Test #5 - Neurological Flashcards
What is autoregulation? (in the brain)
Known as self-regulation
Process allows cerebral arteries to change diameter in response to changes in cerebral perfusion pressure
Auto regulation may be impaired by trauma, ischemia, increased intracranial pressure (ICP)
What are some newborn sensory items? (What affects their sensory experience)
Lights
Sounds
Effects of Gravity
Abundance of tactile stimuli @ birth
Orientation= Ability to be alert, follow and fixate on complex visual stimuli for short periods of time & able to attend to and interact with environment
Vision= Prefers face, eyes and bright shiny object
Auditory= Searches for appealing sounds
Habituation-Diminish response to specific repeated sounds
Selects people by smell
Responds differently to different tastes
Sensitive to being touched, cuddled & held
Self-quieting behavior
What are some signs of overstimulation in preterm infants?
Oxygenation Changes:
Blood pressure, pulse and resp instability
Cyanosis, pallor or mottling
Flaring nares
Decreased oxygen saturation levels
Sneezing, coughing
Behavior Changes:
Stiff, extended arms and legs
Fisting of the hands or playing (spreading wide apart) of the fingers
Arching
Alert, worried expression
Turning away from eye contact (gaze aversion)
Regurgitation, gagging, hiccupping
Yawning
Fatigue signs
What are some interventions to reduce stimuli?
Cluster Care
Reduce stimuli
Low noise
Face bed away from bright lights
Soft classical music
Promote rest - Have designated time for lights off/no sound
What are some asseessments of cerebral/cognitive function?
Appearance, behavior, orientation, speech patterns, memory, logic and affect
Level of consciousness-Alert, awakes easily
How do you assess the cerebellar function?
Balance
Coordination
Gait
How do you assess reflexes?
Superficial deep tendon reflexes
What do you assess for with the head of an infant?
Infant- Head circumference, fontanels, sutures (sizes, tenseness, pulsation)
Anterior fontanel- Closes ~12-18 months
Posterior fontanel – Closes ~2-4 months
Head & Facial symmetry, spacing, movement, control, shape, check tongue for deviation, dysmorphic features
What do you assess for in the eyes of infants?
Position, size, visual acuity, color vision, peripheral vision, strabismus, field of vision, muscle function, PERRLA, cornea and blink reflex
Note: True eye color does not occur before 6 month
What do you assess for in the ears of an infant?
Alignment- Low-set, external ear, hearing acuity
Infant assessment, audiometry, whisper test, conduction tests)
Otoscope examination, history for risk factors for hearing loss
3 and younger: Pull pinna down and back
3 and older: Pull pinna up and back
How do you assess the neuromuscular system?
Symmetry & strength of movements
Head lag of less than 45 degrees
Ability to hold head erect briefly
Tremors or seizures
Is infant able to move all extremities?
Is there a visible defect present on the spine
What are some abnormal neurological findings?
Failure to attain a skill by expected time
Persistent reflex behavior beyond normal time
High-pitched shrill cry
Behavior disturbances
Change in level of consciousness
Glasgow Coma Scale
Seizures
Change in pupil reactivity
Pain
What are some neurological diagnostics?
Head & Spine X-Rays
CT Scans
MRI
EEG
Lumbar Puncture
Lab
Angiography
Nuclear brain scan
Extensive history
What is Level of Consciousness and the different types?
Most important indicator of neurologic dysfunction
Describing LOC
Conscious vs. Unconscious
Alertness: Ability to react to stimuli
Cognitive Power: processing of data
Levels of Consciousness
What are some causes of loss of consciousness?
Trauma and/or injury
Space-occupying Lesion
Aneurysm
Hypoxia
Infection (MC cause of altered LOC in children)
Poisoning
Seizures
Fluid – Overproduction or malabsorption
Endocrine or metabolic disturbances
Electrolyte or acid-base imbalance
Congenital structural defect
What are some interventions for neurological disorders?
Evaluating neurological status
The pediatric Glasgow Coma Scale
Eye opening, verbal response & motor response
Monitor vital signs
Manage the airway
Manage bladder and bowel elimination
Maintain hydration and nutrition
Provide proper hygiene
Position & perform exercises
Ophthalmic ointment/patches
Provide for safety
Anticipate seizures
What is increased intracranial pressure?
Intracranial pressure (ICP) = The pressure exerted by the blood, brain, Cerebral spinal fluid (CSF) and any other space-occupying fluid or mass inside the skull
IICP = 20mmHg or > for 5 minutes or longer
What are some assessments of IICP?
What are some interventions for IICP?
Close monitoring (neurological status) + ICP
Maintain a patent airway-No hyperventilation
Monitor Vital signs closely (Cooling blankets)
IV fluids, I&O, Labs include glucose and weight
Elevate HOB 30 degrees, maintain alignment
Protect from injury
Appropriate stimuli
Administer anticonvulsant medications
Provide emotional support
Administer medications to DEC cerebral edema
Analgesia and sedation
BE CAREFUL with O2…. Can cause increase in swelling
What is a prevention for neural tube defects (Spina Bifida)?
Mother needs 4/10 mg of Folic Acid daily (10x that if trouble absorbing or hx or neural tube defects in family)
What are some risk factors for spina bifida?
Diabetes, Poor maternal nutrition, obesity, inability to absorb folic acid, seizure medications
What are some assessments of Spina Bifida?
There are three forms: Occulta, Cystica (Meningocele), Cystica (Myelomeningocele)
What are some diagnostics for Spina Bifida?
Prenatal Ultra sound
Maternal serum testing for alpha-fetoprotein (AFP)
Done @ 16-18 weeks gestation
If elevated, amniocentesis and fetal ultrasound are performed
After birth – CT scan or myelography
What are some interventions for SPina Bifida?
