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Flashcards in exam #2 Deck (58):
1

abnormal adhesion to bony or fixed structure that puts traction on the cord

tethered cord

2

s/s of increased ICP in infants

- irritability, poor feeding
- high-pitched cry, difficult to soothe
- tense, bulging fontanels
- separation of cranial sutures
- distended scalp veins
-setting sun sign (eyes pointed down)

3

s/s of increased ICP in children

- HA
- vomiting with/without nausea
- diplopia, blurred vision
- Ataxia
- Seizures
- Irritability, restlessness, fatigue, drowsiness, decrease in activity & motor skills

4

Nursing care for child with increased ICP

- neuro checks q 1-2 hrs
- elevated head of bed 30 degs
- maintain patent airway and fluid restriction
- eliminate or minimize environmental noise
- reduce crying/agitation
- maintain temp < 3.8 C

5

Late signs of increasing ICP

- Decreased LOC
- Decreased motor response to command
- decreased sensory response to painful stimuli
- alterations in pupil size and reactivity
- decerebrate or decorticate posturing
- cheyne stokes respirations

6

Types of hydrocephalus

- Communicating
- Non-communicating

7

Communicating Hydrocephalus

overproduction or inadequate absorption of CSF in brain

8

Non-communicating hydrocephalus

obstruction of CSF flow

9

s/s of hydrocephalus in infants

- Head grows at an abnormal rate; OFC > 95th %
- Bones of skull become thin & sutures separate
- Signs of increased ICP

10

most common types of neural tube defects

- Anencephaly
- Spina bifida

11

neural tube defect antenatal diagnostic testing

- Ultrasound
- Elevated alpha-fetoprotein in amniotic fluid 16-18 weeks gestation

12

major cause of neural tube defects

folic acid deficiency

13

Anencephaly

- Absence of cerebral hemispheres
- Brainstem function may be intact
- can live up to few hours to months
- Death due to respiratory failure

14

When do the neural tube normally close?

about 30 days after conception

15

failure of osseous spine to close

Spina Bifida

16

types of spina bifida

- occulta
- cystica

17

Spina bifida occulta

- Incomplete fusion of vertebrae at one level (most commonly L5-S1)
- No exposure of meninges or CSF
- May see dimple, tuft of hair, lipoma, hemanigioma at site.
- May lead to “tethered cord” as child gets older
- altered gait, motor weakness, foot deformities
bowel/bladder problems

18

types of Spina bifida cystica

- Meningocele
- Myelomeningocele (most common)

19

most common type of spina bifida

Myelomeningocele

20

Meningocele

- Sac contains meninges and spinal fluid but no neural elements
- No neurologic deficits
- Repaired surgically
- Tethered cord may develop later in childhood

21

Myelomeningocele

- Sac contains meninges, spinal fluid, and spinal nerves
- May occur anywhere along the spinal column
- Lumbar and lumbosacral areas most common
- May be diagnosed prenatally or at birth
- Varying and serious degrees of neurologic deficit

22

Myelomeningocele motor defict: L5 - S1

- dorsiflexion & plantar flexion of feet
- weakness of glutei

23

Myelomeningocele motor defict: L3 - L4

- dorsiflexion & plantar flexion of feet
- weakness of glutei
- Involvement of quadriceps & hamstrings

24

Myelomeningocele motor defict: L1 - L2 or above

complete paraplegia (flacci paralysis)

25

Myelomeningocele (L5-S1): Prognosis for ambulation

With or without short leg braces

26

Myelomeningocele (L3-L4): Prognosis for ambulation

- May be able to ambulate with long leg braces & crutches
- hip dislocation common

27

Myelomeningocele (L1 - L2 or above): Prognosis for ambulation

No functional ambulation

28

Initial management of Myelomeningocele

- Prevent Infection
- Prevent trauma to sac
- Assessment of neurologic and associated anomalies
- closure within 12-48 hours after birth

