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Peds > Peds Neuro > Flashcards

Peds Neuro Flashcards

1
Q

what is the earliest indicator of improvement or deterioration of neurologic status?

A

change in LOC

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2
Q

what is deCORicate posturing?

A

flexion posturing extremities toward the core

severe dysfunction of the cerebral cortex or lesions to corticospinal tracts

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3
Q

what is decerebrate posturing?

A

extension posturing

dysfunction at level of midbrain or lesions of brainstem

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4
Q

what are the three parts of the glasgow coma scale?

A

eyes
verbal response
motor response

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5
Q

what does a score of 15 on the glasgow coma scale mean?

A

unaltered LOC

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6
Q

what does the score of 8 or below on the glasgow sclale?

A

accepted definition of coma

less than 8 intubate

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7
Q

what is a score of 3 on the glasgow coma scale considered?

A

deep coma or death

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8
Q

Tense, bulging fontanel
* Separated cranial sutures
* Irritability / restlessness
* Drowsiness
* High pitched cry
* Distended scalp veins
* Poor feeding
* Setting sun sign (eyes rotated
downward)
Setting Sun
Sign

are signs associated with what in infants

A

increased intracranial pressure

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9
Q

what is epilepsy?

A

seizures triggered recurrently from within the brain

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10
Q

what are the diagnostic and lab test for seizures?

A

EEG, Lumbar Puncture, MRI, CT

CBC, Electrolytes, glucose, BUN

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11
Q

what are the nursing interventions for seizures?

A

Keep safe, suction, oxygen, rail
padding
* If prolonged seizure >5 minutes, medicate
* Monitor respiratory status after medications

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12
Q

what does management of seizures focus on?

A

focuses on controlling
seizures or reducing their frequency.
* Medications: Benzodiazepines,
anticonvulsants
* Surgery: remove area of brain responsible
for seizure
* Diet: Ketogenic Diet
* Implant: Vagal nerve stimulato

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13
Q

febrile seizure

A

6 months to 5 years of age
* No previous neurologic abnormality
* Absence of CNS infection
* Return to alert mental status within 30
mins
* Rapid rise of fever >100.4 or 38 Celsius
* Risk factors: viral infection; family history
* 1-2.4% of having seizures as an adult
depending on different factors

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14
Q

Absence (Petit mal)

A

sudden cessation of activity or speech with black facial expression

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15
Q

Tonic Clonic (Grand Mal)

A

generalized most dramatic

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16
Q

myoclonic

A

sudden, brief muscle jerks

may involve whole body or one body part

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17
Q

atonic (drop attacks)

A

sudden loss of muscle tone

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18
Q

status epilepticus

A

Neurologic emergency.
Prolonged seizure or clustered seizures
where consciousness does not return
between seizures.

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19
Q

what is the cause of 50% or more neural tube defects?

A

folic acid deficiency

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20
Q

All pregnant mothers need to take_____ Folic
Acid daily, more if hx of NTD

A

0.4mg

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21
Q

what are the types of neural tube defects?

A

Anencephaly
* Spina Bifida Occulta
* Spina Bifida Cystica: Meningocele or
myelomeningocele

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22
Q

Anencephaly

A

Absence of cerebral hemispheres
* Brainstem function may be intact
* Incompatible with life
* Few hours to few days
* Death due to respiratory failure
Nursing Management
* Supportive in nature; focuses on
comfort measures for the dying
infant
* Parental support; infant cap can be helpful

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23
Q

spina bifida occulta

A
  • Not visible externally
    Defect of the vertebral bodies
    without protrusion of the spinal cord
    or meninges
  • May have sacral dimple, hairy
    patch, discoloration of skin
    Potential complication: Tethered cord
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24
Q

Meningocele

A

Sac contains meninges and spinal
fluid but NO neural elements

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25
Q

Myelomeningocele

A

Sac contains meninges, spinal
fluid, and nerves
* Varying and serious degrees of neurologic deficit

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26
Q

Chiari Malformation

A

Anatomic anomalies of the craniocervical junction along with
downward displacement of the
cerebellar structures

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27
Q

Type I Chiari Malformation

A

usually not associated with hydrocephalus; more benign form

28
Q

Type II (Arnold–Chiari)

A

is the most
common and is usually associated
with hydrocephalus and myelomeningocele. Obstruction of
CSF

29
Q

Chiari Malformation symptoms

A

Neck pain, gagging,
headache. More severe:
hydrocephalus, extremity spasticity

30
Q

therapeutic management of Chiari malformation type 2

A

Therapeutic management of the type
II Chiari malformation includes
surgical decompression, VP shunt
placement

31
Q

craniosynostosis

A

Premature closure may lead to decreased brain growth.

Only one suture is fused, neurologic impairments are rarely
seen.

Two or more sutures are fused, neurologic complications such as
hydrocephalus with increased ICP
are more likely to occur

32
Q

craniosynostosis treatment

A

surgery

33
Q

plagiocephaly

A

Positional plagiocephaly refers to
asymmetry in head shape without
fused sutures.

“Back to sleep” program brough rise
of plagiocephaly

34
Q

plagiocephaly treatment

A

Tummy time when
awake, avoid baby in car seat other
than when in car, Molding helmet

35
Q

hydrocephalus

A

Imbalance in the production and absorption of CSF in the
ventricular system.

