Care Of The Child With Neurological Disorders Flashcards by Jade Ring

Expected closure of the

Anterior Fontanel….

Posterior Fontanel….

Anterior (Front) Fontanel: 7 -18 months

Posterior (Rear) Fontanel: 2 - 3 months

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A suture in the skull is a fibrous joint that connects the bones of the skull

The spaces where sutures meet are called _____ (soft spots).

fontanelles

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5 states of consciousness

Full consciousness
Confusion
Obtunded
Stupor
Coma

cannot be aroused even with painful stimulation

limited response and falls asleep unless stimulated

disoriented, responds inappropriately

only responds to vigorous stimulation

Full consciousness: A & O x4 / age appropriate behavior

Confusion: disoriented, responds inappropriately

Obtunded: limited response and falls asleep unless stimulated

Stupor: only responds to vigorous stimulation

Coma: cannot be aroused even with painful stimulation

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Posturing Description:

Arms flexed tightly to the chest

Legs extended and internally rotated

Feet plantar flexed

Indicates:

Damage to the cerebral cortex or above the brainstem (e.g., internal capsule, thalamus)

Posturing Description:

Arms extended and rotated outward

Wrists flexed, fingers curled

Legs extended with plantar flexion

Indicates:
Damage to the brainstem (below the red nucleus,

Decorticate / Decerebrate

Decorticate

Arms flexed tightly to the chest

Legs extended and internally rotated

Feet plantar flexed

Indicates:
Damage to the cerebral cortex or above the brainstem (e.g., internal capsule, thalamus)

Decerebrate Posturing
Description:

Arms extended and rotated outward

Wrists flexed, fingers curled

Legs extended with plantar flexion

Indicates:

Damage to the brainstem (below the red nucleus,

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Categories for Glasgow coma scale…

Eye opening

Motor response/ movement

Verbal Response

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Age < 3 years: 4
3–7 years: 3
7–13 years: 2
>13 years: 1

Gender

Male: 2
Female: 1

Diagnosis
Neurological / Metabolic / Seizures 4

Respiratory / Cardiac / Other 3

Other diagnoses 2

Cognitive

Not aware of limitations 3
Forgets limitations 2
Oriented to own ability 1

Environmental Factors

History of falls, sedated, traction: 4
Crutches / IV / Drainage tubes :3
None 2

Response to Surgery / Sedation

Anesthesia Within 24 hours: 3
Within 48 hours, 2
> 48 hours / None 1

Medication Usage:
On sedatives, anticonvulsants, etc. 3
On 1 high-risk med 2
None 1

Risk Levels….

Risk levels:

< 12 = Low risk

≥ 12 = High risk

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Procedure to diagnose hemorrhage or infection in the cranium……

CSF analysis

Contraindicated with increased ICP

Lumbar puncture

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X ray with an injection of contrast media.

Used to observe blood flow

Procedure….

Cerebral angiogram

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Diagnose seizures or brain death, evaluates tumors / hemorrhages

Measures electrical activity in the brain

Electroencefalogram

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Intercrainal pressure monitoring.

Device placed in head

Can drain CFS to reduce ICP

______ is the gold standard for ICP measurement.

Direct ventricular pressure measurement

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Detects

Brain death
Localized seizures
Tumors
Encephalitis
Hydrocephalus

Uses radiopharmaceuticals.

Single- Photon Emission Computed Tomography (SPECT)

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Increased ICP is often caused by Neurological Disorders

Normal ICP

Adult…
Children…
Infants…

Adult <15

Children 3 - 7

Infants 1.5 - 6 mm Hg

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Early or Late signs of increased ICP

Headache
Vomiting Projectile
Visual changes
Dizziness
Decreased HR & RR

Early

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Early or Late signs of increased ICP

Changes in pupils reactions
Sunset eyes
Changes in LOC
Seizures
Bulging fontanel
Increased circumference of head (Infants)

Early

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Early or Late signs of increased ICP

Decreased LOC
Depressed motor / sensory response
Bradycardia
Irregular respiration
Cheyne-strokes
Decerebrate / decorticate posture
Fixed & Dilated Pupils

Late signs

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Most seizures are causes by disorders outside the brain

Fever, metabolic compromise, toxins/drugs, HTN

Stroke, neoplasm, congenital brain abnormalities, trauma

Diffuse brain dysfunction

Fever, metabolic compromise, toxins/drugs, HTN, infection

Focal brain dysfunction
Stroke, neoplasm(tumor), congenital brain abnormalities, trauma

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A seizure that does not respond to standard treatments, including antiepileptic medications. These are also called drug-resistant seizures and often require alternative therapies like surgery, vagus nerve stimulation, or ketogenic diet.

