Chapter 13 - Neurological and Sensory Disorders Flashcards
(204 cards)
1
Q
West Nile Virus can cause:
A
encephalitis.
2
Q
What is the central component of the Nervous System?
A
Neuron
the smallest part, the Nerve Cell
3
Q
What is Dandy-Walker syndrome/malformation?
A
it is a malformation of the Cerebellum and fluid-filled spaces around it.
Congenital brain malformation.
4
Q
Dystonia is:
A
muscle contraction and twisting movements of muscle groups; abnormal posture
5
Q
What are two other AKAs for Spina Bifida?
A
- Myelomeningocele
2. Neural Tube Defect
6
Q
What is Meningocele?
A
Membrane around the SC (spinal cord) is enlarged, creating a mass.
Root word: mening/i/o = meninges (membranes of the CNS)
suffix cele = protrusion of; hernia; swelling
7
Q
4 types of nonviral causes of Encephalitis are:
A
- Bacteria
- Parasites
- Fungi
- Rickettsiae
8
Q
Anticonvulsant medications for seizure disorder are:
A
Valproic acid (depakene) Phenytoin (dilantin)
9
Q
Diagnostic evaluation of Reye Syndrome includes:
6 items
A
- history, revealing recovery from a recent viral disease
- sudden onset of vomiting and mental confusion
- Elevated Liver enzymes
- Below normal Blood Glucose
- Elevated Ammonia levels
- Prolonged partial thromboplastin time
10
Q
Name 4 kinds of Movement Disorders in children.
A
- Tics
- Tremors
- Dystonia
- Chorea
11
Q
What is a petit mal seizure?
A
staring seizure, or absence seizure, a brief loss of awareness.
12
Q
What is agenesis of the Corpus Callosum?
A
Absence of the structure that connects the 2 hemispheres. Congenital brain malformation
13
Q
Meningitis is a precursor to:
A
Encephalitis.
14
Q
Febrile Seizures are due to:
A
fever, in young children.
15
Q
Alterations in the firing of neurons in the brain are:
A
seizures
16
Q
What is the most common cause of acute paralysis in children?
A
Gullain Barre Syndrome
GBS
17
Q
Hydrochephalus occurs as a result of:
A
an IMBALANCE between CSF production and absorption.
18
Q
A complete loss of tendon reflexes occurs with G_____ B_____ Syndrome
A
Gullain Barre
19
Q
3 signs of Cushing’s Triad
A
- Bradycardia (tachycardia that leads to bradycardia)
- Irregular respiratory pattern
- Systolic hypertension with WIDE pulse
pressure.
20
Q
List 3 kinds of Infectious Neurologic health problems:
A
- Meningitis
- Encephalitis
- Reye Syndrome
21
Q
If a child has meningitis, it is treated as a:
A
medical emergency
22
Q
The most common reason for a shunt revision is:
A
a child’s growth
23
Q
List 7 symptoms of Meningitis
A
- Severe headache
- Stiff neck
- Sudden high fever
- Bulging fontanels (infants)
- Altered mental status
- Depending on age: irritability or sleepiness
- May have a RASH, with certain bacterial infection
24
Q
The general public often mistake tics to be:
A
voluntary.
Tics are involuntary. It can cause a child to be disciplined even though it is a medical condition.
25
Generalized seizures have what type of body movements associated with it?
(2 items)
Tonic (rigid)
| Clonic (jerking)
26
Two classification of Meningitis is:
1. Viral
| 2. Bacterial (strep pneumonia)
27
It is important for the nurse to teach the family with a child who has epilepsy to:
1. medication effects and side effects
2. obtain a med alert bracelet for child to wear
3. find alternatives for contact sports
4. avoid swimming or climbing along
28
Children with SB (spina bifida) have a 50% chance of having what type of allergy?
Latex allergy
29
Vertebrae are completely ossified at birth.
| True or False
False
30
What are LATE signs of Hydrocephalus in an older child?
| there are 6 signs
Late signs of Hydrocephalus in an older child:
1. Seizures
2. BP increased
3. Blindness from herniated of Optic disc
4. Decerebrate rigidity
5. Heart rate decreased
6. Respiratory pattern altered
31
Chorea resembles:
dancing movements.
| muscle contractions result in quick, rhythmic movements.
