Neurological or Sensory Condition

Question 1

What nervous system involves the brain & spinal cord?

Answer 1

CNS

Question 2

What nervous system involves the nerves?

Answer 2

PNS

Question 3

PNS divided into what two nervous systems?

Answer 3

sensory-somatic nervous system and autonomic nervous system

Question 4

removes waste and supplies nutrients to brain and spinal cord

Answer 4

CSF

Question 5

a term that refers to the skull’s ability to indent under pressure

Answer 5

craniotabes

Question 6

Skull ossification continues through what?

Answer 6

puberty until mid-20s

Question 7

Pressure of CSF in the subarachnoid space between the skull and the brain

Answer 7

ICP

Question 8

Complications of increased intracranial pressure?

Answer 8

decreasing cerebral perfusion leads to ischemia and anoxia

Question 9

Early signs of Increased Intracranial Pressure in infants:

Answer 9

headache, emesis, change in LOC, decrease in GCS score, irritability, sunsetting eyes, decreased eye contact, pupil dysfunction, seizures

Question 10

Late signs of Increased Intracranial Pressure in infants:

Answer 10

further decrease in LOC, bulging fontanels, decreasing spontaneous movements, posturing, PAPILLEDEMA, pupil dilation with decreased or no response to light, increased blood pressure, irregular respirations, cushings triad

Question 11

Priority care of Increased ICP?

Answer 11

maintaining airway & cerebral perfusion, PREVENT SEIZURES

Question 12

CPP formula

Answer 12

MAP-ICP

Question 13

When do you intubate a patient (based on GCS)?

Answer 13

GCS <8

Question 14

Vent Settings for increased ICP

Answer 14

PO2 120-140 mm hg, PCO2 30-35 mm Hg

Question 15

temp elevation (non –responsive to antipyretics), hypothermic blanket to keep T< F, b/c shivering can increase ICP) is a sign of what in increased ICP

Answer 15

intracranial bleeding

Question 16

What kind of fluids are given to patients with increased ICP?

Answer 16

ISOTONIC

Question 17

Medications for increased ICP

Answer 17

Mannitol, barbiturates, sedation

Question 18

What is a way of temporary compensation for increased ICP?

Answer 18

open fontanels

Question 19

Structural defects in the Cerebellum, caused by an indented bony space at the lower rear of the skull. Women are affected more than men. Type II and III are most often seen in children

Answer 19

Arnold-Chiari Malformation

Question 20

Symptoms including dizziness, muscle weakness, numbness, vision problems, headache, and problems with balance and coordination What is it??

Answer 20

Arnold Chiari Malformation

Question 21

Treatment of Arnold Chiari Malformation

Answer 21

surgery

Question 22

Postop care for Arnold-Chiari Malformation?

Answer 22

q 1 hr neuro checks, incision care(observation for CSF leak), pain management

Question 23

Premature closure of one or more cranial sutures due to a defect in ossification Growth stops in direction that is perpendicular to the closed suture but continues in the direction parallel to the closed suture

Answer 23

Craniosynostosis

Question 24

most common neuro tumor in kids; slow growing; surgery

Answer 24

Astrocytoma (glioma)

Question 25

most common malignant brain tumor; surgery, chemotherapy, radiation

Answer 25

Medulloblastoma

Question 26

brain tumor inside of brainstem; surgery not an option; radiation possible; lifespan less than 2 years after diagnosis

Answer 26

Brain Stem glioma:

Question 27

brain tumor that usually in posterior fossa; hydrocephalus; surgery

Answer 27

Ependymomas

Question 28

Electrical disturbance in brain Causes: genetic, trauma/injury, infection, anoxia, toxic ingestion, hypoglycemia, maternal teratogens, congenital causes, idiopathic

Answer 28

Seizures

Question 29

\< 3 y.o., etiology unknown, tonic-clonic seizure, fever, no epileptiform, \< 15 min, loss of consciousness, no aura, post-confusion, severity of temp. elevation

Answer 29

Febrile seizures

Question 30

localized to one area of the brain, S&S: one area affected: hands, lips, wrist, arms, face. Impaired loss of consciousness at onset.

Answer 30

Partial Seizures

Question 31

A seizure is occuring, what a nurse should do?

Answer 31

Call for help and stay with a child Airway, respirations are priority Loosen clothing , lateral Medication: (Valium, Ativan, Cerebryx) per order After seizure care: lateral recumbent position Continuous CR/Sat monitor Do not restrain Collaborate between PCP, school nurse, family

Question 32

Life- threatening disease that leads to multisystem failure – primarily cerebral edema Cause: unknown; although linked to aspirin products used to treat viral infections Recommended not to give children under the age of 19 ASA for any fever-causing illnesses.

