Week 5 Chapter 38 Flashcards

1
Q

Any environmental substance that can cause physical defect in developing embryo and fetus.

A

Teratogens

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2
Q

Premature infants are at greater risk for brain damage and intracranial hemorrhage/ bleeding

A

True

More premature the infant, greater the risk

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3
Q

What makes up the central nervous system?

A

Brain and spinal cord.

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4
Q

Development occurs at __ to___ weeks gestation from the neural tube.

A

3-4 weeks

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5
Q

What can affect normal CNS development?

A

Infection, trauma, teratogens, and malnutrition can cause physical defects and may affect CNS development.

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6
Q

At birth the cranial bones are well developed.

A

False

Increased risk for infection.

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7
Q

What is highly vascular organ?

A

Brain.
Increased risk for intracranial hemorrhage.

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8
Q

_____________ and ______ provide for brain growth.

A

Sutures and fontanels.

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9
Q

In a child the spinal cord is_________.

A

Mobile. High risk for cervical spine injury.

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10
Q

What is large to proportion to the body?

A

Head of the infant.

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11
Q

Head of infant accounts for ___ of the body height.

A

1/4.

Adults is 1/8th.

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12
Q

Child’s neck and muscles are ________ developed.

A

Not well developed.

Leads to increased incidence of head injury from falls.

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13
Q

PMH related to Neurologic Disease in Children

A

Prematurity
Difficult birth
Infection during Pregnancy
Falls
Recent Trauma

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14
Q

Common S/S related to Neurological Disease in children

A

Nausea, vomiting
Headaches
Changes in gait
Loss of motor function
Visual disturbances
Recent Trauma
Poor feeding
Lethargy
Fever
Pain
Changes in LOC
Increased irritability
Altered muscle tone

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15
Q

Inspection an observation with a Neurologic Disorder

A

LOC
VS
Head, face, and neck
Cranial Nerve Function
Motor Function
DTR
Sensory Function
Increased ICP

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16
Q

Earliest indicator of improvement or deterioration of neurologic status.

A

Loss of consciousness

Lack of response to painful stimuli is abnormal and can indicate life threatening condition. Report finding immediately to HCP.

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17
Q

5 States of Consciousness

A

Full
Confusion
Obtunded
Stupor
Coma

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18
Q

Child can’t be aroused even with painful stimuli.

A

Coma

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19
Q

Child responds to vigorous stimuli

A

Stupor

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20
Q

Child has limited responses to the environment and falls asleep unless stimulation is provided.

A

Obtunded

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21
Q

Disorientation exists, child may be alert but responds to inappropriately to questions

A

Confusion

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22
Q

Child is awake and alert, is oriented to time, place, person, and exhibit appropriate age behaviors.

A

Full Consciousness

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23
Q

Objective measure of child’s LOC by assigning numeric values to the presence of developmentally appropriate cues(eye opening, verbal response, and motor response.)

A

Pediatric Glasgow Coma Scale

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24
Q

Alterations in CN function can be result of

A

Compression of nerve, infection, or trauma leading to brain injury.

