Module 4 Care of the child with Neurological disorders Flashcards
1
Q
The higher the injury is to the brain, the more
A
symptoms
2
Q
In the Glasgow scale a 9-10 means
A
light coma
3
Q
In the Glasgow scale a 6,7,8 score means
A
deep coma
4
Q
under 3 in the glasgow scale means child is
A
totally unresponsive
5
Q
for a child that has just sustained a head injury it is important for them not to
A
go to sleep
6
Q
5 S&S of Increased Intracranial Pressure
A
Lethargy Shrill cry Poor muscle tone Seizures Poor appetite
7
Q
What is the tx for Hydrocephalus
A
VP shunt
8
Q
How does a VP shunt work
A
fluid goes from head to abdomen for liver to absorb so it can go back into circulation
9
Q
Children with VP shunts have a tendency to be
A
unbalanced
10
Q
In a child with a VP shunt how should you position them
A
un-operative side
11
Q
Congenital embryonic neural tube defect - imperfect closure of spinal vertebrae
A
Spina Bifida
12
Q
What decreases incidence of Spina Bifida?
A
Folic acid
13
Q
Define Spina Bifida occulta and it’s manifestations
A
Minor variation - opening in spinal column small & no protrusion of structures
Tuft of hair or small dimple
Occurs at L5 or S1
14
Q
Non congenital defect causing muscle weakness due to lack of oxygen at birth
A
Cerebral palsy
15
Q
What actions are affected in cerebral palsy?
A
Impaired movement
Delayed milestones
Difficulty feeding
16
Q
Type of CP that has slow and snake-like movement
A
Athetoid
17
Q
Type of CP that shows no coordination
A
Ataxic
18
Q
Type of CP where muscles don’t contract
A
Rigidity
19
Q
Combination of other CP’s
A
Mixed
20
Q
Altered neurological impulse causing rapid muscle contraction
A
Seizure
21
Q
What can cause a seizure
A
Unknown
Fever
Trauma
Brain tumor
22
Q
How long do seizures last and what can happen during and after a seizure has occurred?
A
30-90 seconds
Person becomes incontinent of urine
Person develops amnesia of the seizure event
23
Q
Another name is tonic-clonic seizure
A
Gran-Mal
24
Q
What causes Reye’s syndrome?
A
Viral infection
25
How does Reye's syndrome present itself?
```
Vomiting
Sluggish behavior
Lethargic
Seizures
Stroke like symptoms
```
26
Inflammation of the meninges - meningitis can be caused by
A virus or a bacteria
27
What kind of isolation is used for meningitis and when is isolation constituted
Respiratory isolation and only if there's + brudzinski sign
28
What decreases the risk of developing meningitis?
HIB vaccine
29
Signs and symptoms of meningitis
Severe headache, stiff neck (nuchal rigidity) irritability, fever, restlessness, petechia, vomiting & + brudzinski sign (when you put chin into chest, knees goes up involuntarily)
30
What is a lumbar puncture
Small amount of cerebral
| Spinal fluid is extracted
31
What color should CSF be
Clear
32
What is encephalitis
Inflammation of the brain usually caused by a virus
33
What adverse effect is common if encephalitis is left untreated or undiagnosed?
Deafness
34
Positioning for lumbar puncture
Place child in lateral position
Hold neck and thighs to
Make a curve in the spine
Talk quietly to child for reassurance
35
Signs and symptoms of a head injury such as a concussion or a skull fracture
Increased ICP
Headache
Hypoxia
Change in LOC
36
Why do we not medicate for pain in head injuries
We do not want to mask symptoms. Symptoms tell us if condition is worsening
37
Describe decerbrate positioning in head injuries
Supine hands flexed back
38
Describe decorticate positioning in head injuries
Arms wrist and fingers flexed up
39
What is a neuroblastoma
Malignant tumor in the adrenal gland
40
When abdomen in palpated in neuroblastoma what will be found
Abdominal mass
41
Signs and symptoms of neuroblastoma
Abdominal mass
HTN
Tachycardia
Respiratory depression
42
Why is the prognosis poor in neuroblastoma
Metastasis of the tumor occurs before it is even discovered
43
Mental retardation - Intellectual disability/impairment definition
Below average mental functioning
| Onset before 18 years old
44
Signs and symptoms of MR
Deficit in adaptive behavior
| Affects memory mood and language
45
Treatment for MR
Early intervention
Emphasize strengths
Family support
AHRC
46
What is Down's syndrome
Mild to severe form of MR
47
Characteristics of Down's syndrome
```
Small head
Round face
Flat nose
Protruding tongue
Close set eyes
Simian crease
Short thick hands
Congenital heart defects
```
48
Diagnosis of Spina Bifida pre natal
Alfa-fetal protein level at 13-15 weeks
| Amniocentesis if indicated
49
What is one thing we must not let kid do after a head injury
Go to sleep
50
What does the b/p and the p do with increased ICP
B/p goes up and pulse goes down
51
If kid has bulging fontanels what position should we put them in and if they had sunken fontanels what position should we put them in
```
Bulging = sit them up
Sunken = lay them down
```