29

most common neurologic dysfunction in children

seizures

30

s/s of seizure

- Change in LOC
- Involuntary movements
- Posturing
- Changes in perception, behaviors or sensations

31

age group with the highest incidence of seizures

< 2 y/o

32

causes of seizures

- Birth injuries (anoxia) or congenital defects of CNS
- Acute infections in late infancy and early childhood
> 3 years, is usually idiopathic

33

types of seizures

- partial
- generalized

34

types of generalized seizures

- absence
- tonic/clonic

35

One continuous, unremitting seizure lasting longer than five minutes or a series of brief seizures without gaining premorbid level of consciousness

status epilepticus

36

status epilepticus medications

- Diastat (rectal)
- Ativan (IV)
- phenytoin (IV loading dose, ongoing management)
- phenobarbital (IV loading dose, ongoing management)

37

- recurrent, unprovoked seizures
- group of syndromes

epilepsy

38

common seizure triggers in peds

- Changes in dark-light patterns (camera flashes, headlights, video games)
- Sudden loud noises
- Extreme temperature changes
- Dehydration
- Fatigue

39

tx of epilepsy

- Medication is first line of treatment
- Ketogenic Diet (80% of kcals from fat)
- Surgery:
- Vagus nerve stimulation

40

Any type of intellectual disability

Cognitive Impairment (CI)

41

Diagnostic Criteria for CI: IQ?

IQ = 70 to 75 or below

42

For a diagnosis of CI, child must demonstrate Functional impairment in how many adaptive skill domains?

at least two

43

Any significant lag or delay in physical, cognitive, behavioral, emotional, or social development

Developmental Delay

44

Most common developmental delays?

- Language skills
- cognitive skills
- Fine and gross motor skills

45

Etiology of CI

- Familial, social, environmental, organic, and unknown causes
- Chromosomal disorders
- Prenatal toxin exposure

46

Primary Prevention of CI

- Avoidance of prenatal rubella infection—keep immunizations current
- Genetic counseling
- Use of folic acid supplements
- Education regarding the dangers of smoking or alcohol use during pregnancy and ingesting lead during childhood
- Reduction of head injuries
- Future gene therapy for genetic disorders, such as PKU

47

Secondary Prevention of CI

- Early identification to initiate treatment to avert damage
- Ex:
- Prenatal diagnosis or carrier detection of disorders
such as Down syndrome
- Newborn screening for treatable inborn errors of
metabolism

48

Treatable inborn errors of metabolism?

- Congenital hypothyroidism
- Phenylketonuria (PKU)
- Galactosemia

49

Tertiary Prevention of CI

Treatment to minimize long term consequence
-Ex:
- Early ID of therapies and rehabilitation services
- Treatment of coexisting problems
- Programs for infant stimulation, parent training,
preschool education
- Counseling services to preserve the family unit

50

Early Behavioral Signs of Cognitive Impairment

- No response to contact, voice, movement
- Irritability
- Poor/slow feeding
- Poor eye contact during feeding
- Diminished spontaneous activity

51

Classification of CI and IQ level?

Educable/mild: 50 to 75
Trainable/moderate: 36 to 49
Severe: 20 to 35
Profound: < 20

52

A recognized pattern of malformations with a single, specific anatomic, physiologic, or biochemical cause.

Syndrome

53

Most common CI in children?

Down Syndrome
- AKA Trisomy 21

54

Cause of Down Syndrome?

- Extra chromosome 21
- Translocation of chromosome 21 in 3% to 6%
- Mosaicism in 1% to 3%

55

is most common congenital anomaly associated with Down syndrome?

congenital heart disease

56

Visual acuity reqs to be legally blind?

20/200 or less

57

Complex brain dysfunction accompanied by broad range and severity of intellectual and behavioral deficits

Autistic Spectrum Disorders (ASD)

58

ASD usually appears at what age?

18 to 36 months of age