X Neuro: Child (Ms Si) Flashcards
Meningitis
- Infection and Inflammation of meninges (surr Brain/SC)
- begins in resp tract and travels into blood then to Brain/SC
- Causes: Bacterial, Viral, Fungal (adults/pedes)
- Preventable w Vaccine (don’t mix vaccines)
Newborn
birth - 4 wks
Infant
1 mos - 12mos
Bacterial Meningitis: Causes
Newborn: group B strep; E.coli, Listeria, monocytogenes
Infant: strep pneumonia, Neisseria meningitides, Haemophilus influenza type b
Adolescents/Young Adults: Neisseria Meningitidis, Streptococcus pneumoniae
Meningitis: Infant: SS
-Irritability
-fever
-lots of sleeping
-poor feeding
-high pitch cry
-opisthotonos (arching of back)
-cries when picked up/being held
-inconsolable crying
-bulging Fontanelle
-noticeably diff temp
(non specific as SS are of a normal irritable child)
Meningitis: 1yr and older: SS
- neck/back pain
- HA
- Sleepiness
- confusion
- irritability
- F
- refusal to eat
- DEC LOC
- Sz
- photophobia
- N/V
- nuchal rigidity
- Kernig’s / BreZinskys sign
Meningitis:Dx
- med Hx
- analysis of CSF (lumbar punc, if meningitis present w show UP WBC, UP protein, LO BG, cloudy
- CT head ( IICP? If so don’t do lumbar px, treat w Abx)
Meningitis: MM
- IV Abx
- MED: Dexamethasone (steroid, LO inflam)
- Bed Rest
- fluid (isolation b/c airborne, 24hrs once IV Abx started
- Anticonvulsants
- Antipyretics
Meningitis: NI
- rapid ID of bacterial Men
- **Admin Abx
- Promote rest
- DEC environ stimuli (quite peaceful setting)
- Neuro checks
- Monitor VS
- Monitor I/O
- Provide support for child and fam
Bacterial Meningitis: Complications
-RARE
-hearing loss
-mem diff
-learning diff
-brain damage
-gait problems
-Sz
-Renal failure
-Death
-30% have neuro deficits after disease
Pg 1041
Hydrocephalus (water brain)
- buildup of excess CSF on brain
- CAUSE: imbalance of production and absorbtion
Brain Review
- 4 cavities (Ventricles), produce CSF
- CSF circulates thru brain, SC and nourish CNS before reabsorption into bloodstream
- CSF made in Choroid Plexuses (lateral /4th ventricle)
What part of brain is CSF made in?
Cerebrospinal fluid (CSF) is produced by the choroid plexus in the lateral, third, and fourth ventricles and circulates through the subarachnoid space between the arachnoid mater and the pia mater.
Hydrocephalus: causes
- obstruction in ventricle system stops CSF from flowing
- bloodstream not adequately re-absorbing CSF d/t hemorrhage in subarachnoid space. SA space has absorptive membrane, if brain is bleeding, it covers membrane and blocks re absorption of CSF.
- child’s brain produces excessive CSF d/t tumor in choroid plexus?
- Atresia (no duct or canal in ventricles)
Atresia
absence of a duct opening of canal
Hydrocephalus: SS
- huge head
- eyes bulge out
- downward cast gaze
- prominent scalp veins
- developmental delays
- constant sleepiness
- diff remaining alert
- poor appetite
- irritability
- severe V
- Sz
Hydrocephalus: Dx
-US
-MRI
-CT Scan
If prenatal, they can Dx in 3rd trimester
Hydrocephalus: Rx
-shunt VP (peritoneal) or VA (atria) shunt
(fluid exits brain and delievered into peritoneum or atria)
-endoscopic 3rd ventriculostomy (drill into ventricle, drain)
Hydrocephalus: NI
- neuro checks
- monitor IICP, VS, I/O
- emotional support and shunt education on complications and SS
Is a shunt a LT or ST fix?
Long Term
Shunt Complication Education
SEE PIC. basically all the SS of Hydrocephalus as the shunt malfunction would mean no relief from HE
Spina Bifida (split spine)
- permanently disabling birth defect
- defect in closure of neural tube
- neural tube develops into brain and sc
Neural Tube
develops into brain / SC
Spina Bifida: Types
- Spina Bifida Occulta (minor, most don’t even know, dimpling at coccyx, tuft hair, lump of fat)
- Meningocele
- Myelomeningocele (MOST SEVERE)
Spina Bifida: Meningocele
- meninges push out thru neural tube defect (only meninges push thru)
- SC develops normally
- Min - NO neural defects
- can be corrected
Spina Bifida: Myelomeningocele
-SC, meninges, CSF and nerves protrude
This is the type lay people are usually referring to when they say Spina Bifida
Spina Bifida: Myelomeningocele: SS
- absent motor/sensory fx beyond defect
- paralysis
- incontinence
- hydrocephalus in 80% cases
Spina Bifida: Myelomeningocele: Rx
- position on abd not back
- dressing: cover sac with moist saline guaze
- Sx
- shunt if hydrocephalus present (80%)
Lead Poisoning
- preventable
- blood level OVER 5 mcg/dl
- source: lead based paint /lead contaminated dust
- @risk: all children under 6
Lead Poisoning (more facts)
- excreted via GI/GU
- accum in bone
- chronic ingestion –> lead deposits into circulatory system
- 90% attach to erythroceytes (RBC)
- takes 2ce as long to excrete vs accumulate
Lead Poisoning: System Effects
- Hematologic System: prevents formation of HgB–> anemic
- Renal System: damages tubules –> renal failure
- CNS: UP membrane permeability –> UP ICP –> tissue ischemia/atrophy –> brain damage
Lead Poisoning: SS
- Anemia
- PICA (eating non edible things)
- Anorexia
- lethargy
- learning diff
- DEC attention
- hearing diff
- growth/dev failure
Lead Poisoning: Rx
- remove source of contamin
- balanced nutrition (absorb less lead that those w unbalanced nutrition)
- chelation therapy (levels 45 an UP)
- no MED Rx recom for kids levels lower than 45
- Iron supp
Neonatal Abstinence Syndrome (NAS)
- occurs when deloping feturs is exposed to opiods, antidepress, benzodiazepines, ETOH
- after birth, infant thru withdrawal
- d/t drug addicted mom
Neonatal Abstinence Syndrome (NAS): SS
- poor intrauterine growth
- premature birth
- low birth weight
- Sz
- Birth defects
- develop delays
- learning diss
- low IQ
Neonatal Abstinence Syndrome (NAS): more SS
- tremors
- irritability
- sleep problems
- high pitched cry
- tight muscle tone
Neonatal Abstinence Syndrome (NAS): even more SS
- hyperactive reflexes
- yawning
- stuffy nose
- poor feeding/sucking
- V/D/dehydration
- sweating
- F, labile Temp
- excessive sucking
Neonatal Abstinence Syndrome (NAS): NI
- quiet envnt
- swaddling
- pacifier (for excessive suck)
- IV fluid
- UP calories (b/c burn lots of calories w excess crying)
- BREASTFEED
Neonatal Abstinence Syndrome (NAS): MEDS
- Morphine (Opiods)
- Methadone
- Phenobarbital