Pediatrics- Neurology Flashcards
What is Meningitis?
An inflammation of the meninges
Can be bacterial, viral, or fungal.
What is Reyes Syndrome
A life-threatening disorder that involves a cute encephalopathy and fatty changes of the liver
How do you determine between meningitis and reyes syndrome
Testing- ( spinal tap)
Which meningitis is contagious
Bacterial
Why has bacterial meningitis decreased in age groups
The interaction of the HIB and pneumococcal conjugate vaccine
Expected finings in  Meningitis
Photophobia (light bothers you) vomiting irritability headache
Meningitis physical assessment Finding a newborn
Poor muscle tone we cry poor sock refuses feeding vomiting diarrhea neck is supple without Michael rigidity 
What is a late finding a newborns with meningitis
Bulging fontanelles
What is a physical assessment finding of meningitis in three months to two years
Seizures high-pitched cry fever irritability bulging fontanelles possible nuchal rigidity poor feeding vomiting brudzinskis sign and Kermit’s sings
Expected findings of meningitis in two years through adolescence
Seizures (often initial finding) nuchal rigidity positive brudzinski and Jernigan sign fever chills headache vomiting irritability delirium stupor coma petechiae( rash) Chronic pain in your involvement of joints
Brudzinski sign
Flexion of extremities occurring with deliberate flexion of the Child’s neck
Kernigs sign
Resistance to extension of the child’s leg from a flexed position
What is an Indicative laboratory test of meningitis
CSF ( cerebral spinal fluid) 
What were the cerebral spinal Fluid look like in bacterial meningitis
Cloudy color elevated WBC count elevated protein count elevated glucose count positive Gram stain
What would the cerebral spinal fluid look like in viral meningitis
Clear colors slightly elevated WBC count negative Gram stain
What is a definite diagnostic test for meningitis
Lumbar puncture (spinal tap) 
What position said the patient be in during a lumbar puncture
Side lane position with the head flexed and knees drawn up toward the chest
What is the client education after a lumbar puncture
Remain in a flat position to prevent leakage and a resulting spinal headache
What requires immediate medical attention in meningitis
Presence of petechiae or a purpuric type rash
What type of precaution should a child with meningitis be on
Droplet precautions are required a private room provider should wear a mask and child should remain in respiratory isolation for a minimum of 24 hours after initiation of antibiotic therapy
What should you be Monitoring in a child with meningitis
Monitor head circumference in fontanelles for presence of changes in bulging
What should the environment look like in a patient with meningitis
Quiet environment minimize exposure to bright light position the patient without a pillow and slightly elevate The head of the bed
Implement seizure precautions
What medication should you use in a patient with meningitis
Corticosteroids: dexamethasone
Not effective for long term 
Complications of meningitis
Monitor for manifestations of increased ICP
High-pitched cry increased head circumference diplopia seizures
What systems of the bodies does Reyes syndrome affect
Liver and brain
Pausing liver dysfunction in cerebral edema
Risk factors for Reye’s syndrome
Using aspirin (salicylate)
Typically follows a viral illness
(Influenza, gastroenteritis, varicella)
What causes Reyes syndrome
 recent illness or use of aspirin
Laboratory test for Reyes syndrome
Liver enzymes (ALT + AST): elevated
Blood ammonia: elevated
Electrolytes altered
 Diagnostic procedures for reyes syndrome
Liver biopsy- Risk for hemmorage
 lumbar puncture to rule out meningitis
Nursing care for Reye’s syndrome
Accurate I and o
Keep head of bed elevated 30
Prevent hemorrhage
Implement seizure precautions 
Medication‘s for Reyes syndrome
Osmotic diuretic: Mannitol 
(To decrease cerebral swelling) 
Complication of reyes syndrome
Speech or hearing impairment
Death 
A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness which of the following action should the nurse take?