Answer 32

Reye Syndrome

Question 33

Diagnostic Procedure for Reye Syndrome:

Answer 33

Liver biopsy, Lumbar Puncture (to rule out meningitis), Labs (increased ammonia, liver enzymes or prolonged coagulation may indicate)

Question 34

Nursing Interventions for Reye Syndrome:

Answer 34

Maintain hydration Administer prescribed osmotic diuretics Monitor coagulation

Question 35

Inflammation of the meninges, Viral vs. bacterial

Answer 35

Meningitis

Question 36

S&S of Meningitis in Neonates

Answer 36

Hard to diagnose Vomiting, poor muscle tone, irritability, lethargy, irregular respirations/apnea

Question 37

S&S of Meningitis in 2mos-2yo children

Answer 37

High-pitched cry, seizures, fever, poor feedings, vomiting, irritable, bulging fontanels, possible nuchal rigidity

Question 38

S&S of Meningitis in 2yo-adolescence

Answer 38

Excruciating Headache Irritable, Nausea, vomiting, fever, chills, photophobia, nuchal rigidity, positive Brudzinski’s sign, positive Kernig’s signs, seizures

Question 39

Meningitis caused by S.pneumonia (bacterial organism) will have what distinct symptom?

Answer 39

draining ear

Question 40

Meningitis caused by N.meningitides (bacterial organism) will have what distinct symptom?

Answer 40

red macular rash

Question 41

Meningitis caused by N.meningitides and H.influenza (bacterial organism) will have what distinct symptom?

Answer 41

involvement of the joints

Question 42

Classic finding on examination for a child suspected of meningitis include a positive sign from what two signs?

Answer 42

Kernig's or Brudzinski's Sign

Question 43

Diagnosis of Meningitis

Answer 43

CSF, Assume positive in infants \<2 months old until cultures come back negative

Question 44

Nursing Inverventions for Meningitis:

Answer 44

Monitor ICP; neuro checks q2; isolate children, hydrate, decrease stimuli, prevent future episodes, comfort care

Question 45

How to prevent future episodes of Meningitis:

Answer 45

Teach family about complete and early treatment of URI; Hib vaccine in children under 5

Question 46

Usually viral in origin Signs and symptoms - variable Confusion High fever Hallucinations Seizures Nuchal rigidity Coma What is it??

Answer 46

Encephalitis

Question 47

Nursing Care for Encephalitis:

Answer 47

Antivirals/Antibiotic Neuro checks q2h HOB elevated Antipyretics

Question 48

Infectious material in the brain tissue

Answer 48

Brain Abscess

Question 49

Signs and symptoms Localized headache Fever Drowsiness Ataxia Seizures What is it??

Answer 49

Brain Abscess

Question 50

Nursing care for brain abscess

Answer 50

Watch for symptoms of increased intracranial pressure Antimicrobial therapy Post surgical care

Question 51

Ascending muscle weakness or paralysis Rare, autoimmune Signs and symptoms Ascending muscle weakness/paralysis Three phases: acute, second, recovery

Answer 51

Guillain-Barre Syndrome

Question 52

Medications given to a patient with Guillain-Barre Syndrome

Answer 52

Administer immunoglobulin (IVIG) Steroids O2 Sats Range of motion Pain control

Question 53

Neural tube fails to close

Answer 53

Spina Bifida - Neural tube defects (NTDs)

Question 54

no spinal cord involvement, Dimple/tuft of hair

Answer 54

Occulta, S&S of Spina Bifida

Question 55

meninges protrude but no neural elements present

Answer 55

Meningoecele, S&S of Spina Bifida

Question 56

most sever S&S of spina bifida

Answer 56

Myelomeningocele

Question 57

3 major S&S of Spina Bifida

Answer 57

Occulta, Meningocele, Myelomeningocele

Question 58

Nursing Care for Spina Bifida:

Answer 58

prone position after birth, do not place bladder over defect, Latex allergy alert!

