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PEDS > Week 7 > Flashcards

Week 7 Flashcards

1
Q

main differences between adults and children - cranium

A

CHILD
- skull and brain grow rapidly during early childhood = increased risk for brain injury
- top heavy as a child (head large in proportion to body)
- neck muscles not well developed
- thin cranial bones not well developed until 2

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2
Q

main differences between adults and children - cervical spine

A
  • excessive spinal mobility (immature muscles, joint capsule, ligaments, cartilagenous vertebral bodies, incomplete ossification
  • greater risk for high cervical spine injury at C1-C2 level OR compression fractures with falls`
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3
Q

3 meninges

A
  • dura mater
  • arachnoid membrane
  • pia matter
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4
Q

Dura mater - two spaces (2)

A
  • epidural space - between 2 dura mater layers
  • subdural space - between dura mater and arachnoid
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5
Q

Arachnoid mater - space

A
  • subarachnoid space - filled with CSF
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6
Q

Pia mater - what

A
  • contains arteries and veins that supply the brain
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7
Q

Cerebral blood flow - 3 characteristics

A
  • auto-regulation
  • oxygen
  • blood brain barrier
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8
Q

Cerebral blood flow - autoregulation

A
  • intracranial pressure –>
  • cerebral arteries change their diameter in response to fluctuating cerebral perfusion
  • Cerebral Perfusion Pressure (CPP) = MAP (mean arterial pressure) - Intracranial Pressure
    • CPP = MAP - ICP
  • IE - increased ICP = blood pressure must increase for perfusion
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9
Q

Cerebral blood flow - oxygen

A
  • needs alteration with temperature (ex fever = needs more oxygen)
  • brain sensitive to PaO2 and PaCO2
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10
Q

Cerebral blood flow - blood brain barriers

A
  • at birth, it is indiscriminate = allows passage of protein as well as oxygen and glucose (why meningitis is prevalent in this age group)
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11
Q

Neuro assessment - what (3)

A
  • level of consciousness
  • basics + more complex elements
  • head circumference
  • fontanels
  • suture lines in infants
  • Pupil size, shape, equality, light
  • developmental milestones
  • posture/movement
  • neck stiffness - meningitis ?
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12
Q

Neuro assessment - level of consciousness

A
  • Glasgow coma scale - Kidz edition
  • recognize caregiver?
  • irritable, difficult or calm to console
  • range is 3-15 (anything below an 8 you lose ability to protect airway effectively )
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13
Q

Neuro assessment - basics

A
  • allertness
  • ability to keep up with other children vs tires easliy with feeding or activity
  • sleep patterns
  • concentration, attention span, hyperactivity, memory or learning problems
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14
Q

Neuro assessment - more complex elements

A
  • seizures
  • fainting spells
  • dizziness
  • numbness
  • brain injuries
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15
Q

Neuro assessment - head circumferance (3)

A
  • hydrocephalus?
  • fontanels and sutures
  • palpation
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16
Q

Neuro assessment - fontanells (4)

A
  • closed?
  • flat and soft?
  • sunken?
  • full and bulging?
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17
Q

Neuro assessment - suture lines in infants

A
  • separated?
  • overriding?
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18
Q

Neuro assessment - pupils (4)

A
  • pupillary size
  • shape
  • equality
  • reqctive to light
  • PERRL
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19
Q

Neuro assessment - posture and movement

A
  • infant posture and movement = test via primitive reflexes
  • observe patient doing spontaneous activity
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20
Q

Neuro assessment - neck stiffness

A

meningitis ?!!!`

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21
Q

Elevated ICP

A
  • potentially devastating complication of neuro injury
  • often complication of traumatic brain injury
  • may occur in children with hydrocephaly, brain tumours, infectious hepatic encephalopathy, impaired central nervous system venous outflow (tumours)
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22
Q

Management of elevated ICP

A
  • early recognition and prompt management
  • TREAT = reduce ICP, correct original cause
    • ex a VP shunt
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23
Q

Pupils - coning

A
  • unequal size and shape of pupils
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24
Q

Pupils - bilateral dilation

A
  • can be from something as simple as a pupil dilator (ophthalmology)
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25
Q

Pupils - bilateral pinpoint

A
  • very sedated/high kids
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26
Q

