peds neuro cont (1) Flashcards
abnormal “normal” labs for Hypothyroidism is:
low T4, high TSH
Symptoms of hypothyroidism in newborn include:
too good baby= quiet & good baby, prolonged jaundice, lethargy, poor appetite, bradymacroglossia (large tongue), long gestation > 42 weeks
What happens if levothyroxine sodium is not given to patient shortly after birth?
mental retardation and growth failure
Inadequate treatment ( med underdose) for congenital hypothyroidism can lead to
fatigue, sleepy, decrease appetite, constipation
Levothyroxine overdose includes
rapid pulse, irritability, fever, weight loss, and diarrhea
What should you educate parents about in regards to congenital hypothyroidism tx with levothyroxine?
check pulse before tx, single dose in AM, and child will need lifelong tx
_____ is defined as abnormal electrical activities in the nerve cells in the brain
seizures
Convulsion
a more severe seizure characterized by involuntary spasmodic contraction of any or all muscles throughout the body
Epilepsy
a chronic recurrent pattern of seizure activities
How long can a status epilepticus seizure last
Tonic-clonic seizures up to 30 min
Status epilepticus involves ____ involvement, ______, ___tension, PVCs
status epilepticus involves airway involvement, hypoxia, hypotension, and PVCs
Biggest differences between generalized and partial seizure
Generalized = affect the entire brain surface consciousness loss. Partial = affects part of the brain surface
What is the tonic and clonic?
tonic phase- generalized stiffness of entire body. Clonic phase- spasm followed by relaxation
The 3 types of generalized seizures include:
tonic clonic (grand mal), absence (petit mal), myoclonic
Biggest difference between tonic-clonic (grand mal) and absence (petit mal)
TC= loss of consciousness. A= momentary loss
Absence (petit mal)
momentary loss of consciousness, posture maintained, minor face, eye and hand movement
Difference between simple and complex partial seizure
simple= no impairment of consciousness. Complex= impaired consciousness
Patient has an aura, Loss of consciousness, stiffness, apnea, cyanosis, pupil dilated, incontinence is a description of ______
tonic-clonic (grand mal)
This seizure lasts 5 - 10 seconds, appears inattentive, daydreaming, age 4-12 year old is an example of what type of seizure
absence seizures ( petit mal)
What happens in post-ictal phase?
CNS depression, patient may be disoriented and sleepy
What is the most common cause of increased seizure activity?
non compliance with medication
Tegretol, dilantin, and depakene are used to tx what?
partial simple or complex seizures
Zarontin and Depakene are used to treat what?
absence seizures ( petit mal)
Tx for status epilepticus includes
valium and ativan
Diazepam (Valium)
short acting and must be given in repeated doses. Usually followed by long acting anticonvulsant ( Dilantin)
Lorazepam (Ativan)
drug of choice for status epilepticus because it lasts longer than Valium
_____ _____ is seizure not controlled by meds
intractable epilepsy
If meds don?t work for epilepsy, what are alternatives?
Ketogenic diet, surgery, vagus nerve stimulator, experimental drugs
Ketogenic diet
high-fat, adequate protein, low-carb diet
What should the nurse educate parents about epilepsy home management?
drug monitoring, med withdrawal, counseling, safety, immunizations
You witness a seizure, what do you do?
assess immediate environment & protect pt. from harm, assess airway, O2 prn, medicate, side laying afterward, observe and describe (time, incontinence)
This disease is an acquired neuromuscular disorder with a bacterial, viral or congenital origin leading to inflammation and demyelination of the myelin sheath causing impaired nerve conduction
Guillain-Barre Syndrome
Paresthesia
numbness and tingling
What would you find a nursing assessment of a patient with Guillain Barre?
paresthesia, muscle weakness of less (progressing to face, trunk and upper extremities), difficulty in talking, chewing, swallowing, increase HR, pain in back of leg, ortho HTN
What is supportive nursing care for guillan barre patients?
monitor respiratory status, positioning and skin care, ROM and PT, and urinary cath
Common medication management for GBS include:
IV immunoglobulins (lessen the immune attack), steroids, and plasmapheresis (removes antibodies)
What are the #1 cause for spinal cord injury in a newborn and an infant?
newborn- shaken baby. Older child- MVA
True or false, you should use a rigid cervical collar on immobilization board for anyone with spinal cord injury
TRUE
Would you take a child that was just in a car accident out of his or her carseat?
NO
You are the nurse caring for Timmy who has sustained a severe spinal cord injury. You need to give him some medication to prevent any further swelling. You have prednisone and methylprenisolone available. Which do you give and how often?
Methylprednisolone, Q 8 hours
Describe your assessment for Timmy ( spinal cord injury)
assess breathing pattern & auscultate lungs, check neurologic vital signs frequently (sensory and motor), cardio status, abdomen for distention, temp (hyperthermia common), psychosocial status
You are discharging Timmy (spinal cord injury), what education would you provide to him and his family as to when they should seek medication attention?
recurrent vomiting, seizure, loss of consciousness, worsening headache, change in behavior, difficulty walking
In what disease does organisms spread to CNS causing inflammatory response?
Meningitis
Haemophilus influenza, neisseria meningitis, streptococcus pneumoniae are all causes of which type of meningitis?
Bacterial
What might a lumbar puncture show in meningitis?
Increased WBC, decrease glucose, elevated protein, increase ICP, positive culture for meningitis
Clinical Manifestations of an older child with meningitis include:
s/s of increased ICP (LOC changes, irritability, vomiting), neck stiffness, photophobia, Kernig sign, Brudzinski sign, fever, chills)
Clinical Manifestations of an infant with meningitis include:
absence of classic signs, ill, poor feeding, vomiting, BULGING FONTANELS, seizures
True or False, there is a vaccine for meningitis
TRUE
Most brain tumors are _____, making them difficult to excise surgically. Also, are close to ___ structures
infratentorial, vital
What are common symptoms associated with brain tumors?
headache upon wakening, vomiting with nausea, loss of concentration, change in behavior, vision problems
Post-op care priorities for brain tumor excision include:
increased ICP and seizures, monitor I & O, admin steroids and osmotic diuretics
In post-op phase of brain tumor surgery, how are you going to position your client?
Keep HOB elevated to decrease swelling. Most infratentorial tumors are prescribed to lie flat or turn to either side
What 4 things can cause increased ICP?
suctioning, coughing, straining, and turning
