunset Eyes -Pupil reaction changes -Increasing head circumference -Bulging/tense fontanelles -HR and respirations BEGINNING to decrease
32
Late signs of increased ICP?
- Cushing’s triad - Shitty LOC - Depressed motor/sensory response -Decer/Decor posturing -Fixed and dilated pupils
33
How would you position a newborn for a lumbar puncture? Child or older infant?
-Upright with head flexed forward - On the side with head flexed forward and knees to abdomen
34
Nursing management for lumbar puncture?
- EMLA cream (anesthetic cream-lidocaine +) to the site 30-60 min prior to puncture -Strict asepsis -Help them maintain the position needed for the procedure - Keep them supine if ordered x1 hr. -Pressure dressing afterward - Encourage fluids
35
What are the neural tubes? What disorders do neural tube defects (NTD) include?
- The tubes that will close at 3-4 weeks gestation to form the brain and spinal cord. - Hydrocephalus - Anencephaly -Microcephaly -Meningocele -Myelomeningocele -Encephalocele -Spina bifida
36
What kind of deficiency is linked to NTDs?
Folate, prior to and during pregnancy
37
What is anencephaly?
- Upper end of the neural tube fails to close. - Forebrain (the hemispheres, thalamus, and hypothalamus) and cerebrum (cerebral cortex) do not form. - Incompatible with life.
38
Nursing management for anencephaly?
- May be born stillborn. If not, keep the infant comfortable -Support for the parents as they grieve and make end of life decisions -They may be overwhelmed with how the infant looks. An infant cap can help them feel comfortable holding and bonding with the infant.
39
What is Encephalocele?
-Protrusion of the brain and meninges through a skull defect. - Will appear as a visible sac protruding from the skull
40
Nursing management of Encephalocele?
-Prevent rupture of the sac -Prevent infection -Adequate nutrition and hydration - Large risk for hydrocephalus —> So monitor for increased ICP. **head circumference**
41
What is microencephaly?
-Head circumference is 3 standard deviations below the mean for age and sex of the infant - As child ages, head growth will fail while the face will continue to grow at a normal rate. —> Small head, large face, loose and wrinkled scalp - Cognitive and intellectual disabilities associated with lack of brain growth and development - Just support parents in how to deal with a child with these impairments.
42
Causes of bacterial meningitis? Other than the 3 pathogens you already know.
Secondary infx to: -URI -Ear infx - Sinus infx -Direct intro through LP, VP shunt, Cochlear implant -Skull fx/severe head injury -Congenital structural abnormalities.
43
Symptoms of meningitis in infants can be subtle- Include?
- Rash (abrupt, petechial or purplish rash) -Poor sucking and feeding/lethargy -Vomiting - Weak cry -May lie in opisthotonic position to relieve discomfort- Head and neck are hyperextended to relieve discomfort
44
How to confirm Reye’s syndrome?
- Elevated LFT’s and elevated serum ammonia levels - HX of recent viral infx- Chickenpox, croup, flu, URI, particularly. Salicylate ingestion w/in 3 weeks of the viral illness. Includes Pepto and Alka-seltzer
45
Symptoms of Reye’s and management.
-Severe/continual vomiting - AMS -Lethargy/irritability -Hyperreflexia - Early recognition -Safety for LOC change and seizure precautions -Prevent dehydration -Preventing increased ICP -Education for prevention- What it is and what common things contain Salicylates.
46
What is Reye’s Syndrome?
- Viral illness + Salicylates = Bad - Rxn causes cerebral edema, liver failure, and death in hours if treatment is not initiated.
47
What is considered mild to moderate closed head injury?
Brain injury without any penetrating injury to the brain. No LOC No other injury to the head or body Normal behavior after the injury Healthy status before the injury So essentially just a whack to the head without visible external injury anywhere. Management = Just teach what to look for with decline after a head injury
48
What is considered a severe head injury?
Ranges from temporary unconsciousness that resolves quickly to remaining in comatose state for prolonged period of time. Management= - Monitor ABC’s -Monitor Neuro status
49
Nursing management for near drowning. Aside from shit you already know.
- Infx monitoring related to aspiration of water -Promote oxygenation - Education and support if neuro damage will be long term and child requires long-term management or rehabilitation -Obvi water safety- Empty water from all containers, even 5 gallon buckets immediately after use

Pediatrics (14 decks)

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