Pediatric Neurological Infections and Conditions

Question 1

Pathophysiology:

BACTERIA enters the BLOOD STREAM via SURGERY, HEAD INJURY, or LOCALIZED INFECTION.
Most commonly caused by a SINUS INFECTION.

INFLAMMATION of the meninges of the brain, causes a TOXIC RESPONSE.

TOXINS released during inflammation increases cerebral capillary permeability causing an alteration in blood flow leading to EDEMA.

Edema inside the cranium increases intracranial pressure [ICP] and causes DAMAGE to the tissues and neurons.

The toxins increase inflammation of the meninges and DESTROYS the leukocytes (WBCs) in the blood stream.

The WBCs main function is to protect and defend the brain against pathogens. This allows the toxins to cross the blood brain barrier.

The BASEMENT MEMBRANE is destroyed by the toxins which increases swelling because this releases ALBUMIN and WATER into the subdural space.

INCREASED FLUID in the SUBDURAL SPACE means INCREASED INTRACRANIAL PRESSURE/ICP.

This is the cause of what Neurological Condition?

Answer 1

Meningitis

Question 2

Assess for abdominal pain.
> Always think that the pain is FIRST being caused by the CSF fluid draining from the VP Shunt into the abdomen being infected and causing pain. This commonly occurs in patients being treated for concurring hydrocephalus.

Promote Independence.
> Educate on Self-Catheterization for Bladder training.
> Encourage Bowel Training for BMs.

Promote Mobility.
> Encourage exercising the NON-Paralyzed Limbs

These are the Nursing Implications for what Neurological Condition?

Answer 2

Lumbosacral Myelomeningocele

Question 3

GROUP BETA STREP which is acquired from the pregnant mom can KILL THE CHILD WITHIN ONE HOUR after being born. E. COLI exposure can increase the risk for acquiring this condition.
This is the cause of what Neurological Condition?

Answer 3

Meningitis in Neonates (Less than 28 days old)

THIS IS IMPORTANT.

Question 4

MORBIDITY is between 5-10% when this condition is acquired. This is high!
These are the statistics for what Neurological Condition?

Answer 4

Meningitis

Question 5

LIVER FUNCTION TEST
> Elevated Ammonia Levels and Liver Enzymes

LIVER BIOPSY to diagnose increased for FATTY deposits in the liver.

What is the NURSING PRIORITY?
_________
B/C Altered LOC DECREASES QUICKLY from LETHARGY to COMA and this is a LIFE THREATENING EMERGENCY.🚑

These diagnostic tests as used to diagnose what Neurological Condition?

Answer 5

Nursing Priority? NEURO CHECKS ✅

Reye’s Syndrome

Question 6

Assess for bulging fontanels because of increased ICP this is diagnosed using a BRAIN SCAN.

Increased ICP can decrease brain development because the increased fluid in the ventricles puts pressure on the developing brain tissue preventing expansion leading to brain cell death caused by injury.

If this occurs EARLY in utero the DAMAGE to the patient’s brain will increase the risk for developmental disabilities that will be IRREVERSIBLE.

This is commonly seen in patients with a Lumbarsacral Meningocele, Meningitis, and Spina Bifida.

This describes what Neurological Condition?

Answer 6

Hydrocephalus

Question 7

HIB VIRUS (b/c of dorms and they are NOT VACCINATED) , NEISSERIA MENINGITIS, STREP PNEUMONIA.
This is the cause of what Neurological Condition?

Answer 7

Meningitis in children 2 mos to 12 years

Question 8

The cause can be viral or fungal. The cause varies depending on the age of the child. If the cause is BACTERIAL they will need to be on ISOLATION for 24 hours.
This is the cause of what Neurological Condition?

Answer 8

Meningitis

Question 9

Post-Op:

Required Positioning:
> PRONE

Assess VITAL signs.

Provide INCISION care.

Monitor for signs of AV shunt malfunction.
-If this condition is not surgically corrected in utero they will develop hydrocephalus and the patient will need to have an AV shunt put into their brain. The AV shunt fluid exits through the abdomen into the stomach.

High Risk for Infection.
> Could get meningitis because of bacteria introduced to the brain during AV Shunt SURGERY and from bacteria located at AV shunt DRAINAGE site traveling up the shunt into the brain.

