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ADN005 Pediatrics > Week 5 Chapter 38 > Flashcards

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
Q

When assessing oculomotor function be sure to note…

A

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.

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26
Q

How do we evaluate brainstem function in patients who are comatose.

A

Doll’s Eye Maneuver

Tests cranial nerves III, IV, VI and VIII.

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27
Q

Ensure the patient has a stable cervical spine without c spine precautions or neck injuries.

A

Doll’s Eyes Maneuver

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28
Q

Brainstem is intact when?

A

Head turned quickly in one direction, eyes move to opposite like Doll’s Eyes.

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29
Q

Possible Lesion of the Midbrain or Pons

A

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 .

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30
Q

Damage to the cerebral cortex.

A

Decorticate Positioning

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31
Q

Occurs with damage at the level of the brainstem.

A

Decerebrate Posturing

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32
Q

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.

A

True. Both have extremely rigid muscle tone

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33
Q

Carries out essential functions of your brain

A

Memory, thinking, learning, reasoning, problem solving, emotions, consciousness and sensory functions.

Cerebral Cortex

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34
Q

Sends messages to the rest of the body

A

Brainstem

Regulates balance, breathing, heart rate, sleep)

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35
Q

CNS has a dynamic balance of fluid (CSF) that bathes the brain and spinal cord at a specific pressure called

A

ICP

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36
Q

Possible Causes of ICP

A

Head Trauma, birth trauma, birth trauma, hydrocephalus, brain tumors

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37
Q

IICP shows what triad?

A

Cushing’s
Increase Systolic BP
Decreased in Pulse and Respirations

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38
Q

Shock Symptoms

A

Decreased B/P
Increased in Pulse and Respirations

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39
Q

How can you decrease ICP?

A

Elevate 30 degrees and use mannitol

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39
Q

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.

A

IIP

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40
Q

Early Signs of ICP

A

Headache
Vomiting
Visual Change
Dizziness
Decreasing HR and RR
Sunset eyes
Changes in LOC
Seizures
Bulging Fontanel and increasing head circumference - infants

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40
Q

Eyes are focused downward, visible white space between the sclera and the iris

A

Sunset Eyes

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41
Q

Late Signs of ICP

A

Decreased LOC
Depressed motor, sensory responses
Bradycardia
Irregular respirations
Cheyne Stokes Respirations
Decerebrate, decorticate postures
Fixed and dilated pupils

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42
Q

Nursing Assessment Reminders

A

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

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43
Q

Common Lab and Diagnostic Tests

A

LP and CSF analysis
ICP Measurements
EEG
Head and Neck Radiograph
Ultrasound
Fluoroscopy
CT, MRI, PET, SPECT

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43
Q

Other procedures and treatments for Neurological Disorders

A

Ventricular Shunt
Hyperventilation
PT,OT, ST therapists
EVD
Ventricular tap
Vagal Nerve Stimulator
Ketogenic diet

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44
Q

Nerve stimulator is implanted and a lead wiring running under the skin is wrapped around the vagus nerve.

A

Vagal Nerve Stimulator

Used in children older than 12 years of age.

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44
Q

Hyperventilation can due what?

A

Decrease PaCO2 results in vasoconstriction and decrease ICP.

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45
Q

High in fat and protein, low carbs to prevent, control and reduce seizures.

A

Keto Diet

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45
Q

_____________ is available in rectal form to stop prolonged seizures.

A

Diazepam

Useful for home management

Nurses must educate parents on administration and when to call 911.

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46
Q

Medications used to treat Neurological Disorders

A

Antibiotics
Anticonvulsants
Benzodiazepines
Analgesics
Osmotic Diuretics
Corticosteroids

46
Q

Types of Neurological Disorders in Children

A

Structural Disorders
Seizure Disorders
Infectious Disorders
Trauma to Neurological System
Blood flow disruption Disorders
Chronic Disorders

46
Q

Common Types of Structural Defects

A

Neural Tube Defects
Microcephaly
Arnold- Chiari Malformation
Hydrocephalus
Intracranial Arteriovenous Malformation
Craniosynostosis

47
Q

Account for majority of congenital anomalies and defects the spine and brain

A

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
Q

Type I and Type II are under what catergorical disease?

