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NURS 332 > Chapter 27: Neurologic Dysfunction > Flashcards

Chapter 27: Neurologic Dysfunction Flashcards

1
Q

What are the main cerebral pediatric differences?

4 main differences

A
  • large head in proportion to body (chest circumference) – heavy skull
  • poorly developed neck muscles – greater risk for cervical spine injury
  • thin cranial bones
  • unfused sutures
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2
Q

What are the 3 things that we’re examining for with pediatric LOC?

A
  1. what stimuli is needed?
  2. what is the quality of the response?
  3. what is the length of the response?
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3
Q

What are the 4 types of concerning LOC?

A
  • confusion: disorientation to time, place, or person
  • delirium: characterized by confusion, fear, agitation, hyperactivity, or anxiety; like a behavioral component of confusion
  • stupor: response to vigorous stimuli only (sternal rub)
  • coma: severely diminished response
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4
Q

Describe the Glasgow coma scale?

A
  • the lower the score, the poorer the outcomes
  • 0 - 15 scale
  • loss of 1 point is pretty bad
  • loss of 2+ points, likely the pt will suffer from long-term neuro consequences
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5
Q

What are some s/s of increased ICP in infants?

10 s/s

A
  • irritability
  • poor feeding
  • high-pitched cry (cat-like cry)
  • inconsolable using conventional methods
  • tense and bulging fontanels
  • separated cranial sutures
  • setting-sun sign – visible eye whites above iris
  • scalp veins are distended
  • Macewen sign
  • increased occipitofrontal circumference
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6
Q

What are some s/s of increased ICP in children?

A
  • h/a
  • vomiting – w/ or w/o nausea
  • motor weakness
  • discoordination
  • seizures
  • diplopia
  • blurred vision
  • irritability, restlessness
  • behavioral changes
  • sleep alterations
  • somnolence – flat affect, problems staying asleep/waking
  • personality changes
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7
Q

What are some late s/s of increased ICP (for both infants and children)?

A
  • bradycardia
  • decreased LOC
  • decreased motor response to commands
  • decreased sensory response to painful stimuli
  • alterations in pupil size and reactivity
  • papilledema
  • flexion or extension posturing
  • Cheyne-Stokes respirations
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8
Q

What is the difference between decorticate and decerebrate posturing?

A
  • decorticate = flexion
  • decerebrate = extension
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9
Q

What are seizures?

A
  • abrupt, abnormal, excessive, and uncontrolled electrical discharges of neurons within the brain
  • seizures may be symptoms or a diagnosis
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10
Q

What is a tonic-clonic seizure?

A

seizures with visible movement

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11
Q

What is status epilepticus?

A
  • prolonged continuous seizure of 5 minutes
  • serial intermittent seizures lasting >15 minutes without return to baseline
  • medical emergency
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12
Q

What are febrile seizures?

5 aspects

A
  • these are specific to peds – occurs 6 months - 6 y.o.
  • parent hx of febrile seizures is common
  • fever is cause of seizure
  • the younger the child, the more likely febrile seizure will reoccur
  • sepsis evaluation/work-up determines if there is an infection causing the fever
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13
Q

What are important items to document for seizures?

5 items

A
  • time seizures began
  • order of events – aura, where it began, where it progressed to, length from beginning to post-ictal stage
  • associated symptoms
  • LOC
  • s/s when seizure stops
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14
Q

What are some interventions for seizures?

7 interventions

A
  • remain calm
  • stay with pt
  • protect pt from injury
  • keep pt warm
  • provide time for child to recover
  • reassure and support child and others
  • document
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15
Q

How are seizures diagnosed?

A
  • febrile = lumbar puncture
    – r/o meningitis which can cause seizures
  • seizures = EEG, electrolytes, MRI
    – EEG diagnoses if someone is currently having a seizure
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16
Q

How are seizures treated?

A
  • prevent with adequate fever control
  • meds:
    – phenobarbital or diazepam – only if second febrile seizure
    – valproic acid
    – phenytoin
17
Q

What is a major education topic for parents with a child with seizures?

A

diastat – rectal med admin for seizures

18
Q

There are 2 types of meningitis. Which is the worse one?

A

bacterial

19
Q

What causes bacterial meningitis?

A
  • caused by various bacteria
    – Step. pneumoniae
    – Neisseria meningitidis
    – GBS – infants < 2 months
    – Listeria monocytogenes – children 2 months - 17 y.o.
    – E. coli – rare after infancy
  • Hib and pneumococcal vaccines decrease incidence
20
Q

How is bacterial meningitis transmitted?

