Peds Test # 2 Neuro Flashcards
What are the 4 factors that influence ICP?
1) Pressures - Arterial, venous, intra-abdominal and intrathoracic
2) Posture
3) Temperature
4) Blood gasses (CO2)
What are the 3 essential components that maintain ICP under normal conditions?
1) Brain tissue
2) Blood
3) CSF
What are the 10 general SxS of ⬆ ICP?
1) Headache - Often continuous and happens in the morning
2) Vomiting - Often projectile and not preceded by nausea
3) Difficulty following commands
4) ⬇ pupillary response to light
5) Cushing’s Triad - bradycardia, hypertension & abnormal respiratory pattern
6) LOC Changes - i.e., disorientation & confusion
7) Posturing - decorticate and decerebate positions
8) ⬇ motor Fx and reflexes
9) Flaccid response to pain
10) Positive for Babinski reflex - Should not be present in children who can walk.
Explain Decorticate Vs. Decerebate positioning
1) Decorticate - a) Cerebral cortex dysfunction
b) Draws extremities to the core
c) Arms abducted at shoulders and flexed on chest
d) Legs extended and adducted
2) Decerebate - a) Midbrain dysfunction
b) Arms & legs extended and pronated
What are the categories used for scoring on the Glasgow Coma Scale and what is the score range?
1) Categories - Eye movement, verbal response , and motor response
2) Score Range - 3 to 15
What are the 7 SxS of ⬆ ICP in an infant?
1) Bulging fontanel
2) ⬆ head circumference
3) Cranial sutures separated
4) High-pitched cry
5) Poor feeding
6) Vomiting
7) Irritability & restlessness
What are the 7 SxS of ⬆ ICP in a child?
1) Headache
2) Diplopia
3) Mood swings
4) Slurred speech
5) Nausea and Vomiting - especially in the morning
6) Altered LOC
7) Papilledema - Late sign that could lead to blindness
What are the 5 classes of meds used to treat ⬆ ICP?
1) Mannitol
2) Corticostoids
3) Barbituates
4) Antiseizure
5) Oxygen - PAO2 > 100 mmHg should be maintained
What is Bacterial Meningitis?
Bacterial infection of the CNS (brain or spine)
List the 6 SxS of Bacterial Menengitis.
1) Positive Kernig’s Sign (pain with extension of leg and knee)
2) Severe headache
3) Brudzinski’s Sign (flexion of the head causing flexion of the hips and knees)
4) Photophobia
5) ⬇ LOC
6) ⬆ ICP
What 5 complications can rise from Bacterial Meningitis?
1) Bradycardia
2) Seizures
3) CN III Palsy (can’t move eye, results in diplopia)
4) Hypertensive Coma
5) Death
What are the 5 different methods of diagnosing Bacterial Meningitis?
1) Blood culture
2) Lumbar puncture and analysis of CSF
3) X-ray
4) CT scan
5) MRI
Why should you examine the fundus of the eyes before lumbar puncture for Bacterial Meningitis?
To identify presence of increased ICP
Name three appropriate nursing diagnoses for a PT with bacterial meningitis.
1) Disturbed sensory pattern
2) Acute pain
3) Hyperthermia
What are the 4 SxS of a viral Meningitis?
1) Headache
2) Fever
3) Photophobia
4) Stiff neck
Describe Reyes Syndrome and list the 4 major effects it has on the body.
Reyes Syndrome is an acute, rapidly progressing encephalopathy causing:
1) Liver dysfunction
2) Cerebral edema > ⬆ ICP
3) Hypoglycemia
4) Shock
What are the effects of Reyes Syndrome on the liver?
1) Bleeding and poor clotting
2) ⬆ Ammonia levels
The etiology of Reyes Syndrome is unknown, but what situations has been linked to its onset?
1) Viral illness in winter (i.e., chk pox & flu)
2) Administration of aspirin and salicylate with concurrent viral illness
What are the 5 different ways to diagnose Reyes Syndrome?
1) LFT
2) Liver biopsy
3) Lumbar puncture
4) Serum ammonia level
5) Coagulation time
Mild Reyes Syndrome is self limiting and resolves in days, but what are the SxS of Severe Reyes Syndrome?
1) ⬇ neuro fx
2) Cerebral edema > ⬆ ICP
3) N & V
4) Liver dysfunction
What is used to treat ⬆ ammonia levels and bleeding/poor clotting in patients with Reyes’ Syndrome?
1) ⬆ Ammonia Levels treated with Neomycin
2) Bleeding/Clotting problems treated with vitamin k
Explain Spina Bifida Occulta Vs. Menegocele Vs. Myelomenegocele
1) Spina Bifida Occulta - Invisible, no SxS, only defect in bony spine
2) Menegocele - No neuro SxS, Spinal defect with sac-like protrusion containing no spinal nerve.
3) Myelomenegocele - Neuro SxS, spinal defect, sac-like protrusions contains meninges, spinal fluid and nerves.
Discuss the etiology of Spina Bifida
1) 70% - Insufficient folic acid in maternal diet (mothers need 400 mcg of folic acid daily before becoming pregnant and during pregnancy).
2) 30% - Unknown
How is Spina Bifida diagnosed in utero?
ALpha Fetal Protein (AFP) Amniocentesis, which is a blood test
What is Hydrocephalus and what are the common causes?
hydrocephalus is an accumulation of CSF within the ventricles of the brain. Athe most common causes are:
1) Meningitis complication
2) Obstruction of CSF flow btw the ventricles
What are the 5 SxS of Hydrocephalus in an infant?
1) Irritability & Lethargy
2) ⬆ head circumference
3) Bulging fontanelles
4) separated suture lines
5) High-pitched cries
What are the SxS of Hydrocephalus in a child?
1) Headache in the morning that is relieved by emesis or sitting upright
2) N & V
3) ⬇ LOC
4) ⬇ pupil response
5) Seizures
6) Irritability
7) Personality change
Describe a Ventriculoperitoneal shunt
A shunt inserted into a ventricle and its tubing is tunneled through the skin to the peritoneum. The shunt valves open at a certain pressure and drains excessive CSF fluid.
What is Cerebral Palsy
An injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (involuntary movements).
Describe the 3 classifications of Cerebral Palsy.
1) Spastic - Most common, hypertonic, poor posture balance and coordination, may involve one or both sides.
2) Dyskinetic/Athetoid - Involuntary movements, early life = flaccid and limp while later life = slow writhing motions.
3) Ataxic - Wide based gait, rapid/repetitive movement, ⬇ fine motor control
What are the SxS of Cerebral Palsy?
1) Persistent reflexes after 26 months
2) Developmentally delayed
3) Poor suck/tongue thrust
4) Spasticity
5) Scissoring of legs
6) Involuntary movements
7) Seizures
8) Sensory alterations
What types of medications are used to manage symptoms of a cerebral Palsy?
1) Anticonvulsants
2) Muscle Relaxants
What is a LATE sign on ⬆ ICP in a child that could lead to blindness?
Papilledema
What are the components of Cushing’s Triad
1) Bradycardia
2) Hypertension
3) Abnormal respiration