32
If there is malformation or damage to any area of the CNS, what is the result?
Some form of IMPAIRMENT
| Damage/Malformation = impairment
33
What are 2 primary ways to diagnosis an infant/child with Cerebral Palsy?
1. Neural exam
| 2. Health history (neural)
34
List 3 clinical manifestations of Battle Sign
1. leakage of CSF from nose or ears
2. Raccoon eyes, periorbital ecchymosis.
3. Bruising behind the ears
35
5 Behavioral signs of Cerebral Palsy are:
1. extreme irritability or crying
2. does not smile by 3 months old
3. feeding difficulties
4. persistent gagging or choking when fed
5. persistent extrusion reflex after 6 months old.
36
Ominous sign for the eyes is?
Pupils are dilated and fixed.
| a nerve is compressed (Oculomotor nerve)
37
What are the 2 early Signs of Hydrocephalus: in an older child with Hydrocephalus, compared to symptom for an infant with Hydrocephalus?
Older child = headache + strabismus
Infant = head size increase + fontanel bulging.
38
Which type of muscular dystrophy is more common in boys?
Duchenne's muscular dystrophy
39
What type of DME may assist a child with Cerebral Palsy?
Splints,
Braces,
Adaptive feeding devices.
40
Tethered Cord Syndrome is:
limited spinal cord movement inside the spinal column
41
What is the nonprogressive motor disorder of the CNS called?
Cerebral Palsy
42
What type of headaches do most children experience?
| 2 types
Tension headache,
| Migraine
43
What is Meningitis?
You should know this by now.
```
itis = inflammation
mening = meninges (membrane of the CNS)
```
44
Assessing Level of Consciousness using
the Glasgow Coma Scale (GCS).
List 4 general things about the GCS
1. Nurse uses the scale to apply a value from 1-15
2. Provides clues to neurological status
3. Categories: eye opening, motor response and verbal response
4. 0-3 is Deep Coma
45
List 7 items in a General Assessment of the Pediatric Nervous System
1. gather History (of pregnancy and Family hx) [Listen]
2. LOC and Glasgow Coma Scale (level of consciousness)
3. Ht and Wt (measure)
4. Head (circumference, suture lines and anterior fontanel)
5. Developmental Milestones
6. Assess behavior, (and describe it), interactions and general appearance.
7. VS, for baseline. (vital signs)
46
Cyclic vomiting is treated with:
antidepressant,
| amitriptyline
47
Neurological Assessments
identify 6 assessment items
Assess:
1. EYES (eg. response, size, funduScopic exam)
2. Cranial nerves
3. Coordination (is there any?, eg. throwing a ball)
4. Mental Status (for school-age & adolescents)
5. Motor Fxn (eg. strength, tone, smooth, purposeful movement)
6. Sensory Fxn (eg. deep tendon reflexes & other appropriate reflexes)
48
It is a common skull fracture that occurs with children.
Battle sign
49
What type of diuretic would you administer to a child with ICP?
Mannitol,
| it is an osmotic diurectic.
50
List 3 general concepts about Assessment of the Pediatric Nervous System
1. Children under the age of 2: require special evaluation
2. Most info is gained through OBSERVING spontaneous and elicited REFLEX RESPONSES.
3. Red Flags = Delay or deviation from expected milestones, OR, re-appears of primitive reflexes
51
A priority nursing consideration pre-surgery for a child with Spina Bifida is:
maintain skin integrity of the sac.
52
__% of childhood seizures are idiopathic.
50%
| Half!
53
Symptoms of Hydrocephalus in older children:
| there are 8 signs
1. HeadACHE
2. Blurred vision, or, double vision
3. Balance problems
4. Lethargy
5. New urinary incontinence
6. Papilledema (swollen optic disc)
7. Sunsetting Eyes
8. Vomitting
54
A seizure that lasts 30 minutes or more is:
a pediatric emergency, aka status epilepticus
55
Anencephaly is:
a congenital malformation, where both cerebral hemispheres are ABSENT.
Stillborn infants have this defect. so sad!!!
