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Fall - Pediatrics > Neuro/Autism > Flashcards

Neuro/Autism Flashcards

(78 cards)

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1
Q

How much does the brain grow in the first year of life?

A

2.5 times original weight

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2
Q

What does babies brain need to grow?

A

Glucose

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3
Q

What percent does a babies head weight vs adult head weigh?

A

10% of newborns weight
2% of adult weight

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4
Q

Which electrolyte has an inverse relationship with water? What does this mean?

A

Salt

80% of newborns brain is water –> shifts in salt/water can provoke seizures

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5
Q

When does the fontanel close? What does this matter?

A

Anterior: 18 months
Posterior: 2 months

Can accommodate for increased ICP and hydrocephalus better than adults d/t expanding fontanels

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6
Q

What is papilledema? Is this common?

A

Swelling of the optic nerve form increase intracranial pressure

Rare

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7
Q

How much cerebrospinal fluid does an infant have vs. and adult?

A

50ml for infant
150ml for adult

Much lower baseline ICP

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8
Q

What are some tips and tricks to complete a pediatric neuro exam? (9)

A

Observation of play/activity
Doorway assessment
“Not acting right”
Hand sized toys to assess motor coordination,neuro-muscular strength
Extra ocular movements
Cognitive skills/speech
Finger to nose
Silly games
Sensory function such as soft/hard, cold/hot

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9
Q

What are some red flags on a neuro assessment? (5)

A

Delay in expected milestone
Regression or loss of milestone
Persistence or reappearance of primitive reflexes that should be gone by 5-9 months
Rapid change in head circumference - bulging fontanels
High pitched cry (underlying neuro/IICP)

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10
Q

What is full LOC?

A

awake, oriented, interacts with objects

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11
Q

What is confused LOC?

A

Lacks ability to think clearly

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12
Q

What is disoriented LOC?

A

Lacks ability to recognize place or person

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13
Q

What is lethargic LOC?

A

awakens easily but exhibits limited responsiveness

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14
Q

What is obtunded LOC?

A

sleep unless aroused, once aroused they have limited interaction with the environment

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15
Q

What is stupor LOC?

A

requires considerable stimulation to arouse

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16
Q

What is coma LOC?

A

vigorous stimulation and still produces no verbal or motor response

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17
Q

If a parent tell you their child is lethargic, obtunded, ect.. what should you ask them?

A

Also ask them what they mean. They may have different meanings than healthcare.

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18
Q

What causes ICP? If increase ICP is not relieved what can occur?

A

Brain mass
CSF
Blood

Unrelieved –> herniation and death

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19
Q

What does herniation present as?

A

EOL posturing
Cushing triad
Cheyne-strokes respirations

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20
Q

What is the nursing diagnosis for increased ICP?

A

Ineffective tissue perfusion r/t increased ICP d/t too much pressure on brain tissue

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21
Q

What is the cause of IICP r/t congenital hydrocephalus? TBI?

A

Congenital hydrocephalus: imbalance of CSF

TBI: tissue edema, bleeding

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22
Q

What should the head be the same size of?

A

Chest

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23
Q

What is a neural tube defect? What if it is a high defect? What is the most common cause?

A

Defect in vertebrae that can occur at any level in spinal column

The higher the defect, the greater neurological dysfunction

Lack of folic acid in mom

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24
Q

What is the cause of neural tube defect? When do neural tubes form? How is it diagnosed?

