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Pediatrics > Alterations in Neurological Function > Flashcards

Alterations in Neurological Function Flashcards

1
Q

Development of size of brain from birth

A

Birth: 1/4 of adult size
9 months: size has doubled
5-7: close to full weight
7-10: full weight

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2
Q

What age does the skull expand until?

A

2

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3
Q

CSF in infant vs adult

A

50ml vs 130-150ml

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4
Q

Nervous system __________ but _________ at birth

A

Complete but immature

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5
Q

Infants are born with all the _______ they will ever have

A

Nerve cells

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6
Q

What type of injury are infants at high risk for?

A

High cervical spine (C1-C2)

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7
Q

Myelination is incomplete until age

A

4

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8
Q

Development/Myelination proceeds in the

A

cephalocaudal direction

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9
Q

Head proportion infant vs adult

A

Infant: head proportionally large

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10
Q

Neck muscle consideration infant

A

poorly developed

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11
Q

Neck muscle consideration infant

A

poorly developed

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12
Q

Cranial bone consideration infant

A

thin, not well developed, unfused sutures, expands until age 2

prone to brain injury and skull fracture with falls

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13
Q

Infants have _____ spinal mobility

A

excessive

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14
Q

Describe the muscles, joint capsules and ligaments of the cervical spine of infant

A

immature, wedge-shaped, cartilaginous, incomplete ossification

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15
Q

What may cause infant/child to not respond when doing neuro assessment/alter GCS score?

A

deep sleep
unfamiliar voices
sedation

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16
Q

7 General Points of Neuro Assessment

A
  1. LOC/GCS
  2. Head Circumference
  3. Vital Signs
  4. Cranial Nerve Function
  5. Pupil Function
  6. Reflexes
  7. Signs of ICP
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17
Q

Cushing’s Triad

A

Signs of acute elevation of ICP

  1. bradycardia
  2. widening pulse pressure (difference in systolic and diastolic)
  3. irregular respirations
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18
Q

Early ICP signs

A
  1. headache
  2. repetitive vomiting
  3. visual disturbances
  4. slight VS changes
  5. slight LOC changes
  6. seizures
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19
Q

Considerations of ICP assessment in infants

A

Cannot verbalize: headache, visual disturbances, LOC changes

Assess:
- bulging fontanelles
- increased head circumference
- irritability/high pitched cry
- dilated scalp veins
- widening sutures

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20
Q

Late signs of increases ICP

A
  • significant decrease in LOC
  • decreased motor/sensory responce
  • bradycardia
  • irregular respirations
  • posturing
  • fixed/dilated pupils
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21
Q

Posturing is a ___________

A

Very late and serious sign of alterations in neuro status/increased ICP

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22
Q

Decorticate posturing

A

Flexor - abnormal flexion of the arms with extension of the legs

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23
Q

Decerebrate posturing

A

Arms and legs being help straight out, toes pointed downward, and head/neck being arched backward

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24
Q

What is the most important indicator of neurologic dysfunction?

A

level of consciousness

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25
Q

How can you describe LOC?

A

Conscious (alertness and cognition) or unconscious

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26
Q

Alertness

A

ability to react

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27
Q

Cognition

A

processing of data/response

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28
Q

Meningitis definition

A

Inflammation of the meninges

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29
Q

Most common infectious process affecting CNS

A

Meningitis

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30
Q

Many of the bacteria or viruses that can cause meningitis are:

A

fairly common and are more often associated with other everyday illnesses.

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31
Q

Where does meningitis usually originate?

A

Any source: skin, GI, GU

Most common: respiratory

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32
Q

Most common symptoms of meningitis

A

Fever, headache, lethargy, irritability, confusion

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33
Q

Manifestation of meningitis in younger children

A

o Bulging fontanelles
o poor feeding or sucking
o high pitched/different cry
o lethargy
o hypothermia
o apnea,
o seizures
o rash
o irritability
o inconsolable crying.

