Test #5 - Neurological Flashcards

Question

What is hydrocephalus?

Answer 1

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

Answer 2

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

Answer 3

Rapid INCREASED head circumference-newborns-fontanels Increased ICP

Answer 4

Ultrasound during prenatal exam, CT, MRI, Lumbar puncture pressure-Monitor

Answer 5

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

Answer 6

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

Answer 7

Chronic, nonprogressive disorder of posture & movement Characterized by difficulty in controlling the muscles because of an abnormality in the extrapyramidal or pyramidal motor system

Answer 8

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

Answer 9

EEG, CT, MRI, metabolic workup The Gross Motor Function Classification System (GMFCS) Classify severity of CP and assess acquisition of future motor skills

Answer 10

**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

Answer 11

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

Answer 12

Nonpenetrating injury to the head in which no break occurs in the integrity of the barrier between the outside environment and the intracranial cavity

Answer 13

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

Answer 14

Cerebral injury sustained directly below the site of impact

Answer 15

Cerebral injury sustained in the region or pole opposite the site of impact Caused by the rapid movements of the semisolid brain within the cranial vault

Answer 16

Penetrating injury of the skull or brain Most often caused by bullet

Answer 17

Penetrating injury caused by piercing of the scalp, skull or brain by a sharp object

Answer 18

Linear: straight-line fracture; dura not involved Depressed: Bone pressing downward, indented Basilar: Fracture of the base of the skull

Answer 19

Battle sign (bruising over the mastoid process) Raccoon Eyes Rhinorrhea Otorrhea Hemotympanum (Blood behind eardrum)

Answer 20

Spine X-Ray CT MRI EEG ICP Monitoring Cerebral blood flow Profusion pressure

Answer 21

Provide immediate care to prevent life-threatening complications Maintain airway patency & oxygen administration Immobilize cervical spine Insert IV Monitor I&O hourly and serum electrolytes Assess neurological status: LOC, VS NO nasotrachiosuction or NGT NO packing or blowing nose Position HOB 30-45 degrees and maintain alignment Assess & Manage pain Document assessments, interventions, evaluations and changes Check nasal drainage Glucose stick – If + for glucose spinal fluid leak Ph stick – If alkaline means spinal fluid leak

Answer 22

Caused by vigorously shaking of the infant while the child is held by the extremities or shoulders Leads to whiplash-induced intracranial and retinal bleeding Usually no external signs of trauma

Answer 23

Inconsistent caregiver report & other signs of abuse should raise suspicion Retinal Hemorrhage Seizure activity, apnea, budging fontanels, coma, bradycardia & cardiovascular collapse Less severe-Vomiting, hypothermia, lethargy, irritability, difficulty arousing Cerebral edema 24-72 hours after trauma

Answer 24

CT Scan or MRI Skull radiography Ocular funduscopic Exam

Answer 25

Provide respiratory & cardiovascular support Assess for ICP Insert OG tube Maintain seizure precautions Maintain adequate fluid & nutritional intake Assess & document visible injuries Discuss short or long term care Assess parental concerns Legal & ethical responsibility

Answer 26

Known as “silent” event Survives more than 24 hours after submersion Poor prognosis if child was under longer than 10 min, received CPR for longer than 25 min, arrive at the ED in deep coma (Glasgow score of 5 or lower) and did not regain consciousness within 48-72 hours of hospitalization

Answer 27

Airway, breathing rate, depth & effort, lung sounds, continuous pulse ox LOC, Glasgow coma scale, reflexes Cardiac – Cap refill and heart rate Conscious - Hypothermia Conscious – Minor blood gas alterations Unconscious – Moderate hypothermia Unconscious – Moderate respiratory distress

Answer 28

Assess and maintain airway/oxygenation Initiate IV, I&O, Electrolytes Prevent IICP Maintain normal body temperature Insert NG tube for nutrition Control infection Pain management Provide Emotional support

Answer 29

Epilepsy Seizure disorder lasts seconds to minutes Status epilepticus Seizure lasts \>30 minutes Or a series of small seizures in which consciousness is not regained

Answer 30

Children who have febrile seizures Perinatal Asphyxia leading to hypoxic-ischemic encephalopathy Intracranial hemorrhage Metabolic disturbances Intrauterine and perinatal infectious disorder Cerebral infarcts Drug withdrawal Hyperthermia Hypoglycemia Congenital anomalies of the CNS Inherited Syndromes

Answer 31

Neonates: eyelid fluttering, sucking, smacking, drooling, tongue thrusting, pedaling movements of the legs, swimming movements of the arms and apnea History

Answer 32

CT MRI Skull radiograph angiography EEF Lab Lumbar puncture

Answer 33

Observation & Nursing care during seizure Ensure airway management-position, suction, oxygen Implement seizure precautions (Padded side rails, oxygen, suction equipment, IV access and anticonvulsant medications) Provide continuous cardiac, respiratory & oxygen monitoring Check blood sugar & give glucose if needed (During seizures glucose stores are depleted) Complete a detailed history/documentation progression Identify possible triggers Educate & support client and family Instruct caregivers in CPR Keep school nurses, teachers and club leaders informed Encourage medical alert identification bracelet Long term management of seizures Medications Adjunct Therapy: Ketogenic Diet Vagus nerve stimulation Family teaching Management of seizure at home, school Importance of giving meds as prescribed Blood levels may be needed to monitor anticonvulsant dosing

Answer 34

Depends on the tumor location, tumor type and the age of child History: Developmental milestones achieved, headache, vomiting Neurological deficits Signs of IICP, GCS, VS, LOC Nutritional status, weight Pain HALLMARK SIGN: Headache and morning vomiting related to getting out of bed The shift in intracranial pressure with the change in position from lying flat to standing up causes the vomiting.

