Neuro

Question 1

What are the main differences between adult and pediatric brains?

Answer 1

Brain not fully developed

Nerve cells immature

Incomplete myelination at birth

Brain cells easily damaged if blood flow and oxygenation not maintained.

Question 2

What reflexes should be gone for good once they go away?

Answer 2

Moro and Babinski

Question 3

What are early signs of increased intracrainial pressure?

Answer 3

headache

vision trouble

nausea/vomiting

subtle changes in vital signs

pupillary slowing

Question 4

What are ICP signs for babies?

Answer 4

Vague

Look for:
Irritability
Cat-like crying
Bulging fontanel
Bradycardia (below 160)
Cushing's triad
Sluggish pupil reaction

Question 5

What is cushing’s triad?

Answer 5

irregular respirations
widening systolic
bradycardia

Question 6

What is confusion?

Answer 6

impaired decision making

disoriented to person, place, time

Question 7

What is delirium?

Answer 7

State of confusion, fear, irritiability, or agitation

Question 8

What is lethargy?

Answer 8

sleepy, rousable with moderate effort, sluggish speech

Question 9

What is stupor?

Answer 9

Deep sleep, responds only to vigorous and repeated stimulation

Question 10

What is coma?

Answer 10

No motor or verbal response to noxious stimuli

Question 11

What is a permanent vegetative state?

Answer 11

permanent lost function of cerebral cortex

Question 12

What is the best score for GCS?

Answer 12

15

Question 13

What is the worst score for GCS?

Answer 13

3

Question 14

If patient on mannitol, what labs should be monitored?

Answer 14

Kidney
Livery
Heart
BMP
CBC

Question 15

What IV solution given to child with increased ICP?

Answer 15

hypertonic saline

may be more effective than mannitol for reducing ICP

Question 16

What labs should be monitored for child with ICP?

Answer 16

electrolytes

Question 17

Is it ok to suction patient with ICP?

Answer 17

No!!

Very contraindicated

Question 18

How should ICP patient be positioned?

Answer 18

HOB 30 degrees

Avoid neck vein compression

Head placed midline

Question 19

How should environment sound for child with ICP?

Answer 19

minimal or no environmental noise

Question 20

Avoid stressful activities such as ___ and ___ that may increase ICP

Answer 20

eliciting pain

emotional stress

Question 21

What meds will be given to ICP patient who is on a vent?

Answer 21

sedatives
analgesics
paralytics

Question 22

What is epidural hematoma?

Answer 22

bleeding between dura and skull

hematoma formed

Question 23

What is subdural hematoma?

Answer 23

Forms more slowly

Birth trauma, falls, shaken baby syndrome

swelling in small space makes high risk for ICP

Question 24

What is cerebral edema?

Answer 24

24-72 hours after head trauma.

If child loses consciousness or vomits more than 3 times, see doctor!

Question 25

What are the priorities for seizure patient?

Answer 25

Airway Protect from injury Medication safety

Question 26

How is airway protected in seizure patient?

Answer 26

position on side

Question 27

How is seizure patient protected from injury?

Answer 27

pad rails helmet

Question 28

What is medication safety for seizure patient?

Answer 28

SLOW IV PUSH If going for surgery, give meds with one sip of water even if NPO

Question 29

What is ketogenic diet?

Answer 29

high fat | low carb

Question 30

What equipment should you need nearby if child is seizure?

Answer 30

oxygen suction

Question 31

What medications are given for seizures?

Answer 31

Benzo Phenobarbitol phenytoin (Dilantin fosphenytoin (Cerebryx) carbamazepine (Tegretol) valproic acid (Depakote)

Question 32

Is it ok to abruptly discontinue seizure medications?

Answer 32

No. Must taper down

Question 33

What is status epilepticcus?

Answer 33

continuous seizures for up to 30 minutes

Question 34

What medications are given for status epilepticcus?

Answer 34

rectal diazepam (Valium) intranasal midazolam (Versed) IV diazepam or lorazepam (Ativan)

Question 35

What do we teach home management of seizures?

Answer 35

CPR for family members Rectal diazepam for intractable seizures No swimming alone

Question 36

What are s/sx of Reye Syndrome?

Answer 36

cerebral edema elevated liver enzymes and ammonia

Question 37

What is cause of Reye Syndrome?

Answer 37

viral infection treated with aspirin

Question 38

What meds are given if child has viral illness or fever?