Refractory/Intractable Seizure

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A medical emergency defined as a seizure lasting longer than 5 minutes or repeated seizures without regaining consciousness between them. It can lead to brain damage or death if not treated promptly.

Status Epilepticus:

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A subjective sensation or experience that precedes a seizure, often acting as a warning sign. Auras can include visual changes, strange smells, deja vu, or emotional shifts and are technically considered focal aware seizures.

Aura

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Involuntary, repetitive movements or behaviors that occur during certain types of seizures (often complex partial seizures). Examples include lip smacking, chewing, fidgeting, or wandering without awareness.

Automatism:

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Recurring and unprovoked seizures is called…

Epilepsy

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Valproic Acid (Depakote)
Levetiracetam (Keppra)
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)

Laser Interstitial thermal therapy

Resection: hemispherectomy, focal Resection, Corpuscular Callosotomy

Ketogenic diet

Vagal nerve stimulator Placement

Treatment for..

Childhood epilepsy

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Tonic clonic is a type of generalized seizure

What do the words mean…

Tonic: stiffen

Clonic: rhythmic Jerking

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Generalized seizures affect both sides of the brain

Give 3 examples…

Tonic clonic
Absence seizure
Atonic seizure

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Generalized (both sides of brain) seizures Tonic-clonic Absence Atonic Muscles suddenly become limp Short period of "Blanking Out Stiffening & rhythmic Jerking

Tonic-clonic Stiffening & rhythmic Jerking Absence Short period of "Blanking Out" Atonic Muscles suddenly become limp

Focal (1 side of the brain) seizures Focal Aware Seizure (Simple Partial) Person is awake and aware but may have unusual sensations, emotions, or movements (like an aura). Focal Impaired Awareness Seizure (Complex Partial) Person is confused or unaware; may have automatisms (lip-smacking, picking at clothes). True or False

True

Ataxia....

Ataxia refers to lack of coordination or control over voluntary muscle movements, unsteady movements, difficulty with balance, and fine motor problems: writing or speaking

Antiepileptic drugs SE...

Allergic reactions Sleepiness Changes in mood/behavior Vision changes Ataxia

Febrie seizures happen in children 6 months - 5 years with a temp higher than ____ without another possible cause of seizure.

38°c

Febril seizures peak between 12 - 18 months and are more common in males than females. Use antipyretic to reduce fever T or F

Neonatal seizures are treated aggressively to prevent brain damage. Causes: Hypoxic ischemic encephalopathy Metabolic disorders Neonatal infection Infraction/ hemorrhage When is the Neonatal period...

First 4 weeks of life

Safety precautions for seizures...

Oxygen & bag/mask Suction & yanker Padded rails Continuous monitoring PRN meds

Management of Status Epilepticus Support vital functions how... Check blood glucose... (T or F) Administration Oxygen IV Medication.... If not IV...

Vital functions CAB - Circulation, Airway, breathing True check BS IV lorazepam (Ativan) fast onset 2 - 5 min & long half life 12 - 24 hrs Rectal diazepam 15 min onset Or IM, intranasal, buccal Midazolam 8min onset

Status Epilepticus If IV / rectal lorazepam or IM, intranasal, buccal Midazolam are ineffective Give....

IV Phenytoin, fosphenytoin, phenobarbital

Difference in mode of meningitis contagion. Direct vs secondary...

Direct: LP, Injury, surgery, implants Secondary: ear, sinus, upper respiratory infection

Viral antibiotics or nonsteroidal anti-inflammatory drugs (NSAIDs) Autoimmune May cause inflammation that can cause meningitis. It is typically considered more serious than bacterial meningitis. T or F

F It usually resolves on its own but still very serious

Assessment Findings of Bacterial meningitis HA Photophobia Nuchal rigidity Rash Irritation Lethargy Stiff muscles Seizures Name posistion infant might be displayed in.... Name 2 signs that are associated with bacterial meningitis...