Surgery happens soon after birth (within 48 hours)
Place newborn in prone position with hips slightly flexed and legs abducted (To prevent injury to sac)
Cover sac with sterile, warm, saline dressing
Monitor for CSF leakage
V/S, I&O, head circumference & assess fontanel
Provide Latex free environment to prevent sensitization
Foods that have cross-reactions with latex: Banana, avocado, kiwi, chestnut
Provide postoperative care for laminectomy & closure of defect, prone or side-lying position
POST OP- Assess Neurological status
Assess bowel & bladder function – Clean cath
Prevent constipation (Inc fluids and fibers)
May use anticholinergics
@ risk for UTI
Regular diaper changes to prevent it from getting in hole
Evaluate orthopedic function – Braces & devices
Prevent joint contractures
Manage pain
Crying leads to IICP
Feed with head turned to side
Promote collaboration of specialists and therapies
Educate & support patient and family
Refer to organizations
NEVER do rectal temps
Monitor for signs of infection
Irritability, INC VS, Lethargy
What is hydrocephalus?
Develops as a result of an imbalance between production and absorption of CSF.
Excess CSF accumulates in the ventricular system, the ventricles become dilated and the brain is compressed against the skull
This results in enlargement of the skull if the sutures are open; If fused=S&S of IICP
What are some risk factors for hydrocephalus?
Congenital
Results from defects such as:
Arnold-Chiari malformations, arachnoid cysts, tumors, aqueductal stenosis
Trauma
Disease:
Often associated with Myelomeningocele
Older children it usually results from meningitis
Intrauterine infection and perinatal hemorrhage can cause in infants
What are some assessments for hydrocephalus?
Rapid INCREASED head circumference-newborns-fontanels
Increased ICP
What are some diagnostics for hydrocephalus?
Ultrasound during prenatal exam, CT, MRI, Lumbar puncture pressure-Monitor
Surgical shunt replacement is a treatment for hydrocephalus, what do you assess and do post op?
Surgical Shunt Replacement
Post-Op Interventions:
Lay flat, INC HOB slowly over days, prepare parents
Infection of shunt: IV antibiotics
Surgically remove shunt til gone
Post-Op Assessment for Infection:
IICP, seizures, poor feeding, N/V, Malaise, redness on skin along where shunt is placed, apnea, INC VS
What are some interventions for IICP?
Measure head daily
Give pre-op and post-op antibiotics
Assess neurological status
VS
Assess abdominal status (pain, bowel sounds and circumference)
Position flat then elevate gradually
Anticipatory guidelines-Regular visits with PCP
Refer to community support
www. hydroassoc.org
www. hydrosupport.org
Educate family and provide emotional support
Recognize complication & shunt malfunction
No contact sports
Safe transport (Need to be in rear facing, reclining seat)
Medications
What is Cerebal Palsy?
Chronic, nonprogressive disorder of posture & movement
Characterized by difficulty in controlling the muscles because of an abnormality in the extrapyramidal or pyramidal motor system
What are some risk factors for cerebral palsy?
What are some assessments for cerebral palsy?
Vary Depending on the area of the brain involved and extent of damage
Persistence of infant reflexes
Delayed motor development by exam & history
Muscular hypotonia or hypertonia
Abnormal posture, gait or spasticity
Comorbidities include:
Cognitive impairment
Cognitive Impairment
Hearing and speech impairment
Visual impairment
Seizures
What are some diagnostics of cerebral palsy?
EEG, CT, MRI, metabolic workup
The Gross Motor Function Classification System (GMFCS)
Classify severity of CP and assess acquisition of future motor skills
What are the different types of cerebral palsy and what are the assessments?
**Spastic: MC type. **
Most effected brain is cortex
ASSESSMENTS:
Inc deep tendon reflexes
Hypertonia
Flexion
Contractures
Scissors gait
Hip flexion w/ adduction and internal rotation
Toe walking due to tight heel cords
Ataxic:
Effected area of the brain is the cerebellum
ASSESSMENT:
Loss of coordination, equilibrium, and kinesthetic sense
Child appears clumsy
Dyskinetic (Athetoid)
Disorder in the basal ganglia
ASSESSMENT:
Slow writhing
Uncontrolled, involuntary movements involving all extremities
Mixed
Combination of spastic and dyskineti
Rigid (Tremor Atonic)
Rare in children
Assessment:
Tremors are apparent both at rest and during movement
What are some interventions for cerebral palsy?
Use splints & braces
Promote Self-care
Surgery
Address feeding problems
Provide intellectual stimulation
Ensure safe environment
BENEFIT from massage therapy
Administer Medications
Muscle Relaxants
Dantrolene Sodium – Dantrium
Baclofen – Lioresal by infusion pump
Botox
Phenobarbital – Luminal
Phenytoin – Dilantin
Diazepam – Valium
What is a closed head injury?
Nonpenetrating injury to the head in which no break occurs in the integrity of the barrier between the outside environment and the intracranial cavity
What is an open head injury
Penetrating injury to the head in which there is a break in the integrity of the barrier (skull, meninges) between the outside environment and the intracranial cavity;
Infection is a MAJOR concern
What is a coup injury?
Cerebral injury sustained directly below the site of impact
What are the different classifications of seizures?
What is some observations and nursing care during a seizure?
Common seizure medication chart
Potential Functional deficits related to a brain tumor chart
Pediatric differences in vision function chart
Signs & Symptoms of potential vision problems
Types of refractive disorders chart
Types of Strabismus chart
What are some interventions for a child with visual impairmetn?
Educate
Promote Relationships
Promote optimum development
Types and Etiology of hearing loss chart
Risk Factors indicating the need for hearing screening chart
Expected Skills according to intelligence scores chart
Causes of Intellectual Disabilties Chart
