Peds - Exam 3 - Neuro Flashcards

Question

Bacterial Meningitis by age group

Answer 1

Occurs in epidemic form, predominantly in school-age children and college students because of close contact or living conditions ≥1 month and 3 months and <19 years

Answer 2

Brudzinski's sign + - Passively elevate the head, knees would also flex toward abdomen Kernigs sign + Passively elevate the leg and try to extend it at the knee, there would be resistance Most definitive test - LP done to rule out meningitis Onset can be abrupt or develop over 1-2 day - High fever (103-104 typically) - Headache - Rash - Neck pain, nuchal rigidity - Vomiting - Then deteriorating neuro changes - Many times present with seizure or will have seizure within 48 hours Infants - Fever or hypothermia - Poor feeding - Irritability - Restlessness - Bulging tense fontanel - High pitched cry

Answer 3

- IV antibiotics STAT - Maintain strict iso precautions, maintain adequate hydration, manage sepsis and septic shock as needed - Decrease stimuli – quiet dark room, to help keep them comfortable - Manage pain - Encourage vaccines (Hib, Menectra)

Answer 4

Causative agents are principally viruses Frequently associated with other diseases - Measles, mumps, herpes, leukemia Onset abrupt or gradual - Manifestations—headache, fever, malaise - Symptoms usually milder Diagnosis and treatment - Might start abx even before the results of LP - Also manage symptoms – maintain hydration, manage pain Prognosis - Prognosis good, self-limiting - Would work it up as we would bacterial meningitis

Answer 5

- Seizure is a SYMPTOM, rather than a disease, caused by malfunctions of brain’s electrical system - Determined by site of origin - Most common neurologic dysfunction in children (mostly under 2 years of age)

Answer 6

Seizure - A single seizure not generally classified as epileptic - Single seizure not generally treated with long-term Rx - Will resolve once medical condition is resolved (e.g., meningitis) Epilepsy - Condition characterized by two or more unprovoked seizures - Multiple causes by a variety of pathologic problems in the brain

Answer 7

Change in LOC Involuntary movements Posturing Changes in perception, behaviors, or sensations

Answer 8

Birth injuries (anoxia) or congenital defects of CNS Acute infections in late infancy and early childhood In children older than 3 years, usually is idiopathic (no known cause)

Answer 9

- Monotherapy - gradually increase dose until seizure controlled or signs of toxicity - Polypharmacy if uncontrolled with just one - Monitor therapeutic levels, increase dose as child grows - Monitor side effects - Avoid abrupt discontinuation - needs to gradually dose reduce to take child off med Are they going to have to be on medication life-long? - Can come off when seizure-free for 2 years and normal EEG - Not going to d/c during puberty or times when pt suffers frequent illnesses - Recurrence can occur within first year and they may have to go back on meds

Answer 10

- Side lying - Maintain patent airway - No suctioning during - ready for after (many secretions) - No tongue blade - Put pillow under their head - Do not restrain - Time seizure Home mgmt: - CPR training for fam members - How to give rectal diazepam More than 5 minute seizure at home/school: CALL 911! First time having seizure, regardless of duration, CALL 911!

Answer 11

Formerly called petit mal or lapses Sudden onset Brief loss of consciousness, a blank stare, and automatisms (motor changes - lip smacking or eye twitching) Most common between ages 5 and 12 years Often stop spontaneously in the teenage years Sudden onset of 20+ events per day No warning/no aura Duration 5 to 10 seconds Motor—lip smacking, twitching of eyes, face, slight hand movements May drop object; child rarely falls No incontinence Often misdiagnosed with inattention or ADHD –Inattention/daydreaming ADD/ADHD School issues-- missing bits of information throughout day

Answer 12

AKA tonicclonic seizure Formerly known as grand mal Usually occurs without warning Consists of two distinct phases Tonic Eye rolling and loss of consciousness Tonic muscle contractions Clonic Intense jerking movements Average duration 30-50 seconds May have incontinence, caution w/ airway concerns

Answer 13

Further subdivided into three parts Simple partial seizures No alteration of consciousness Clinical manifestations related to the area of cerebral involvement May consist of motor, sensory, autonomic, or psychic symptoms. Complex partial seizures Complex symptoms and impairment of consciousness. Simple or complex seizures secondarily generalize Simple or complex partial seizures that evolve into generalized seizures, usually a tonic–clonic event

Answer 14

Sudden momentary loss of muscle tone Onset usually ages 2 to 5 years May or may not have loss of consciousness Sudden fall to ground, often on face – no motor ability to catch themselves Patient will wear helmet to protect themselves if it happens frequently Less severe—head droops forward several times

Answer 15

Sudden brief contractions of muscle group May be single or repetitive No loss of consciousness Often occur when falling asleep May be nonspecific symptom in many CNS disorders Nonspecific symptom of other disease May be mistaken as exaggerated startle reflex in infant If you can flex head forward, then NOT a seizure

Answer 16

Transient disorder of childhood Affect approximately 3% of children Usually occur between ages 6 months and 3 years Rare after age 5 Twice as frequent in males 95% to 98% of children with febrile seizures do not have epilepsy or neurologic damage – usually happens with that rapid temp change ``` Management Avoid tepid baths—usually ineffective Vigorous use of antipyretics Protect child from injury during seizure Call 911 if seizure lasts more than 5 minutes ``` Cause? Usually in temperatures higher than 101.8° F Seizure occurs when temperature is rising, not after Seizure usually over before the child arrives in the emergency department