A) Place the client on NPO status
B) Prepare the client for a liver biopsy
C) Position the client dorsal recumbent
D) Put the client in a protective environment
A) place the client on NPO status
A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings with the nurse identify as indicating viral meningitis ( Select all that apply)
A) Negative Gram stain
B) Normal glucose content
C) cloudy color
D) decreased WBC count
E) Normal protein content
A) negative Gram stain
B) Normal glucose content
E) normal protein content

A nurse is assessing a four month old infant who has meningitis which of the following manifestations should the nurse expect
A) Depressed anterior fontanel
B) constipation
C) Presence of the rooting reflex
D) High-pitched cry
D. High pitched cry
A client is reviewing the medical record of the client who has reye syndrome which of the following findings should the nurse identify as a risk factor for Reyes syndrome
A. Recent history of infectious cystitis caused by Canadida
B. Recent history of bacterial Otitis media
C. Recent episode of Gastro enteritis
D. Recent episode of haemophilus influenzea meningitis 
C. Recent episode of Gastro enteritis
A nurse is developing an educational program about viral and bacterial meningitis the nurse should include that the introduction of which of the following immunizations decrease the incidence of bacterial meningitis in children (select)
A. Inactivated polio vaccine
B. Pneumococcal conjugate vaccine
C. Diphtheria and tetanus toxoid and acellular pertussis vaccine (DTaP)
D. Haemophilus influenzae type B (HIB) Vaccine
E. Trivalent inactivated influenza vaccine
B. Pneumococcal conjugate vaccine
D. Haemophilus influenzae type B (HIB) Vaccine
What is a seizure
An abnormal involuntary excessive electrical discharges of neurons within the brain
What is a partial (focal) seizure 
Involves one area of the brain
What is a generalized seizure
Involves the entire brain
How is a diagnosis of Epilepsy made? 
If a client has two unprovoked seizures at least 24 hours apart
Or if a single unprovoked seizures occurs during the time period of 10 years following two unprovoked seizures
Risk factors for seizures
No known etiology
Febrile episodes
cerebral edema
intracranial infection
brain tumors
absence of O2( anoxia)
Toxins lead poisoning tetanus
Risk factors for epilepsy
Trauma
hemorrhage
congenital defects
anoxia
infection
hypoglycemic injury
uremia
migraine
What is a tonic clonic seizure
Onset without warning
most prevalent of all seizures
What is the tonic phase of a tonic clonic seizure
Last 10 to 20 seconds
eyes roll upward
loss of consciousness
contraction of entire body
tongue can be bitten
apnea leading to cyanosis
What is the clonic phase of a tonic clonic seizure
Last 30 to 50 seconds
violent jerking movements of the body can have foaming at the mouth experiences rhythmic contraction and relaxation
can be incontinent
What is the postictal State
Last 30 minutes
remain semi conscious confused for several hours
possible vomiting headache or visual or speech difficulties
sleeps for several hours
sore
no Recollection of seizure
What is an absent seizure
Between ages 4 to 12
loss of consciousness lasting 5 to 10 seconds
motionless blank stare
affect schoolwork
daydreaming or inattentiveness
unable to recall episode 
drop items 
What is a myoclonic seizure
Can involve only the face and trunk or one of them more extremities
might not lose consciousness
What is an atonic or akinetic seizure
Drop attacks
between 2 to 5 years
muscle tone is lost for a few seconds causing for confusion follows
should wear a helmet
What is a aversive seizure
Most common partial seizure
eyes and head turn away from side of focus
What is a Rolandic seizure
Tonic clonic movements involving the face salvation arrested sleep 
most common
What is a simple partial seizure with sensory manifestations
Tingling numbness or pain in one area of the body then spreading to other parts with visual sensations
What is a complex partial seizure (psychomotor seizure)
Altered behavior in ability to respond to the environment impaired consciousness regains in less than five minutes confusion and inability to recall event
aura
What is west syndrome (infantile spasms) 
Rare disorder onset between three and seven months
sudden brief symmetric muscle contractions
possible cry or giggle before after treated with ACTH
What is Lennox gastaut syndrome 
Mixture of different seizures and child with cognitive defects
aggressive and hyper active behavior 
Febrile seizures
Associated with a sudden spike in temperature is high is 102 - 104
duration 15 to 20 seconds
 diagnostic procedures for seizures
EEG- electrical activity
Remain quiet during procedure
No caffeine
Wash hair 
Nursing care for seizures
Protect from injury place blanket under head
maintain patent airway
side laying position
loosen restrictive clothing
do not attempt to open jaw
do not put anything in mouth 
remove glasses
note onset time and characteristic
Nursing actions For post seizure
Maintain side lying position
perform neurological checks
assessed for injury
re-orient and calm client
know if experienced an aura and what it was
Medication‘s for seizures
Diazepam - Should not be mixed with any other solution other than 0.9% 
What is a focal resection
Resection of the area of the brain to remove Epileptogenic zone 
What is a hemispherectomy
Removal of one hemisphere of the brain procedure is reserved for catastrophic intractable epilepsy