56
What are the 3 diagnostic tests help verify Meningitis?
1. Lumbar puncture
2. Blood cultures
3. Nose and throat cultures
57
What is Post concussion Syndrome?
Child may become easily upset and may be irritable if tired or stressed.
Memory problems are common.
Double vision, dizziness, headaches, may last for months.
58
States of Consciousness in a patient
| Lists 5 states of consciousness
1. Alert
2. Lethargy
3. Obtundation
4. Stupor
5. Coma
59
Narcolepsy is:
extreme tendency to fall asleep, at inapropriate times
60
Hypersomnia is:
excessive sleepiness, sleeping at inapropriate times
61
Name 4 common neuromuscular disorders.
1. Cerebral palsy
2. Muscular dystrophy
3. Myasthenia gravis
4. Spinal muscle atrophy
62
Performing a Lumbar Puncture
List 6 things to consider while performing a Lumbar Puncture.
1. Instruct child to lie on side
2. Instruct child to bend knees, until knees touch chin
3. Wash back ( cool liquid)
4. Tell child, will feel a "pinch" or "sting"
5. Check CardioPulmonary status
6. Support client and family
63
Encephalitis is usually caused by a:
Virus
64
List 3 important Nursing Interventions for Meningitis.
1. Isolation
2. Monitor Neurologic Status (LOC)
3. Monitor IV fluids
Other Nursing Interventions:
monitor Cardiorespiratory status (frequent VS)
have emergency airway equipment in room/bedside
provide env't that will minimize ICP
monitor for cerebral edema
Doctor's orders: antipyretics, administer as ordered
monitor for complications such as seizure, hearing loss, visual alterations
65
Identify 4 Nursing Intervention for Teaching Parents to care for child with a Head Injury:
1. Ice (to child's head)
2. Rest (for the child)
3. Limit foods, if child vomits
4. Watch for 2 full days. Awaken child at parent's bedtime and again 4 hours later to make sure child is alert and can answer your questions appropriately
66
When to call the physician immediately for a head injury:
| the list is long, 10 items
1. bleeding that does not stop after putting pressure for 10 minutes on area.
2. needs sutures
3. under 1 yr old
4. Unconscious or confused
5. Severe headache, vomitting
6. Slurred speech, blurred vision
7. Blood or watery fluid coming from ear or nose
8. Unequal pupils or crossed eyes
9. Difficulty walking or crawling, or weakness in the arms.
10. Other symptoms that concern you.
67
What is Lissencephaly?
Absence of folds, grooves and fissures of the brain.
Congenital brain malformation.
68
Is transient neonatal Myasthenia Gravis a real thing?
yes.
69
Gullain Barre Syndrome requires a ___________ assessment. Deaths are due to __________ failure.
Respiratory,
respiratory
(yes, same word twice for fill in the blanks).
70
List 9 Diagnostic tests of the NS (Nervous System)
1. CT scan
2. AngioGraphy
3. EchoEncephaloGraphy
4. ElectroEnchephaloGraphy (electrodes)
5. Lumbar Puncture
6. MRI (head is restrained)
7. Nuclear Brain Scan
8. Subdural Tap
9. Ventricular Puncture
71
Becker's muscular dystrophy is:
1. progressive weakness in the pelvis and legs (over time)
2. Symptoms begin around age 12
3. Weakness in the heart muscles can occur
72
__________ rarely occurs in infancy.
Papilledema (mass of blown out blood vessels are the Optic Nerve)
73
Neural tube forms the anterior end (the brain) and the posterior end (spinal cord).
If there are defects, what is the result?
result is defects in the brain and Spinal cord.
| AKA, neural tube defects.
74
What are the affects of Sleep Disorders have on children?
| list 6 items
1. affect rest
2. affect learning and behavior
3. disruptive to family (parents/siblings)
4. problems with insomnia
5. problems with sleep arousal
6. problems with early-morning awakenings
75
What is the most commong infection of the CNS?
Meningitis
76
The main goal for all children with Cerebral Palsy is:
Self-care.
77
Myoclonic seizures are:
sudden brief jerks of muscle groups with possible loss of consciousness.