Answer 17

Definition—seizure lasting more than 30 minutes or series of seizures without regaining premorbid LOC Treatment Maintain airway Establish IV access ASAP – can be difficult w/patient actively seizing Medications to stop it

Answer 18

Treatment aimed at prevention Supplementation—0.4 mg/day folic acid If history of NTD—4 mg/day folic acid 1998 FDA fortifies cereal grains with folic acid Begin at preconception Ideally 3 months prior Women of child bearing age should be supplementing with folic acid

Answer 19

Elevated α-fetoprotein in amniotic fluid at 16 to 18 weeks Chorionic villus sampling but not until 10 weeks of gestation Uterine ultrasound Why do we want to know? Family to be prepared – especially if they are considering termination If giving birth, will be delivered via c-section

Answer 20

Spina bifida occulta Not visible externally Spina bifida cystica Visible defect Saclike protrusion

Answer 21

Neural tube fails to close May be anywhere along the spinal column Lumbar and lumbosacral areas most common May be diagnosed prenatally or at birth Sac contains meninges, spinal fluid, and nerves Varying and serious degrees of neurologic deficit Clinically, the term “myelomeningocele” is interchangeable with “spina bifida” The sac May be fine membrane Prone to leakage of CSF; easily ruptured May be covered with dura, meninges, or skin Degree Location and magnitude of defect determine nature and extent of impairment Not necessarily uniform on both sides of defect Initial management Prevent infection Assessment of neurologic and associated anomalies (hydrocephalus) Positioning – prone position / parents won't be able to hold Early closure within 12 to 72 hours after birth – surgery to repair

Answer 22

Commonly associated with myelomeningocele Hydrocephalus develops in 80% to 85% of children with SB May not be apparent at birth May appear after primary closure of defect Results from disturbances in dynamics of CSF Enlarged lateral and third ventricle Management Head Circumferences daily Fontanel tension – increased ICP? (tense bulging fontanel?) Serial ultrasounds—ventricle size CT or MRI for initial diagnosis – enlarged ventricles?

Answer 23

Drains CSF intermittently or continuously Closed, sterile system with transparent pliable tubing, a collection bag, and possibly a drip chamber between the parts Hung on IV pole at bed-side Placed at the level of the child’s external ear HOB at 20- to 30-degree elevation **** If lower or raise HOB, close system (for short periods of time) / but generally maintain position

Answer 24

Infection Signs/symptoms Shunt malfunction (Fever and inflammation of tract Abdominal pain Malfunction- Emergency! can happen from exudate, kinking, plugging, displaced by child's growth spurt) Chances greatest in 1-2 mos after placement Signs/symptoms Increased ICP Worsening neurologic status/altered LOC

Answer 25

Spastic Most common clinical type Initially presents with hypotonia Hypertonicity and poor control of posture, balance, and coordinated motion Athetoid/dyskinetic Slow, wormlike movements of extremities, trunk, face, tongue Drooling, speech problems Lead to jerky involuntary movements worsen w/ emotional stress Ataxic rapid repetitive movements; wide gait, unable to hold onto objects Mixed/dystonic combination or spastic and athetosis

Answer 26

* *Goals of therapy for children with CP are early recognition and promotion of an optimum developmental course to allows these children to attain their potential within the limits of their dysfunction. There is no cure for CP and therapy is symptomatic and preventive. - orthotics used on feet to prevent or reduce deformity and control alignment - customized devices to help with mobility - surgery reserved for kids who do not respond to conservative measures or if spasticity is causing progressive deformities (correct contractures, stabilize joint, bone alignment, tendon-lengthening) - Meds: to control spasticity and pain - technical aides: toys used to improve functioning. Computerized toys to enhance hand-eye coordination or to aide with speech difficulties

Answer 27

**Children with CP have a wide range of intelligence, and 50-60% have normal IQ. A large percentage of children with CP do not have mental impairment. Can be difficult to assess intelligence d/t motor and sensory deficits. Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.

Answer 28

- Children with ASD have core deficits in social interaction, communication and behavior. Impaired social interaction is one of the hallmarks- may include early abnormal eye contact, failure to mile, failure to orient to name, lack of imitation, lack of interactive play, and lack of gesture use, such as waving or pointing. - communication impairment may be absent to delayed speech or abnormal speech like grunting or humming - autism regression= when the ASD child develops normally and then regresses suddenly. - any kid who doesn’t babble or gesture by 12 mo, a single word by 16 mo, and 2-word phrases by 2 years should have immediate hearing and language eval - behavior impairments range from mild-severe - repetitive impulsive spinning, twirling, rocking, flapping hands, head nodding are all common with ASD

Answer 29

When inpatient should provide decreased stimulation and place child in private room when possible. Each child with ASD are unique and their care should be individualized. Communication should be at the child’s developmental level, brief, and concrete. Wide variation in individual client response to treatment efforts No cure for autism Most promising results seem to be through highly structured routines and intensive behavior modification programs