A

Multifactorial etiology

4th week of gestation

Parental or postnatal diagnosis

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25
What is a protective factor against neural tube defect?
Folic acid
26
What type of defect is Spina Bifida?
Neural tube defect
27
What are the classifications of Spina Bifida? (3)
Occulta (most minor) Meningocele Myelomeningocele (most severe)
28
What are the CM of Spina Bifida occulta? (8)
Cutaneous lesions - dimple in the skill Vertebral malformation ONLY Tethered cord Presentation/diagnosis delayed Bowel and bladder deficits Persistent toe walking Back pain Not much neuro impairment
29
What does a tethered cord present as?
Pain Toe walking Bowel and bladder issues
30
Where does Spina Bifida myelomeningocele affect?
Spinal cord Meninges CSF
31
What are the nursing diagnoses r/t Spina Bifida myelomeningocele
Risk for poor cerebral perfusion Risk for infection
32
What is the nursing management for Spina Bifida myelomeningocele?
Prepare for surgery (either 24-48 hours after life or intrauterine) Support ABCDs (depend on level of lesion) Monitor ICP/neuro Monitor s/s of infection (no diaper) Prone to sideline position
33
What does monitor ICP/neuro look like for a patient with Myelomeningocele?
HC once/shift if pt is stable Frequent pupil reaction, sternal rub/heel flick, moro/sucking reflex
34
What can Myelomeningocele lead to? What are s/s?
Meningitis Congenital hydrocephaly Meningitis: Nuchal rigidity, fever, decrease BP, not feeding well, irritability, crying, inconsolability, increase desating
35
If a child has Myelomeningocele how will the birthing plan differ?
Planner c-section d/t hydrocephaly and rupture of the sac May have to help parents engage with baby other than holing
36
What is the most common cause of increased ICP?
congenital hydrocephalus
37
What are risk factors for congenital hydrocephalus? (confirm this)
Neural tube defect Prematurity
38
What is congenital hydrocephalus?
Imbalance between CSF production and absorption --> enlarged ventricles --> affect cerebral perfusion
39
What are nursing interventions for risk for poor cerebral perfusion r/t Myelomeningocele?
Hourly VS Daily head circumference Neuro assessments every 1-2 hours Support family bonding by encouraging breast feeding and education
40
What does the neuro assessments include r/t Myelomeningocele?
Fontanels Assess motor sensation above and below lesion Assess bowel and bladder function
41
What should be done immediately in the post natal period r/t risk for infection?
Maintain skin integrity of sac by keeping it sterile and moist with sterile saline dressing Assess for CSF leaks Positioning to keep pressure of the area, Avoiding contamination form urine/stool Assess for infection and administer per-op antibiotics
42
Head circumference is steadily increasing, baby more irritable, frequently desatting, and not meeting feeding goals. What does this infant have?
43
What are early s/s of increased ICP in an infant? (7)
Rapid head growth Bulging fontanels Irritability Poor feeding Prominent scalp veins Shrill, high pitched crying desat --> bradycardia
44
What are early s/s of increased ICP in an child? (6)
HA that is worse in morning or when supine HA relieved by emesis or sitting up N/V (projectile possibly) Diplopia Irritable Fatigue
45
What are late s/s of increased ICP? (3)
Pronounced frontal bone enlargement (bossing - bulging frontal lobe that is popping out to sides/outside facial feature) Seizures Visual changes such as abnormal pupil response, strabismus fixed, setting sun sign
46
What are the goal around ICP management? (2) Acute? (4)
Treat underlying cause Preserve cerebral function (decrease demands and nourish tissue) Maintain airway Assess neuro status Assess for ICP decompensation ICP management
47
How does care differ d/t seizure risk with IICP?
Rescue meds Padded rails No loose clothing or objects Safety and timing
48
What is possible underlying causes for increase ICP that need to be treated and what is the treatment?
Remove mass or lesion such as tumor/hemorrhage Reduce brain tissue edema with diuretics. mannitol, steroids, hypertonic IVF Decrease vascular volume Congenital defect place VP shunt
49
What is the acute management for IICP?
Maintain airway Assess neuro status Assess for ICP decompensation ICP management
50
What should you do for increase ICP? (9)
VS hourly Oxygen Control temp and BP HOB 30-45 degrees to avoid flexion at hips/neck Decrease stimulation Cluster care Neuro/LOC assessments I&Os Monitor electrolytes
51
What should be avoided what patient has increase ICP? (5)
