Ch 36: Peds Neuro Flashcards Preview

NCLEX > Ch 36: Peds Neuro > Flashcards

Flashcards in Ch 36: Peds Neuro Deck (41):
1

Head Injury - early signs

slight change in vital signs
slight change in LOC
infant: irritability, high pitched cry, bulging fontanel, increased head circumference, dilated scalp veins, Macewen's sign, setting sun sign
Child: headache, nausea, vomiting, visual disturbances, seizures

2

Macewen's sign

cracked pot sound on percussion of the head

3

setting sun sign

sclera visible above the iris

4

Head Injury - late signs

decrease in LOC
bradycardia
decreased motor and sensory responses
alteration in pupil size and reactivity
decorticate (flexion) posturing
decerebrate (extension) posturing
cheyne-stokes respirations
coma

5

decorticate (flexion) posturing

adduction of the arms at the shoulders
arms are flexed on the chest w wrists flexed and the hands fisted
lower extremities are extended and adducted
*seen w severe dysfxn of cerebral cortex
* indicates a lesion in the cerebral hemisphere or disruption of the corticospinal tracts.

6

decerebrate (extension) posturing

rigid extension and pronation of the arms and the legs
*sign of dysfunction at the level of the midbrain
* indicates damage in the diencephalon, midbrain, or pons

7

CSF drainage

positive for glucose

8

Communicating Hydrocephalus

occurs as a result of impaired absorption w/in the subarachnoid space
no interference of the CSF in the ventricular system

9

Non communicating Hydrocephalus

Obstruction of CSF flow in the ventricular system DOES occur

10

ventriculoparitoneal shunt

CSF drains into the peritoneal cavity from the lateral ventricle

11

ventriculoatrial shunt

CSF drains into th eright atrium of the heart from the lateral ventricle, bypassing the obstruction (used in older children and in children w pathological conditions of the abdomen)

12

bacterial meningitis dx

lumbar puncture: CSF is cloudy with increased pressure, increased WBC count, elevated protein, and decreased glucose levels

13

Kernig's sign

inability to extend the leg when the thigh is flexed at anteriorly at the hip.
Meningitis
to perform --> client's leg is raised w/ the knee flexed and then extended at the knee.
positive if any pain or resistance is noted.

14

Brudzinski's sign

neck flexion causes adduction and flexion movements of the lower extremities
"flexion of the head causes flexion of the hips and knees"
Meningitis

15

Meningitis interventions

respiratory isolation precautions maintained for at least 24 hrs after abx administered
administer abxs as soon as they are prescribed after lumbar puncture
*meds administed IV

16

Reye's syndrome

acute encephalopathy that follows a viral illness (4-7 dys post).
characterized pathologically by cerebral edema and fatty changes in the liver.
liver biopsy = definitive dx
Acetaminophen = medicine of choice

17

Seizures

generalized
partial
unclassified

18

Generalized seizures

tonic-clonic
absence
myoclonic
atonic

19

Head Injury - Brainstem involvement

deep, rapid, or intermittent and gasping respirations
wide fluctuations or noticeable slowing of pulse
widening pulse pressure or extreme fluctuations in BP
sluggish, dilated, or unequal pupils
** notify physician immediately if these signs develop.

20

Spina Bifida

CNS defect that results from failure of the neural tube to close during embryonic development

21

Spina bifida occulta

posterior vertebral arches fail to close in the lumbosacral area
spinal cord remains intact, not visible
meninges are not exposed
neurological deficits not present

22

Spina bifida cystica

protrusion of the spinal cord or meninges or both
defect results in incomplete closure of the vertebral and neural tubes --> sac like protrusion in the lumbar or sacral area
can indlude: meningocele, myelomeningocele, lipomeningocele, and lipomeningomyelocele

23

Meningocele (spina bifida)

protrusion involves meninges and a sac like cyst that contains CSF in the midline of the back (lumbosacral area)
neurological deficits are evident

24

absence seizures

brief episodes of altered awareness or momentary loss of consciousness.
no muscle activity occurs except eyelid fluttering or twitching.
child has a blank facial expression.
last 5-10 seconds, may occur one after another several times a day.

25

myoclonic seizures

brief random contractions of a muscle group that can occur on one or both sides of the body

26

simple partial seizures

consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or face or neck

27

meningitis: classic signs

severe headache
fever
stiff neck
change in LOC

photophobia (may also be a prominent early sx, r/t meningeal irritation)

28

transtentorial herniation

occurs when part of the brain herniates downward and around the tentorium cerebelli.
can be unilateral or bilateral and may involve anterior or posterior portions of the brain.
if a large amt of tissue is involved, the risk of death is upped bc vital brain structures are compressed and become unable to perform their fxn.

29

LOC obtunded

child sleeps unless aroused, once aroused has limited interaction w/ the environment.

30

LOC confusion

ability to think clearly and rapidly is lost

31

LOC disorientation

ability to recognize place or person is lost

32

increased ICP, SIADH secretion

urine specific gravity > 1.020
weight gain
hypertension

33

increased ICP, diabetes insipidus

high urine output

34

post op infratentorial tumor

position the child flat

35

post op supratentorial tumors

position the child with head up / elevated

36

temporal lobe herniation (uncal herniation)

refers to a shifting of the temporal lobe laterally across the tentorial notch.
this produces compression of the third cranial nerve and ipsilateral pupil dilation.
if pressure continues up --> flaccid paralysis, pupil dilation, pupil fixation, and death will result

37

Down Syndrome risk

increased risk for developing leukemia compared to the average child.

38

decorticate to decerebrate progression

indicates a deteriorating neurological fxn

39

newborn subdural hematoma s&sx

subdural hematoma can cause pressure on a specific area of the cerebral tissue --> such pressure can cause changes in the stimuli responses in the extremities on the opposite side of the body.

40

fragile X syndrome

common inherited cause of cognitive impairment.

41

fragile X syndrome clinical manifestations

long, wide, and/or protruding ears
a long, narrow face w/ a prominent jaw
large protruding ears
large testes