Pupils - blown

A

can indicate brain death

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27
Q

Pupil - Unilateral dilated and reactive to light

A

can in indicate an intracranial mass

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28
Q

Pupil - Unilateral fixed and dilated

A

impending brainstem herniation

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29
Q

Pupil - Bilateral fixed and dilated

A

brainstem herniation from ICP

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30
Q

Flexor or Decorticate posturing (what, neuro associations)

A
  • characterized by rigid flexion (arms in, feet in)
  • associated with lesions above the brainstem int he corticospinal tracts
  • “decorticate = bring towards ‘Cort’’
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31
Q

extensor or decerebrate posturing (what, neuro associations)

A
  • characterized by rigid extension
  • associated with lesions of the brainstem
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32
Q

Causes of decreased LOC (10)

A
  • hypoxia
  • trauma
  • infection
  • poisoning
  • seizures
  • endocrine or metabolic disturbances
  • electrolyte or biochemical imbalance
  • acid base imbalance
  • cerebrovascular pathology
  • congenital structural defect
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33
Q

Traumatic head injury (4)

A
  • TBI is the leading cause of death or severe disability in children older than 1 year
  • most common cause of traumatic brain injury is fall
  • 61% children with moderate to severe TBI experience
  • even children without overt neuro deficits resulting from TBI can show impairment in academic performance, attention and concentration, memory, and executive function
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34
Q

Mild TBI

A
  • manifests as a concussion = biomechanically induced alteration of brain function affecting memory and orientation, may involve loss of consciousness
  • loss of consciousness sis not required for a diagnosis of concussion
  • a GCS of 14-15
  • computed tomography cannot be used to diagnose concussion and should generally be avoided to prevent unnecessary radiation exposure (can be used to rule out a more severe TBI)
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35
Q

Traumatic head Injuries - COACHV

A
  • C - cognitive function
  • O - oculomotor dysfunction
  • A - affective disturbances
  • C - cervical spine disorders
  • H - headaches
  • C - cardiovascular anomaly
  • V - vestibular dysfunction
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36
Q

Traumatic head Injuries - cognitive symptoms (3)

A
  • memory impairment
  • decreased attention and concentration
  • slowed processing speed
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37
Q

Traumatic head Injuries - ocular dysfunction (4)

A
  • convergence insufficiency
  • blurred vision
  • abnormal saccades/smooth pursuit
  • photophobia
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38
Q

Traumatic head Injuries - cervical spine disorders (4)

A
  • neck pain
  • headaches
  • dizziness
  • balance difficulty
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39
Q

Traumatic head Injuries - cardiovascular anomaly (4)

A
  • exercise intolerance
  • heart rate variability or elevation
  • postural orthostatic tachycardia syndrome
  • autonomic dysfunction
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40
Q

Traumatic head Injuries - affective disturbances (6)

A
  • fatigue
  • sadness
  • irritability’
  • sleep disturbances
  • poor concentration
  • emotionality

*could also indicate depression

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41
Q

Traumatic head Injuries - vestibular dysfunction

A
  • dizziness
  • vertigo
  • balance difficulties
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42
Q

Post-concussion syndrome - what (2)

A
  • sequela to brain injury with or without loss of consciousness
  • typically occurs after mild head injury (may also occur after moderate or severe)
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42
Q

Post-concussion syndrome - what (2)

A
  • sequela to brain injury with or without loss of consciousness
  • typically occurs after mild head injury (may also occur after moderate or severe)
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43
Q

Post-concussion syndrome - symptoms

A

at least 3 of the following (typically develop within days and resolve within 3 months:
- headaches (most common)
- dizziness
- light sensitivity
- fatigue
- nausea
- irritability
- restlessness
- difficulty concentrating memory impairment

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44
Q

Return to play progression: post concussion - stages

A
  • no activity
  • nonaerobic activity
  • light aerobic activity
  • moderate activity
  • heavy noncontact activity
  • full contact
  • competitive activities
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45
Q

Return to play progression: post concussion - no activity

A

complete physical and cognitive rest for 24-48 hours

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46
Q

Return to play progression: post concussion - nonaerobic activity

A

normal daily activities that do not provoke symptoms (reintegrate into work and school)

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47
Q

Return to play progression: post concussion - light aerobic activity

A
  • exercise bike, walking, light jogging at slow pace (no weights, jumping, running) (5-10 mins)
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48
Q