Opisthotonic: back arched, head back, side laying Brudzinski: Laying, pull neck towards chest and legs go up Kernig: supine, flex leg 90°, attempt to straighten if pain is worse in head / neck positive sign

Ages most at risk for bacterial meningitis...

1 month - 1 year & 15 - 24 yrs

Bacterial meningitis has this type of precaution...

Droplet precaution for atleast 24 hours after the start of antibiotics Gloves, masks, possibly gown

Treatment for bacterial meningitis (5)

1. LP & Culture 2. Antibiotics 3. Corticosteroids 4. Supportive measure 5. Education

In addition to being less serious than bacterial meningitis, Aseptic meningitis is also the most common. Treatment is usually supportive T or F

Fungal, bacterial, viral, protozoan invasion can cause cerebral edema and neurological dysfunction. Risk factors: travle, animals, outdoor activities Problem....

Encephalitis

Can antiepileptics be given for encephalitis...

Yes

Rare causes swelling of the brain, liver failure, and death within hours... Associated with acetylsalicylic acid

Reye syndrome

Don't use aspirin containing products (Alka-selter / Pepto-bismol) in <15 when they have a fever/ viral infection. Why....

Reye syndrome Encephalitis, liver failure, death in hours

Which part of the brain has excess fluid in hydrocephalus...

Ventricles & subarachnoid

Results from an underlying brain disorder This condition is an imbalance of CSF production & absorption Results in enlarged ventricles and increased ICP.

Hydrocephalus

Most common type of hydrocephalus CSF is blocked within the ventricles Aqueductal stenosis, neural tube defects, trauma, tumors, Chiara malformation Type of hydrocephalus...

Noncommunocating Obstructive hydrocephalus

CSF is blocked after it exits the ventricles Usually defective absorption issue with in the subarachoid space Subarachnoid hemorrhage, meningitis, leukemia infiltration Tyoe of hydrocephalus...

Communicating nonobstructive hydrocephalus

Hydrocephalus Extracranial Shunt Ventriculoperitoneal shunt VP - Most common Atrioventricular Shunt AV requires revision with growth Monitor for.... Endoscopic third ventriculostomy ETV - Trials underway Medications....

Infection Acetazolamide/ Diamox Furosemdie / Lasix

Hydrocephalus Signs of infection: Poor feeding Vomiting Seizures Lethargy Increased BP/HR/fever When infection is present Antibiotics are started and Shunt is externalized with EVD until...

CSF is clear from infection

Hydrocephalus Shunt Signs of malfunction....(3)

Increased Abdominal Circumference Vomiting, dizziness HA

Reasons for shunt malfunction in hydrocephalus....

Kinked or separated catheter Blockage

Skull fractures: Linear fractures Depressed fractures Diastatic fractures Basilar Fractures Most dangerous battle signs & raccoon eyes Simple break follows straight line Broken & pushed inwards increased pressure on the brain Break through the sutures

Linear fractures: Simple break follows straight line Depressed fractures: Broken & pushed inwards increased pressure on the brain Diastatic fractures: Break through the sutures Basilar Fractures: Break in bottom of the skull. Most dangerous battle signs & raccoon eyes

Compound skull fractures Lacteration of skin & Splinter. Exposes the cranial contents to the external environment. Risks....

Infection Risk: Meningitis, brain abscess, or osteomyelitis due to open wound. Neurological Damage: From bone fragments or direct trauma to the brain. CSF Leak: Possible if dura mater is torn. Hemorrhage: External or internal bleeding may occur.

Blood collection between the dura and the cerebrum...

Subdural hematoma

Subdural hematoma Treatment.... Monitoring....(2) Supportive care...(4)

Acute cases: Surgical evacuation via burr hole or craniotomy Chronic cases: May be managed conservatively or with burr hole drainage Monitoring: Neuro checks, ICP monitoring if indicated Supportive care: Oxygen, IV fluids, seizure prophylaxis, manage BP

Injury caused by impact & results in disruption of electrical brain activity....

Concussion

Bruising of the cerebral tissue...

Contusion

Collection of blood outside of the dura but with in the skull...

Epidural hematoma

Priority interventions for severe closed head injury...

