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Pediatrics/ Maternity > Pediatrics- Neurology > Flashcards

Pediatrics- Neurology Flashcards

1
Q

What is Meningitis?

A

An inflammation of the meninges
Can be bacterial, viral, or fungal.

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2
Q

What is Reyes Syndrome

A

A life-threatening disorder that involves a cute encephalopathy and fatty changes of the liver

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3
Q

How do you determine between meningitis and reyes syndrome

A

Testing- ( spinal tap)

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4
Q

Which meningitis is contagious

A

Bacterial

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5
Q

Why has bacterial meningitis decreased in age groups

A

The interaction of the HIB and pneumococcal conjugate vaccine

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6
Q

Expected finings in  Meningitis

A

Photophobia (light bothers you) vomiting irritability headache

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7
Q

Meningitis physical assessment Finding a newborn

A

Poor muscle tone we cry poor sock refuses feeding vomiting diarrhea neck is supple without Michael rigidity 

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8
Q

What is a late finding a newborns with meningitis

A

Bulging fontanelles

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9
Q

What is a physical assessment finding of meningitis in three months to two years

A

Seizures high-pitched cry fever irritability bulging fontanelles possible nuchal rigidity poor feeding vomiting brudzinskis sign and Kermit’s sings

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10
Q

Expected findings of meningitis in two years through adolescence

A

Seizures (often initial finding) nuchal rigidity positive brudzinski and Jernigan sign fever chills headache vomiting irritability delirium stupor coma petechiae( rash) Chronic pain in your involvement of joints

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11
Q

Brudzinski sign

A

Flexion of extremities occurring with deliberate flexion of the Child’s neck

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12
Q

Kernigs sign

A

Resistance to extension of the child’s leg from a flexed position

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13
Q

What is an Indicative laboratory test of meningitis

A

CSF ( cerebral spinal fluid) 

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14
Q

What were the cerebral spinal Fluid look like in bacterial meningitis

A

Cloudy color elevated WBC count elevated protein count elevated glucose count positive Gram stain

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15
Q

What would the cerebral spinal fluid look like in viral meningitis

A

Clear colors slightly elevated WBC count negative Gram stain

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16
Q

What is a definite diagnostic test for meningitis

A

Lumbar puncture (spinal tap) 

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17
Q

What position said the patient be in during a lumbar puncture

A

Side lane position with the head flexed and knees drawn up toward the chest

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18
Q

What is the client education after a lumbar puncture

A

Remain in a flat position to prevent leakage and a resulting spinal headache

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19
Q

What requires immediate medical attention in meningitis

A

Presence of petechiae or a purpuric type rash

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20
Q

What type of precaution should a child with meningitis be on

A

Droplet precautions are required a private room provider should wear a mask and child should remain in respiratory isolation for a minimum of 24 hours after initiation of antibiotic therapy

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21
Q

What should you be Monitoring in a child with meningitis

A

Monitor head circumference in fontanelles for presence of changes in bulging

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22
Q

What should the environment look like in a patient with meningitis

A

Quiet environment minimize exposure to bright light position the patient without a pillow and slightly elevate The head of the bed
Implement seizure precautions

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23
Q

What medication should you use in a patient with meningitis

A

Corticosteroids: dexamethasone

Not effective for long term 

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24
Q

Complications of meningitis

A

Monitor for manifestations of increased ICP

High-pitched cry increased head circumference diplopia seizures

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25
Q

What systems of the bodies does Reyes syndrome affect

A

Liver and brain

Pausing liver dysfunction in cerebral edema

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26
Q

Risk factors for Reye’s syndrome

A

Using aspirin (salicylate)
Typically follows a viral illness
(Influenza, gastroenteritis, varicella)

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27
Q

What causes Reyes syndrome

A

 recent illness or use of aspirin

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28
Q

Laboratory test for Reyes syndrome

A

Liver enzymes (ALT + AST): elevated
Blood ammonia: elevated
Electrolytes altered

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29
Q

 Diagnostic procedures for reyes syndrome

A

Liver biopsy- Risk for hemmorage
 lumbar puncture to rule out meningitis

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30
Q

Nursing care for Reye’s syndrome

A

Accurate I and o
Keep head of bed elevated 30
Prevent hemorrhage
Implement seizure precautions 

