Neuro Disorders

Question 1

3 forms of spina bifida

Answer 1

Spina bifida occulta
Meningocele
Myelomeningocele

Question 2

Type of spina bifida:
‣ tuft of hair present, dimpling at base of spine
‣ no protrusion of spinal nerves, but missing bone

Answer 2

oculta

Question 3

Type of spina bifida:

Protrusion containing meninges and spinal fluid ,,, NO nerves

Answer 3

Meningocele

Question 4

Type of spina bifida,,,

Protrusion containing meninges, spinal fluid, and nerves

Answer 4

Myelomeningocele

Question 5

What is the general name for the disorder that causes neural tube defects affecting g the CNS

Answer 5

Spina bifida

Question 6

Spina bifida increases risk of what allergy?

Answer 6

Latex!

*can be life threatening allergic reaction

Question 7

Spina bifida increases risk of what disorder that requires shunting at it?

Answer 7

Hydrocephalus

Question 8

Bladder and bowel issues/paralysis with which types of spina bifida?

Answer 8

Meningocele and Myelomeningocele

Question 9

Can we take rectal temps on spina bifida patients?

Answer 9

Heck no!

Question 10

What kind of dressing goes over lower back of spina bifida patient?

Answer 10

Sterile moist dressing initially, change ever 2 hours

Question 11

What position do we place new born spina bifida patient in?

Answer 11

Prone

Avoid pressure on sac

Question 12

What kind of hold is recommended for spina bifida newborn?

Answer 12

Football hold — avoid pressure on sac

Question 13

Can spina bifida babes be born vaginally?

Answer 13

No! C section

Question 14

When is surgery done to repair spina bifida site after birth?

Answer 14

Within 24-48 hours of birth

Question 15

Long term considerations for spina bifida

Answer 15

risk for ineffective ADL/ impaired elimination/ mobility
◦ education: in and out every 4 hours
◦ OT to help with bowel training
◦ ROM exercises

Question 16

Is hydrocephalus common in spina bifida patients?

Answer 16

Yes! 90-95% have it

Question 17

This disorder is an imbalance in the PRODUCTION and/or ABSORPTION of the CSF

Answer 17

Hydrocephalus

Question 18

What does hydrocephalus do to fontanel?

Answer 18

Accumulation of blood in ventricles causes bulging of the fontanels

Question 19

Post op consideration for VP (ventricular peritoneal) Shunt (think: positioning)

Answer 19

position change follows Dr. orders
‣ do not elevate too fast –> fluid drain too quickly –> injury to brain
‣ lay child flat on his or her nonsurgical side to prevent rapid reduction in intracranial fluid

Question 20

S/s if increased icp in infant

Answer 20

◦ bulging fontanel 
	◦ increase in head circumference 
	◦ high pitched cry
	◦ lethargic
	◦ vomiting
	◦ widening of cranial suture lines

Question 21

S/s of increase ICP IN CHILD

Answer 21

◦ headache
	◦ lethargic
	◦ n/v
	◦ double vision
	◦ decreased LOC 
	◦ seizure

Question 22

Disorder causing movement, muscle control, and posture deficits caused by hypoxia to the brain

Answer 22

Cerebral palsy

Question 23

Most common disability of childhood to effect the movement

Answer 23

Cerebral palsy

Question 24

4 types of cerebral palsy

Answer 24

Spastic
Dyskinentic
Ataxic
Mixed

Question 25

Type of CP: hypertonicity- muscles tight, increased reflexes, clonus, poor control with balance/ posture/movement, fine/gross motor difficulties, pyramidal, crouched gait with scissoring motion of legs, Babinski reflex

Answer 25

Spastic

Question 26

Type of CP: involuntary jerking, slow worm like movements, non-spastic, extrapyramidal, slow twisting movements, drooling and speech impairment

Answer 26

Dyskinetic CP

Question 27

Type of CP: wide based gait, difficulty with coordination, can't do repetitive motions well, difficulty with purposeful movement like reaching for an object

Answer 27

Ataxic CP

Question 28

When is CP diagnosed

Answer 28

• diagnosed in infancy when child fails to meet milestones of development

Question 29

Interventions for CP

Answer 29

◦ no cure but can use OT/PT/ surgery/equipment/meds like anti anxiety/seizure meds to manage it • Safety : protective equipment- helmet/pads, safe toys preventing aspiration, position child upright with feeding, educate parents

Question 30

Most common type of seizure in pedes? What causes it?

