Neuro PPT Flashcards by Rosemary Haas

ways a child can sustain a neural or cerebral injury

prenatally - CP
acquired - trauma - Shaken Baby
genetics - fragile X syndrome - Rhett syndrome

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persistence of rudimentary reflexes correlates to what disorder

Cerebral Palsy

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Pediatric Glasgow Coma Scale looks at what 3 parameters

eyes
verbal
motor

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what is the standardized assessment of child with altered LOC

PED Glasgow Coma Scale
pupil size/reactivity
LOC* - most sensitive indicator

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Scoring of Glasgow Scale

15 - unaltered LOC

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t or f, the lower the score of Glasgow at admission, the poorer the outcome

true

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decorticate flexion correlates to an injury where?

cerebral cortex

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what is decorticate flexion

arms/legs flexed to the core/mid-line

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decerebrate extension correlates to an injury where?

mid-brain injury

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what is anoxia

brain isn’t getting enough oxygen

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fixed/dilated pupils on assessment is assoc with what?

anoxia; deficit of cranial nerve #3, hypothermia
use of eye drops - atropine medication causes dilation
death

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what is atropine used for?

stimulate heart to go a little faster, check pupils first

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AVPU method for assessment stands for

awake, verbal stimuli, painful stimuli, unresponsive

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why is I/O an important assessment for neurological status

to assess cerebral edema - keep pt on dry side for prevention (salt/fluid restrictions)

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to reduce increased metabolism r/t fever provide this type of therapy

anti-pyretic therapy - keep comfortable

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do we want to mask s/s of head injury with pain mgmt

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what should be avoided with neuro problems/head injury

narcotics - morphine

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what is the recommended pain mgmt to avoid masking the effects of head injury

codeine

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s/s of ICP in infants

bulging fontanels
increased head circumference
sunset eyes
prominent scalp veins
vomiting with or without nausea
assess for seizures
high-pitched cry
headache (older kids)
diplopia -double/blurry vision (older kids)

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what could happen as a result of increased ICP

herniate brain stem-death

head is a closed box

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mgmt for ICP

head circumference daily
prepare for CT or MRI
palpate fontanels
reflexes
LOC
keep head mid-line 15-30 degrees

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those with spina bifida(myelomeningocele) have a high correlation with

hydrocephaly

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communicating hydrocephalus

no break in system to plexus to villi

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non-communicating hydrocephalus

tumor or stenosis is obstructing

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assessment criteria/manifest. for hydrocephaly

``` macewen sign (cracked-pot sound) - percussion on top of head back arching (opthisotonus) ```

what is positive trans-illumination

assessment where a light source held against head - CSF trans-illuminates

in shunt placement for hydrocephaly does child need to undergo surgeries with growth spurts

no, shunt coils in peritoneum as child grows shunt will lengthen

what is the purpose of shunt placement for hydrocephaly

draw CSF from ventricle to peritoneum where it will be reabsorbed

what type of shunt is used in hydrocephaly

V-P Shunt

pre-op care for shunt placement

head circumference | no s/s of infection

post-op care after shunt placement

``` flat on un-operative side wound care (sterile q-tip w/anti-biotic ointment) behind ear monitor for s/s of infection (high temp) GI status watch for ICP ```

2 classic signs of shaken baby syndrome

retinal tears | intracranial bleeds

consequence of shaken baby syndrome

``` ID seizures CP hydrocephalus motor fxn disorders blindness ```

what will older kids w/bacterial meningitis complain of

the worst headache they ever had nuchal rigidity/pain-stiff neck (touch chin to chest) photophobia

is bacterial meningitis spreadable?

yes - even during ruling out | put on **droplet precautions - at least 24hrs of anti-biotic therapy

what causes a child to have bacterial meningitis

strep pneumoniae (pneumococcal) meningococcal HIB

are you at high risk of developing meningitis if you have a local infection

yes - can become a systemic infection

Assessment technique to confirm bacterial meningitis

+ kernig and brudzinski sign

what is a kernig sign*

lift leg - child complains of pain in back of neck

what is a brudzinski sign*

lift back of neck - child lifts legs

severe form of bacterial meningitis is called

meningococcemia - medical emergency

manifestations of meningococcemia

purpuric or petechial rash - ominous sign

how do we dx bacterial meningitis

LP - lumbar puncture done at L3-L4

preparation of infants for LP-lumbar puncture

side lying knee-chest position - press on fontanel to expedite CSF drops

signs of bacterial meningitis in CSF

``` cloudy, turbid fluid WBC (1000-2000) Protein (100-500) *Glucose lower than blood sugar (bacteria needs glucose to grow) positive culture pressures are elevated ```

draw a venous specimen a half hour before lumbar tap, t or f

true

bacteria needs glucose to grow which is why glucose is lower than blood sugar in CSF for bacterial meningitis, t or f

true

nurs interventions for bacterial meningitis

``` isolation (droplet precautions) timely iv anti-biotic admin neuro checks/fontanelo pain mgmt quiet environment min. maint. fluids ```

is aseptic meningitis bacterial in nature

no - may be caused by a virus antibiotics are not indicated - supportive therapy (hydration,rest) not as lethal

will children with aseptic meningitis complain of the same things as bacterial meningitis

yes - headache, stiff neck, photophobia, n/v

what will cerebral spinal fluid show in aseptic meningitis

elevated lymphocytes

how should we position patient with spina bifida (myelomeningocele)

prone to prevent pressure or tears in the sack

what would happen if sack breaks its integrity

infection

is somebody has myelomeningocele there is a high incidence of

arnold chiari malformation - a form of hydrocephaly

assoc problems with myelomeningocele/spina bifida

paralysis of lwr extremities issues w/bowel-bladder control (bowel training/urinary cath) hip dysplasia

trt for spina bifida

surgery - to prevent infection/further problems | multi-disciplinary approach to care/trt

post op care for spina bifida surgery

pin diaper below suture line to ensure no contamination | bowel/bladder routines (GI/GU)

**correlation between latex allergy and spina bifida t or f

true

what are the plastic pieces worn for anatomical alignment for children with CP

MAFO - molded ankle foot orthotics | never put plastic next to the skin

assessment for CP

failure to achieve milestones (dx at 6-12 mos) | persistence of rudimentary reflexes

what are children at high risk for with CP

contractures scoliosis (assess) hearing and eye problems seizures/spastic issues

what should we teach parents for children with CP

passive range of motion exercises

do children with CP typically have some form of ID

yes - from profoundly MR to cognitive fxn

trt for CP

``` early detection/trt MAFO's PT and ROM dental care modify environment good nutrition ```

more frequent type of CP seen

spastic

medications used to trt CP

baclofen - implanted in abdomen - intrathecal space | anti-epileptics

what clinical behaviors are expected in infant w/meningitis

``` poor feeding irritability high-pitched cry lethargy bulging fontanel nuchal rigidity ```

definitive meningitis is based on what test

LP - lumbar puncture

why low-level of fluids for pt with meningitis

cerebral edema leading to ICP

can meningitis be prevented

yes - HIB vaccine