CAB Circulation airway breathing

Severe closed head injury Why cautious giving narcotics for pain relief...

May mask neurological decline

Retinal hemorrhages are common with this injury...

Shaken baby syndrome

Purple phase (Colic) is a normal phase of infants. Happens during this time span of growth...

2 weeks & peaks at 2 months.

PURPLE phase of infants happens between 2 weeks & peaks at 2 months. It is a normal part of development and doesn't indicate a problem with thr infant. What does PURPLE stand for...

Peak of crying Unexpected Resist soothing Pain-like face Long lasting Evening

The premature brain is at greater risk for these types of problems...

Hemorrhage Due to increased vascular

The nervous system Mylenation develops in this way....

Cephalocaudal. Head - Toe Inwards - Outwards

A head circumference is a normal part of peds measurement until this age....

2 yrs

Bulging fontanels is associated with increased ICP, Hemorrhage, Hydrocephalus, head trauma, meningitis. When may it be a normal sign...

When crying- but will go way quick

Irritability or inconsolable crying Lethargy or poor feeding Vomiting Seizures High-pitched cry Changes in level of consciousness Downward deviation of the eyes ("sunsetting eyes") With a BULGING FONTANEL can mean these issues...

Head trauma Hemorrhage Hydrocephalus Meningitis Increased ICP

Glasgow coma scale What do the following values mean.. 3 6 8

3. Minimal 6. Increased ICP 8. Possibly Intubation

When do you close a External Ventricular Drain - used to drain CSF and decreased ICP...

When the pt. Is getting up / moving

When to diagnose epilepsy...

2 unprovoked seizures 1 unprovoked seizures with high risk of more

Surgery to treat childhood epilepsy includes LITT Lazer interstitial thermal therapy Describe...

Ablation - of abnormal areas of the brain

Why does a ketogenic diet help with seizures...

Reduces excitablity of the brain

Imbalances that may lead to seizures...

Hypoglycemia- High risk Hyponatremia- High risk Hypoglycemia-High Hypomagnesemia- High

Febrile seizures are most likely in this age range...

<5yrs Peaks 12 - 18 months

Why is a lumbar puncture contraindicated with Increased ICP...

Risk of brain herniation Brain will move from area of more pressure to less. Fatal

Where is CSF found in the brain...

Ventricles Between the arachnoid mater and pia mater

Describe the 3 layers of the meninges...

Dura = hard outer case Arachnoid = soft inner bubble wrap with fluid Pia = cling wrap touching the object directly

With bacterial meningitis how quickly to give antibiotics...

Within 1st hrs. Ensure Blood Cultures taken first

Vaccines that protects from meningitis....(3)

Meningococcal Pneumnococcol HiB

Diagnose meningitis with this procedure...

Lumbar puncture. Contraindicated in increased ICP

CSF with meningitis Describe: WBC... Protein... Glucose....

WBC Increased Protein Increased Glucose Decreased

________ = "Stiff and Sick" → Stiff neck, headache, photophobia. ______ = "Mind is Messed" → Confusion, personality changes, seizures.

Meningitis = Stiff & Sick Encephalitis = Mind is Messed

What is the first sign in hydrocephalus Infants .... First sign of hydrocephalus in children....

Rapid increase in head circumference. >95% Children: personality change

McEwen's Sign (in Hydrocephalus).....

Cracked pot sound heard when percussing the skull of an infant with hydrocephalus or raised intracranial pressure.

Setting Sun Sign (common in infants with hydrocephalus) What it is.... Why...

A downward deviation of the eyes, where the sclera is visible above the iris. Why it happens: Due to pressure on the brainstem or cranial nerves affecting eye movement.

Mcewins (Cracked Pot) signs is used to assess for... Transillumination is used to assess for...

McEwins (cracked pot) for Non-Communicating Obstructive hydrocephalus- CSF Within Ventricles Transillumination: Communicating nonobstructive hydrocephalus- CSF is blocked After leaving Ventricles

Hydrocephalus treatment. Describe. Ventriculoperitoneal shunt... Atrioventricular Shunt....