A

Chiari Malformation

48
Q

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

A

Type I

49
Q

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

A

Type II- Arnold Chiari

50
Q

Results from an imbalance in production and absorption of CSF

CSF causes the ventricles to enlarge and increases ICP

A

Hydrocephalus

51
Q

S/S of Hydrocephalus

A

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
Q

Hydrocephalus acquired after birth

A

Intentional or nonintentional trauma
IVH in premature infants
Neoplasms
Infections
Mlaformations

53
Q

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

A

Nursing Management of Hydrocephalus

54
Q

Diverts the flow of CSF to the peritoneum where it is absorbed across the peritoneal membrane

A

Ventriculoperitoneal Shunt
VP Shunt

Will be need to be replaced as the child grows ( shunt revision)

  • Post Op Care- Measure Head Circumference
54
Q

Symptoms of Shunt Infection

A

Elevated vital signs (fever), poor feeding, vomiting, decreased responsiveness, seizures, local inflammation, along shunt tract

55
Q

Symptoms of Shunt Malfunction

A

Vomiting, Drowsiness, headache

56
Q

Normally the capillaries connect the arteries to veins, in ___________ happens when what is missing?

A

AVM; capillaries

57
Q

Nursing interventions for AVM

A

BP, pulse, assess pain, neuro status, focal deficits, maintain airway, administer oxygen to prevent hypoxia, maintain BP

58
Q

Rare congenital disorder caused by an abnormal development of blood vessels ; “tangle of blood vessels”

A

Intracranial Arteriovenous Malformation
AVM

59
Q

Blood from artery flows under high pressure then_____ then______ vessels swell____then _____ and __________

A

vein then blood and then burst and bleed

60
Q

AVMs that ____________ can lead to neurological defects

A

Hemorrhage

61
Q

Symptoms of AVM

A

Sudden onset, severe headache, N/V, slurred speech, confusion, paralysis, seizures

62
Q

Premature closure of the cranial sutures and can inhibit brain growth and show a distorted skull appearance

A

Craniosynostosis

When 2 or more sutures fused Hydrocephalus with increased ICP more likely to occur

Requires Surgical Correction

62
Q

Treatment Options for AVM

A

Surgical Excision and Endovascular embolization

63
Q

Asymmetry in head shape without fused sutures

Increase in incidence in “ back to sleep”

Results from gravitational force on developing cranium

A

Positional Plagiocephaly

Therapeutic Management

Tummy time
Molding Helmet

64
Q

Common types of seizures include

A

Infantile spasms
Absence
Tonic- Clonic
Myoclonic
Atonic
Simple Partial
Complex Partial
Status Epilepticus

65
Q

Usually by age 4 or 5 more than half of children who have IS will develop other types of seizures

A

True
Higher risk of developing Autism

66
Q

Infantile Spasms Characteristics

A

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
Q

Treatment for Infantile Spasms

A

ACTH
Anti Seizure drug vigabatrin
Surgery if in brain lesion

67
Q

Criteria for Febrile Seizures

A

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
Q

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

A

Simple Febrile

69
Q

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

A

Complex Febrile

70
Q

Higher incidence in neonates due to immature brain

Metabolic, infectious, structural, and toxic diseases are likelyy to be seen in this group

A

Neonatal Seizures

71
Q

Associated with: Hypoxic Ischemia

Hypoglycemia and hypocalcemia

Infection

Intracranial Hemorrhage

A

Neonatal Seizures

72
Q

May causes ____________ with neonatal seizures

A

Neurodevelopmental Problems

Tx is Phenobarbital and correct underlying cause

73
Q

Common neurological emergency in children and can occur with any seizure activity

A

Status Epilepticus

Can be life threatening

74
Q

Prolonged or clustered seizures where consciousness does not return between seizures

Age, cause, an duration influence prognosis

Requires prompt medical attention

A

Status Epilepticus

75
Q

Tx of Status Epilepticus

A

Basic life Support- ABCs
Administration of anticonvulsants to cease seizure ex: lorazepam, diazepam, fosphenytoin

Blood glucose levels and electrolytes, evaluate the underlying cause

76
Q

Tonic and Clonic Seizures Interventions

A

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
Q

Antiepileptic Drugs include

A

Phenytoin, Carbamazepine, Valproic Acid

78
Q

Selective inhibition of sodium channels and is an antileptic drug

A

Phenytoin

79
Q

Suppresses high frequency neuronal discharge and is an antileptic drug

A

Carbamazepine

80
Q

Blocks sodium and calcium channels to prevent neuron firing

A

Valproic Acid

81
Q

What to watch for Antileptic Drugs?