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34
Q

Manifestations of meningitis in older children

A

o a headache
o photophobia (eye sensitivity to light)
o stiff neck
o Skin rashes

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35
Q

Brudzinski’s sign and Kernig’s signs are signs of

A

Meningitis

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36
Q

Brudzinski’s sign

A

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

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37
Q

Kernig’s sign

A

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

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38
Q

Bacterial meningitis comparison to viral

A
  • less common
  • more serious/life threatening
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39
Q

Bacterial Meningitis Incidence

A

Common in very young and very old

Teenagers have more risk because of time spent in close contact with peers

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40
Q

Viral meningitis incidence

A

More common in children

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41
Q

Meningitis cause birth-3 months (neonatal)

A

GBS and E.Coli

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42
Q

Meningitis cause 3mon-6years

A

o Neisseria meningitis (meningococcal)
o Haemophilus Influenza Type B
o Streptococcus pneumoniae (pneumococcus)

Vaccine preventable

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43
Q

Older children and adolescent meningitis cause

A

o Streptococcus pneumoniae (pneumococcus)
o Meningococcal Meningitis

Vaccine preventable

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44
Q

Aseptic Meningitis

A

Any type that isn’t bacterial

Bacteria do not grow in cultures of the cerebrospinal fluid

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45
Q

Aseptic meningitis is characterized by

A

headache, fever, and inflammation

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46
Q

Viral meningitis is relatively ________ and far less ______ than bacterial meningitis

A

common
serious

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47
Q

Treatment for viral meningitis is

A

symptomatic and supportive

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48
Q

If a patient presents with signs of meningitis, what is the immediate management?

A

Lumbar puncture, bloodwork and begin antibiotics immediately because of how serious, if suspected. If bloodwork returns viral then antibiotics stop

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49
Q

Diagnosis of meningitis

A
  1. lumbar puncture
  2. bloodwork
  3. prevention
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50
Q

WBC in meningitis

A

increased in LP and BW

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51
Q

Glucose in LP for meningitis

A

decrease

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52
Q

Protein in LP for meningitis

A

increased

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53
Q

Appearance of CSF in LP for meningitis

A

cloudy r/t presence of proteins

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54
Q

Encephalitis defintion

A

inflammation of the brain, but it usually refers to brain inflammation caused by an infection or toxin which results in edema and neurological dysfunction.

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55
Q

True or false: encephalitis is a common disease

A

False: rare disease that only occurs in approximately 0.5 per 100,000 individuals

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56
Q

Symptoms of encephalitis

A
  • Severe headache
  • Fever
  • Nausea and vomiting
  • Stiff neck
  • Dizziness
  • Ataxia
  • Convulsions (seizures)
  • Sensory disturbances
  • Drowsiness
  • Coma
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57
Q

Causes of encephalitis

A
  • Herpes Simplex Virus (HSV)
  • Ticks
  • Mosquitoes
  • Measles, mumps, chickenpox, rubella (German measles) - (MMR Preventable) and mononucleosis.
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58
Q

Untreated infants with HSV encephalitis have a _____ mortality rate

A

85%

59
Q

Early treatment of HSV encephalitis decreases mortality rate by

A

50%

60
Q

Prevention of neonatal HSV

A
  • c section
  • contact drainage
  • secretion precautions
  • oral acyclovir or valacyclovir during in the last few weeks of pregnancy to women with a history of genital HSV may prevent recurrences at the time of delivery and decrease the need for cesarean delivery.
61
Q

Encephalitis diagnosis

A
  • CT/MRI
  • EEG
  • LP
  • BW
62
Q

Treatment of Encephalitis

A

Prevention and Symptom Management

  • antivirals
  • corticosteroids to reduce inflammation
  • anticonvulsants PRN symptom management
  • antipyretics PRN symptom management
63
Q

How can you prevent Encephalitis

A

cannot be prevented except to try to prevent the illnesses that may lead to it.
o Prevent mosquito and tick bites
o Immunization.

