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Pediatrics > Peds Final Review - Neuro > Flashcards

Peds Final Review - Neuro Flashcards

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1
Q

DOWN SYNDROME

Most common chromosomal abnormality in children

A

Results from a trisomy of chromosome 21, and in less than 5% of cases, a translocation of chromosome 21

Down syndrome is associated with maternal age over 35

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2
Q

DOWN SYNDROME Nursing Assessment:

A

Flat, broad nasal bridge

Inner epicanthal eye folds

Upward, outward slant of eyes

Protruding tongue

Short neck

Transverse palmar crease (simian crease)

Hyperextensible and lax joints (hypotonia)

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3
Q

DOWN SYNDROME Nursing Assessment:

Common associated problems:

A

Cardiac defects

Respiratory infections

Feeding difficulties

Delayed developmental skills

Mental retardation

Skeletal defects Altered

immune function

Endocrine dysfunctions

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4
Q

DOWN SYNDROME Nursing Diagnoses

A

Delayed growth and development

Risk for impaired parenting

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5
Q

DOWN SYNDROME Nursing Interventions:

Assist and support parents during the diagnostic process and management of child’s associated problems

Assess and monitor growth and development

Teach use of bulb syringe for suctioning nares

A

Teach signs of respiratory infection

Assist family with feeding problems

Feed to back and side of mouth

Monitor for signs of cardiac difficulty or respiratory infection

Refer family to early intervention program

Refer to other specialist as indicated: nutritionist, speech therapist, physical therapist, and occupational therapist

The nursing goal in caring for a child with Down syndrome is to help the child reach his or her optimal level of functioning.

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6
Q

CEREBRAL PALSY (CP)

Nonprogressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (involuntary movements).

A

Associated problems may include mental retardation and seizures.

Causes include:

Anoxic injury before, during, or after birth

Maternal infections

Kernicterus

Low birth weight (major risk factor)

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7
Q

CEREBRAL PALSY (CP)

Nursing Assessment:

A

Persistent neonatal reflexes (Moro, tonic neck) after 6 months

Delayed developmental milestones

Apparent early preference for one hand

Poor suck, tongue thrust

Spasticity (may be described as “difficulty with diapering” by mother or caregiver)

Scissoring of legs (legs are extended and crossed over each other, feet are plantar-flexed; a common characteristic of spastic CP

Involuntary movements

Seizures

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8
Q

CEREBRAL PALSY (CP)

Nursing Diagnoses:

A

Delayed growth and development related to …….

Risk for imbalanced nutrition: less than body requirements related to…….

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9
Q

CEREBRAL PALSY (CP)

Nursing Interventions:

A

Identify cerebral palsy through follow-up of high-risk infants such as premature infants.
Refer to community-based agencies.

Coordinate with physical therapist, occupational therapist, speech therapist, nutritionist, orthopedic surgeon, and neurologist.

Support family through grief process at diagnosis and throughout the child’s life. Caring for severely affected children is very challenging.

Administer anticonvulsant medications such as phenytoin (Dilantin) if prescribed.

Administer diazepam (Valium) for muscle spasms if prescribed.

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10
Q

CEREBRAL PALSY (CP)

A

NCLEX Hint: Feed infant or child with cerebral palsy using nursing interventions aimed at preventing aspiration.

Position child upright, and support the lower jaw.

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11
Q

INCREASED INTRACRANIAL PRESSURE

Nursing Assessment:

Signs of increased intracranial pressure:

Infant

A

Poor feeding or vomiting

Irritability or restlessness

Lethargy

Bulging fontanel

High-pitched cry

Increased head circumference

Separation of cranial sutures

Distended scalp veins

Eyes deviated downward

Increased or decreased pain response

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12
Q

INCREASED INTRACRANIAL PRESSURE

Nursing Assessment:

Signs of increased intracranial pressure:

Child

A

Headache

Diplopia

Mood swings

Slurred speech

Papilledema

Altered level of consciousness

Nausea and vomiting, especially in morning

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13
Q

SPINA BIFIDA

Definition:

A

Malformation of the vertebrae and spinal cord resulting in varying degrees of disability and deformity.

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14
Q

Spina bifida occulta

A

is a defect of vertebrae only. No sac is present, and it is usually a benign condition, although bowel and bladder problems may occur.

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15
Q

SPINA BIFIDA With meningocele and myelomeningocele

A

a sac is present at some point along the spine.

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16
Q

SPINA BIFIDA

Meningocele

A

contains only meninges and spinal fluid and has less neurologic involvement than a myelomeningocele.

