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NURS 406 > Quiz 2: Neurological Alterations > Flashcards

Quiz 2: Neurological Alterations Flashcards

1
Q

Seizures

A
  • Brief paroxysmal behavior caused by excessive abnormal discharge of neurons.
  • The earlier and more frequent the seizure, the poorer the outcome.
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2
Q

Infant seizures

A

Are difficult to detect due to being so subtle

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3
Q

Seizures are classified into what two categories?

A
  1. Partial Seizures: local onset, involves a small location of the brain
  2. Generalized Seizures: involves both hemispheres of the brain
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4
Q

Seizure Assessment:

A
  1. Obtain info from the parents about: Time of onset, precipitating events, behavior before & after seizure
  2. Determine the child’s hx r/t seizures
  3. Ask child about presence of an aura (warning sign of impending seizure)
  4. Monitor for apnea & cyanosis
  5. Post-seizure: the child is disorientated & sleepy
  6. Video recording and EEG monitoring help ID seizure
  7. Identify metabolic causes
  8. CT and MRI: to ID trauma, tumor or congenital malformation.
  9. Neonate labs: TORCH (Toxoplasmosis, other agents, rubella, cytomegalovirus, HSV)
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5
Q

Seizure Managment

A
  • Treat the whole child
  • Maintain airway: turn on side and support head (avoid neck flexion)
  • Maintain seizure precautions
  • Monitor therapeutic drug levels
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6
Q

Seizure precautions

A
  • Raise side rails when child is resting
  • Pad side rails & hard objects
  • Waterproof mattress or pad
  • Carry medical identification
  • Swim with a companion
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7
Q

What are goals for seizure management?

A
  • Identify and correct the cause
  • Eliminate the seizure with minimal side effects
  • Normalize the lives of the child and family
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8
Q

Seizure treatment

A
  • Vagus Nerve Stimulation (delivers electrical impulse to the brain to reduce number and severity of seizures)
  • Ketogenic Diet (carb free, mostly fat: produces state of ketosis that is though to control seizures)
  • Antiepileptic Medications
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9
Q

Febrile Seizures

A
  • Generally seen in young children.
  • Due to height and rapidity of temperature elevation
  • Occurs during the temperature rise
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10
Q

Infantile spasms

A
  • Infantile spasms are not clearly understood

- Cause: Perinatal aspyxia and Intracranial hemorrhage

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11
Q

Increased ICP

A
  • Reflects the pressure exerted by the blood, brain, CSF and other space occupying fluids.
  • Defined as pressure sustained at 20 mm Hg or higher for 5 minutes or longer.
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12
Q

What are complications of increased ICP?

A
  • Will compromise cerebral perfusion and produce shifting of brain tissue -> herniations.
  • Types of herniations include: transtentorial herniation, temporal lobe herniation, tonsillitis herniation, and brainstem herniation (results in death).
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13
Q

Signs and Symptoms of Increased ICP in Infants

A
  1. Poor feeding/vomiting
  2. Lethargy
  3. Bulging fontanel
  4. High-pitched cry
  5. Increased head circumference (at 2 y/o, stop measuring)
  6. “Sun setting” eyes
  7. Separation of cranial sutures
  8. Distending scalp veins
  9. Increased/decreased response to pain .
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14
Q

What are signs and symptoms of increased ICP in a child?

A
  1. Headache
  2. Diplopia
  3. Mood swings
  4. Slurred speech
  5. Papilledema
  6. Altered LOC
  7. N/V (especially in the morning)
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15
Q

How do vital signs change with increased ICP?

A
  • Cushing’s response: increased systolic, widened pulse pressure, bradycardia, change in RR.
  • As ICP rises: Cheyne-stokes repspiration -> neurogenic hyperventilation or apneustic breathing.
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16
Q

Hydrocephalus

A

-Results from imbalance between production and absorption of CSF; and/or obstruction to the flow of CSF.

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17
Q

What can cause hydrocephalus?

A
  • Developmental malformations
  • Neoplasms
  • Trauma
  • CNS infections
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18
Q

Hydrocephalus affect on the ventricles

A
  • Causes an increased accumulation of CSF in ventricles
  • Ventricles become dilated and compress the brain substance against the surrounding cranium.
  • If it happens before the sutures fuse -> enlargement of the skull and dilation of the ventricles occur.
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19
Q

Since infants have open fontanels, how does it affect their ability to handle ICP?