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31
Q

Medication‘s for Reyes syndrome

A

Osmotic diuretic: Mannitol 

(To decrease cerebral swelling) 

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32
Q

Complication of reyes syndrome

A

Speech or hearing impairment
Death 

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33
Q

A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness which of the following action should the nurse take?
A) Place the client on NPO status
B) Prepare the client for a liver biopsy
C) Position the client dorsal recumbent
D) Put the client in a protective environment

A

A) place the client on NPO status

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34
Q

A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings with the nurse identify as indicating viral meningitis ( Select all that apply)
A) Negative Gram stain
B) Normal glucose content
C) cloudy color
D) decreased WBC count
E) Normal protein content

A

A) negative Gram stain
B) Normal glucose content
E) normal protein content


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35
Q

A nurse is assessing a four month old infant who has meningitis which of the following manifestations should the nurse expect
A) Depressed anterior fontanel
B) constipation
C) Presence of the rooting reflex
D) High-pitched cry

A

D. High pitched cry

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36
Q

A client is reviewing the medical record of the client who has reye syndrome which of the following findings should the nurse identify as a risk factor for Reyes syndrome
A. Recent history of infectious cystitis caused by Canadida
B. Recent history of bacterial Otitis media
C. Recent episode of Gastro enteritis
D. Recent episode of haemophilus influenzea meningitis 

A

C. Recent episode of Gastro enteritis

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37
Q

A nurse is developing an educational program about viral and bacterial meningitis the nurse should include that the introduction of which of the following immunizations decrease the incidence of bacterial meningitis in children (select)
A. Inactivated polio vaccine
B. Pneumococcal conjugate vaccine
C. Diphtheria and tetanus toxoid and acellular pertussis vaccine (DTaP)
D. Haemophilus influenzae type B (HIB) Vaccine
E. Trivalent inactivated influenza vaccine

A

B. Pneumococcal conjugate vaccine
D. Haemophilus influenzae type B (HIB) Vaccine

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38
Q

What is a seizure

A

An abnormal involuntary excessive electrical discharges of neurons within the brain

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39
Q

What is a partial (focal) seizure 

A

Involves one area of the brain

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40
Q

What is a generalized seizure

A

Involves the entire brain

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41
Q

How is a diagnosis of Epilepsy made? 

A

If a client has two unprovoked seizures at least 24 hours apart
Or if a single unprovoked seizures occurs during the time period of 10 years following two unprovoked seizures

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42
Q

Risk factors for seizures

A

No known etiology
Febrile episodes
cerebral edema
intracranial infection
brain tumors
absence of O2( anoxia)
Toxins lead poisoning tetanus

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43
Q

Risk factors for epilepsy

A

Trauma
hemorrhage
congenital defects
anoxia
infection
hypoglycemic injury
uremia
migraine

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44
Q

What is a tonic clonic seizure

A

Onset without warning
most prevalent of all seizures

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45
Q

What is the tonic phase of a tonic clonic seizure

A

Last 10 to 20 seconds
eyes roll upward
loss of consciousness
contraction of entire body
tongue can be bitten
apnea leading to cyanosis

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46
Q

What is the clonic phase of a tonic clonic seizure

A

Last 30 to 50 seconds
violent jerking movements of the body can have foaming at the mouth experiences rhythmic contraction and relaxation
can be incontinent

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47
Q

What is the postictal State

A

Last 30 minutes
remain semi conscious confused for several hours
possible vomiting headache or visual or speech difficulties
sleeps for several hours
sore
no Recollection of seizure

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48
Q

What is an absent seizure

A

Between ages 4 to 12
loss of consciousness lasting 5 to 10 seconds
motionless blank stare
affect schoolwork
daydreaming or inattentiveness
unable to recall episode 
drop items 

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49
Q

What is a myoclonic seizure

A

Can involve only the face and trunk or one of them more extremities
might not lose consciousness

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50
Q

What is an atonic or akinetic seizure

A

Drop attacks
between 2 to 5 years
muscle tone is lost for a few seconds causing for confusion follows
should wear a helmet