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17
Q

SPINA BIFIDA

Myelomeningocele

A

is more severe than meningocele because the sac contains spinal fluid, meninges, and nerves.

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18
Q

SPINA BIFIDA

A

The severity of neurologic impairment is determined by the anatomic level of the defect.

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19
Q

SPINA BIFIDA

A

Every child with a history of spina bifida should be placed on latex precautions.

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20
Q

SPINA BIFIDA

Prevention:

A

folic acid 0.4 mg is taken daily for all women of child bearing age

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21
Q

SPINA BIFIDA Nursing Assessment:

Spina bifida occulta: dimple with or without hair tuft at base of spine

Presence of sac in myelomeningocele is usually lumbar or lumbosacral

Flaccid paralysis and limited or no feeling below the defect

Head circumference at variance with norms on growth grids

A

Associated problems:

Hydrocephalus (90% with myelomeningocele)

Neurogenic bladder, poor anal sphincter tone

Congenital dislocated hips

Club feet

Skin problems associated with anesthesia below the defect

Scoliosis

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22
Q

SPINA BIFIDA Nursing Diagnoses:

A

Risk for infection R/T

Impaired urinary elimination patterns R/T

Impaired physical mobility R/T

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23
Q

SPINA BIFIDA Nursing Diagnoses:

A

Risk for infection R/T

Impaired urinary elimination patterns R/T

Impaired physical mobility R/T

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24
Q

SPINA BIFIDA Nursing Interventions

Preoperative:

A

Place infant in prone position
Keep sac free of stool and urine

Cover sac with moist sterile dressing

Position child on his/her abdomen, with legs abducted

Measure head circumference every 8 hours; check fontanel

Assess neurologic function
Monitor for signs of infection

Empty bladder using Crede’ method, or catheterize if needed

Promote parent-infant bonding

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25
SPINA BIFIDA Nursing Interventions Postoperative:
place infant in prone position Make same assessments as preoperatively Assess incision for drainage and infection Assess neurologic function
26
SPINA BIFIDA Nursing Interventions Long-term care
Teach family catheterization program when child is young Help older children to learn self-catherization Administer urecholine ( a cholinergic medication)as prescribed to improve continence Develop bowel program - -High fiber diet - -Increased fluids - -Regular fluids - -Suppositories as needed Assess skin condition frequently Assist with range-of-motion (ROM) exercises, ambulation, and bracing, if client is able Coordinate with team members: neurologist, orthopedist, urologist, physical therapist, and nutritionist Support independent functioning of child Assist family to make realistic developmental expectations of child
27
HYDROCEPHALUS Condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain
It is usually caused by an obstruction in the flow of CSF between the ventricles Hydrocephalus is most often associated with spina bifida. It can be a complication of meningitis.
28
HYDROCEPHALUS Nursing Assessment: Early manifestations of hydrocephalus in the INFANT:
Rapid head growth Full, bulging fontanel Irritability Poor feeding Distended, prominent 
scalp veins Widely separated cranial sutures
29
HYDROCEPHALUS Early manifestations of hydrocephalus in the CHILD:
Strabismus Headache that occurs in the morning and is relieved by emesis or sitting upright Nausea and vomiting 
(may be projectile) Diplopia Restlessness Behavior or personality changes Ataxia Sluggish or unequal pupillary responses Confusion Changes in school work Lethargy
30
HYDROCEPHALUS Late manifestations in the infant
“Setting sun” sign Frontal bone enlargement or bossing Vomiting, difficulty swallowing or feeding Increased blood pressure Decreased heart rate Altered respiratory pattern Shrill, high-pitched cry Sluggish or unequal pupillary responses
31
HYDROCEPHALUS Late manifestations in the child
Seizures Increased blood pressure Decreased heart rate Alteration in respiratory pattern Blindness from herniation of the optic disc Decerebrate rigidity
32
HYDROCEPHALUS
NCLEX HINT: Baseline data on the child’s usual behavior and level of development are essential so changes associated with increased ICP can be detected early.
33
HYDROCEPHALUS Nursing Diagnosis:
Delayed growth and development related to Risk for injury related to
34
HYDROCEPHALUS Nursing Interventions:
Prepare infant and family for diagnostic procedures Monitor for signs of increased ICP Maintain seizure precautions ``` Prepare parents for surgical procedure ---Shunt is inserted into ventricle ---Tubing is tunneled through skin to peritoneum where it drains excess CSF ```
35
HYDROCEPHALUS Nursing Interventions:
Prepare infant and family for diagnostic procedures Monitor for signs of increased ICP Maintain seizure precautions ``` Prepare parents for surgical procedure ---Shunt is inserted into ventricle ---Tubing is tunneled through skin to peritoneum where it drains excess CSF ```
36
HYDROCEPHALUS Nursing Interventions: Postoperative care
1. Assess for signs of shunt malfunction Infant: ---Changes in size, signs of bulging, tenseness, and separation in fontanels and suture lines ---Irritability, lethargy, or seizure activity ---Altered vital signs and feeding behavior Older child: Increase in ICP ---Change in LOC ---Complaint of headache ---Changes in customary behavior (sleep patterns, developmental capabilities) 2. Assess for signs of infection 3. Monitor I&O closely
37
HYDROCEPHALUS Nursing Interventions: Teach home care program
Teach to watch for signs of increased ICP or infection Note that child will eventually outgrow shunt and show symptoms of difficulty Note that child will need shunt revision Provide anticipatory guidance for potential problems with growth and development
38
HYDROCEPHALUS
NCLEX HINT: The signs of increased intracranial pressure (ICP) are the opposite of those of shock: Shock: Increased pulse, decreased blood pressure Increased Intracranial pressure: Decreased pulse, increased blood pressure
39
HYDROCEPHALUS
NCLEX HINT: The signs of increased intracranial pressure (ICP) are the opposite of those of shock: Shock: Increased pulse, decreased blood pressure Increased Intracranial pressure: Decreased pulse, increased blood pressure
40
SEIZURES Uncontrolled electrical discharges of neurons in the brain
Seizure are more common in children under the age of 2 years Seizures can be associated with immaturity of the CNS, fever, infection, neoplasms, cerebral anoxia, and metabolic disorders Seizures are categorized as generalized or partial
41
SEIZURES Generalized seizures are:
Tonic-clonic (grand mal): Absence (petit mal): Myoclonic;
42
SEIZURES Tonic-clonic (grand mal):
consciousness is lost. Tonic phase: generalized stiffness of entire body Clonic phase: spasm followed by relaxation
43
SEIZURES Absence (petit mal):
momentary loss of consciousness, posture is maintained; has minor face, eye, hand movements
44
SEIZURES Myoclonic;
sudden, brief contractures of a muscle or group of muscles, no postictal state. May or may not be symmetrical or include loss of consciousness
45
SEIZURES Partial seizures
arise from a specific area in the brain and cause limited symptoms. Examples are focal and psychomotor seizures.
46
SEIZURES Nursing Assessment Tonic clonic (grand mal)
Aura (a warning sign of impending seizure) Loss of consciousness Tonic phase: generalized stiffness of entire body Apnea, cyanosis Clonic phase: spasms followed by relaxation Pupils dilated and nonreactive to light Incontinence Postseizure; disoriented, sleepy
