QUIZ 6: CHAPTER 49: NURSING CARE OF A FAMILY WHEN A CHILD HAS A NEUROLOGIC DISORDER Flashcards
● severely alter the child’s Iife; some result in life-threatening complications.
● Prevention must be the highest priority; neural tissue does not regenerate; nervous system degeneration is likely permanent.
Neurologic disorders
● are unique among body cells in that, instead of being compact, they consist of a cell nucleus and extensions: one axon and several dendrites.
Nerve Cells (Neurons)
transmits impulses to the cell nucleus;
dendrite
transmits impulses away from the cell nucleus to body organs.
axon
● cranial nerves, the spinal nerves, and the somatic and visceral divisions. The visceral division includes the autonomic system.
Peripheral nervous system (PNS)
● consists of the brain, the spinal cord, and the surrounding membranes or meninges that protect the brain and spinal cord from normal trauma.
Central nervous system (CNS)
can be used to indicate whether a parent’s concern about a preschool child is well founded
Denver Developmental Screening Test
Cerebral Function
1.___ : refers to whether children are aware of who and where they are, and what day it is
○ Children, younger than 4 yrs: may not know both first and last names
○ Children younger than 7 or 8 yrs: may have difficulty with the days of the week, confusing “yesterday” “today” “tomorrow”
Orientation
Cerebral Function
2.____: is the ability to retain a concept for a short time
○ Ask to remember a series of numbers and repeat them
○ Child 4 years: can repeat three digits
○ Child older than 6 yrs: can repeat five digits
Immediate recall
Cerebral Function
_____:covers a slightly longer period of time
○ Ask older children what they ate for breakfast to test recent memory
Recent memory
Cerebral Function
____: is long-term recall
○ For preschoolers: ask what they ate for breakfast
○ For older children: ask name of first grade teacher
Remote memory
● Refers to the ability to recognize an object by touch and tests sensory interpretation.
● Ask the child to close eyes; then place a familiar object, such as a key, a penny, or a bottle cap, in her hand and ask her to identify it.
Stereognosis
● The ability to recognize a shape that has been traced on the skin.
● Ask the child to close eyes; trace first a circle, then a square, on the back of the hand, and ask whether the shapes are the same or different.
Graphesthesia
● The ability to distinguish movement. Have the child close the eyes and extend hands in front.
● Raise one of the fingers and ask whether it is up or down
Kinesthesia
● Tests for cerebellar function are tests for normal balance and coordination.
Cerebellar Function
● Muscle size, strength, and tone
are part of assessment
Motor Function
● If sensory systems are intact, they should be able to distinguish light touch, pain, vibration, hot, and cold.
Sensory Function
● Deep tendon reflex testing, which is part of a primary physical assessment, is also a basic part of a neurologic assessment.
Reflex Testing
Introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis
LUMBAR PUNCTURE
In infants, CSF may be obtained by a subdural tap into a ventricle through the anterior fontanelle
Small space on scalp over insertion site is shaved and area is prepped with antiseptic
Infant’s head: should be held firmly in supine position
VENTRICULAR TAP
An X-ray study of cerebral blood vessels that involves the injection of a contrast material into the femoral or carotid artery
Cerebral angiography.
X-ray study of the spinal cord following the introduction of a contrast material into the SF by lumbar puncture to reveal the presence of space-occupying lesions of the spinal cord
Myelography.
involves the use of X-rays to reveal densities at multiple levels or layers of brain tissue and to confirm presence of brain tumor or encroaching lesions
Computed tomography.
ELECTROENCEPHALOGRAPHY
Reflects the electrical patterns of the brain summarizing the physical and chemical interactions within the brain at the time of the test
Most beneficial in diagnosing absence seizures
is the unexplained development of subcutaneous tumors.
The disorder can occur as a mutation, or it can be inherited as an autosomal dominant trait carried on the long arm of chromosome 17
Neurofibromatosis
is a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction.
Affected children also may have speech or ocular difficulties, seizures, cognitive challenges, or hyperactivity.
Cerebral palsy (CP)
Spasticity is excessive tone in the voluntary muscles that results in loss of upper motor neurons.
PYRAMIDAL OR SPASTIC TYPE
“can move but slow”
The athetoid type of CP involves abnormal involuntary movement.
Athetoid means “wormilke.” Early in life, the child is limp and flaccid.
Later, In place of voluntary movement, children make slow, writhing motions.
EXTRAPYRAMIDAL OR DYSKINETIC TYPE
Children with — have an awkward, wide based gait.
On neurologic examination, they are unable to perform the finger-to-nose test or to perform rapid, repetitive movements (tests of cerebellar function) or fine coordinated motions.
ataxic involvement
Some children show symptoms of both spasticity and athetoid movements.
Ataxic and athetoid movements also may be present together.
This combination results in a severe degree of physical impairment.
MIXED TYPE
is an infection of the cerebral meninges.
It occurs most often in children younger than 24 months of age.
Caused most frequently by Streptococcus pneumoniae or group B Streptococcus. In children younger than 2 months or age, group 8 Streptococcus and Escherichia coli are common causes
BACTERIAL MENINGITIS
A major cause of meningitis in newborns is group B streptococci.
The organism is contracted either in utero or from secretions in the birth canal.
It can spread to other newborns if good handwashing technique is not used.
GROUP B STREPTOCOCCAL INFECTION
is an inflammation of brain tissue and, possibly, the meninges as well
Encephalitis
is acute encephalopathy with accompanying fatty infiltration of the liver, heart, lungs, pancreas, and skeletal muscle.
It occurs in children from 1 to 18 years of age regardless of gender.
The cause is unknown, but it usually occurs after a viral infection such as varicella (chickenpox) or influenza that was treated with a salicylate such as acetylsalicylic acid (aspirin).
Reye’s syndrome
is a perplexing syndrome that involves both motor and sensory portions of peripheral nerves.
It affects both sexes and occurs most often in school-age children and adolescents.
Guillain-Barré syndrome (inflammatory polyradiculoneuropathy)
occurs when spores of Clostridium botulinum colonize and produce toxins in the intestine.
Botulism
is nerve compression of the median nerve that passes through the carpal tunnel at the wrist.
Compression of the nerve causes numbness and sharp pain and burning In the thumb and the second, third, and fourth fingers of the hand.
Carpal tunnel syndrome
Facial palsy is facial paralysis of the seventh (facial) cranial nerve, the nerve that innervates the muscles of facial expression.
The syndrome occurs abruptly, usually after a herpes or Lyme disease infection.
It may occur as a result of cold air from skiing or from riding in a convertible.
FACIAL PALSY (BELL’S PALSY)
is an involuntary contraction of muscle caused by abnormal electrical brain discharges.
Although seizures can be idiopathic (without cause), they also can be attributed to infection, trauma, or tumor growth. Familiar or polygenic inheritance may be responsible,
RECURRENT SEIZURES)