78
List 3 kinds of Head Injuries
1. Shaken Baby Syndrome
2. Battle Sign
3. Near Drowning
79
Neuropathy is a condition in which __________ nerves are damaged.
peripheral
80
What is the difference between a headaches caused from a primary or secondary cause?
Primary headache occurs spontaneously, NOT due to trauma, or any other problem.
Secondary headaches are due to trauma, illness, tumors.
81
An infant's head is ___% of an Adult's head.
66%
82
What is considered an Acquired Neurologic Health Problems?
Seizure disorders
83
What is the name of the muscular dystrophy that is the least disabling of all 3?
Fasioscalpohumeral muscular dystrophy.
| weakness in the shoulder and fascial muscles
84
Shaken Baby Syndrome is:
a sign of physical abuse
caused by vigorous shaking of the infant.
Whiplash-induced intracranial and retinal bleeding
85
Pre-operative VP shunt measurements of an infant include:
VS, pupil reactivity/symmetry, fontanels & suture lines, head circumference.
Remember: baseline, baseline, baseline.
86
Ventriculomegaly is:
an enlargement of the ventricles.
| It causes harmful pressure on the fragile tissues of the brain.
87
What is a unique teaching piece for Encephalitis?
Educate family to avoid areas infected with Mosquitoes.
88
What are the 2 types of Hydrocephalus?
1. Congenital
| 2. Acquired
89
4 Warning signs of a migraine are:
Aura,
flashing lights,
colored spots in the visual field
blurry vision
90
Motor tics can involve which body parts?
| 7 different body parts
```
Could be the eye,
neck,
shoulder,
nose,
teeth tensing,
chest,
abdomen.
Brief, involuntary muscle movements.
```
91
The Nervous System has 2 main parts, what are they?
1. Central Nervous System
| 2. Peripheral Nervous System
92
Encephalitis has a wide range of clinical manifestations, what are they?
1. Signs of Upper Respiratory Infection.
2. Speech disturbances
3. Motor dysfunction
4. Cranial Nerve deficits
5. Focal/generalized seizures, that alternate with periods of screaming
6. Hallucinations
7. Bizarre movements
93
If primitive reflexes re-appear in a child at 5 months old, what does that mean?
It is associated with a Neurological Disease.
| primitive reflexes are: moro, grasp and rooting
94
Decerebrate is __________ positioning.
Extension
| notice all of the "e's" in the word decerebrate. associate with "extension" an 'e' for an 'e'
95
Spina Bifida:
immediate Post-natal Nursing consideration is:
(there are 4 items)
1. MONITOR for leakage of spinal fluid from SAC as well as skin integrity of sac
2. ASSESS for INFECTION around SAC
3. ASSESS for Degree of SENSATION (at/below Lesion)
4. high risk for Latex allergy (50% chance)
96
Spinal Muscular Atrophy is a __________ disorder of the anterior horn cell of the ________ cord.
1. degenerative
| 2. spinal
97
What are your 5 areas of neuro nursing interventions?
1. Assess (Neuro Status, VS)
2. Maintain airway / perfusion
3. Patient safety
4. Lower ICP
5. Nutrional & fluid needs
98
Tics appear at what age?
10 years old.
| Then disappear by age 18.
99
Cyclic vomitting is a:
migraine variant with no headache.
100
Spina bifida ______ is the mildest and most common form of spina bifida.
Occulta
101
The 2 most common neural tube defect are:
1. Spina Bifida
| 2. Anencephaly
102
Spina Bifida Myelomeningocle is:
Saclike Herniation contains meninges, CS and portion of SC, or, nerve roots)
Root word: myelo = spinal cord; marrow; bone marrow
mening/i/o = meninges
suffix: cele = hernia; protrusion of; swelling
(the longer the word, the worse it is!)
103
Post-Surgical Shunt Placements for Hydrocephalus.
Its a long list for Nursing Considerations/interventions.
Identify 10 N-interventions.
1. VS every 15 min - 1 or 2 hours, as needed.
2. Measure, head circumference daily
3. Elevate head, no more than 30 degrees
4. Follow Doctors Orders: IV Antibiotics, analgesics, dressing changes
5. Monitor shunt tract for: swelling, redness
7. Observe for drainage (head, tummy & chest), Peritonitis (tummy pain/tenderness), LOC
8. Position child OFF shunt site
9. Therapeutic play, as child recovers
10. Education for parents on home care
104
What are LATE manifestations/signs of Hydrocephalus in an infant?