A

Gives them more time until ICP becomes a real issue because the pressure has somewhere to go.

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20
Q

Glasgow Coma Scale

A
  • Assesses LOC
  • Consists of a 3 part assessment:
    1. Eye opening
    2. Verbal response
    3. Motor response.
  • Total numerical scores range from:
    1. 15 = no change in LOC
    2. 3 = deep coma and poor prognosis

*NEED TO KNOW

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21
Q

Hydrocephalus: Dandy-walker malformation

A
  • Involves cystic expansion of the 4th ventricle

- Obstruction of CSF flow

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22
Q

What are clinical manifestations of hydrocephalus in infants?

A
  • Abnormal rate of head growth
  • Frontal bossing
  • Irritable & lethargic
  • Lower extremity spasticity
  • Cries when held and rock, calms when lying still
  • Setting-sun sign
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23
Q

What are clinical manifestations of hydrocephalus in children?

A
  • Symptoms caused by increased ICP
  • Headache in morning
  • Papilledema
  • Strabismus
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24
Q

Fetal Evaluation of Hydrocephalus consists of

A

-Ultrasonography as early as 14-15 weeks gestation

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25
Q

Infant evaluation of hydrocephalus

A

Diagnosis based on head circumference

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26
Q

Primary diagnostic tools for hydrocephalus include

A
  • CT

- MRI

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27
Q

Treatment for Hydrocephalus

A

Ventriculoperitoneal Shunt

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28
Q

Ventriculoperitoneal Shunt

A
  • Provides primary drainage of CSF from ventricles to an extracranial compartment. (Usually peritoneum)
  • Allows for excess tubing (minimizes the number of revisions that are needed.
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29
Q

What are major concerns associated with ventriculoperitoneal shunts?

A
  • Infection: can occur anytime; at greatest risk during the first 6 months after placement; treated with IV ABT for 7-10 days.
  • Malfunction: most often caused by mechanical obstruction.
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30
Q

Meningitis

A
  • Infectious process infecting the CNS

- Droplet Transmission

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31
Q

How is meningitis diagnosed?

A
  • Testing CSF via lumbar puncture
  • Clinical Findings:
    • Increased CSF pressure
    • Cloudy SCF
    • High protein concentration
    • Low glucose level
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32
Q

What are clinical manifestations of meningitis?

A 
No single hallmark sign.
Vague and non-specific in children:
-poor feeding
-vomiting
-bulging fontanel
-irritability
-headache
-photophobia
-altered level of consciousness
-petechial or purpuric rash
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33
Q

What are signs of meningitis?

A
  • Kernig’s sign: inability to extend the leg when flexed anteriorly at the hip
  • Brudzinski’s sign: neck flexion -> adduction and flexion movements of lower extremities
34
Q

Treatment for Viral Meningitis

A
  • Supportive

- Usually complete recovery

35
Q

Treatment for Bacterial Meningitis

A
  • ABT: administered after lumbar puncture
  • Steroid therapy
  • Supportive: recovery good with early recognition and treatment.
  • Pneumococcal conjugate vaccine: for all children beginning at age 2 months to protect against meningitis
36
Q

What are complications associated with meningitis?

A
  • Hydrocephalus
  • Vision and hearing loss
  • Delayed growth and development
  • Seizures
  • Cranial nerve palsy
37
Q

Reye Sydnrome

A
  • Metabolic encephalopathy with organ involvement that follows a viral illness or toxin (or giving aspirin with viral disease)
  • Body’s response from exposure to virus or toxin: elevated temperature.
  • Not well understood
38
Q

Reye Syndrome can lead to

A
  • Liver cell damage
  • Toxic levels of serum ammonia
  • Cerebral dysfunction, F&E imbalances and coagulopathies.
39
Q

Reyes Syndrome is characterized pathologically by:

A
  • Cerebral edema

- Fatty liver changes

40
Q

What are clinical manifestations of Reyes Syndrome?

A
  • Nausea & vomiting
  • Progressive neurological deterioration
  • Elevated serum ammonia levels
  • Hypoglycemia
  • Increased ICP
  • Staged from I to V
41
Q

How is Reyes’s Syndrome managed?