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25
When assessing oculomotor function be sure to note...
Nystagmus or sunset appearance of the eyes. ( Sclera of eyes showing over the top of iris) May indicate increased ICP as seen in hydrocephalus. Pupillary response is abnormal when neuro disorder is present.
26
How do we evaluate brainstem function in patients who are comatose.
Doll's Eye Maneuver Tests cranial nerves III, IV, VI and VIII.
27
Ensure the patient has a stable cervical spine without c spine precautions or neck injuries.
Doll's Eyes Maneuver
28
Brainstem is intact when?
Head turned quickly in one direction, eyes move to opposite like Doll's Eyes.
29
Possible Lesion of the Midbrain or Pons
Eyes continue to look straight (midline) without movement relative to head position, negative for doll's eyes This reflexed is suppressed in a conscious patient normal neurologic function function .
30
Damage to the cerebral cortex.
Decorticate Positioning
31
Occurs with damage at the level of the brainstem.
Decerebrate Posturing
32
Because cortical control of motor function is lost in certain neurologic disorders postural reflexes re emerge and are directly related to the area of the brain that is damaged.
True. Both have extremely rigid muscle tone
33
Carries out essential functions of your brain
Memory, thinking, learning, reasoning, problem solving, emotions, consciousness and sensory functions. Cerebral Cortex
34
Sends messages to the rest of the body
Brainstem Regulates balance, breathing, heart rate, sleep)
35
CNS has a dynamic balance of fluid (CSF) that bathes the brain and spinal cord at a specific pressure called
ICP
36
Possible Causes of ICP
Head Trauma, birth trauma, birth trauma, hydrocephalus, brain tumors
37
IICP shows what triad?
Cushing's Increase Systolic BP Decreased in Pulse and Respirations
38
Shock Symptoms
Decreased B/P Increased in Pulse and Respirations
39
How can you decrease ICP?
Elevate 30 degrees and use mannitol
39
Changes in LOC - Flat affect, decreased orientation and attention, coma Eyes- papilledema, pupillary changes, impaired eye movement Posturing- Decerebrate, decorticate, flaccid Decreased motor function- Change in motor ability and posturing Headache and Seizures- Impaired sensory and motor function Changes in VS- Cushing's Triad Vomiting- No nausea, may be projectile Changes in Speech Infants show- Cranial Suture separation, Increased Head Circumference, High pitched cry.
IIP
40
Early Signs of ICP
Headache Vomiting Visual Change Dizziness Decreasing HR and RR Sunset eyes Changes in LOC Seizures Bulging Fontanel and increasing head circumference - infants
40
Eyes are focused downward, visible white space between the sclera and the iris
Sunset Eyes
41
Late Signs of ICP
Decreased LOC Depressed motor, sensory responses Bradycardia Irregular respirations Cheyne Stokes Respirations Decerebrate, decorticate postures Fixed and dilated pupils
42
Nursing Assessment Reminders
Alterations in VS and check frequently All Children younger than 3 and any head size that is questionable should have their head circumference and plotted on growth chart Important to assess cranial nerve function and motor function as part of neuro assessment Assessing reflexes in infants, primitive reflexes should be assessed Palpation is used to assess the infant skull and fontanels
43
Common Lab and Diagnostic Tests
LP and CSF analysis ICP Measurements EEG Head and Neck Radiograph Ultrasound Fluoroscopy CT, MRI, PET, SPECT
43
Other procedures and treatments for Neurological Disorders
Ventricular Shunt Hyperventilation PT,OT, ST therapists EVD Ventricular tap Vagal Nerve Stimulator Ketogenic diet
44
Nerve stimulator is implanted and a lead wiring running under the skin is wrapped around the vagus nerve.
Vagal Nerve Stimulator Used in children older than 12 years of age.
44
Hyperventilation can due what?
Decrease PaCO2 results in vasoconstriction and decrease ICP.
45
High in fat and protein, low carbs to prevent, control and reduce seizures.
Keto Diet
45
_____________ is available in rectal form to stop prolonged seizures.
Diazepam Useful for home management Nurses must educate parents on administration and when to call 911.
46
Medications used to treat Neurological Disorders
Antibiotics Anticonvulsants Benzodiazepines Analgesics Osmotic Diuretics Corticosteroids
46
Types of Neurological Disorders in Children
Structural Disorders Seizure Disorders Infectious Disorders Trauma to Neurological System Blood flow disruption Disorders Chronic Disorders
46
Common Types of Structural Defects
Neural Tube Defects Microcephaly Arnold- Chiari Malformation Hydrocephalus Intracranial Arteriovenous Malformation Craniosynostosis
47
Account for majority of congenital anomalies and defects the spine and brain
Neural Tube Defects - Spina Bifida Occulta Myelomeningocele Anencephaly - small or missing brain, skull or scalp Encephalocele- Protrusion of brain and meninges through a skull defect Microcephaly- Head circumference more than 3 standard deviations Folic acid supplementation can decrease of NTD by 50%- ).4 mg PO Daily
47
Type I and Type II are under what catergorical disease?
Chiari Malformation
48
Cerebral tonsils displacing into the upper cervical canal More benign Symptoms: Seen in teens and adults Neck pain Recurrent Headaches that increase with physical activity and laughing, sneezing, and crying Lower Extremity spasticity