Answer 35

Surgical Resection Radiation therapy Chemotherapy Combination

Answer 36

Educate and support through selected therapy Post-Op care IV steroids and anticonvulsants Neurological assessment Airway and fluid management Prevent infection Manage pain Ensure adequate nutrition Promote normal growth and development Ensure good communication & collaboration Provide Emotional Support

Answer 37

Vision screening, signs of problem Amblyopia Color Blindness Nystagmus Blindness

Answer 38

Educate Promote Relationships Promote optimum development

Answer 39

Immature blood vessels in retina constrict & necrose may lead to vision loss

Answer 40

High Levels of OXygen

Answer 41

Laser therapy Surgical procedure

Answer 42

Minimize exposure to light Titrate oxygen closely Educate parents regarding eye exams

Answer 43

Hemorrhage into the anterior chamber of the eye

Answer 44

Rest, sedation Monitor for further hemorrhage Monitor increased intraocular pressure – pain, N/V, inflamed Promote decreased activity – music, books HOB 30-40 degrees Protective shielding

Answer 45

Rapid eye flushing 30 minutes to 4 hours followed by pH analysis of the chemical agent at ED

Answer 46

Prescribed medical treatment Comfort Injury prevention Education Follow-up

Answer 47

Adequate hearing depends on intact auditory structures and quality of sound. Sound is defined in terms that combine volume and pitch or frequencies. Types of hearing loss: Slight: failure to hear at 16-25dB Mild: failure to hear at 26-40dB Moderate: failure to hear at 14-55dB Moderately Severe: failure to hear at 56-70dB Severe: failure to hear at 71-90dB Profound: failure to hear more than 90dB

Answer 48

Newborn hearing screening Risks that indicate more hearing screening is neededAssess hearing and language development at each visit Early detection & treatment has best results Treatment depends on cause – Amplification aid or cochlear implant When caring for hearing impaired infant/child: Encourage use of hearing aid before speaking Look directly into child’s face, speak clearly Eliminate background noise, use of visual aids American sign language, Promote communication Prevent hearing loss, genetic counseling

Answer 49

Criteria for Intellectual Impairment/Disability 1. IQ below average 2. Limitations in functions of daily life 3. Onset before 18 years old

Answer 50

Occurs when three representatives of chromosome 21 are present instead of just the normal 2 A particular region of chromosome 21 is responsible for the facial features, heart defects, intellectual impairment and dermatologic changes.

Answer 51

Brachycephaly (Disproportionate shortness of the head) Flat profile Inner epicanthal folds Wide Flat nasal bridge Narrow, high arched palate Protruding tongue Small, short ears which may be low set Short stature Singular transverse creases across the palm and sole of the foot Wide gap between first and second toes Dry skin with tendency to crack and fissure Hyper extensibility of joints with hypotonicity of muscles Atlantoaxial instability (At the first and second vertebrae) Hearing deficits

Answer 52

Be sensitive to needs of the parents Promote early intervention Ensure that care is geared toward physical, developmental and emotional needs Coordinate programs Help families cope emotionally Provide resource information

Answer 53

Caused by an underlying single gene defect on the X chromosome Most common inherited cause of cognitive impairment Most common cause of Autism (But can present with or without autism) Males present with more severe form versus females

Answer 54

Characteristics, family history Parental concerns Deoxyribonucleic acid test Overall areas that are affected span 6 categories: Intellectual functioning Physical Characteristics Social and emotional relatedness Speech and language capability Sensory impairment Presence of co-morbid disorders that are commonly associated w/syndrome

Answer 55

Assist with identifying Educate Support Refer to resources

Answer 56

Pervasive developmental disorders Symptoms noticeable by 3 years of age

Answer 57

Impairment in social reciprocity Communication impairment Restrictive and repetitive behaviors, interests, or activities Screening of all children during well visits

Answer 58

Promote awareness of need for early intervention Promote early language development Encourage social competence Stay aware of the child’s physical boundaries and reluctance to be touched When hospitalized work with routine and communication

Answer 59

Concussion—most common head injury Confusion, amnesia, transient, reversible, Children will not always have a loss of consciousness

Answer 60

loss of awareness and responsiveness lasting a few minutes to hours. -- followed by amnesia for the moment of injury and maybe for a period after the injury

Answer 61

Hypoxia (↓0 ₂) and hypercapnia (↑ CO₂) threaten the energy requirements of the brain and ↑ cerebral blood flow (CBF). The ↑ volume across the blood-brain barrier along with the loss of autoregulation, exacerbates cerebral edema. Pressure inside the skull that is \> arterial pressure results in inadequate perfusion. compresses the brainstem and occludes the posterior cerebral arteries