Assess for Increased intracranial pressure EX. BULGING FONTANELS in BRAIN SCAN

What is the NURSING PRIORITY?
Decrease Intracranial Pressure > ICP

These are the Nursing Implications for what Neurological Condition?

Answer 9

Lumbosacral Myelomeningocele

Question 10

Disorder defined as ACUTE TOXIC ENCEPHALOPATHY.

Caused by a TOXIN, INJURY, INFLAMMATORY RESPONSE, or an ANOXIC INSULT that may result in permanent tissue damage, although the dysfunction may improve over time.

This describes what Neurological Condition?

Answer 10

Reye’s Syndrome

Question 11

This condition is most commonly seen in high schoolers and college students when it is caused by the NEISSERIA bacteria and this requires DROPLET PRECAUTIONS.
This is the cause of what Neurological Condition?

Answer 11

Meningitis

Question 12

The patient will lie flat on their back with one leg straight and one leg bent at the knee. As the bent knee is straightened upward to the sky the neck will flex and the other knee will also bend to protect from painful pulling and irritation.
This diagnostic test is used to diagnose what Neurological Condition?

Answer 12

+ Kernig’s Sign Diagnoses Meningitis

Question 13

Pre-Op:

Positioning: PRONE

Provide Skin Care
> Maintain moisture and protection

Meet Nutritional Needs.

These are the Nursing Implications for what Neurological Condition?

Answer 13

Lumbosacral Myelomeningocele

Question 14

A lumbar puncture is used to diagnose _______ to determine the CAUSATIVE agent.

The LP determines whether it is BACTERIAL, VIRAL, or FUNGAL.

This will guide the nurses in how to properly TREAT the meningitis.

It could be caused by STREP PNEUMONIA, GROUP B STREP, HIB VIRUS, or the NEISSERIA Bacteria.

A SIDE LYING POSITION MUST be used to preform a LP on an INFANT.

This is a diagnostic test for what Neurological Condition?

Answer 14

Meningitis

Question 15

2/3 of patients RECOVER with early diagnosis and aggressive therapy.

Monitor serum for ELEVATED AMMONIA levels.
> This occurs due to severe damage to the liver causing in LIVER FAILURE which is because the liver can no longer convert Ammonia into Urea to be excreted in the urine.

MECHANICAL VENTILATION is needed if the patient becomes COMATOSE.

What is the NURSING PRIORITY?
PREVENT OR DECREASE CEREBRAL EDEMA and DECREASE INTRACRANIAL PRESSURE.

These are the Nursing Implications for what Neurological Condition?

Answer 15

Reye’s Disease

Question 16

DO NOT place them SUPINE.

Prepare the patient for SURGERY.

Provide SKIN CARE.
> Maintain moisture and protection.

Meet NUTRITIONAL needs
> Gentle Feeding

Provide EMOTIONAL support
> Empower Parents

These are the Nursing Implications for what Neurological Condition?

Answer 16

Lumbosacral Myelomeningocele

Question 17

CT Scan
Blood Cultures
Lumbar Puncture
This diagnostic test is used to diagnose what Neurological Condition?

Answer 17

Meningitis

Question 18

The patient will lie flat on their back with the legs straight. If the patient flexes the neck forward the legs and hips will lift up to the sky and bend on their own to protect from painful pulling and irritation.

This diagnostic test is used to diagnose what Neurological Condition?

Answer 18

+ Brudzinski’s Sign Diagnoses Meningitis

Question 19

Signs and Symptoms of Complications:

1. SEVERE HEARING LOSS.
   > 30% of patients with this condition will have this after they recover from this condition.

2.SUBDURAL EFFUSION
> Fluid Volume Excess between the surface of the brain and the outer lining covering the brain. Ex. Dura Mater. If this fluid becomes infected, the condition is called a subdural EMPYEMA.

3. DIABETES INSIPIDUS
   > Fluid Volume Deficit R/T Hyposecretion of, or insensitivity to the effects of, antidiuretic hormone (ADH). ADH is created in the Hypothalamus and transported to the posterior Pituitary to be secreted which is the cause of Polyuria.

These are the complications of what Neurological Condition?

Answer 19

Meningitis

STUDY TIP: SUBDURAL EFFUSION >

REMEMBER: Antidiuretic hormone (ADH) is also known as Arginine Vasopressin (AVP).