What is corpus callosotomy
Separation of the connection between the two hemispheres in the brain 
What is status epilepticus 
Prolong seizure activity less than 30 minutes or longer
Requires emergent treatment to prevent loss of brain function
A nurse is caring for a child who has absent seizures which of the following findings with the nurse expect( select)
Loss of consciousness
appearance of daydreaming
dropping held objects
falling to the floor
having piercing cry
Loss of consciousness
appearance of daydreaming
dropping held objects
A nurse is caring for a client who just experienced a generalized seizure which of the following is a priority action for the nurse to take
position the child on a side lying position
try to determine the seizure trigger 
re-orient a child to the environment know the time of postictal period
Position the child on a side lying position
A nurse is providing teaching to the guardians of a child who is having an electroencephalogram EEG. Which of the following statements by a guardian indicates teaching was effective
my child to remain quiet and still during this procedure
I cannot wash my child’s hair prior to the procedure
I should not give my child anything to eat prior to the procedure
this procedure will be very painful for my child
My child to remain quiet and still during this procedure
A nurse is teaching a group of caregivers about the risk factors for seizures which of the following factors should the nurse include in the teaching ( select)
Febrile episodes
hypoglycemia
sodium imbalances
low blood lead levels
presence of diphtheria
Febrile episodes
hypoglycemia 
sodium imbalances
A nurse is reviewing treatment options with the guardian of a child who is worsening seizures which of the following treatment option should the nurse include in the discussion (select)
Vagal nerve stimulator
additional antiepileptic medication
corpus callostomy
Focal resection
radiation therapy
Vagal nerve stimulator
additional antiepileptic medication
corpus callostomy
Focal resection
 what is a concussion
A traumatic injury to the brain that alters the way the brain functions
What is a contusion to the brain
Bruising of the cerebral tissue
How is a skull fractures caused 
Direct trauma to the skull
What is a laceration to the brain
Tearing of the cerebral tissue
What is a linear fracture
Most common and involves single fracture beginning from the point of impact
do not cross suture line
What is depressed fractures
Broken bone fragments are pushed in word
Comminuted fracture’s
Made up of more than one linear fracture in occur following intense impact or repeated trauma
What is a Basliar a fracture
Involve those at the anterior or posterior base of the skull
What is an open fracture
Involves a disruption of the skin survive
Complications include osteomyelitis and meningitis
What is a growing fracture
Fracture worsens due to pressure from brain herniation
 symptoms of Head injury
Amnesia
loss of consciousness
confusion 
pallor
lethargy
altered mental state
neurological deficits
agitation
Severe injury to a head causes
Increased intracranial pressure
forceful vomiting
bulging fontanelle
alteration in pupil response
seizures
What is flexion posturing
Severe dysfunction of the cerebral cortex demonstrates the arms race elbow and fingers flex and bent in word into the chest and legs extended rotated internally
What is extension posturing
Severe dysfunction at the level of the midbrain demonstration of backward origin of the legs and arms flex wrist and fingers extending the clench jaw and possible of an arched back
Nursing care for head trauma
Ensure spine stabilization until spinal cord injury ruled out 
maintain patent airway
monitor consciousness pupils IC P assess for clear fluid or drainage from ears or nose
assessed for bleeding
Medication’s for head trauma
Mannitol: osmotic diuretic to decrease ICP and Cerebral edema
Therapeutic procedures for head trauma
Burr holes craniotomy
What is an epidural hematoma
Bleeding between the Dura and the skull
Short period of unconsciousness followed by normal period for several hours then lethargic or coma 
What is a subdural hemorrhage
Bleeding between the Dura and the arachnoid membrane
increase head circumference anemia seizures in coma
When does cerebral edema occur
Can develop within 24 to 72 hours post trauma
increased ICP
What is brain herniation
And what symptoms
Downward shift of the brain tissue
loss of blinking
lots of gag reflex
pupils fail 
The nurse is in the emergency department is assessing a child following of motor vehicle crash the child is unresponsive in spontaneous respirations of 22 per minute and has a laceration on the forehead that is bleeding which of the following action should the nurse take first
Stabilize the child neck
Clean the child’s laceration with soap and water
implement seizure precautions for the child
initiate IV access for the child
Stabilize the child’s neck
A nurse is caring for an adolescent who has a closed head injury which of the following findings are indications of increased intracranial pressure
Report of headache
alteration in pupillary response
increase motor response
increase sleeping
increased sensory response 
Report of headache
alteration of pupillary response
increase sleeping
A nurse is caring for a child who has an ICP which of the following action should the nurse take (select)
Suction the endotracheal tube every two hours
maintain a quiet environment