  • With accumulation of CSF, ventricles dilate and compress brain
    tissue which leads to increased intracranial pressure (ICP)
  • Causes include developmental defects, neoplasms, infections,
    trauma, or hemorrhage
36
Q

Abnormally rapid
head growth
* Bulging fontanels
(tense and non-
pulsatile)
* Dilated scalp veins
* Separated sutures

A

hydrocephalus early infancy

37
Q

Frontal enlargement/bossing
* Depressed eyes
* Setting sun sign (downward
rotation of eyes)
* Sluggish pupils with unequal
response to light

A

severe cases of hydrocephalus in infants

38
Q

hydrocephalus nursing care management

A

Observe for signs of
increasing ICP
* Measure head
circumference
* Palpate fontanels and
suture lines

39
Q

hydrocephalus therapeutic management

A

Placement of
ventriculoperitoneal
(VP) shunt.
* Endoscopic Third
Ventriculostomy (ETV)

40
Q

bacterial meningitis

A

infection of the meninges, the
lining that surrounds the brain and
spinal cord

41
Q

what vaccine has decreased bacterial meningitis infections?

A

Vaccination for Haemophilus
influenzae type B has decreased
infection

42
Q

Stiff neck, fever, headache,
vomiting, high-pitched cry (infants), bulging fontanel,
photophobia, rash (petechia or
purpuric), Kernig and Brudzinski signs.

A

bacterial meningitis

43
Q

Bacterial Meningitis Diagnostics

A

Lumbar Puncture—Fluid pressure is
measured, sample is analyzed and
cultured
CSF pressure will be elevated
CSF will have elevated
* White blood cells (WBCs)
* Protein
Low glucose in CSF (the bacteria
present feed on the glucose).
Complete blood count (CBC)—WBCs will
be elevated.
Blood, urine, and nasopharyngeal culture

44
Q

bacterial meningitis treatment

A

Isolation
IV antibiotics immediately after CSF
and Blood cultures are obtained.
Seizure precautions
Monitor for signs of increased ICP
Fluid resuscitation but lower rate to
prevent increased ICP
Fever treatment
Prevention: Vaccinations Hib,
meningitis vaccine

45
Q

Encephalitis

A

Encephalitis is an inflammation of the brain that may also include an inflammation of
the meninges.

46
Q

Encephalitis causes

A

protozoan, bacterial, fungal, or viral invasion

47
Q

Fever, Flu-like symptoms, Altered LOC, Headache, Lethargy,
Generalized weakness, Seizure activity

A

encephalitis common symptoms

48
Q

diagnostic and lab test for encephalitis

A

LP, CBC, MRI, CT, Electrolytes, glucose

49
Q

encephalitis treatment

A

Antivirals (most often cause)

Seizure precautions

Monitoring LOC

50
Q

reye syndrome cause

A

Reaction triggered by use of
salicylates to treat a viral infection

51
Q

Brain swelling, liver failure, and death in hours
if not treated.

Patient symptoms: profuse vomiting, change
in mental status, lethargy, irritability,
hyperreflexia, seizure

A

reye syndrome

52
Q

reye syndrome diagnostic evaluation

A

liver biopsy,
ammonia levels, liver function tests

53
Q

reye syndrome nursing management

A

care as per any
unconscious child and increased ICP

54
Q

reye syndrome family education

A

NO aspirin or aspirin
containing products such as Pepto-Bismol

55
Q

cerebral palsy

A

Term used to describe a range of nonspecific
clinical symptoms characterized by abnormal
motor pattern and postures caused by
nonprogressive abnormal brain function.
* 80% of causes occur before delivery
* Can also occur in the natal and postnatal
periods
* Cause may be unknown
* Most common movement disorder of
childhood
* Wide variations in severity of symptoms

56
Q

cerebral palsy complications

A

mental impairments,
seizures, growth problems, impaired vision
or hearing, abnormal sensation or
perception, and hydrocephalus

57
Q

cerebral palsy spastic

A

most common clinical type

58
Q

cerebral palsy diakinetic

A

Abnormal involuntary
movements

59
Q

cerebral palsy ataxic

A

Affects balance and depth perception

60
Q

cerebral palsy mixed type

A

combination of spastic and dyskinetic

61
Q

cerebral palsy medications

A

Decrease
spasticity, decreased
movements

62
Q

mild head injury

A

No loss of
consciousness, no penetrating
injury to brain
Cared for and observed at home

63
Q

head injury signs and symptoms to report

A

vomiting slurred speech, changes
in ambulation, headache, fluid
from nose or ears

Check child every 2 hours for
changes in responsiveness

64
Q

Severe head injury

A

Hospitalization until stable
NPO, IV fluids, Seizure precautions
Close monitoring of fluid balance

65
Q

Down syndrome

A

Trisomy 21 (Down syndrome) is a genetic
disorder caused by the presence of all or
part of an extra 21st chromosome.
It is the most common chromosomal
abnormality associated with intellectual
disability

66
Q

Some degree of intellectual disability
Hypotonia, Short stature
Depressed nasal bridge and small nose
Upward slant to eyes, Low-set, small ears
Protrusion of tongue; tongue is large
compared to mouth size.
A single deep transverse crease on the
palm of the hand (simian crease)
Short neck, with excessive skin at the
nape
Health problems: Congenital heart
disease occurs in 40% to 50%. Increased
risk for leukemia and thyroid disorders

A

down syndrome

Peds (4 decks)

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