64
Q

Seizure

A

an involuntary contraction of muscle caused by abnormal electrical brain discharges.

65
Q

Status Epilepticus

A

Prolonged and clustered seizures in which consciousness does not return between seizures

66
Q

Intractable seizures

A

Seizures that continue to occur even with optimal medication management.

67
Q

Epilepsy

A

reoccurring seizures that have no immediate underlying cause or an underlying problem that cannot be corrected

68
Q

Seizures often result from

A

acute brain insults such as trauma or infection

69
Q

Peak incidence of seizures

A

neonatal period and infancy.

70
Q

what percent of childrenin NICU will have seizures

A

1.5-5%

71
Q

Primary causes of seizures in NICU

A

Rx for hemorrhage and ICP

72
Q

Classification of seizures

A
  1. Partial/Focal: simple v complex
  2. Generalized: absence v atonic v myoclonic v tonic clonic
73
Q

Partial Seizure

A

electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain).
* Partial seizures may spread to cause a generalized seizure

74
Q

Simple Partial Seizure (4 components)

A
  1. no LOC change
  2. motor twitch
  3. autonomic response (increase HR, sweating, pupil dilation)
  4. sensory symptoms (alteration to taste, smell)
75
Q

Complex Partial Seizures (5 components)

A
  1. impaired LOC
  2. altered mental status
  3. unilateral tonic clonic movement
  4. period of confusion, lethargy, sleep following
  5. difficult to control
76
Q

Generalized Seizure

A

affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure.

impair consciousness, either briefly or for a longer period of time

77
Q

Absence Seizures

A

are lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds.

78
Q

Is there a warning sign or after effect with absence seizures?

A

No

79
Q

Onset of absence seizures

A

Uncommon before age 5

80
Q

How long do absence seizures last

A

less than 30 seconds

81
Q

Frequency of absence seizures

A

Frequent attacks: (50-100/day), interferes with school and learning.

82
Q

Atonic seizures

A

produce an abrupt loss of muscle tone. They produce head drops, loss of posture, or sudden collapse.
Child loses consciousness.

83
Q

Myoclonic seizures

A

rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body.
Occasionally, they involve one arm or a foot, sudden jerks or clumsiness.
Child may or may not lose consciousness.

84
Q

Loss of consciousness myoclonic vs atonic

A

Atonic: lose consciousness
Myoclonic: may or may not lose consciousness

85
Q

Most common and best known type of generalized seizure

A

Tonic Clonic

86
Q

Tonic vs Clonic phase of tonic clonic seizure

A

o Tonic phase: begin with stiffening of the limbs followed by
o Clonic phase: jerking of the limbs and face

87
Q

Onset of infantile spasms

A

3-12 months

88
Q

Do infantile spasms alter consciousness

A

May occur with altered consciousness

89
Q

Occurence of infantile spasms

A

5-150 a day

90
Q

True or false infantile spasms decrease with intensity and duration over time

A

False they increase

91
Q

6 causes of seizures

A
  • fever
  • genetics
  • cerebral lesions
  • progressive brain disease (rare)
  • head trauma
  • infections
92
Q

Diagnosis r/t seizures

A

MRI
CT
EEG
Videos/description from parents and family

93
Q

Use of MRI/CT for seizure diagnostic

A

diagnose cause - infection v trauma

94
Q

Consideration of EEG for seizure diagnosis

A

where the seizure is occurring in brain – not always able to obtain when seizure is occurring

95
Q

Rescue Agents for Status Epilepticus

A

Benzodiazepine

intranasal midazolam or rectal diazepam

96
Q

Medication treatment following seizure activity

A

Phenobarbitol: rescue agent - not always first choice

Tegretol/Carbamazepine: management of various seizure types, particularly focal and generalized tonic-clonic seizures

Dilantin/Phenytoin: long term prevention/control of epilepsy

97
Q

Who is a ketogenic diet used for in seizure treatment

A

under age 8 years with myoclonic and absence seizures.