Question 20

VP SHUNT enters the VENTRICLES of the brain through the side of the head.

The tubing then re-enters through a scar on the neck which is fed down into the abdominal area.

This is the treatment for what Neurological Condition?

Answer 20

Hydrocephalus

Question 20

Hepatic / Liver dysfunction.
> Elevated Ammonia levels and Liver Enzymes

Personality changes.
> Slurring, Staring, Listlessness, Combativeness, Anger, Confusion, Disoriented, and Increased Irritability.

HYPOGLYCEMIA
> Treatment is giving I.V. Glucose

The s/sx present in stages from 1-5.

These are the signs and symptoms of what Neurological Condition?

Answer 20

Reye’s Syndrome

Question 22

Do NOT LAY the baby on their BACK.
> PRONE ONLY

DO NOT cover the BACK with something DRY Ex. Towel / Blanket

Cover the baby’s BACK and lower body with a BOWEL bag to protect the area.

Cover the area with WET STERILE SALINE GAUZES.
> This is to maintain MOISTURE.

Keep them on their abdomen in a PRONE position to protect them from injury.

These are the Nursing Implications for what Neurological Condition?

Answer 22

Lumbosacral Myelomeningocele

Question 23

Complaints of a HEADACHE.

NUCHAL RIGIDITY.

Altered level of consciousness.

Decreased appetite / anorexia.

Crying.

Agitation.

SENSITIVE to Loud NOISE and SOUND.

Positive KERNIG’s sign.

Positive BRUDZINSKI’s sign.

These are the signs and symptoms of what Neurological Condition?

Answer 23

Meningitis in Children.

Question 24

Wearing HELMETS, headbands, and time corrects this malformation.

The type of treatment implemented depends on the shape of brain.

Ex. Brachycephaly and Scaphocephaly.

This is the treatment for what Neurological Condition?

Answer 24

Plagiocephaly

Question 25

Turn the baby over and look at their back for a CLOSED DIMPLE or tuft of HAIR could be considered OCCULT or CLOSED.

An OPEN sac would be easy to assess visually.

This diagnostic test is used to diagnose what Neurological Condition?

Answer 25

Spina Bifida

Question 26

Signs and Symptoms of a VIRAL infection:

LESS SEVERE symptoms than BACTERIAL

Fever.

Lethargy.

IRRITABILITY.

MALAISE.

MACULOPAPULAR RASH.

These are the signs and symptoms of what Neurological Condition?

Answer 26

Meningitis

Question 27

The infant hyperextends the neck to release pressure from nuchal rigidity. This is an abnormal position. What is this positioning called? This is a sign and symptom of what Neurological Condition?

Answer 27

Opisthotonic Position

- Meningitis

Question 28

The infant hyperextends the neck to release pressure from nuchal rigidity. This is an abnormal position.

These are the signs and symptoms of what Neurological Condition?

Answer 28

Meningitis

Question 29

Lower extremity weakness.

BOWEL and BLADDER control issues
> If it is OPEN the nerves do not innervate the lower extremities.

Ambulation difficulties.

Hydrocephalus.

These are the signs and symptoms of what Neurological Condition?

Answer 29

Spina Bifida

Question 30

Signs and Symptoms of Complications:

1. Developmental Delays
   > 30% have Lifelong Neuro Sequela
2. Learning Delays and Disabilities R/T Increased ICP causing increased pressure on the brain tissue leading to decreased circulation, hypoxia, and brain tissue death.
3. Behavioral Problems
4. Seizures
   > Long Term Therapy is Treatment
5. PHOTOPHOBIA

These are the complications of what Neurological Condition?

Answer 30

Meningitis

Study Tip: Sequela means After Effects

Question 31

Poor SUCKING REFLEX.

Projectile vomiting
> Large Amount. Should not be confused with spit up.

Diarrhea.
> This occurs to decrease fluid volume but can increase risk for Fluid Volume Deficit

Poor muscle tone
> FLACCID

Weak or high-pitched cry.
> Cardinal Sign

BULGING FONTANELLES.
> Fluid Volume Excess

D. I. C.
> Disseminated Intravascular Coagulation
Ex. Increased Risk for Bleeding

What is the NURSING PRIORITY?
Alternating HYPOTHERMIA and HYPERTHERMIA.
Ex. This is called a Labile temperature.