A
  • Monitor in hospital setting
  • Frequent neurological checks
  • Hydration
  • Correct acid-base imbalances
  • Protect from coagulation injuries
42
Q

What does the neural tube close?

A

1 month after conception.

43
Q

Defects of Neural Tube Closure: Degree of Neurological Dysfunction

A
  • Depends on where the sac protrudes through the vertebrae
  • Anatomical level of the defect
  • Amount of nerve tissue involvement
44
Q

What can decrease the change for neural tube defects?

A

Folic acid intake of 0.4 mg daily.

45
Q

Where do neural tube defects most often occur?

A

Neural tube defects can happen anywhere along the spinal column BUT the lower back is the most common

46
Q

Myelodysplasia

A

Refers to any malformation of the spinal canal and cord

47
Q

Spina Bifida

A

Midline defects involving the failure of the osseous spine to close.

48
Q

What are the two types of spina bifida?

A
  1. Spina Bifida Occulta

2. Spina Bifida Cystica: meningocele and myelomeningocele

49
Q

Spina Bifida Occulta

A
  • Defect not visible externally but you can feel it
  • Has superficial cutaneous indications
  • Has neuromuscular disturbances
  • Evaluated by MRI
50
Q

Spina Bifida Occulta: Superficial cutaneous indications include

A
  • Skin depression/dimple
  • Port wine nevi
  • Tufts of hair
  • Soft cutaneous lipomas
51
Q

Spina Bifida Occulta: Neuromuscular disturbances include

A
  • Changes in gait with foot weakness: may walk pigeon toed
  • Foot deformity
  • Bowel and bladder sphincter disturbances
  • May not be evident until child is walking or toilet trained
52
Q

Spina Bifida Cystica

A
  • Visible defect with external saclike protrusion.
  • Two types:
    1. Meningocele: contains meninges and spinal fluid; no neural elements
    2. Myelomeningocele: contains meninges, spinal fluid and nerves.
53
Q

Myelomeningocele

A
  • Most frequently associated with hydrocephalus (neural tube fails to close)
  • Sac contains meninges, CSF and nerves.
  • Varying and serious degrees of neurologic deficit.
54
Q

Where are myelomeningoceles most often found?

A

May be found anywhere along the spinal column but lumbar and lumbosacral areas are most common.

55
Q

Myelomeningocele: Degree

A
  • Location and magnitude of defect determine nature and extent of impairment.
  • Not necessarily uniform on both sides of defects.
56
Q

Myelomeningocele: If defect is below second lumbar vertebra, it can result in

A

flaccid paralysis of lower extremities and sensory deficit

57
Q

When are myelomeningoceles monitored?

A

After repair

58
Q

What are clinical manifestations of myelomeningoceles?

A 
Prenatal: 16-18 weeks gestation
Post natal:
-Readily apparent on inspection
-Incontinence
-Poor anal and sphincter control 
-Sensory disturbances 
-Motor dysfunction
59
Q

Myelomeningocele Management

A
  • Prevent infection: keep site covered until closure, skin care
  • Surgical closure (very gently, surgeon will “shove” contents back into the spinal column and close it up)
  • Possible life long management of neurological, orthopedic and urinary problems
60
Q

Myelomeningocele Post Procedure Management

A
  • ATB
  • Bladder elimination
  • Administering antispasmodics (increase bladder capacity and improve incontinence)
  • Bowel program: increase fiber, water and suppositories prn
  • Risk for allergy to latex and rubber.
61
Q

Cerebral Palsy

A
  • A chronic non-progressive permanent disorder of posture and movement which causes activity limitation.
  • Due to disturbances that occurred in the developing fetal or infant brain.
62
Q

Cerebral Palsy: Involves disturbances in

A
  • Sensation
  • Perception
  • Communication
  • Cognition
  • Behavior
63
Q

Cerebral Palsy: Manifestations

A
  • Delayed gross motor development
  • Poor control of oral musculature
  • Seizures: Most common generalized tonic clonic and minor motor
  • Many associated disabilities
64
Q

Possible Physical Signs of Cerebral Palsy

A
  • Poor head control after 3 mo
  • Stiff or rigid arms or legs
  • Pushing away or arching back
  • Floppy or limp body posture
    -Cannot sit up without support by 8 mo
  • Uses only one side of the body
  • Clenches hands after 3 mo
  • Persistence of primitive reflexes past 6 mo
    -Hand preference demonstrated before 18 mo
  • Leg scissoring
  • Seizures
  • Sensory impairment (hearing, vision)
    -Persistant tongue thrusting (after 6mo old)
65
Q