(there are 8 signs)
Late signs of Hydrocephalus for infant:
1. Sunsetting eyes
2. Frontal bone bossing (enlargement)
3. BP increased
4. Cry is high-pitched, or shrill
5. Difficulty swallowing
5. Feeding is difficult
6. Heart Rate decreased
7. Pupil response is sluggish, unequal
8. Vomitting
105
Humans are dependent on a functional Nervous System. True? or False?
True
106
How is Hydrocephalus managed?
1. preventing CSF accumulation
2. surgery (placement of a shunt, either a ventriculoperitoneal or ventriculoatrial shunt) The tubes re-route the CSF.
3. NURSE: monitors for Pain, infection, administers antibiotics as ordered and teaching family about dressing changes and shunt problems.
107
There is an alteration in voluntary muscle control related to this cerebral insult:
Cerebral Palsy
108
Atonic Seizures are:
sudden loss of muscle tone AND loss of consciousness.
| AKA, drop attacks.
109
The neural tube is a bundle of nerves in a human embryo.
| True or False
True
110
Gullain Barre Syndrome is an _____ inflammatory demyelinating polyneuropathy that affects the ________ nervous system.
1. acute
| 2. peripheral
111
Why does PapillEdema rarely occur in infants?
Because of the open fontanels and sutures. (allows for expansion)
PapillEdema is swelling inside the skull that pushes down on pupil and optic nerve.
112
What are neurocutaneous disorders?
Disorders in the nerve cells that lead to abnormal growth of tumors in various parts of the body.
Distinct neurocutaneous lesions.
```
Examples:
Neurofibromatosis,
Sturge-Weber syndrome,
Tuberculosis sclerosis,
Ataxia-telangiectasia
```
113
Myasthenia Gravis is an ____________ disease.
autoimmune.
| predominantly weakness and fatigue.
114
Abdominal migraine is:
migraine variant,
more common in girls
acute midline abdominal pain, nausea
may last for 1 hour to 3 days
115
Vocal tics can involve:
| 7 items
```
sniffing,
clearing of the throat,
grunting,
squeaking,
humming sounds,
clicking the teeth together (yuck)
sucking sounds
```
116
Parasomnia is:
abnormal behavior associated with sleep such as night terrors, sleep walking, REM sleep behavior disorder, nightmares.
117
Which seizures are unique to children?
febrile seizures
118
A spinal cord injury requires checks every 2 hours on:
spine alignment
Pulse oximeter
skin care, turning
119
By 4th week (28th day) of Gestation, the ________ tube has closed at the anterior end to form the BRAIN.
# Fill in the blank answer: Neural.
By 4th week (28th day) of Gestation, the neural tube has closed
120
Seizures involving the entire brain are:
generalized seizures
121
In an infant, brain growth can be screened by performing what task?
Measuring head circumference
122
List 5 general items about Fetal Development
1. Nervous System is 1st system to form in Utero (4th week)
2. Rapid growth from 2 mo. - 5 yr old (2 months of Gestation through to 5 yrs old)
3. Head Circumference:
Term infant is 34-35 cm.
6 months = 44 cm
1 yr old = 47 cm
4. Peripheral nerves NOT myelinated at birth
5. Coordination and fine muscle movement improves as myelinization occurs.
123
When does Reye Syndrome develop?
usually after a mild viral illness
| such as Chicken Pox, or Influenza
124
Spina Bifida Meningocele Cystica is:
saclike PROTRUSION contains meninges and CSF, at some point along the posterior vertebrae. it is visible.
Sensory and motor impairments
125
A severe spinal cord injury will cause ________ paralysis and complete ____ of sensation below the severed level.
1. complete
| 2. loss
126
Nursing Consideration for ICP
Head of Bed elevation should be:
30-45 degrees
127
How much CSF does an Infant have compared to an adult? (in ml)
Infant as 50 ml.
| Adult has 150 ml.
128
What are the 8 physical signs of Cerebral Palsy?