Question 59

Priority nursing intervention for Spina Bifida:

Answer 59

infection prevention

Question 60

Increase in CSF production, impedance of absorption, or an obstruction to flow

Answer 60

Hydrocephalus

Question 61

unable to reabsorb CSF

Answer 61

Communicating Hydrocephalus

Question 62

ventricular system does not communicate with arachnoid villi due to obstruction to CSF flow

Answer 62

Noncommunicating Hydrocephalus

Question 63

most common cause of Hydrocephalus; MRI shows narrowing of Aqueduct of Sylvius Enlargement of lateral and 3rd ventricles, but normal 4th ventricle

Answer 63

Aqueductal Stenosis

Question 64

S&S of Hydrocephalus in preemies

Answer 64

bradycardia, apnea, seizures, hypotonia, opthalmoplegia, sunset eyes, macrocephaly

Question 65

S&S of Hydrocephalus in Infants with open sutures

Answer 65

bulging fontanels, splayed sutures, sunset eyes, increased head circumference

Question 66

S&S of Hydrocephalus in Children

Answer 66

vomiting, lethargy, paralysis of upward gaze (Parinaud’s sign), frontal bossing, delayed development, headache

Question 67

Classic sign of Hydrocephalus

Answer 67

"Cracked pot" sound on percussion

Question 68

Nursing/medical treatment of Hydrocephalus:

Answer 68

LP Ventricular reservoir Shunts 3rd ventriculostomy (aqueductal stenosis) Measure head circumference

Question 69

Complication of Hydrocephalus medical treatment:

Answer 69

Shunt malfunction

Question 70

Most common permanent physical disability in childhood Nonprogressive, occurs before cerebral development is complete

Answer 70

Cerebral Palsy

Question 71

most common, stiff muscles because of increased muscle tone, and the muscles are predisposed to contracture. Will have poor posture, coordinated movement, and balance. Classified according to limbs affected.

Answer 71

Spastic Cerebral Palsy

Question 72

characterized by uncontrolled involuntary writhing movement of extremities

Answer 72

Athetoid (dyskinetic) Cerebral Palsy

Question 73

have difficulties with balance and depth perception. Walk with unsteady gait, demonstrate poor coordination, and often have fine motor control problems.

Answer 73

Ataxic Cerebral Palsy

Question 74

a child has two or more types of CP. Common symptoms: difficulty or inability to walk, speech difficulty, swallowing problems, breathing difficulties, bowel or bladder incontinence, seizures, vision problems, learning disabilities, hearing deficits, attention or behavioral problems, and impaired senses.

Answer 74

Mixed Cerebral Palsy

Question 75

Confusion to brief loss of consciousness after a mechanical blow to the head; transient and reversible

Answer 75

Concussion

Question 76

Skin and skull integrity maintained after blow to the head; damage to underlying tissue

Answer 76

Closed Injury

Question 77

bruise to brain

Answer 77

Contusion

Question 78

Blood clot within the skull; can cause increased ICP; result of skull fracture, venous or arterial tear; subdural hematoma is bleeding between the dura and the brain

Answer 78

Intracranial hematoma

Question 79

Complication of head injury Signs: fixed dilated pupils, deteriorating level of consciousness, Cheyne-Stokes respirations, hemodynamic instability, and abnormal posturing

Answer 79

Brain Herniation

Question 80

Nursing interventions for brain herniation

Answer 80

Elevate bed 30 degrees Administer Mannitol as prescribed Ventilate patient Frequent VS/ neuro checks

Question 81

is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia.

Answer 81

drowning

Question 82

is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious secondary complications, including death, after the event.

Answer 82

near drowning

Question 83

occurs when a person's lungs become unable to extract oxygen from the air; laryngospasm w/out aspiration

Answer 83

dry drowning

Question 84

Extra-axial hemorrhages in subdural and subarachnoid spaces Retinal hemorrhages Skull films show fractures

Answer 84

Shaken Impact Syndrome

Question 85

Signs and symptoms Seizure activity, apnea, budging fontanels, coma, hemorrhage, bradycardia & cardiovascular collapse, poor feeding, lethargy, small for height/weight charts Sign of child abuse; mandated to report What is it??

Answer 85

Shaken Baby Syndrome

Question 86

Signs and symptoms Numbness, tingling, or loss of function What is it??

Answer 86

Spinal Cord Injury

Question 87

Speak in a normal tone of voice, state of consciousness

Answer 87

Alertness

Question 88

Speak in a loud voice, state of consciousness

Answer 88

Lethargy

Question 89

Shake gently to arouse, state of consciousness

Answer 89

Obtundation

Question 90

Use a painful stimuli, state of consciousness

Answer 90

Stupor

Question 91

Apply repeated painful stimuli, state of consciousness

Answer 91

Coma