Possible Behavioral Signs of Cerebral Palsy

A
  • Extreme irritability or crying
  • Feeding difficulties
  • Little interest in surroundings
  • Excessive sleeping
66
Q

Diagnostic Evaluation of Cerebral Palsy

A
  • Neurologic examination and history: primary method for diagnosis
  • Neuroimaging: MRI to identify lesions or abnormalities
  • Metabolic and genetic testing: if not structural abnormalities identified with neuroimaging
67
Q

Cerebral Palsy: Diagnosis cannot usually be confirmed until

A

After two years

  • Motor tone abnormalities may be indicative of another neuromuscular illness
  • Some children who demonstrate signs before 2 years do not demonstrate signs after 2 years
68
Q

Cerebral Palsy Management

A
  • Orthotics: to prevent or reduce deformity
  • Surgery: to improve function
  • Medications: pain, spasticity, seizure management
  • Physical therapy: prevention of contracture deformity; directed toward good skeletal alignment
69
Q

Cerebral Palsy Prognosis

A
  • Depends on type and severity: activities and work depend on this as well.
  • Achieve adulthood
  • Survival influences by existing morbidities
  • If child does not ambulate by 7 years of age: chances are poor for ambulation and independence.
70
Q

Guillain-Barre Sydnrome

A
  • AKA infectious polyneuritis
  • Uncommon acute demyelinating polyneuropathy (progressing ascending flaccid paralysis)
  • Immune mediated disease: associated with viral or bacterial infections or vaccine administration
71
Q

Guillain-Barre Syndrome: Nerve Conduction

A

Nerve conduction is impaired due to inflammation and edema of spinal and cranial nerves.

72
Q

How is Guillain-Barre Syndrome diagnosed?

A
  • Based on paralytic manifestations: Symmetric nature of paralysis helps to differentiate
  • EMG
73
Q

Guillain-Barre Syndrome has 3 phases

A
  1. Acute or Progressive
  2. Plateau
  3. Recovery
74
Q

Guillain-Barre Syndrome: Acute or Progressive Phase

A
  • Onset of symptoms
  • Continues until new symptoms stop appearing or deterioration ceases
  • May last up to 4 weeks.
75
Q

Guillain-Barre Syndrome: Plateau Phase

A
  • Symptoms remain constant
  • No further deterioration
  • Lasts from days to weeks
76
Q

Guillain-Barre Syndrome: Recovery Phase

A
  • Begins to improve
  • Progress to complete recovery
  • Lasts weeks to months
77
Q

What are clinical manifestations of Guillain-Barre Syndrome?

A
  • Influenza-like symptoms precede GBS
  • Rapid onset
  • Ascending paralysis from lower extremities
  • Tendon reflexes diminished or absent
  • Inability or asymmetric: Smile, raise eyebrows, puff out cheeks, grasp bilaterally, raise legs
  • Shallow, irregular respirations
  • Lower limb or back pain
  • Urinary incontinence/retention or constiparion
78
Q

Guillain-Barre Syndrome Treatment

A
  • Supportive
  • Mechanical ventilation
  • IVIG: primary treatment if started within two weeks of disease onset
  • Steroids
79
Q

Guillain-Barre Syndrome Prognosis

A
  • Recovery begins 2-3 weeks after onset
  • Most regain full muscle strength
  • Progress in the reverse order of paralysis (Lower extremities the last to recover)
80
Q

Nursing Care for Guillain-Barre Sydnrome

A
  • Emphasis on close observation of paralysis
  • Support all aspects related to paralysis
  • Prevention of Complications
81
Q

Guillain-Barre Syndrome Management: Prevention of Complications

A
  • Susceptible to skin infections
  • Passive range of motion exercises: Prevent muscle and joint contractures
  • Prevention of DVT
82
Q

Guillain-Barre Syndrome Management: Supporting all aspects related to paralysis

A
  • Especially respiratory function
  • May need to feed thru NG or GT
  • Temporary catheter may be needed
  • Pain management

NURS 406 (18 decks)

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