Type I
49
Cerebellum, medulla oblongata and 4th ventricle displace into the cervical canal and most common Usually associated with hydrocephalus and myelomeningocele Symptoms Detected prenatally or at birth Weak cry Stridor Apnea Surgical Decompression
Type II- Arnold Chiari
50
Results from an imbalance in production and absorption of CSF CSF causes the ventricles to enlarge and increases ICP
Hydrocephalus
51
S/S of Hydrocephalus
2 years or less: High pitched cry, bulging fontanels, irritability and changes in LOC, vomiting and poor feeding, frequent seizures and sunset eyes Congenital- Present at birth: Myelomeningocele NTD Intrauterine Infections
52
Hydrocephalus acquired after birth
Intentional or nonintentional trauma IVH in premature infants Neoplasms Infections Mlaformations
53
Maintaining Cerebral perfusion Minimizing Neurologic Complications Recognizing and Preventing shunt infection and malfunction Maintaining adequate nutrition Promoting growth and development Supporting and educating the child and family
Nursing Management of Hydrocephalus
54
Diverts the flow of CSF to the peritoneum where it is absorbed across the peritoneal membrane
Ventriculoperitoneal Shunt VP Shunt Will be need to be replaced as the child grows ( shunt revision) - Post Op Care- Measure Head Circumference
54
Symptoms of Shunt Infection
Elevated vital signs (fever), poor feeding, vomiting, decreased responsiveness, seizures, local inflammation, along shunt tract
55
Symptoms of Shunt Malfunction
Vomiting, Drowsiness, headache
56
Normally the capillaries connect the arteries to veins, in ___________ happens when what is missing?
AVM; capillaries
57
Nursing interventions for AVM
BP, pulse, assess pain, neuro status, focal deficits, maintain airway, administer oxygen to prevent hypoxia, maintain BP
58
Rare congenital disorder caused by an abnormal development of blood vessels ; "tangle of blood vessels"
Intracranial Arteriovenous Malformation AVM
59
Blood from artery flows under high pressure then_____ then______ vessels swell____then _____ and __________
vein then blood and then burst and bleed
60
AVMs that ____________ can lead to neurological defects
Hemorrhage
61
Symptoms of AVM
Sudden onset, severe headache, N/V, slurred speech, confusion, paralysis, seizures
62
Premature closure of the cranial sutures and can inhibit brain growth and show a distorted skull appearance
Craniosynostosis When 2 or more sutures fused Hydrocephalus with increased ICP more likely to occur Requires Surgical Correction
62
Treatment Options for AVM
Surgical Excision and Endovascular embolization
63
Asymmetry in head shape without fused sutures Increase in incidence in " back to sleep" Results from gravitational force on developing cranium
Positional Plagiocephaly Therapeutic Management Tummy time Molding Helmet
64
Common types of seizures include
Infantile spasms Absence Tonic- Clonic Myoclonic Atonic Simple Partial Complex Partial Status Epilepticus
65
Usually by age 4 or 5 more than half of children who have IS will develop other types of seizures
True Higher risk of developing Autism
66
Infantile Spasms Characteristics
Waking from sleep common but can happen during any moment in the day Often happen in clusters or back to back. Clusters last several minutes Often occur at ages 3 - 12 months and continue
66
Treatment for Infantile Spasms
ACTH Anti Seizure drug vigabatrin Surgery if in brain lesion
67
Criteria for Febrile Seizures
Convulsion with temperature greater than 38 Child older than 3 months younger than 6 years Absence of CNS or inflammation Absence of acute systemic metabolic abnormally that may produce convulsions No history of previous afebrile seizures
68
Type of seizure that is in ages of 6 months to 5 years 1 seizures that lasted less than 15 minutes and is a tonic Clonic seizure
Simple Febrile
69
Less than 6 months or greater than 5 years More than 1 seizure in a 24 hour period that are longer than 15 minutes and is a focal seizure
Complex Febrile
70
Higher incidence in neonates due to immature brain Metabolic, infectious, structural, and toxic diseases are likelyy to be seen in this group
Neonatal Seizures
71
Associated with: Hypoxic Ischemia Hypoglycemia and hypocalcemia Infection Intracranial Hemorrhage
Neonatal Seizures
72
May causes ____________ with neonatal seizures
Neurodevelopmental Problems Tx is Phenobarbital and correct underlying cause
73
Common neurological emergency in children and can occur with any seizure activity
Status Epilepticus Can be life threatening
74
Prolonged or clustered seizures where consciousness does not return between seizures Age, cause, an duration influence prognosis Requires prompt medical attention
Status Epilepticus
75
Tx of Status Epilepticus
Basic life Support- ABCs Administration of anticonvulsants to cease seizure ex: lorazepam, diazepam, fosphenytoin Blood glucose levels and electrolytes, evaluate the underlying cause
76
Tonic and Clonic Seizures Interventions
Maintain Airway Protect from harm No objects in mouth Observe and record event Note the: Onset, LOC, Muscle tone, pupils, cyanosis, incontinence, altered salivation
77
Antiepileptic Drugs include
Phenytoin, Carbamazepine, Valproic Acid
78
Selective inhibition of sodium channels and is an antileptic drug
Phenytoin
79
Suppresses high frequency neuronal discharge and is an antileptic drug
Carbamazepine
80