Return to play progression: post concussion - moderate activity

A
  • jogging, brief running, moderate intensity stationary bike, light resistance activities (limit body and head movement)
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49
Q

Return to play progression: post concussion - heavy noncontact activity

A

running, noncontact drills, weight lifting, stationary biking (cognitive activity during exercise can be added)

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50
Q

risk with getting concussion before 8

A

if a child experiences the first concussion before 8 their is twice the risk of sustaining a second concussion before 18

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51
Q

Moderate and severe TBI - classification

A
  • GCS - moderate - GSC score of 9-13
  • GCS - severe - less than 8
  • more severe injuries differentiated from mild based on clearer imaging findings
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52
Q

Differences between pediatric brain adult brain in and head trauma (3)

A
  • pediatric brain is more resilient to focal lesions (stroke, surgical excisions) due to plasticity
  • the younger a child is when experiencing a severe TBI the longer the take to recover
  • the morbidity from TBI seems to be significantly higher in children than adults (due to high water content and incomplete myelination)
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53
Q

Space-occupying traumatic brain injuries (3)

A
  • the most urgent clinical factor associated with TBI
  • rapid expansion of space-occupying lesions (ex bleeds, progressing edema)
  • post traumatic hydrocephalus is much less common in children than adults and can often be managed conservatively (negative need for decompression or evacuation)
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54
Q

Epidural hemorrhage (what)

A

bleed between skull and dura mater

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55
Q

subdural hemorrhage (what)

A

bleed under dura layer

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56
Q

subarachnoid hemorrhage (what)

A

bleed in subarachnoid space

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57
Q

Epidural hemorrhage - clinical picture (2)

A
  • low velocity falls, child abuse, motor vehicle accidents
  • clinical picture = momentary unconsciousness, followed by period of lethargy and coma (cushing triad: hypertension, widening pulse pressure bradycardia, respiratory depression)
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58
Q

Cushing triad

A
  • bradycardia
  • irregular respirations
  • widened pulse pressure
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59
Q

Subdural hemorrage - clinical picture

A
  • develop slow, spread thinly and widely
  • birth trauma, falls, violently shaking infants
  • irritability, vomiting, increased head circumferance, bulging anterior fontanelle, lethardy coma seizure
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60
Q

Monro-Kellie doctrine (3)

A
  • cranial cavity is a rigid sphere
  • filled to capacity with non compressible contents
  • increase int he volume of one of the constituents results in a rise in pressure
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61
Q

Monro-Kellie doctrine - compensation

A
  • may lose venous volume and CSF to compensate
  • once you run out of fluid you compress structures = they want a way out = impinge on brainstem = braindeath
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62
Q

Monro-Kellie doctrine - stages (4)

A
  • high compliance = compensation
  • decreasing compliance = compensatory reserve gradually depleted
  • minimal compliance = increased risk of cerebral ischemia and herniation
  • no compliance = collapse of cerebral microvasculature
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63
Q

Monro-Kellie doctrine - progression of ICP

A

NON-LINEAR - ICP increases rapidly

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64
Q

Measuring ICP - in the ICU

A
  • ICP monitor
  • EVD (extra-ventricular drainage device)
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65
Q

Increased intracranial pressure - early warning signs (10)

A
  • change in behaviours
  • irritability
  • high pitch cry
  • headaches
  • vomiting
  • dizziness
  • slight change in LOC
  • pupils slightly sluggish
  • sunsetting eyes
  • bulging fontanel/wide sutures
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66
Q

Increased intracranial pressure - late warning size

A
  • significant decrease in LOC
  • change in pupil response (ex fixed and dilated, pailledema
  • change in vital signs
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67
Q

Normal CSF pressures in children at time of lumbar puncture

A

12-28 centimetres of water
- ICP of 20 for greater than 5 minutes with signs and symptoms is threshold of treatment
- sneezing, coughing can cause transient increase, but sustained is abnormal
dont know #

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68
Q

Cushings triad

A
  • change in vitals = hypertension (change in pulse pressure, widening distance between systolic and diastolic pressures()
  • bradycardia
  • irregular respirations
69
Q

Nursing care for TBI - acute (7)