A
  • droplet transmission
  • risk increases with number of contacts
  • predominantly occurs in school-age children and teens
  • an extension of other bacterial infections through vascular dissemination –> organisms spread to CSF
21
Q

What are s/s of meningitis?

A

– newborns:
* poor muscle tone
* weak cry
* poor feeding
* bulging fontanels – late sign
– 2 months - 2 y.o.:
* seizures – high pitched cry
* fever
* nuchal rigidity
– 2 y.o. - adolescent:
* seizures
* nuchal rigidity
* positive brudzinski – flex head to chest while supine, involuntary flexion of knees = positive
* positive kernig’s – knee to chest flexion, then leg extension at knee – resistance or pain = positive
* fever
* h/a
* vomiting
* photophobia
* petechia
* irritability – coma

22
Q

How is bacterial meningitis diagnosed?

A

lumbar puncture
* bacterial:
– cloudy CSF
– increased WBCs
– increased protein count
– decreased glucose
* viral:
– clear CSF

can also diagnose with:
* CBC – elevated WBCs
* blood cultures

23
Q

How is bacterial meningitis managed?

8 management

A
  • seizure precautions
  • droplet isolation for 24H
  • vitals
  • neuro checks
  • dark, quiet environment – cluster care, no lights, no TV, no noise
  • monitor fluids to prevent overload
  • head circumference
  • meds:
    – IV antibiotics
    – corticosteroids – decrease inflammation and ICP
    – anticonvulsants
    – analgesics
24
Q

What is Reye syndrome?

A
  • toxic encephalopathy associated with other characteristic organ involvements
  • associated with aspirin use and influenza – or other viral infections where aspirin was given
25
Q

What are s/s of Reye syndrome?

5 s/s

A
  • fever
  • profuse vomiting
  • neurologic impairment
  • seizure
  • disordered hepatic function
26
Q

What is encephalitis? What are s/s?

A

– encephalitis: acute inflammation of the brain caused by a virus
* mosquitoes
* West Nile virus
* western equine virus
– s/s:
* fever
* irritability
* severe h/a
* bulging fontanel
* alternal mental status

27
Q

What is hydrocephalus?

A
  • “water on the brain”
  • increase in the amount of CSF in the ventricles and subarachnoid spaces of the brain
  • caused by obstruction to flow of CSF or impaired absorption of CSF
  • commonly associated with myelomeningocele (most severe form of spina bifida; both are neural tube defects)
28
Q

What are some s/s of hydrocephalus?

6 s/s

A
  • increased head circumference
  • split cranial sutures
  • high pitched cry
  • bulging fontanels
  • irritability
  • seizures
29
Q

What are some interventions for hydrocephalus?

A

VP or AV shunt (ventricle to peritoneum or ventricle to atrium)
* drains CSF from ventricles
* observe for vomiting, h/a, irritability, redness along shunt line or fluid leakage

30
Q

What is myelomeningocele?

A
  • neural tube defect present at birth that affects the CNS and osseous spine
  • posterior portion of vertebral laminae fails to close somewhere along spinal cord –> sac protruding containing CSF, meninges, and portion of spinal cord
31
Q

What are some s/s of myelomeningocele?

6 s/s

A
  • impairments depends on level of spinal injury
  • joint deformities
  • bowel and bladder incontinence
  • developmental delays – common s/s
  • hydrocephalus
  • latex allergy – unique to this
32
Q

What are some interventions for myelomeningocele?

7 interventions

A
  • protect sac from injury and infection – sterile, moist dressings; prevent pressure on back
  • surgery
  • straight cath
  • prevent latex allergy development
  • PT and other departments to address developmental delays
  • prevent neurogenic bladder and bowel
  • prevent skin, urine, and respiratory infections
33
Q

What is the major difference between pediatrics and adult pts who experience head injuries?

A

damage to intracranial contents – force of impact is greater than amount of support provided by skull and musculoligamentous system

34
Q

What kinds of head injuries are pediatric pts more susceptible to?

A

acceleration-deceleration (shearing) injuries

35
Q

What is a concussion?

6 aspects

A
  • transient state of neurologic dysfunction caused by a jarring of the brain
  • reversible
  • result of trauma to the head
  • instantaneous loss of awareness and responsiveness
  • can last minutes to hours
  • followed by amnesia and confusion
36
Q

How are head traumas treated?

5 interventions

A
  • NPO initially
  • possible surgery
  • frequent VS
  • frequent neuro checks
  • meds: analgesics and sedatives

NURS 332 (13 decks)

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