These are the signs and symptoms of what Neurological Condition?

Answer 31

Meningitis in Infants.

Question 32

Fever.

Profuse vomiting.

CEREBRAL EDEMA
> Diagnosed by Radiology Tests
Ex. CT Scan, X-Ray, or MRI

The s/sx present in stages from 1-5.

These are the signs and symptoms of what Neurological Condition?

Answer 32

Reye’s Syndrome

Study Tip: This patient will be treated in the PICU.

Question 32

What does SEQUELA mean?

Answer 32

Neurological after effects.

Question 33

Usually NOT a life threatening disorder, surgery can make permanent corrections if possible.

Surgery will PULL THE JAW FORWARD to decrease RISK of CHOKING and SHORTNESS of BREATH.

This is the treatment for what Neurological Condition?

Answer 33

Pierre Robin Syndrome

Question 35

Etiology: Unknown.

Often follows the use of TYLENOL, ASPIRIN, AKLA-SELTZER, and/or PEPTO-BISMUTH for the treatment of a fever, pain, or upset stomach due to mitochondrial damage.

Also often follows a VIRAL infection:
> Varicella Virus
> Influenza Virus
> Upper Respiratory Infection

This is the cause of what Neurological Condition?

Answer 35

Reye’s Syndrome

Question 36

Skull progressively FLATTENED.
Not associated with brain malformation.
This describes what Neurological Condition?

Answer 36

Plagiocephaly

Question 37

If this is caused by a BACTERIAL agent then the patient will require ANTIBIOTIC therapy.

If this is caused by a VIRAL agent then the nurse will only be able to provide SYMPTOM RELIEF.

The patient MUST be put on DROPLET isolation precautions.

This is the treatment for what Neurological Condition?

Answer 37

Meningitits

Question 38

Jaw is SMALLER than normal.

The tongue is pulled back and falls into the throat increasing risk for SHORTNESS OF BREATH and CHOKING.

This patient with have a HIGH ARCH cleft palate.

This describes what Neurological Condition?

Answer 38

Pierre Robin Syndrome

Question 38

Elevated Seizure activity.

DECEREBRATE RIGIDITY.

FATTY CHANGES IN THE LIVER
> AMMONIA levels and LIVER Enzymes are ELEVATED which are cardinal signs of this condition.

The s/sx present in stages from 1-5.

These are the signs and symptoms of what Neurological Condition?

Answer 38

Reye’s Syndrome

Question 39

Congenital Spinal Malformation.

Experimental birth surgeries are being done to fix the defect.

Spine can be repaired while still in the woman and the uterus can be stitched closed afterwards.

This describes what Neurological Condition?

Answer 39

Spina Bifida

Question 40

Signs and Symptoms of a BACTERIAL infection:

Fever.

Lethargy.

VOMITING.

HEADACHE.

NUCHAL RIGIDITY.

These are the signs and symptoms of what Neurological Condition?

Answer 40

Meningitis

Question 41

EEG changes.
> Ex. Abnormal electrical brain activity

Respiratory arrest.

What is the NURSING PRIORITY?
RAPID changes in level of consciousness.
> Ex. Lethargy quickly becomes a coma

The s/sx usually present in stages starting from 1 and ending with 5.

These are the signs and symptoms of what Neurological Condition?

Answer 41

Reye’s Syndrome

Question 42

Signs and Symptoms of Complications:

1. SIADH
   > Fluid Volume Excess R/T Inappropriate Excretion of Aldosterone from the Adrenal Glands caused by increased pressure in the brain leading to Retention of Salt and Water.

What is the NURSING PRIORITY?
2. HYDROCEPHALUS
> Fluid Volume Excess inside the Ventricles of the Brain. R/T Inappropriate Excretion of Aldosterone from the Adrenal Glands caused by increased pressure in the brain leading to Retention of Salt and Water.

These are the complications of what Neurological Condition?

Answer 42

Meningitis

Question 43

Do NOT give children with a viral infection TYLENOL because it will cause this condition.

EDUCATE parents to give ACETAMINOPHEN or IBUPROFEN instead during VIRAL infections.

This is the cause of what Neurological Condition?

Answer 43

Reye’s Syndrome

Question 44

What is anacephaly defined as?

Answer 44

No brain.