Peds. Flashcards
An infant’s brain is ___ the weight of an adult’s brain.
2/3.
Posterior fontanel closes around ___ months. Anterior fontanel closes around ___ months.
3, 18-24.
Measure head circumference until ___ months; at 12 months head circumference will equal ___.
36, chest.
An infant is better able to accommodate rising ICP because…
the skull is more elastic; fontanels not yet closed.
S/S of rising ICP in an infant:
high pitched cry, bulging fontanel, dilated scalp veins, wide sutures (with palpation), and irritability.
newborns are hypertonistic and draw up in a fetal position.
Factors that predispose infants and children to head injury:
poor judgment, unsteady gait, immature immune system, fragile neurons, nerve cells not completely myelinated, top heavy, weak neck muscles, thinner cranium, small subarachnoid space, uncoordinated.
Cushing’s triad:
hypertension - increased systolic; widened pulse pressure - difference of > 30-40; bradycardia; combined with dilated pupils.
Assess CN II and III:
shine light source in eye; rapid, concentrically constricting pupils should result.
Assess CN II, IV, and VI:
perform with eyes held open (doll’s eyes) and head moved horizontally or vertically.
Assess CN III and VIII:
place head midline and slightly elevated, inject ice water into ear canal; eyes deviate to the toward irrigated ear.
Assess CN V and VII:
touch cornea with sterile cotton swab; should blink.
Assess CN IX and X:
irritate pharynx with cotton swab; should gag.
Doll’s eye:
sign of impending brain death.
Hydocephalus:
increased production, impaired absorption or block of CSF that results in excessive amounts of SCF within the cerebral ventricles; highly associated with spinal bifida.
2 types of hydrocephalus:
communicating: faulty absorption of CSF; flows freely between normal channels and pathways, but the absorption is altered in the subarachnoid space.
non-communicating: obstruction of cerebral blood flow; tumor, infection, blood clot from a brain bleed, more common.
Hydrocephalus is often ___ and commonly associated with ___. It can occur as a result from ___.
congenital, myelomeningocele, the complication of an illness (meningitis or brain tumor or hemorrhage).
S/S of hydrocephalus:
neonate: sunsetting sign - visible sclera above the iris, macewen’s sign - hollowed sign when skull percussed; rapidly increasing head circumference, tense bulging fontanel, protrusion of frontal area, translucent skin covering forehead, prominent scalp veins, head will be disproportionally large as compared to face; will be fussy, restless, poor feeding and cat-like cry.
older child: no head increase, Increased ICP, headache, nausea, vomiting, irritability, decreased judgment, confusion, change in motor ability; will lose interest in activities and will not eat; may also have papilledema (swelling of the optic disc), strabismus, and decreased visual acuity.
Arnold-Chiari malformation
Dandy-Walker Syndrome.
Arnold-Chiari malformation:
congenital herniation of the brainstem and lower cerebellum through the foramen magnum into the cervical vertebral canal
type 1: adult; more common, s/s won’t be noticed until adulthood.
type 2: pediatric; more severe; will be noticed immediately.
s/s: headache, poor hand coordination, dizziness, difficulty swallowing, surred speech.
Dandy-Walker syndrome:
congenital brain malformatoin involving the cerebellum and the fluid filled spaces around it; genetically sporadic disorder, mostly in females; enlargement of 4th ventricle.
Tx of hydrocephalus:
shunts placed as soon as dx; after shunt - lay <30 on unoperative side; VS frequently; infection most likely 1-2 months after surgery (staph); measure head; note every change.
S/S of shunt infection:
low grade fever, malaise, nausea, headache, increase in leukocytes; CSF will have increased WBC, elevated protein, decreased glucose and positive for pathogen.
S/S of shunt malfunction:
signs of increased ICP.
S/S of over drainage:
low BP, postural HS while sitting decreased HR, seizure, NV, lethargy, and irritability.
Meningitis S/S:
poor feeding, irritability, fever, seizures, photosensitivity, SIADH or DI, bulging fontanel, lethargy, refusal o feed, vomiting.
triad: fever, stiff neck (nuchal rigidity), and change in LOC.
with bacterial will have rash.
Bacterial meningitis:
pneumococcal (strep), meningococcal (neisseria), staph, haemophilus influenzae, listeria monocytogenes.
Viral meningitis:
enteroviruses (polioviruses, coxsackieviruses, echoviruses), adenoviruses, paramyxoviruses, herpes virus, epstein-barr, cytomegalovirus.
85% viral.
Encephalitis:
inflammation of the brain, LOC impaired, tick bite - lyme disease; viral - common w herpes; lethargic.
Spinal bifida occulta:
failure of the posterior vertebral arches to fuse; 5th lumbar or 1st sacral vertebrae; no herniation; not visible externally.
will see dimple or small depression; may not be detected until toddler.
Encephalocele:
brain and meninges herniate through defect in skull and into a sac; sx repair in stages.
Meningocele:
sac contains meninges and CSF, but not spinal cord.
Meningomyelocele:
sac contains meninges, CSF, and portion of spinal cord or nerve roots; the higher the lesion, the higher the neuro deficit.
Cerebral palsy:
abnormal muscle tone and movement, lack of coordination with spasticity; chronic, non-progressive; caused by damage to the motor areas of the brain; congenital malformation or injury to the brain.
most dx by age 3.
S/S of spastic CP:
70% of cases, walk on toes, scissor gate.
Cause of CP:
premature birth or very low birth weight; will see if shaken baby or head trauma.
Management of CP:
muscle contractures, skin breakdown, nutritional concerns, feeding, use of botulinum toxin to mange spascity; baclofen pump, mainstreaming.
Neurofibromatosis:
von Recklinghausen - tumors grow along nerves; autosomal recessive; mild to debilitating.
skin, eye, bones, cv, cns, endocrine.
Reye syndrome:
sudden brain damange (encephalopathy) and liver function problems of unknown cause.
has occurred with use of aspirin.
S/S of Reye:
vomiting, irritable and aggressive behavior, confusion, lethargy, loss of consciousness or coma, mental changes, NV, seizures, decerebrate posture.
Abusive head trauma:
most common cause of death from child physical abuse.
Common fractures with child abuse:
skull, rib, classic metaphyseal lesion.