use 2 pillows to elevate the hood administer a stool softener
maintain body alignment
Maintain a quiet environment
administer a stool softener
maintain body alignment
A nurse is assessing a child who has a concussion Which of the following findings should the nurse expect (select)
Amnesia
systematic hypertension
bradycardia
respiratory depression
confusion
Amnesia and confusion
A nurse is caring for a child who is taking mannitol for cerebral edema which of the findings should the nurse monitor for an adverse effect of mannitol
Bradycardia
weight loss
confusion
constipation 
Confusion
Where are sensory impairment is most commonly found in children
eyes and ears
What is a risk factor for visual impairments
Prenatal or post natal conditions
prenatal infections 
or chronic illness
What is myopia
Nearsightedness -sees close objects clearly but not objects in the distance
Eye rubbing , difficulty reading, clumsiness
What is hyperopia
Farsightedness sees distant objects clearly but not objects that are close
What is astigmatism
Uneven refractive Curvatures InVision in which only parts of letters on a page can be seen
Appearance of normal vision because tilting the head enables all letters to be seen
What is Anisometropia
Different refractive strength in each eye -excessive eye rubbing poor school performance
What is amblyopia
Lazy eye
Reduced visual acuity in one eye 
What is strabismus
Inward or outward deviation of a misaligned eyes
difficult seeing print clearly one eye can see better than the other
What is Cataracts 
Gray opacity of the lens which prevents light from entering into the eye
Decreased ability to see absence of red reflex inability to reach grab objects in infants
What is glaucoma
Increase in ocular pressure in the eye loss of peripheral vision 
What is partial visual impairment
Classified as 20/70 20/200
What is legal blindness
Classified as 20/200
What is a treatment for strabismus
Patching the stronger Eye 
Treatment for Cataractsand glaucoma
Surgery
What can hearing impairments affect
Speech in the ability to clearly process linguistic sounds
Risk factors for hearing impairments
Chronic ear infection
down syndrome
cerebral palsy
What is conductive losses in hearing
Involve interference of sound transmission which can result from Otis media or excessive earwax
What does sensorineural losses in hearing
Involve interference of transmission along the nerve pathways result from congenital defects
What is central auditory Imperception
Involves all other hearing loss is related to natural causes
Hearing loss Expected findings in infants
Lack of startle reflex failure to respond a noise absent of vocalization by seven months
Hearing loss expected findings and older children
Using gestures yelling to Xpress emotions irritability big shy
 What is a cochlear implant
Used for extensive hearing loss send impulses to the auditory nerve surgically implanted under skin
What can visual and hearing impairments affect in children
Speech and motor development delayed growth
What is down syndrome
 A chromosomal or abnormality
Expected findings in a patient with down syndrome
Enlarged anterior fontanelle’s small round head flattened for head up Wordle word slanted eyes protruding tongue possible congenital heart defect
Prenatal diagnostic procedure for down syndrome
Testing for alpha-fetoprotein and maternal blood
Infant diagnostic procedure for down syndrome
Chromosome analysis and echocardiograph
 Growth in a patient with down syndrome
Both height and weight or reduced weight gain is more rapid then growth in height
Respiratory issues in a patient with down syndrome
Impaired drainage of mucus Associated with underdeveloped nasal bone respiratory infections are common
A nurse is planning to perform a peripheral vision test on a child which of the following action should the nurse take
Place the child 10 feet away from a snellen chart
Show a set of cards to the child one at a time
Cover the childs eye performing the test on the other eye
Have a child focus on an object while performing the test
Have a child focus on an object while performing the test
A nurse is teaching a group of parents about possible manifestations of down syndrome which of the following findings should the nurse include in the teaching ( select) 
A large head with bulging fontanelles
larger ears that are setback
protruding abdomen
Broad short feet and hands
hypotonia
Protruding abdomen
broad short feet and hands
hypotonia- low level muscle tone
A nurse is assessing a child who is myopia which of the following findings should the nurse expect( select)
Headaches
photophobia
difficulty reading
difficulty focusing on close objects
poor school performance
Headaches
difficulty reading
poor school performance
A nurse is assessing a toddler for possible hearing loss which of the following findings are indications of hearing impairment(select)
Use of mono tone speech
speaks loudly
repeat sentences
appear Shy
is overly attentive to the surroundings
Uses monotones
speech speaks loudly
appear Shy 
A nurse is teaching that a parent of an infant who is down syndrome which of the following statements by the parent indicates an understanding of the teaching

I should expect him to have frequent diarrhea
I should place a cool mist humidifier in his room
I should avoid the use of lotion on the skin
I should expect him to grow faster in length than the other infants
I should place a cool mist humidifier in his room