1. Poor head control (after 3 months age)
2. Stiff/rigid arms or legs (increase muscle tone)
3. Poor sucking or swallowing
4. Pushing away or Arching back
5. 3 months old, has clenched fists
6. Uses only 1 side of the body to crawl
7. Floppy or limp body posture
8. 8 months old, cannot sit up without support
129
Seizures are diagnosed by:
the history of the event, EEG recording of brain wave activity.
130
Lab studies used to identify epilepsy are:
| 5 items
WBCs, blood glucose, serum electrolytes, BUN, and Calcium.
131
Which diagnostic procedures assist to verify Hydrocephalus?
Diagnostic Evals for Hydrocephalus:
1. Serial measurements of Head Circumference (easy to do)
2. CT
3. MRI
4. Lumbar Puncture
132
When caring for a 4 year old girl, the nurse notes that her anterior fontanel is open and soft. This finding is:
abnormal for her age
133
Schizencephaly is:
abnormal slits or clefts in the hemispheres of the brain.
Congenital brain malformation.
134
Spina Bifida Occulta is:
1. you get a dimple (dimples are good, right?!)
2. section of SC is malformed
3. Normal nerves AND SC
4. occurs b/n L5-S1
5. the lesser of all 3 evils (spina bifida types)
135
Other clinical signs of Shaken Baby Syndrome:
| 6 items
1. FTT (failure to thrive)
2. Seizures
3. Apnea
4. Respiratory irregularities
5. Vomitting associated with drowsiness or lethargy.
6. Coma
136
What are the 5 symptoms unique to Neonates experiencing Meningitis?
1. Poor muscle tone, poor cry
2. Apnea
3. Hypothermia or hyperthermia
4. Sepsis
5. Disseminated intravascular coagulation
other symptoms:
Poor feeding/sucking, seizures, fullness/tense bulging fontanel, lethargy, vomiting.
137
What are "sun-setting eyes" a symptom of?
Hydrocephalus
138
Battle signs that must be reported to a physician are:
signs of double vision, and vomitting
139
What is Persistent Vegetative state?
Complete unawareness of environment accompanied by sleep-wake cycles.
Most common cause is Hypoxic ischemic Encephalopathy (HiE)
NURSING CARE: sames as unconscious child
140
Hydrocephalus is most often congenital and related to:
prematurity
| tell that baby to stay in there!... until full term for sure
141
Cerebral Palsy develops from:
brain injury occurring BEFORE Cerebral development is complete.
142
Which type of meningitis resolves without treatment?
Viral
143
Neuropathy symptoms are decreased ___________, pain, __________, problems with balance, __________ in the extremities.
1. sensation
2. tingling
3. weakness
144
What is key to being able to maximize a child's abilities when it comes to Cerebral Palsy?
Early detection and
early intervention
plus a team approach.
145
Cerebral Palsy is classified as:
| 5 in total
```
Spastic,
Athetoid,
Ataxic,
Rigid,
Mixed
```
146
What 2 physical things make up the CNS?
1. Brain
| 2. Spinal Cord
147
With or without treatment, this type of meningitis is fatal:
fungal meningitis.
148
What medications is used to treat a headache?
| 2 kinds
ibuprofen
| acetominophen
149
Which cranial nerve innervates the structures necessary for hearing?
Cranial nerve 8
150
In Gullain Barre Syndrome, there is rapid _____ weakness.
limb
151
What is another consideration for Pediatric Stroke?
Premie babies are more at risk,
| MOMS: tell your baby stay inside until full term, if possible
152
Pathophysiology of Reye Syndrome includes:
1. causes Liver damage
2. Leads to rising serum Ammonia levels
Rising ammonia levels leads to cerebral dysfunction, imbalances with fluid, electrolyte, acid-base and coagulopathies.
153
Primary source that causes West Nile Virus is:
infected mosquitoes
154
Decorticate is __________ positioning.