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51
Q

What is a aversive seizure

A

Most common partial seizure
eyes and head turn away from side of focus

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52
Q

What is a Rolandic seizure

A

Tonic clonic movements involving the face salvation arrested sleep 
most common

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53
Q

What is a simple partial seizure with sensory manifestations

A

Tingling numbness or pain in one area of the body then spreading to other parts with visual sensations

54
Q

What is a complex partial seizure (psychomotor seizure)

A

Altered behavior in ability to respond to the environment impaired consciousness regains in less than five minutes confusion and inability to recall event
aura

55
Q

What is west syndrome (infantile spasms) 

A

Rare disorder onset between three and seven months
sudden brief symmetric muscle contractions
possible cry or giggle before after treated with ACTH

56
Q

What is Lennox gastaut syndrome 

A

Mixture of different seizures and child with cognitive defects
aggressive and hyper active behavior 

57
Q

Febrile seizures

A

Associated with a sudden spike in temperature is high is 102 - 104
duration 15 to 20 seconds

58
Q

 diagnostic procedures for seizures

A

EEG- electrical activity
Remain quiet during procedure
No caffeine
Wash hair 

59
Q

Nursing care for seizures

A

Protect from injury place blanket under head
maintain patent airway
side laying position
loosen restrictive clothing
do not attempt to open jaw
do not put anything in mouth 
remove glasses
note onset time and characteristic

60
Q

Nursing actions For post seizure

A

Maintain side lying position
perform neurological checks
assessed for injury
re-orient and calm client
know if experienced an aura and what it was

61
Q

Medication‘s for seizures

A

Diazepam - Should not be mixed with any other solution other than 0.9% 

62
Q

What is a focal resection

A

Resection of the area of the brain to remove Epileptogenic zone 

63
Q

What is a hemispherectomy

A

Removal of one hemisphere of the brain procedure is reserved for catastrophic intractable epilepsy

64
Q

What is corpus callosotomy

A

Separation of the connection between the two hemispheres in the brain 

65
Q

What is status epilepticus 

A

Prolong seizure activity less than 30 minutes or longer
Requires emergent treatment to prevent loss of brain function

66
Q

A nurse is caring for a child who has absent seizures which of the following findings with the nurse expect( select)
Loss of consciousness
appearance of daydreaming
dropping held objects
falling to the floor
having piercing cry

A

Loss of consciousness
appearance of daydreaming
dropping held objects

67
Q

A nurse is caring for a client who just experienced a generalized seizure which of the following is a priority action for the nurse to take
position the child on a side lying position
try to determine the seizure trigger 
re-orient a child to the environment know the time of postictal period

A

Position the child on a side lying position

68
Q

A nurse is providing teaching to the guardians of a child who is having an electroencephalogram EEG. Which of the following statements by a guardian indicates teaching was effective
my child to remain quiet and still during this procedure
I cannot wash my child’s hair prior to the procedure
I should not give my child anything to eat prior to the procedure
this procedure will be very painful for my child

A

My child to remain quiet and still during this procedure

69
Q

A nurse is teaching a group of caregivers about the risk factors for seizures which of the following factors should the nurse include in the teaching ( select)
Febrile episodes
hypoglycemia
sodium imbalances
low blood lead levels
presence of diphtheria

A

Febrile episodes
hypoglycemia 
sodium imbalances

70
Q

A nurse is reviewing treatment options with the guardian of a child who is worsening seizures which of the following treatment option should the nurse include in the discussion (select)

Vagal nerve stimulator
additional antiepileptic medication
corpus callostomy
Focal resection
radiation therapy

A

Vagal nerve stimulator
additional antiepileptic medication
corpus callostomy
Focal resection

71
Q

 what is a concussion

A

A traumatic injury to the brain that alters the way the brain functions

72
Q

What is a contusion to the brain

A

Bruising of the cerebral tissue

73
Q

How is a skull fractures caused 

A

Direct trauma to the skull

74
Q

What is a laceration to the brain

A

Tearing of the cerebral tissue

75
Q

What is a linear fracture

A

Most common and involves single fracture beginning from the point of impact
do not cross suture line