A
  • doctor set parameters to slow down body and brain metabolism
  • pain control
  • sedation
  • quiet dark room
  • temperature control (decrease)
  • HR and BP parameters
  • constant neurovitals and monitoring
70
Q

Nursing care for TBI - chronic (3)

A
  • all of the same for acute plus
  • treatment at rehab facility and support from PT/OT/Speech-language
  • psych consult for the new normal (HR increases, BP changes, metabolic requirements, cerebral perfusion pressures etc)
71
Q

Bacterial Meningitis - common population

A
  • seen in infancy, pre school aged
72
Q

Bacterial Meningitis - symptoms

A
  • prolonged fever
  • rash (non-blanchable)
  • irritability
  • decreased appetite
  • neck stiffness
73
Q

Bacterial Meningitis - common bacteria infants

A
  • group B strep
74
Q

Bacterial Meningitis - common bacteria other age groups

A

streptococcus pneumoniae

75
Q

Bacterial meningitis - prevention

A
  • VACCINATION
  • antibiotics (if mom is carrier for strep B)
76
Q

Bacterial meningitis - testing

A

lumbar puncture
- identify meningitis + which bacteria

77
Q

Epilepsy -

A

seizures

78
Q

Seizures types (3)

A
  • simple partial vs complex partials
  • generalized seizures (bilateral),
  • myoclonic, tonic clonic, atonic etc
78
Q

Seizures types (3)

A
  • simple partial vs complex partials
  • generalized seizures (bilateral),
  • myoclonic, tonic clonic, atonic etc
79
Q

Neural tube defects - what

A
  • congenital malformation of the central nervous system and surrounding tissue
  • occurs early in embryonic development (completed by day 26)
  • often results in miscarage or stillbirth
80
Q

Neural tube defects - prevention

A
  • folic acid supplementation **
  • more common if mothers drink excessively during pregnancy or if the mother is on anticonvulsants for seizure control
81
Q

Infant mortality risk with spina bifida

A

10%

82
Q

spina bifida - common population

A

hispanic mothers

83
Q

Types of neural tube defects

A
  • ancencephaly
  • encephalocele
  • spina bifida (3 types)
84
Q

Anencephaly

A

no development of the brain above the brainstem

85
Q

Encephalocele

A

protrusion of meningeal tissue or meningngeal-covered brain througha defect in the skull

86
Q

Spina bifida - types

A
  • occulta
  • meningocele
  • meningomyelocele
87
Q

Normal care of infant - considering neural tube defects

A
  • monitor for CSF leakage
  • integrety of sac
  • assess extremities for deformities
  • monitor vitals for s/s of infection (meningitis)
  • monitor for wound healing
  • measure head circumference daily (monitor hydrocephaly)
88
Q

Spina bifida - thoracic lesion

A

thoracic - sensory loss in legs, bowel and bladder incontinence, may stand with braces

89
Q

Spina bifida - Lumbar L1-L2 lesion

A

lumbar L1-l2 - may have hip flexion and adduction, can stand with braces, bowel bladder incontinence

90
Q

Spina bifida - L3 lesion

A
  • hip extension, may be able to extend their knees but nothing below (crutches and braces below)
  • bowel and bladder incontinence
91
Q

Spina bifida - L4-L5 lesion

A
  • flex hips extend knees
  • week or absent ankle/toe flexion/extension (need braces)
  • bowel and bladder incontinence
92
Q

Spina bifida - sacral lesion

A
  • mild weakness in ankles and toes
  • may walk 2-3 years, may need ankle braces
  • bowel and bladder MAY be affected
93
Q

Microcephaly - what

A
  • small brain with a head circumference greater than 3 standard deviations below the mean for age and sex (below 3rd percentile)
  • intellectual disability is common
94
Q

Microcephaly - cause

A
  • it may be caused by a genetic disorder
  • destructive insult during infancy, such as infection, metabolic disorder, hypoxia/ischemia
95
Q

Cerebral Palsy

A
  • describes a group of permanent disorders of movement and posture development
  • causes activity limitation (attributed to non-progressive disturbances that occur in developing fetal or infant brain
  • may also have disturbances in sensation, perception, cognition, communication, behaviour
96
Q

Cerebral Palsy - four types of motor dysfunction

A
  • spastic
  • dystonia
  • athetosis
  • ataxic
    • related to location of brain insult
97
Q

Cerebral Palsy - etiology (4)