Answer 30

Febrile — temp >104

Question 31

Safety considerations for seizure

Answer 31

◦ suction/oxygen ◦ bed free of things that can injure them ◦ pad side rails ◦ position on side during seizure --> prevent aspiration of secretions ◦ bed locked and low ◦ loosen restrictive clothing ◦ do not try to restain/put anything in mouth ◦ stay with child ◦ note onset/characteristics

Question 32

What is meningitis?

Answer 32

Infection of the nervous system •Affects covering of the brain and spinal cord (meninges) •Medical emergency – life threatening infection

Question 33

Is meningitis chill or like a big deal?

Answer 33

Medical emergency= life threatening!

Question 34

Tonic phase of seizure =

Answer 34

Stiffening 10-20 seconds

Question 35

Clonic phase of seizure =

Answer 35

Jerking, 30-50 seconds

Question 36

Postictal phase of seizure

Answer 36

Limp body, semiconscious, after tonic and clonic, lasts 30 min

Question 37

2 weird types of seizure disorders from ATI

Answer 37

West syndrome- onset 3-7 mont, tested with ACTH, single sudden seizure of cluster of up to 150 Lennox- gastaut syndrome- mixture of seizure with cognitive deficits

Question 38

S/s of meningitis in infant/child

Answer 38

• infant= low temp, not feeding, lethargy, bulging fontanels • Severe headache • stiff neck • older kids =sudden high fever • photosensitivity • altered mental status • rash = specific type of bacteria- can die within hours! very serious •Kernig’s sign ◦ Flex hip and knee 90° - positive if child cannot extend knee from pain •Brudzinski’s sign ◦ Flexion of neck causes involuntary flexion of knee and hip

Question 39

Re: meningitis sign ◦ Flexion of neck causes involuntary flexion of knee and hip

Answer 39

Brudzinski’s sign

Question 40

Re meningitis sign: ◦ Flex hip and knee 90° - positive if child cannot extend knee from pain

Answer 40

Kernigs sign

Question 41

2 types of meningitis

Answer 41

Viral ( aseptic) and bacterial ( septic)

Question 42

Which type of meningitis is highly contagious and requires droplet precautions

Answer 42

Bacterial

Question 43

When do we give Abx in relation to lumbar puncture?

Answer 43

Before LP!

Question 44

Worst kind of meningitis?

Answer 44

Bacterial

Question 45

Positioning for lumbar puncture - during and after

Answer 45

◦ Proper positioning – hips and knees flexed ‣ Infant – chin to chest and knees to abdomen- check resp. status in this position ◦ Flat in bed after procedure

Question 46

Need to differentiate meningitis from ______ ______

Answer 46

Reye’s syndrome Can cause liver and neuro and looks like meningitis

Question 47

Reye’s syndrome occurs when….

Answer 47

You use aspirin with viral infection Exception=COME BACK TO THIS. WE JUST LEARNED ABOUT IT

Question 48

Signs of increase ICP re: head injury

Answer 48

``` ◦ Slow, sluggish pupil response, increased sleeping ◦ Infant – bulging fontanels ◦ Bradycardia (late sign) ◦ irritable, fussy ◦ emesis ◦ changes in mental status/LOC/ coma ```

Question 49

Education re head injuries

Answer 49

• Preventative education is key: helmets, seat belt, shaken baby syndrome