76
Q

What is depressed fractures

A

Broken bone fragments are pushed in word

77
Q

Comminuted fracture’s

A

Made up of more than one linear fracture in occur following intense impact or repeated trauma

78
Q

What is a Basliar a fracture

A

Involve those at the anterior or posterior base of the skull

79
Q

What is an open fracture

A

Involves a disruption of the skin survive

Complications include osteomyelitis and meningitis

80
Q

What is a growing fracture

A

Fracture worsens due to pressure from brain herniation

81
Q

 symptoms of Head injury

A

Amnesia
loss of consciousness
confusion 
pallor
lethargy
altered mental state
neurological deficits
agitation

82
Q

Severe injury to a head causes

A

Increased intracranial pressure
forceful vomiting
bulging fontanelle
alteration in pupil response
seizures

83
Q

What is flexion posturing

A

Severe dysfunction of the cerebral cortex demonstrates the arms race elbow and fingers flex and bent in word into the chest and legs extended rotated internally

84
Q

What is extension posturing

A

Severe dysfunction at the level of the midbrain demonstration of backward origin of the legs and arms flex wrist and fingers extending the clench jaw and possible of an arched back

85
Q

Nursing care for head trauma

A

Ensure spine stabilization until spinal cord injury ruled out 
maintain patent airway
monitor consciousness pupils IC P assess for clear fluid or drainage from ears or nose
assessed for bleeding

86
Q

Medication’s for head trauma

A

Mannitol: osmotic diuretic to decrease ICP and Cerebral edema

87
Q

Therapeutic procedures for head trauma

A

Burr holes craniotomy

88
Q

What is an epidural hematoma

A

Bleeding between the Dura and the skull
Short period of unconsciousness followed by normal period for several hours then lethargic or coma 

89
Q

What is a subdural hemorrhage

A

Bleeding between the Dura and the arachnoid membrane
increase head circumference anemia seizures in coma

90
Q

When does cerebral edema occur

A

Can develop within 24 to 72 hours post trauma
increased ICP

91
Q

What is brain herniation
And what symptoms

A

Downward shift of the brain tissue

loss of blinking
lots of gag reflex
pupils fail 

92
Q

The nurse is in the emergency department is assessing a child following of motor vehicle crash the child is unresponsive in spontaneous respirations of 22 per minute and has a laceration on the forehead that is bleeding which of the following action should the nurse take first

Stabilize the child neck
Clean the child’s laceration with soap and water
implement seizure precautions for the child
initiate IV access for the child

A

Stabilize the child’s neck

93
Q

A nurse is caring for an adolescent who has a closed head injury which of the following findings are indications of increased intracranial pressure

Report of headache
alteration in pupillary response
increase motor response
increase sleeping
increased sensory response 

A

Report of headache
alteration of pupillary response
increase sleeping

94
Q

A nurse is caring for a child who has an ICP which of the following action should the nurse take (select)

Suction the endotracheal tube every two hours
maintain a quiet environment
use 2 pillows to elevate the hood administer a stool softener
maintain body alignment

A

Maintain a quiet environment
administer a stool softener
maintain body alignment

95
Q

A nurse is assessing a child who has a concussion Which of the following findings should the nurse expect (select)

Amnesia
systematic hypertension
bradycardia
respiratory depression
confusion

A

Amnesia and confusion

96
Q

A nurse is caring for a child who is taking mannitol for cerebral edema which of the findings should the nurse monitor for an adverse effect of mannitol

Bradycardia
weight loss
confusion
constipation 

A

Confusion

97
Q

Where are sensory impairment is most commonly found in children

A

eyes and ears

98
Q

What is a risk factor for visual impairments

A

Prenatal or post natal conditions
prenatal infections 
or chronic illness

99
Q

What is myopia

A

Nearsightedness -sees close objects clearly but not objects in the distance
Eye rubbing , difficulty reading, clumsiness

100
Q

What is hyperopia

A

Farsightedness sees distant objects clearly but not objects that are close

101
Q

What is astigmatism

A

Uneven refractive Curvatures InVision in which only parts of letters on a page can be seen

Appearance of normal vision because tilting the head enables all letters to be seen