A
  • abnormal muscle tone, lack of coordination
  • symptoms depend on age, pattern in extremities may very
    • (diplegia, hemiplegia, quadriplegia)
  • spasticity of muscles inhibits muscle growth
  • leads to contracture that limits joint movement, or deformities such as scoliosis or hip displacement
98
Q

Diplegia

A
  • both legs affected
99
Q

hemiplegia

A

one side of the body is involved
(in CP, the arm is usually more severely affected than the leg)

100
Q

quadraplegia

A

all four extremities are affected

101
Q

Cerebral Palsy - diagnostics (6)

A
  • clinical findings (delayed development, increased or decreased muscle tone)
  • difficult to diagnose early in life (must be different than other neuro conditions, s/s may be subtle)
  • ultrasound of head
  • neuromotor tests
  • genetic and metabolic tests (if anomalities are present)
  • CT and MRI to identify areas + determine cause (once CP is the likely cause)
102
Q

Spastic cerebral palsy - what (2)

A
  • cerebral cortex or pyramidal tract injury
  • 75% of cases
103
Q

Spastic cerebral palsy - symptoms

A
  • increased muscle tone through a joints ROM
  • positive babinski reflex
  • exaggerated deep tendon reflexes (clonus)
  • persistence of primitive reflexes
  • leads to contractures and abnormal curvature of the spine
104
Q

Dyskinetic Athetosis cerebral palsy - what (2)

A
  • extrapyramidal, basal ganglia injury
  • 10-15% of cases
105
Q

Dyskinetic Athetosis cerebral palsy - symptoms (3)

A
  • slow involuntary writhing motions that interfere with ability to maintain a stable posture
  • abnormalities of muscle tone that affect the entire body
  • difficulty with fine and purposeful movements or coordinating the timing of movement; tremors
106
Q

Dyskinetic Dystonia cerebral palsy - what (1)`

A

basal ganglia, extrapyramidal injury

107
Q

Dyskinetic Dystonia cerebral palsy - symptoms (3)

A
  • involuntary sustained muscle contractions leading to sustained or intermittent exaggerated and distorted posturing, twisting, repetitive movements
  • develops 5-10 years after myelination
  • rigid muscles when awake, normal or decreased muscle tone when asleep
108
Q

Ataxic cerebral palsy - what (2)

A
  • cerebellar (extrapyramidal) injury
  • 5%-10% of cases
109
Q

Ataxic cerebral palsy - symptoms (7)

A
  • irregularity in muscle coordination, tone, balance
  • abnormalities of voluntary movement involving balance, position of trunk and limbs, maintaining posture
  • difficulty controlling hand and arm movements during reaching (overshoot, past pointing)
  • increased or decreased muscle tone
  • hypotonia in first couple of years
  • muscle instability and wide based unsteady gait
  • intellectual disability
110
Q

Mixed Cerebral palsy (2)

A
  • injuries to multiple areas
  • no dominant motor pattern; may have mild spasticity, dystonia and/or athetoid movement
111
Q

Cerebral palsy - therapy goals (8)

A
  • half of infants suspected to be at risk for CP at age 1 are unimpaired neurologically by age 2
    • careful monitoring, early referral
  • goal = promote max level of independence and perform ADLs
  • referrals for PT, OT, SLP
  • prognosis depends on level of physical disability and presence of intellectual, visual, hearing deficits (early intervention)
  • some children can ambulate, others need assistance
  • swallowing and aspiration can be an issue (feeding is a challenge, may need G tube)
  • these children are usually cared for in their homes, some cases receive care in LTC facilities
112
Q

Cerebral palsy - nursing management

A
  • listen to caregivers
  • meds (clonazepam, Baclofen)
  • hydration/nutrition (feeds, IV)
  • skin - reposition q3Hr (air mattress, CHAIR)
113
Q

Febrile seizures

A
  • seizures in young ones triggered by fever (either occurs concurrently or fever onset after)
  • does not mean epilepsy
  • use fever lowering drugs (acetaminophen)
  • scares TF out of parents
114
Q

Epilepsy (3)

A
  • disorder of CNS
  • tendency for recurrent and spontaneous seizures
  • diagnosed when person experiences two or more seizures where the seizure is not result of a temporary known cause
115
Q

Seizure (3)