52
Increased AFP shows suspicion of what
Spina Bifida
53
Spontaneous abortion or preterm birth can cause
amniocentesis
54
When should surgery be done for myelomeningocele
within 24-48 hrs
55
What can we do to repair damage the spinal cord
no fix for spinal cord yet
56
Which reflex is absent in myelomeningocele
babinsky reflex
57
Post op Spina bifida how should child be positioned
head slightly elevated
58
Shill cry could mean
increased ICP
59
what are two complications of post spina bifida surgery
chronic constipation
| stool leakage
60
In cerebral palsy what is also affected as a result of lack of OXYGEN
muscle function
61
Spastic Cerebral Palsy is
Twitching
62
Adenoid Cerebral Palsy is
slow snake like movement
63
Ataxic Cerebral Palsy is
Lack of muscle control
64
Rigidity Cerebral Palsy is
unable to move muscles
65
Why do we perform ROM in Cerebral Palsy
to prevent contractions
66
Which population of kids are prone to seizures
Hydrocephalus
67
Head trauma, Rapid rise in Temp, Pressure in brain can cause a
Seizure
68
How long do seizures usually last
30-90 seconds
69
Not all seizures cause _______ however all _______ causes seizures
epilepsy
70
When do kids usually outgrow febrile fevers
By age 3
71
Infertile spasms usually are in _______ kids. They can have an overactive Moro which means they are _______
Myoclonic, they are jumpy
72
When giving anti-convulsants to kids it is important to tell parents that the drugs can cause
drowsiness
73
Reyes syndrome is linked to which drug use
aspirin
74
HIB vaccine for meningitis decreases risk for
Reyes syndrome
75
In reyes syndrome because of STROKE LIKE SYMPTOMS kid has increased risk for
bleeding in brain
76
HIM (Meningitis) which isolation do we place kid on
Resp isolation
77
A common symptom of meningitis is Nuchal head which is
stiff neck cant even pick it up
78
Which sign is specific to meningitis
Brudzinski sign
79
If lifting a child by the head and the child's leg/knee comes up that is a positive sign of
Meningitis
80
What is a major risk when doing lumbar puncture
Paralysis / Spinal damage
81
Before lumbar puncture what is needed
informed consent
82
For lumbar puncture how do we treat parents
dont let them know whats going on, dont keep them in room. dont sedate child we need them with full LOC
83
What do we look for post meningitis / lumbar puncture
leakage
84
post meningitis / lumbar puncture child will be on resp isolation for how long
24-72 hours
85
encephalitis is usually caused by
Mosquito (West nile virus)
86
By the time we diagnose Nephroblastoma we have to tell parents what
prognosis is poor and it has already metastasized, child may not survive
87
What can a distended abdomen mean
malfunction in VP shunt
88
Spaces in the bones is referred to as
Spina bifida
89
Occulta is
Spina bifida
90
Post incontinence, or passing of urine can happen immediately after what
seizure episode
91
Persistent vomiting happens in what
Reyes Syndrome
92
Liver dysfunction can lead to
increased ammonia
93
What is a positive Brudzinski's sign
Push head to chest, if legs come up on their own + sign
94
We elevate HOB for which condition
Hydrocephalus
95
We place child prone or side lying for which condition
Spina Bifida
96
A child with hydrocephalus has increased blood pressure, decreased pulse rate, and decreased respirations. The nurse suspects these symptoms indicate
Increased ICP
97
Infants with spina bifida commonly have an allergy to:
Latex
98
a protrusion of the membranes and cord through an opening in the spine
Meningomyelocele
99
Motor disability caused by a nonprogressive disturbance in brain development
Cerebral palsy
100
Complication that affects the liver and brain
Reyes syndrome
101
A practice that has helped us prevent mental retardation is
blood test at birth
102
Seizure where child cries out, falls on the floor, becomes rigid, and then has a convulsion
Grand-mal
103
he development of Reye’s syndrome has been associated with the use of aspirin while infected with
Meningitis
104
Which is not a characteristic of brain tumors in children
Decreased BP
105
Which is the most useful diagnostic procedure in diagnosing a seizure disorder
Electroencephalography
106
presence of blood in the anterior chamber of the eye
Hyphema
107
What 2 symptoms are early signs of Reyes syndrome
Vomiting and lethargy
108
Encephalitis can be secondary to what
Respiratory infection
109
two symptoms of meningitis
fever and irritability
110
inability to arouse the child is an early sign of
Increased ICP
111
Before surgical repair what position should you place the child in for Meningomyelocele
Prone, maintaining abduction with a pad between legs
112
Whens the best time to do EEG
When child is sleeping
113
Best diet for Seizures
Ketogenic diet (high fat low carb)
114
What is a spica cast
Cast from chest to lower extremities