Answer 38

acetaminophen or ibuprofen

Question 39

What is hydrocephalus?

Answer 39

imbalance in production and absorption of CPF

Question 40

What is hydrocephalus associated with?

Answer 40

myelomeningocele

Question 41

What are s/sx of hydrocephalus?

Answer 41

``` Abnormal head growth Bulging fontanel Dilated scalp veins Separated cranial sutures Frontal enlargement SETTING SUN EYES Depressed eyes Irritability Lethargy high-pitched cry ```

Question 42

How is hydrocephalus relieved?

Answer 42

Drainage of CSF from ventricles via shunt

Question 43

When is the period of greatest risk for VP shunt placement?

Answer 43

first few months

Question 44

What infections can arise from shunt infection?

Answer 44

meningitis ventriculitis septicemia bacterial endocarditis wound infection shunt nephritis

Question 45

How is shunt infection treated?

Answer 45

massive dose of IV abx or shunt removal

Question 46

What is spina bifida cystica?

Answer 46

VISIBLE DEFECT with external saclike protrusion

Question 47

What is a meningocele?

Answer 47

Sac contains meninges and spinal fluid but NO NEURAL ELEMENTS. NO neurologic deficits

Question 48

What is a myelomeningocele?

Answer 48

Sac contains meninges, spinal fluid and nerves

Question 49

Where is myelomeningocele/myelodysplasia normally seen?

Answer 49

Anywhere along spinal column, but common in lumbar and lumbosacral areas.

Question 50

What does the sac contain in myelomeningocele?

Answer 50

meninges spinal fluid nerves

Question 51

Myelomeningocele is a term often used interchangeably with ___

Answer 51

spina bifida

Question 52

If myelomeningocele located below 2nd lunar vertebra, what are the symptoms?

Answer 52

flaccid paralysis of lower extremities | sensory defecit

Question 53

Is there uniformity on both sides of defect with myelomeningocele?

Answer 53

not

Question 54

Myelomeningocele sac may be prone to leakage of ___ if ruptured?

Answer 54

CSF

Question 55

What is the number one thing to prevent with myelomeningocele?

Answer 55

infection

Question 56

When is surgical closure done of myelomeningocele?

Answer 56

within first 24-72 hours

Question 57

What position do we place child with myelomeningocele?

Answer 57

prone

Question 58

What neuro assessment is performed on child with myelomeningocele?

Answer 58

assess extremity movement and infant behavior.

Question 59

Do we take rectal temperatures on baby with myelomeningocele?

Answer 59

no

Question 60

What physical assessments are done on baby with myelomeningocele?

Answer 60

observe urine output observe for abdominal distention measure head distention assess fontanel for bulging

Question 61

How are myelomeningocele children bedded?

Answer 61

in isolette | no clothing

Question 62

How is myelomeningocele dressed?

Answer 62

moist, sterile dressing sterile water sterile dressing sterile gloves sterile, sterile, sterile!!

Question 63

What is cerebral palsy?

Answer 63

abnormal muscle tone, disorder of development of movement and posture.

Question 64

Is cerebral palsy progressive?

Answer 64

No. The damage you see is the damage they have

Question 65

What is the most common cerebral palsy?

Answer 65

Spastic

Question 66

What is spastic cerebral palsy?

Answer 66

hypertonic poor control of posture, balance, and coordinated motion poor fine and gross motor skills

Question 67

What are physical s/sx of spastic cerebral palsy?

Answer 67

Poor head control after 3 mo stiff or rigid limbs arching back, pushing away floppy tone unable to sit without support at 8 months clenched fists after 3 months

Question 68

What are behavioral s/sx of spastic cerebral palsy?

Answer 68

Excessive irritability no smiling by 3 months persistent tongue thrusting frequent gagging or choking with feeds

Question 69

What are goals of therapy for CP patients?

Answer 69

Helping them maintain function and be as normal as possible: establish locomotion, communication, and self-help skills gain optimal appearance and integration of motor functions correct associated defects as effectively as possible provide educational opportunities adapted to child's capabilities promote socialization experiences achieve max independence

Question 70

What are some therapeutic management for CP?

Answer 70

Ankle/foot braces orthopedic surgery to correct spastic deformities PT/OT

Question 71

What is neuroblastoma ?

Answer 71

malignant extracranial tumor

Question 72

Where can neuroblastoma develop?

Answer 72

Anywhere along SNS chain: abdomen adrenal thoracic cervical