A
  • brief disturbance in the electrical activity of the brain
  • excessive and simultaneous firing of action potentials in brain
  • manifestation: alter in persons behaviour (depends on location in brain)
116
Q

Epilepsy - pathophysiology (3)

A
  • fast or long acting activation of excitatory receptors = increased neuronal signalling
  • dysfunctional GABA receptors –> less able to inhibit neuronal signals
    -RESULT = excess depolarization and hypersynchonization of neurons (seizure threshold exceeded)
117
Q

Categories of epileptic seizures (3)

A
  • focal/partial
  • generalized
  • secondary generalized
118
Q

Types of focal/partial seizures (5)

A
  • simple partial seizure
  • complex partial seizure
119
Q

Types of generalized seizures (5)

A
  • absence seizure
  • tonic/clonic seizure
  • myoclonic seizure
  • tonic seizure
  • atonic seizure
120
Q

Simple partial seizure

A
  • no loss of consciousness, symptoms based on brain location
121
Q

Partial complex seizure

A

-` loss of consciousness, symptoms based on brain location

122
Q

Absence seizure (3)

A
  • loss of consiousness
  • staring
  • behavioural arrest`
123
Q

Tonic/clonic seizure (2)

A
  • tonic period (rigid muscles) AND
  • clonic period (contracting muscles)
124
Q

Myoclonic seizure

A

sudden brief muscle contractions

125
Q

Tonic seizure (2)

A

muscle stiffening, loss of consiousness

126
Q

Atonic seizure

A
  • sudden loss of muscle tone (aka “drop seizures”)
127
Q

Seizure in parietal lobe (3)

A

affects touch, taste, temperature

128
Q

Seizure in occipital lobe (1)

A

affects vision

129
Q

Seizure in cerebellum (2)

A

affects balance, coordination

130
Q

Seizure in frontal lobe (1)

A

affects executive functions

131
Q

Seizure in temporal lobe (3)

A

affects hearing, memory, language

132
Q

Seizure in brainstem (3)

A

affects breathing, HR, BP

133
Q

Diagnosis of epilepsy (7)

A
  • medical history
  • bloodwork
  • neuro exam
  • EEG (electroencepholagram)
  • Brain imagine
  • MRI
  • seizure descriptions
134
Q

Diagnosis of epilepsy - age details

A
  • commonly diagnosed in early childhood, or over age 65
  • 50-60% of children will outgrow their seizures as an adult
135
Q

Treatment of epilepsy

A
  • meds (antiepileptic, AEDs)
  • medical devices to prevent and control seizures (3)
  • dietary therapies (2)
  • resective brain surgery
136
Q

Treatment of epilepsy - medical devices

A
  • vagal nerve stimulator
  • responsive neurostimulator
  • deep brain stimulator
137
Q

Treatment of epilepsy - dietary therapy

A
  • low glycemic index treatment
  • ketogenic diet
138
Q

Antiepileptic drugs - mechanism of action (4)

A
  • block sodium channels (phenytoin)
  • block VG calcium channels
  • glutamate antagonists
  • potentiate actions of GABA
139
Q

Antiepileptic drugs - side effects (4)

A
  • nausea
  • dizziness
  • sleepiness
  • double vision
140
Q

Nonpharmacological treatments for epilepsy

A
  • surgery
  • medical devices
  • lifestyle modifications (diet, aerobic exercise, music therapy, acupuncture, herbal remedies, etc)
141
Q

Nursing interventions during seizure (4)

A
  • recovery position
  • prevent injury
  • patent airway
  • comfort and safety
142
Q

Bacterial Meningitis - what

A
  • infection of meninges by a bacterial origin
143
Q

Bacterial meningitis - risk factors (4)

A
  • young age
  • group settings
  • preexisting medical conditions
  • travel
144
Q

Bacterial meningitis - complications (4)

A
  • seizures
  • brain damage
  • hearing loss
  • death
145
Q

Bacterial meningitis - symptoms (12)

A
  • fever
  • headache
  • stiff neck
  • non-blanchable rash
  • seizures
  • nausea
  • vomiting
  • photophobia
  • altered mental status
  • irritability
  • poor feeding
  • bulging fontanel in babies
146
Q

Assessment/diagnosis for meningitis (7)