Blocks sodium and calcium channels to prevent neuron firing
Valproic Acid
81
What to watch for Antileptic Drugs?
Dilantin- gingival, hyperplasia, bradycardia, rash Tegretol- visual problems, leukemia, anemia, thrombocytopenia Valproic Acid- GI upset, hepatoxicity, pancreatitis Need to do levels on these drugs Noncompliance is frequently responsible for Tx failure
82
Padding of side rails and other hard objects Side rails always raised when child is in bed Oxygen and suction at bedside Supervision, especially during bathing, ambulation, and other potential hazards Use of protective helmet Child should wear medical alert bracelet
Seizure Precautions
83
Nursing management of Seizures
Maintain Airway Administer appropriate medication Help family cope with challenges of chronic seizures
84
Types of Infectious Disorders
Bacterial Meningitis Aseptic Meningitis Encephalitis Reye Syndrome
85
Rigid and arches their head back ( severe backward arching)
Opisthotonic Position
86
Infection of the meninges, the lining that surrounds the brain and spinal cord Can Lead to brain damage, nerve damage, deafness, stroke and death
Bacterial Meningitis
87
Decreases with Hib vaccine
Bacterial Meningitis and Hib
88
Bacterial Meningitis is a medical emergency that needs what two things started right away?
IV antibiotics Corticosteroids
89
Opithotonic position for infants and positive kernig and Brudzinski signs
Bacterial Meningitis
90
Preceding URI or sore throat Fever Chills Headache Vomiting Rash Irritability Drowsiness, lethargy Muscle rigidity Seizures
Common S/S of Bacterial Meningitis
91
Infants display poor sucking and feeding, weak cry, lethargy, vomiting Bulging fontanel is late sign
Bacterial Meningitis
92
Group Strep, S. pneumoniae, L. montocytogenes, E. Coli
Common bacterial for bacterial meningitis in NEWBORNS
93
S. pneumoniae, N. meningitis, H influenzae, Group B strep, M. tuberculosis
Common bacterial for bacterial meningitis in Babies and young children
94
N. Meningitis and S. pneumoniae
Common bacterial for bacterial meningitis in Teens and Young adults
95
Labs and Diagnostic Testing for Bacterial Meningitis
LP CBCs and WBCs Blood, urine, and NP culture
96
Nursing management of bacterial Meningitis
Administer antibiotics ASAP Supportive measures to reduce ICP Control Seizures Reduce fever Prevention includes: Treat pregnant mothers who are GBS+ Vaccines: Hib, pneumococcal, meningococcal
97
Most common and affects children younger than 5 years of age S/S include same as bacterial and is less ill and it is self limiting lasting 3-10 days
Aseptic Meningitis Viral
98
Tx of Aseptic Meningitis
Antivirals Supportive Measures - reduce pain and fever Stay home if neuro status is stable and tolerating Discharge teaching to include parental administration of over the counter analgesics
99
Inflammation of the brain, often due to infection or unknown
Encephalitis
100
S/S of Acute Encephalitis
Fever Headache Bulging fontanels Neck Stiffness Sleepiness Lack of energy Increased irritability
101
Tx of Encephalitis
Bed rest Plenty of fluids Corticosteroids Prescription based anti-inflammatory drugs to fight fever
102
Very rare and shows vomiting, diarrhea, rapid breathing, severe fatigue
Reyes Syndrome Symptoms requiring emergency Tx include confusion, seizures, and LOC Tx is supportive care and aggressive monitoring of complications
103
Progressive encephalopathy with hepatic dysfunctions Risk Factor is aspirin use and in born metabolism errors
Reye Syndrome
104
Closed Head Injuries are graded on ?
Severity Mild Moderate Severe May occur with an accident or injury Nonpenetrating injury to the head Normal behavior before the injury, may or may not lose consciousness
105
Leading cause of child mortality in the US
Trauma or Injury
106
Common Causes of Head Trauma in Children
Falls Motor Vehicle Accidents Sports Injuries Pedestrian and Bicycle Injuries Child Abuse
107
Causes of Nonaccidental Head Trauma
SBS Blows to the Head Intentional cranial impacts against the wall furniture, or the floor.
108
2nd leading cause of unintentional injuries between ages 1-14 years of age
Drowning Preventable by proper fencing around pool Water safety training Swimming Lessons Never leave without direct supervision Proper floating devices Learn CPR Know water depth Near drowning - Hypoxia - Promotion of oxygenation and monitoring for infection related to aspiration
109
Occurs less often than adults and many children will develop lifelong cognitive an motor impairments
cute Stroke in Children Ischemic or Hemorrhagic
110
More common stroke Cardiac disorders, coagulation abnormalities, sickle cell, infection, arterial dissection, genetic disorders
Ischemic
111
AVMs, aneurysms, coumadin, malignancy, trauma, hemophilia, liver failure, leukemia, intracranial tumors
Hemorrhagic
112
S/S of Acute Stroke in Children
Weakness on one side Facial Droop Slurred Speech Speech deficits
113
What is important in reducing the risk of injury in children?
Safety Having a neurological disorder can lead to lifelong impairment of individual's physical, cognitive, and psychosocial functioning
114
Assess the child and family in their willingness to learn Provide family time to adjust with diagnosis Repeat info Teach in short sessions Gear teaching to understanding level of family/ child Provide Reinforcement and rewards Use multiple modes of learning involving many senses
Promoting Child and Family Teaching