98
Q

Describe ketogenic diet

A

90%fat, adequate protein and low intake of carbohydrates.

99
Q

What is an extra-temporal cortical resection?

A

resection of the brain tissue that contains a seizure focus.

100
Q

What is the most common extratemporal site for seizures

A

frontal lobe

101
Q

What is a functional hemispherectomy?

A

One hemisphere is removed, corpus callosum cut, disconnecting communication between the 2 hemispheres to prevent the spread of seizures to functional side

102
Q

What is cannabis used for in pediatric epilepsy

A

Drug resistant epilepsy

103
Q

6 Nursing Diagnosis for Seizure Management

A
  • Ineffective breathing Pattern – AIRWAY #1
  • Risk for inadequate oxygen exchange.
  • Risk for injury
  • Risk for Aspiration
  • Ineffective therapeutic regimen management.
  • Potential for inadequate cerebral perfusion
104
Q

6 Nursing Interventions for Seizure Management

A
  • Maximize airway
  • Oxygen
  • Safety-suction
  • Medication
  • Monitor electrolytes (lowering of sodium following protocol to assure it does not cause)
  • Maintain nutrition and fluid balance
105
Q

Spina Bifida

A

any congenital defect involving insufficient closure of the spine.

106
Q

When does spina bifida occur?

A
  • Is a neural tube defect that occurs during the first month of pregnancy.
107
Q

3 most common types of spina bifida

A
  1. myelomeningocele
  2. meningocele
  3. occulta
108
Q

Myeolmeningocele

A

Most common and severe type of spina bifida

Spinal cord and nerves protrude through back

109
Q

Meningocele

A

Spinal cord does not protrude, only meninges

110
Q

Occulta

A

Hidden spina bifida, small gap in spine but no opening or sac

111
Q

Myelomeningocele (most serious) accounts for about ____ of all cases of spina bifida and may affect as many as ____________

A

75%

1 out of every 800 infants.

112
Q

Main cause of neural tube defects

A

Folate deficiency

113
Q

Secondary to maternal folate deficiency, what other factor could cause fetal folate deficiency?

A

maternal inability to metabolize folate caused by genetic predisposition

114
Q

4 Symptoms of Spina Bifida

A
  1. partial/complete paralysis/loss of sensation of the legs
  2. loss of bladder/bowel control depending on level of the spine
  3. hydrocephalus
  4. Sac like protrusion
115
Q

What places a child with spina bifida at increased rx for latex allergy

A

Frequent self catherizations

116
Q

Spina Bifida Diagnosis

A
  1. neuro exam
  2. BW
  3. prenatal US
  4. amniocentesis
117
Q

What would the neuro exam of a child with spina bifida show?

A

indicate loss of neurologic functions below the defect.

118
Q

What would the BW of a women carrying a child with spina bifida show?

A

Eighty-five percent of women carrying a fetus with spina bifida will show elevated maternal serum alpha fetoprotein.

119
Q

What is the treatment of spina bifida?

A

early surgical repair - fetal spina bifida surgery

120
Q

When is fetal spina bifida surgery completed?

A

Prenatal repair of myelomeningocele is performed between 19 and 25 weeks’ gestation.

121
Q

Research shows that fetal spina bifida surgery does what 3 things:

A
  1. reduces need for shunt
  2. improves mobility
  3. improves odds child will walk
122
Q

Risk associated with fetal spina bifida surgery

A

preterm birth resulting in immediate fetal death or preterm labor and delivery due to stimulation of uterus later on

123
Q

Antiseizure medications should be _________ rather than ________

A

tapered slowly

stopped suddenly

124
Q

Medications used for active seizure

A

Midazolam, Lorazepam

125
Q

Why does hydrocephalus develop?

A

an imbalance between the production and absorption of cerebral spinal fluid (CSF).

126
Q

In hydrocephalus, what does CSF build up cause?