A
  • vitals
  • neuro assessment
  • CBC
  • blood cultures
  • MRI/CT scan
  • CSF tap
  • Skin assessment
147
Q

Treatment for meningitis (4)

A
  • antibiotics
  • anticonvulsants
  • pain meds
  • corticosteroids
148
Q

Meningitis - inadequate tissue perfusion - assessments (4)

A
  • vitals
  • neuro status (signs of high ICP)
  • s/s of excess fluid
  • measure head circumference
149
Q

Meningitis - inadequate tissue perfusion - management (6)

A
  • monitor ABGs and O2 saturation
  • keep head/neck along midline
  • elevate bed to 30 degrees
  • administer O2 as needed
  • mannitol
  • anticonvulsants
150
Q

Meningitis - health history questions for the mother (9)

A
  • vaccination status
  • allergies
  • recent infections (UTIs)
  • birth/prenatal history
  • medical history
  • travel history
  • previous experience with meningitis
  • predisposing risk factors
151
Q

Pathophysiology of spina bifida

A
  • occurs in utero, evident at birth
  • spine does not form or close properly
  • presents with or without a herniated sac filled with spinal fluid
  • results in neuro defects
152
Q

Spina bifida oculta

A
  • neural tube defect, but spinal cord and meninges remain int he spinal column
153
Q

spina bifida cystica

A

meninges extend out of spinal column

154
Q

meningocele spina bifida

A

a sac with spinal fluid protrudes through spinal column

155
Q

Myelomeningocele spina bifida

A

a spinal fluid filled sac extends out of the vertebral column, containing the spinal cord

156
Q

Diagnosis of spina bifida (3)

A
  • ultrasound (can be suspected at second trimester fetal anatomy scan)
  • blood tests (can be suspected with elevated maternal serum alpha-fetoprotein [MSAFP])
  • if suspected, mother is referred to tertiary care centre for further imaging
157
Q

Spina bifida - nursing focuses (6)

A
  • mobility
  • hydrocephalus
  • GI
  • GU
  • integumentary
  • emotional support
158
Q

SPina bifidaMobility - complications (5)

A
  • alignment, muscle imbalance, sensory, hip problems, scoliosis
159
Q

Spina bifida mobility - treatment

A
  • braces, walkers, WC, PT, OT, etc.
160
Q

Spina bifida - growth and development - mobility (3)

A
  • delay in gross motor skills
  • increased weight gain and growth in adolescence
  • trend of increased WC reliance in adolescence
161
Q

Nursing role - spina bifida mobility (5)

A
  • promote safety and independence
  • functional equipment
  • good skin care
  • discus para sport (promote physical activity)
  • advocate for accessibility
  • health teaching
162
Q

Hydrocephalus - pathophysiology (4)

A

1) imbalance of CSF absorption/production
2) CSF volume increased in ventricals
3) increased intracranial pressure
4) brain damage

163
Q

Hydrocephalus - treatment

A

1) ventriculoperitoneal shunt placement
2) rapid surgical decompression
3) prophylatic antibiotics (prevent shunt infection

164
Q

Hydrocephalus - nursing role (5)

A

-vitals
- signs of ICP
- inspect shunt resevoir/tubing for s/s of infection
- neuro assessment, GCS
- measure head circumference

165
Q

Signs if ICP (5)

A
  • headache
  • nausea
  • vomiting
  • irritability
  • decreased LOC
166
Q

Gastrointestinal health - spina bifida - treatment

A
  • meds (fiber, stool softeners, etc)
  • nutrition
  • sacra nerve stimulation (prevent incontinence)
  • enema (malone aterogade enema)
  • diversion colostomy
167
Q

Gastrointestinal health - spina bifida - nursing role (4)

A
  • daily bowel movements
  • good nutrition and med admin
  • stoma care education/independence/self esteem/ decrease infection
  • emotional support
168
Q

Genitourinary Health - spina bifida - meds (4)

A
  • anticholinergic meds (kidney function)
  • alpha-adrenerguc antagonists (increase urin flow rate)
  • antibiotics (treat bladder/kidney inffections)
  • botulinum toxin injection (paralize external bladder sphincter to improve continence)
169
Q

Genitourinary Health - spina bifida - surgical procedures

A
  • stoma in umbilicus (for catheter)
  • bladder neck reconstruction

PEDS (9 decks)

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