Flexion
155
Symptoms of Hydrocephalus in INFANTS are:
| there are 6 signs
1. Head SIZE increased rapidly (wicked unusual increase)
2. Irritability
3. Lethargy
4. Seizures
5. Sunsetting Eyes
6. Vomitting
156
Premature closure of sutures and fontanels can cause a potential for:
neurologic damage
157
Near Drowning can be assessed using:
Orlowski's scale
158
After Surgery - Spina Bifida
| list 3 nursing considerations
1. Don't secure diaper, just place it underneath infant.
2. Measure: head circumference---why? it can tell you if Hydrocephalus is developing (hydro = water, cephal = head, us = structure, water in the head structure)
3. Neurogenic Bladder. frequent, clean, straight catherization is preferred.
other Nursing considerations/interventions:
4. Neurogenic Bowel: collaborate with family to develop plan, diet teaching, etc.
5. Collaborate with Physical Therapist
6. Teach child & family to re-position frequently, and INSPECT surgical area for signs of skin breakdown.
159
What is the difference between tension headache and a migraine?
Tension headache is a steady pain, usually able to do activities.
Migraine headache is severe, disabling condition with throbbing, pounding, unilateral pain. Worsens with movement/exertion. Unable to continue with activities.
160
What is Gower's Sign?
Children in a squatting position have to use their hands and arms to "walk" up their bodies in order to stand up.
Weakness in the proximal muscles of the lower limbs.
161
List 6 Nursing Assessment items for Head Injury of a child/infant:
1. ABC's
2. Neck immobilization
3. VS
4. History and Neuro exam (eg. test cranial nerves)
5. Glasgow Coma Scale
6. Assess for alterations in antidiuretic hormone.
162
What is Todd's Paresis?
its the period after the seizure is over:
focal weakness in a part of the body after a seizure.
it is postictal paralysis that is temporary unilateral weakness, (*can be the entire side/half of the body)
Duration: 30 minutes to 36 hours
Occurs most often with: Generalize seizure & febrile seizure.
aka, Todd's Palsy,
163
Before fontanels fuse, an increase in ICP (intracranial pressure) causes an ________ in head ______________.
increase,
circumference.
Before fontanels fuse, an increase in ICP (intracranial pressure) causes an INCREASE in head CIRCUMFERENCE.
164
Nursing considerations when a child has a seizure are:
| 3 items
1. note if the mouth has any deviation to one side or the other, teeth clenching, bleeding, etc.
2. observe for presence and length of apnea
3. note duration of postictal period (altered state of consciousness after an epileptic seizure).
165
At age 1, an infant's brain is ___% of an adult's brain size.
80%
166
Diagnosing Epilepsy with an EEG is also confirmed by a:
MRI
167
It is a late sign of increased intracranial pressure
| what is it called?
Cushing's Triad
Cushing's Triad is a late sign of ICP,
and it has 3 serious signs, plus you MUST notify Physician
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Nursing care of a Head Injury:
1. Same as ICP, plus:
2. No nasogastric suctioning with basilar skull fracture.
3. Assess for fluid and electrolyte imbalance (due to possible problems with ADH).
169
Migraine involves:
Aura, blurry or double vision, eye pain, photophobia.
170
Seizures with no loss of consciousness are:
partial seizures, or FOCAL seizures
171
What are the 3 symptoms unique to Infants experiencing Meningitis?
1. Fever
2. Irritability
3. High-pitched Cry
other symptoms:
Poor feeding, seizures, bulging anterior fontanel, lethargy, vomiting.
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A minor head injury involves:
possible changes in LOC, transient periods of confusion, irritable, vomiting, somnolence and headache.
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MicroEncephaly is:
circumference of the head is more than 2 standard deviations below normal.
Congenital brain malformation.
174
Seizures have a primary and a secondary cause, what is the difference?
Primary cause of seizure: absence of any underlying injury.
| Secondary cause is provoked by a temporary or permanent structural, or, metabolic disorder.
175
Which type of meningitis is fatal if left untreated?
Bacterial
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Anencephaly is:
most of the brain does NOT develop
| prefix: an= without; not
Root word: encphal/o = brain
suffix: y= condition; process
scary, without brain!
177
What is the analogy used to describe a tension headache in children?
it's like a rubber band around the head.
178
What nursing intervention is important to promote for a child with epilepsy?
Promoting development of a positive self-image for the child.
179
Name 5 medications used to treat Reye Syndrome.