A

abnormal enlargement of the ventricles in the brain.

127
Q

What are kids with hydrocephalus commonly in the hospital for?

A

shunt malfunctions or infection

128
Q

Signs and Symptoms of Hydrocephalus

A
  • An unusually large head (only for kids up to 3 because after that sutures have fused)
  • A rapid increase in the size of the head
  • Bulging anterior fontanel
  • Vomiting (because of increased pressure)
  • Sleepiness
  • Irritability
  • Seizures
  • Eyes fixed downward (sunsetting of the eyes)
  • Blurred or double vision
129
Q

2 Types/Causes of Hydrocephalus

A
  1. Obstructive/Non Communicating
  2. Nonobstructive/Communicating
130
Q

Obstructive Hydrocephalus

A

results from an obstruction within the ventricular system of the brain that prevents CSF from flowing or “communicating” within the brain.
o Ex. Tumor, abnormal bone structures

131
Q

Non-obstructive Hydrocephalus

A

results from problems with the production or absorption of CSF; inability to absorb

132
Q

Treatment of Hydrocephalus

A

re-establish the balance between CSF production and reabsorption.
o lumbar puncture
o Shunt insertion
o Tumor removal

133
Q

3 Complications of VP Shunts

A
  1. mechanical failure
  2. shunt infection
  3. blocked shunt
134
Q

Mechanical failure of a shunt results in

A

Alterations in amount of CSF (over or under drainage) from blockage of catheter or failure of valve system

135
Q

Infection of VP shunt leads to need for

A

External shunt utilized to brain infected fluid NOT into peritoneal cavity

136
Q

How is shunt infection treated

A

Vancomycin directly into brain

137
Q

A blocked shunt leads to ______. How is it diagnosed?

A

Increased ICP

MRI/CT/LP

blocking can happen at various levels throughout shunt

138
Q

4 Key components of care of external ventricular device shunt

A
  1. clamp every time
  2. maintained at level of ventricles
  3. sterile technique
  4. measure CSF output Q1h
139
Q

What is vancomycin used to treat?

A

Treatment of patients with Infections due to MRSA, Meningitis, endocarditis, osteomyelitis.

Infections associated with CVLs, VP shunts vascular grafts and prosthetic heart valves.

140
Q

Ativan Class, Action, Side Effects

A

Class: Benzodiazepine.

Action: Enhances the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, in the central nervous system. This results in calming effects.

drowsiness, dizziness, and the potential for dependence or withdrawal symptoms with long-term use.

141
Q

Phenobarbital Class, Action, Side Effects

A

Class: Barbiturate.

Action: Enhances the action of GABA, leading to increased chloride ion influx, which inhibits neuronal activity. It also has anticonvulsant properties.

sedation, dizziness, respiratory depression (at high doses), and the risk of dependence.

142
Q

Dilantin class, action, side effects

A

Class: Hydantoin.

Action: Stabilizes neuronal membranes by inhibiting sodium influx during depolarization. This helps prevent repetitive firing of neurons.

Side effects may include gingival hyperplasia, drowsiness, dizziness, and, at high levels, potential for toxicity (such as ataxia and nystagmus).

143
Q

Tegretol class, action, side effects

A

Class: Anticonvulsant.

Action: Blocks voltage-gated sodium channels, reducing the excitability of neurons. It also has mood-stabilizing properties.

Side effects may include dizziness, drowsiness, and, in some cases, skin reactions (e.g., Stevens-Johnson syndrome). Blood counts and liver function should be monitored.

144
Q

Valproic Acid class, action, side effects

A

Class: Anticonvulsant.

Action: Increases GABA levels, blocks sodium channels, and may inhibit certain excitatory neurotransmitters. It has broad-spectrum anticonvulsant effects.

Side effects may include weight gain, gastrointestinal disturbances, and, rarely, hepatotoxicity. It may also cause sedation and hair loss.

Pediatrics (12 decks)

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