Hyperventilation Fever Hypotension Hip or neck flexion Prone or supine
52
What is ICP decompensation r/t? What does it present as?
R/t pressure on brainstem/lower cranial nerves aka brainstem herniation Cushings triad and Cheyne-stokes respiratory pattern
53
What is cushings triad?
Bradycardia Systolic HTN with widening pulse pressure (higher systolic, lower diastolic) Irregular respirations
54
What is Cheyne stokes respiratory pattern?
AKA agnol breathing Long periods of apnea --> hyperventilation --> hypoventilation --> apnea
55
What can be done to meet the goal of reducing ICP in hydrocephalus?
Ventricle-peritoneal shunt (VP shunt) Shunts CSF from the ventricles
56
What are nursing considerations r/t a VP shunt?
Infection Obstruction Pain (post-op) Parental education regarding ICP home monitoring Seizure
57
What does care for Spina Bifida depend on?
How many issues the patients will have and where the lesion is Upper lesion: resp and arms Lower lesion: Legs, need help walking, bowel and bladder incontinence
58
What are long term chronic complications of Spina Bifida?
Neurogenic bladder and CKD Neurogenic bowel Orthopedic/mobility issues Skin ulceration Latex allergy
59
How do you treat neurogenic bladder/CKD? Treat neurogenic bowel? Treat mobility issues?
CIC regimen - clean intermittent cath 4x/day and foley at night High fiber and high fluid, rectal stims and laxatives PT/OT
60
What should be taught about skin r/t Spina Bifida?
Child and family should inspect the skin areas with decreased sensation on a regular basis
61
What is the collaborative care for Spina Bifida?
Neurosurgery Nursing Urology/Nephrology Ortho Rehab PT/OT Social services
62
What are the 3 primary mechanisms of a head injury?
Closed Open/penetrating/impalement (MVA) Asphyxia (decreased perfusion to brain)
63
What are the 2 types of close head injuries?
Concussion Diffuse axonal injury - shaking
64
What are the 2 examples of asphyxia head injuries?
Near drowning Loss of oxygen
65
What are worsening outcomes that can occur with a head injury?
Contusion Concussion Skull fracture Intracranial hemorrhage Brainstem herniation
66
What are the 4 types of intracranial hemorrhages?
Subdural hematoma Epidural hematoma Intra-parenchymal hematoma IVH (stroke in preemies)
67
What is the management for a concussion?
Cease play Evaluation HCP Restricted by until asymptomatic with rest/exertion Psych testing - should have routine one before concussion to determine changes in score when injured
68
How long does it take for a concussion to heal?
7 days to months
69
What is the best way to prevent a head injury?
Wear helmet
70
What type of injury is shaken baby syndrome?
Coup-coutrecoup Coup is the acceleration injury form initial impact Coutrecoup is the counter or deceleration injury Trauma occurs as brain moves over the skill and subdural vessels are torn Sheering force of all blood vessels and direct injury to brain itself
71
What are complications of a head injury?
Increase ICP from secondary injury like brainstem herniation DIC Death CSF leak Meningitis Focal neurological deficit (motor, seizures, ect) Global neurological deficit (severe impairment, asphyxia)
72
What s/s would make you suspect a skull fracture?
Battle signs like raccoon eyes and mastoid petechiae/eccymosis
73
What is the max score for GCS for Peds? Minor injury? Moderate injury? Severe injury?
Max: 15 Minor: 13-15 Moderate: 9-12 Severe: less that 8
74
What are red flags for ASD?
Impaired social interactions, communication (decreased ability to interpret social cues) and emotional regulation Repetitive behavior/hyperfixation Restricted interests
75
What are early warning signs of ASD?
Poor eye contact Poor or unusual use of toys Preoccupation with creating order Poor attachment to family/poor socialization skills Repetitive body movement like hand flapping, rocking, head banging Problems with using/understanding language Difficulty with transitions such as changes in enviornment d/t sensory Walking on toes Sensory fussiness - if they don’t stop even when they get what they want. Fussy as in pain Playing alone and being socially withdrawn Aggressive Lack of responsiveness to verbal stimulation Issues with food textures and clothing textures d/t sensory issues
76
When are early warning signs of ASD present by?
4 months of age
77
What is a 2 month old missing with ASD?
Social smile
78
What is brain imaging done in ASD? What is it looking for?
2 months and 4 months Looking to see deficit

Fall - Pediatrics (15 decks)

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