102
Q

What is Anisometropia

A

Different refractive strength in each eye -excessive eye rubbing poor school performance

103
Q

What is amblyopia

A

Lazy eye

Reduced visual acuity in one eye 

104
Q

What is strabismus

A

Inward or outward deviation of a misaligned eyes

difficult seeing print clearly one eye can see better than the other

105
Q

What is Cataracts 

A

Gray opacity of the lens which prevents light from entering into the eye

Decreased ability to see absence of red reflex inability to reach grab objects in infants

106
Q

What is glaucoma

A

Increase in ocular pressure in the eye loss of peripheral vision 

107
Q

What is partial visual impairment

A

Classified as 20/70 20/200

108
Q

What is legal blindness

A

Classified as 20/200

109
Q

What is a treatment for strabismus

A

Patching the stronger Eye 

110
Q

Treatment for Cataractsand glaucoma

A

Surgery

111
Q

What can hearing impairments affect

A

Speech in the ability to clearly process linguistic sounds

112
Q

Risk factors for hearing impairments

A

Chronic ear infection
down syndrome
cerebral palsy

113
Q

What is conductive losses in hearing

A

Involve interference of sound transmission which can result from Otis media or excessive earwax

114
Q

What does sensorineural losses in hearing

A

Involve interference of transmission along the nerve pathways result from congenital defects

115
Q

What is central auditory Imperception

A

Involves all other hearing loss is related to natural causes

116
Q

Hearing loss Expected findings in infants

A

Lack of startle reflex failure to respond a noise absent of vocalization by seven months

117
Q

Hearing loss expected findings and older children

A

Using gestures yelling to Xpress emotions irritability big shy

118
Q

 What is a cochlear implant

A

Used for extensive hearing loss send impulses to the auditory nerve surgically implanted under skin

119
Q

What can visual and hearing impairments affect in children

A

Speech and motor development delayed growth

120
Q

What is down syndrome

A

 A chromosomal or abnormality

121
Q

Expected findings in a patient with down syndrome

A

Enlarged anterior fontanelle’s small round head flattened for head up Wordle word slanted eyes protruding tongue possible congenital heart defect

122
Q

Prenatal diagnostic procedure for down syndrome

A

Testing for alpha-fetoprotein and maternal blood

123
Q

Infant diagnostic procedure for down syndrome

A

Chromosome analysis and echocardiograph

124
Q

 Growth in a patient with down syndrome

A

Both height and weight or reduced weight gain is more rapid then growth in height

125
Q

Respiratory issues in a patient with down syndrome

A

Impaired drainage of mucus Associated with underdeveloped nasal bone respiratory infections are common

126
Q

A nurse is planning to perform a peripheral vision test on a child which of the following action should the nurse take

Place the child 10 feet away from a snellen chart
Show a set of cards to the child one at a time
Cover the childs eye performing the test on the other eye
Have a child focus on an object while performing the test

A

Have a child focus on an object while performing the test

127
Q

A nurse is teaching a group of parents about possible manifestations of down syndrome which of the following findings should the nurse include in the teaching ( select) 
A large head with bulging fontanelles
larger ears that are setback
protruding abdomen
Broad short feet and hands
hypotonia

A

Protruding abdomen
broad short feet and hands
hypotonia- low level muscle tone

128
Q

A nurse is assessing a child who is myopia which of the following findings should the nurse expect( select)

Headaches
photophobia
difficulty reading
difficulty focusing on close objects
poor school performance

A

Headaches
difficulty reading
poor school performance

129
Q

A nurse is assessing a toddler for possible hearing loss which of the following findings are indications of hearing impairment(select)

Use of mono tone speech
speaks loudly
repeat sentences
appear Shy
is overly attentive to the surroundings

A

Uses monotones
speech speaks loudly
appear Shy 

130
Q

A nurse is teaching that a parent of an infant who is down syndrome which of the following statements by the parent indicates an understanding of the teaching

I should expect him to have frequent diarrhea
I should place a cool mist humidifier in his room
I should avoid the use of lotion on the skin
I should expect him to grow faster in length than the other infants

A

I should place a cool mist humidifier in his room

Pediatrics/ Maternity (15 decks)

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