A

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
Q

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

A

Seizure Precautions

83
Q

Nursing management of Seizures

A

Maintain Airway
Administer appropriate medication
Help family cope with challenges of chronic seizures

84
Q

Types of Infectious Disorders

A

Bacterial Meningitis
Aseptic Meningitis
Encephalitis
Reye Syndrome

85
Q

Rigid and arches their head back ( severe backward arching)

A

Opisthotonic Position

86
Q

Infection of the meninges, the lining that surrounds the brain and spinal cord

Can Lead to brain damage, nerve damage, deafness, stroke and death

A

Bacterial Meningitis

87
Q

Decreases with Hib vaccine

A

Bacterial Meningitis and Hib

88
Q

Bacterial Meningitis is a medical emergency that needs what two things started right away?

A

IV antibiotics
Corticosteroids

89
Q

Opithotonic position for infants and positive kernig and Brudzinski signs

A

Bacterial Meningitis

90
Q

Preceding URI or sore throat
Fever Chills
Headache
Vomiting
Rash
Irritability
Drowsiness, lethargy
Muscle rigidity
Seizures

A

Common S/S of Bacterial Meningitis

91
Q

Infants display poor sucking and feeding, weak cry, lethargy, vomiting

Bulging fontanel is late sign

A

Bacterial Meningitis

92
Q

Group Strep, S. pneumoniae, L. montocytogenes, E. Coli

A

Common bacterial for bacterial meningitis in NEWBORNS

93
Q

S. pneumoniae, N. meningitis, H influenzae, Group B strep, M. tuberculosis

A

Common bacterial for bacterial meningitis in Babies and young children

94
Q

N. Meningitis and S. pneumoniae

A

Common bacterial for bacterial meningitis in Teens and Young adults

95
Q

Labs and Diagnostic Testing for Bacterial Meningitis

A

LP
CBCs and WBCs
Blood, urine, and NP culture

96
Q

Nursing management of bacterial Meningitis

A

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
Q

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

A

Aseptic Meningitis

Viral

98
Q

Tx of Aseptic Meningitis

A

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
Q

Inflammation of the brain, often due to infection or unknown

A

Encephalitis

100
Q

S/S of Acute Encephalitis

A

Fever Headache
Bulging fontanels
Neck Stiffness
Sleepiness
Lack of energy
Increased irritability

101
Q

Tx of Encephalitis

A

Bed rest
Plenty of fluids
Corticosteroids
Prescription based anti-inflammatory drugs to fight fever

102
Q

Very rare and shows vomiting, diarrhea, rapid breathing, severe fatigue

A

Reyes Syndrome

Symptoms requiring emergency Tx include confusion, seizures, and LOC

Tx is supportive care and aggressive monitoring of complications

103
Q

Progressive encephalopathy with hepatic dysfunctions

Risk Factor is aspirin use and in born metabolism errors

A

Reye Syndrome

104
Q

Closed Head Injuries are graded on ?

A

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
Q

Leading cause of child mortality in the US

A

Trauma or Injury

106
Q

Common Causes of Head Trauma in Children

A

Falls
Motor Vehicle Accidents
Sports Injuries
Pedestrian and Bicycle Injuries
Child Abuse

107
Q

Causes of Nonaccidental Head Trauma

A

SBS
Blows to the Head
Intentional cranial impacts against the wall furniture, or the floor.

108
Q

2nd leading cause of unintentional injuries between ages 1-14 years of age

A

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
Q

Occurs less often than adults and many children will develop lifelong cognitive an motor impairments

A

cute Stroke in Children

Ischemic or Hemorrhagic

110
Q

More common stroke
Cardiac disorders, coagulation abnormalities, sickle cell, infection, arterial dissection, genetic disorders

A

Ischemic

111
Q

AVMs, aneurysms, coumadin, malignancy, trauma, hemophilia, liver failure, leukemia, intracranial tumors

A

Hemorrhagic

112
Q

S/S of Acute Stroke in Children

A

Weakness on one side
Facial Droop
Slurred Speech
Speech deficits

113
Q

What is important in reducing the risk of injury in children?

A

Safety

Having a neurological disorder can lead to lifelong impairment of individual’s physical, cognitive, and psychosocial functioning

114
Q

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

A

Promoting Child and Family Teaching

ADN005 Pediatrics (21 decks)

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