1. Corticosteriods
2. Mannitol
3. Barbiturates (if cerebral edema is severe)
4. Phenytoin (to control seizures)
5. Vitamin K (to aid coagulation)
180
The education of the child with migraines, (and their family) includes:
learning stress management
| avoidance of headache triggers
181
List 6 categories of head injuries.
Closed, open,
| coup, contrecoup injury, missile, impalement.
182
Which diagnostic tests help rule out a brain tumor and gets you closer to a diagnosis of Cerebral Palsy?
Diagnostic tests include:
1. Serum electrolytes
2. Computed Tomography
3. MRI
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Status Epilepticus is a:
pediatric emergency.
184
List 5 Nursing Interventions for Reye Syndrome
1. Care is focused on support of child's physical status
2. Monitor: cerebral edema, I&O, VS, Lab values
3. Perform ongoing neurological assessments
4. Prevent complications of immobility
5. Provided emotional support to family
185
Identify 4 Nursing Interventions/considerations for a child/infant with Cerebral Palsy.
1. Increase calorie intake
2. Seizure precautions
3. Safety (due to poor coordination)
4. Communication board (to help child "talk" to you)
186
Hydrocephalus in infants is most often:
congenital (born with it) or associated with prematurity.
| Note: there is also acquired and etiology unknown
187
List 6 assessment items for Spinal Cord Injury.
1. Spine must be immobilized
2. Airway assessed immediately
3. Circulation
4. Shock
5. Neurologic assessment
6. Trauma to other systems
188
Grand mal seizures are:
generalized seizures
189
When does a Pediatric Stroke occur?
| there are 4 different situations, in which PS can occur
1. in UTERO.
what!???
2. even worse, can occur during birth, or
3. shortly after birth.
4. can occur as a result of TRAUMA, or ILLNESS, or sickle cell disease.
190
A diagnosis of Hydrocephalus is bad enough and to make things worse, it is has a buddy. What is the tag-along with Hydrocephalus?
Myelomeningocele.
Hydrocephalus, is often associated with Myelomeningocele.
191
What type of bed can you use for a child with ICP?
pressure equalizing mattress.
(very fancy and expensive mattress i might add).
192
Spinal shock can last __ weeks or more.
three weeks
193
What is thought to be the cause of neural tube defects?
Folic Acid Deficiency
194
Identify 4 goals a nurse must consider when it comes to teaching parents on the care of a child with Cerebral Palsy.
1. Coping with muscular impairment
2. Using DME, such as splints, braces or assistive equipment.
3. Safety! Safety! Safety!
4. Working with the school (school age child)
195
A 16 year old girl loses consciousness, falls to the floor, and begins jerking her arms and legs. As the school nurse, you know that she is having a seizure. What DONT you do?
put a padded spoon in her mouth to keep her from biting her tongue
196
Which medications help control prolonged seizures?
Lorazepam (ativan)
| Diazepam (valium)
197
At what age does the Posterior Fontanel close?
| At what age does the Anterior Fontanel close?
Posterior Fontanel closes at 2 months old
| Anterior Fontanel closes at 18 months old
198
Craniosynstosis is:
premature closure of the sutures of the infant's head, resulting in abnormal head shape.
Congenital brain malformation.
199
Tourette's Syndrome is:
both motor and vocal tics are present.
MUST have started before the 18th birthday.
MUST have been present for more than 1 year.
200
Which nerves are NOT myelinated at birth?
Peripheral nerves
201
List 4 differences in the CNS for pediatrics.
1. Nervous System is NOT mature at birth
2. Brain is 12% of weight for Newborn
3. Brain is highly vascular
4. Dura can strip away from PeriCranium.
202
Moderate or severe head injury involves:
altered mental status, changes in VS, signs of increased ICP, retinal hemmorhage, hemiparesis and papilledema.
203
How does child obesity affect sleep?
May cause obstructive sleep disorder and sleep apnea.
204
List the 5 stages of Reye Syndrome:
1. vomiting, lethargy
2. combativeness, confusion
3. Coma, decorticate posturing
4. Decerebrate posturing
5. Seizures, loss of deep tendon reflexes, respiratory arrest