Ventriculoperitoneal shunt: Drains ventricular to perineum Atrioventricular Shunt; Drains ventricular to atrium of the heart

This type of skull fracture is most serious and may contain Battle signs (bruising behind ears) & raccoon eyes (black eyes) .... CSF leakage is common and can be detected via glucose reading (presence of glucose in clear fluid = CSF) & Halo Sign (Allow fluid to drip onto gauze - CSF will form a Halo shape around the blood)

Battle sign

Cause: Rupture of bridging veins between the brain and dura mater. Often due to head trauma, especially in falls, child abuse (shaken baby syndrome), or elderly with brain atrophy. Signs and Symptoms: Gradual onset (hours to days or even weeks) Headache Decreased level of consciousness Confusion or personality changes Unequal pupils or motor deficits Vomiting

Subdural Hematoma (SDH)

Cause: Arterial bleed between skull and dura mater, often from middle meningeal artery rupture. Usually caused by blunt trauma to the temporal area (e.g., hitting head on corner). Signs and Symptoms: Lucid interval: Brief unconsciousness → then awake → then rapid deterioration Severe headache Vomiting Seizures Hemiparesis Fixed, dilated pupil (typically on side of bleed) Rapid progression to coma Nursing Considerations: Medical emergency — neurosurgical intervention required

Epidural Hematoma (EDH)

Cause: Mild traumatic brain injury (TBI) from a blow to the head, fall, or jolt. No structural damage seen on CT/MRI. Signs and Symptoms: Temporary loss of consciousness (not always) Headache Dizziness, confusion Nausea, vomiting Memory problems (amnesia before/after event) Sleep disturbances Sensitivity to light/noise Nursing Considerations: Monitor for worsening symptoms (signs of ICP) Educate about post-concussion syndrome: headaches, mood changes, fatigue lasting weeks Encourage rest and gradual return to normal activity

Concussion

Cause: Bruising of brain tissue, often from coup-contrecoup injury (brain hits skull, rebounds). More severe than a concussion. Signs and Symptoms: Similar to concussion but more pronounced and longer-lasting Loss of consciousness Neurological deficits depending on location (speech, motor, vision) Seizures Personality changes May show bleeding or edema on imaging Nursing Considerations: Monitor for progression of symptoms Frequent neuro checks Prevent seizures (possible anticonvulsant) Reduce ICP triggers (coughing, pain, positioning)

Contusion

In Severe Closed Head Injury Pt HT increased & becomes agitation What could this suggest...

Storming. Could be a good thing if pt is in a coma. Shows Brain is still working or something

A rash forms from taking an antiepileptic med. After stopping the medication do what next...

HCP within 24 hrs

After a child has a febrile seizure they are at greater risk for developing them again....

False But increased risk if family members have had them before.

Do you give febrile seizure pts antiepileptics...

Elevated liver enzymes Elevated serum ammonia Vomiting Lethargy Decline mental status Hyperreflexia This problem...

Reyes syndrome

Fever Flu-like symptoms Lowered LOC HA Seizures Lethargy This problem...

Encephalitis

HA Photophobia Nauchal rigidity Rash Drowsiness Irritated Muscle rigidity Seizures This problem...

Meningitis

4 reasons for aspirin administration in peds...

Kawasaki Disease Aspirin is used to reduce inflammation and prevent blood clots. High-dose aspirin during acute phase, followed by low-dose aspirin long-term. 2. Rheumatic Fever Aspirin is used to reduce joint inflammation and fever. 3. Juvenile Idiopathic Arthritis (less common now) Used in some cases for pain and inflammation, though other NSAIDs are preferred today. 4. Pediatric Cardiac Conditions (e.g., post-cardiac surgery or congenital heart defects) Low-dose aspirin may be prescribed to prevent thrombosis (blood clots), especially after procedures like Fontan surgery.

Chiari malformations can be seen with...

Hydrocephalus : Noncommunocating / obstructive Chiari malformations = brain pushing into spinal cord

Subarchnoid hemorrhage Meningitis Leukemia infiltrate Lead to this type of hydrocephalus....

Communicating Nonobstructive

Aqueductal stenosis Neural tube defects Trauma Tumors Chiari malformations Lead to this type of hydrocephalus...

Obstructive Noncommunicating

Main difference between Subdural hematoma & Epidural hematoma....

Sub = Venous rupture, slow bleeding, abuse / falls Epi = Arterial rupture, EMERGENCY SURGERY

Care Of The Child With Neurological Disorders Flashcards

(117 cards)