47
SEIZURES Nursing Assessment Absence seizure (petit mal)
Usually occur between 4 and 12 years of age Last 5 to 10 seconds Child appears to be inattentive, daydreaming Poor performance in school
48
SEIZURES
NCLEX HINT: Medication noncompliance is the most common cause of increased seizure activity
49
SEIZURES Nursing Diagnosis:
Risk for injury: trauma related to seizure activity Noncompliance related to
50
SEIZURES Nursing Interventions:
1. Maintain airway during seizure; turn client on side to aid ventilation 2. Do not restrain client 3. Protect client from injury during seizure, and support head. Avoid neck flextion. 4. Document seizure, noting all data in assessment. 5. Maintain seizure precautions --Reduce environmental stimuli --Pad side rails or crib rails --Have suction equipment and oxygen quickly accessible --Tape oral airway to the head of the bed
51
SEIZURES Nursing Interventions: 1. Maintain airway during seizure; turn client on side to aid ventilation 2. Do not restrain client 3. Protect client from injury during seizure, and support head. Avoid neck flextion. 4. Document seizure, noting all data in assessment. 5. Maintain seizure precautions --Reduce environmental stimuli --Pad side rails or crib rails --Have suction equipment and oxygen quickly accessible --Tape oral airway to the head of the bed
6. Support during diagnostic tests: EEG, CT scan 7. Support during workup for infections such as meningitis 8. Administer anticonvulsant medications as prescribed: a. For tonic-clonic seizures: phenytoin, carbamazepine, phenobarbital, and fosphenytoin b. For absence seizures: ethosuximide (Zarontin), valproic acid (Depakene) 9. Monitor therapeutic drug levels 10. Teach family about drug administration: dosage, action, and side effects.
52
SEIZURES
NCLEX HINT: Do not use tongue blade, padded or not, during a seizure. It can cause traumatic damage to oral cavity.
53
BACTERIAL MENINGITIS Description: Bacterial inflammatory disorder of the meninges that cover the brain and spinal cord.
A. Meningitis is usually caused by Haemophilus influenza type B (less prevalent), Streptococcus pneumonia, or Neisseria meningitides. B. The usual source of bacterial invasion is the middle ear or the nasopharynx. C. Other sources of bacteria from wounds include fractures of the skull, lumbar punctures, and shunts. D. Exudate covers brain, and cerebral edema occurs.
54
BACTERIAL MENINGITIS Lumbar puncture shows
1. Increased WBC 2. Decreased glucose 3. Elevated protein 4. Increased ICP 5. Positive culture for meningitis
55
BACTERIAL MENINGITIS Nursing Assessment: Older children
1. Classic signs of increased ICP 2. Fever, chills 3. Neck stiffness, opisthotonos 4. Photophobia 5. Positive Kernig sign (inability to extend leg when thigh is flexed anteriorly at hip) 6. Positive Brudzinski sign (neck flexion causing adduction and flexion movements of lower extremities)
56
BACTERIAL MENINGITIS Nursing Assessment: Infants
1. Absence of classic signs 2. Ill, with generalized symptoms 3. Poor feeding 4. Vomiting, irritability 5. Bulging fontanel (an important sign) 6. Seizures
57
BACTERIAL MENINGITIS Nursing Diagnoses
A. Disturbed sensory perception R/T B. Risk for trauma R/T
58
BACTERIAL MENINGITIS Nursing Interventions: Isolate (Droplet precautions )for at least 24 hours
A. Administer antibiotics (usually ampicillin, penicillin, or chloramphenicol) and antipyretics as prescribed. B. C. Monitor vital signs and neurologic signs D. Keep environment quiet and darkened to prevent overstimulation E. Implement seizure precautions F. Position for comfort: head of the bed slightly elevated, with client on side if prescribed. G. Measure head circumference daily in infants H. Monitor I & O closely I. Administer Hib vaccine to protect against H. influenza infection
59
BACTERIAL MENINGITIS
NCLEX Hint: Monitor hydration status and IV therapy carefully. With meningitis there may be inappropriate ADH secretions causing fluid retention (cerebral edema) and dilutional hyponatremia.
60
REYE SYNDROME Description: Acute, rapidly progressing encephalopathy and hepatic dysfunction
A. Causes include antecedent viral infections, such as influenza or chickenpox B. Occurrence is often associated with aspirin use C. Disease is staged according to the clinical manifestations to reflect the severity of the condition
61
REYE SYNDROME Nursing Assessment:
A. Usually occurs in school-age children B. Lethargy, rapidly progressing to deep coma with marked cerebral edema C. Vomiting D. Elevated SGOT/AST, SCPT/ALT, lactate dehydrogenase, serum ammonia, decreased PT E. Hypoglycemia
62
REYE SYNDROME Nursing Diagnosis:
A. Excess fluid volume R/T B. Ineffective Breathing Pattern R/T
63
REYE SYNDROME Nursing Interventions:
A. Provide critical care early in syndrome B. Monitor neurologic status: frequent noninvasive assessments and invasive ICP monitoring C. Maintain ventilation D. Monitor cardiac parameters (i.e., invasive cardiac monitoring system). E. Administer mannitol, if prescribed, to increase blood osmolality F. Monitor I & O accurately: G. Care for Foley catheter H. Provide family with emotional support
64
BRAIN TUMORS Description: Second most common cancer in children
Most pediatric brain tumors are infratentorial, making them difficult to excise surgically Tumors usually occur close to vital structures Gliomas are the most common childhood brain tumors.
65
BRAIN TUMORS
NCLEX Hint: Headache on awakening is the most common presenting symptom of brain tumors.
66
BRAIN TUMORS Nursing Assessment:
Headache Vomiting (usually in the morning), often without nausea Loss of concentration Change in behavior or personality Vision problems, tilting of head ``` In infants: --widening sutures, --increasing frontal occipaital circumference, --tense fontanel ```
67
BRAIN TUMORS Nursing Interventions: Identify baseline neurologic function Support child and family during diagnostic workup and treatment ``` If surgery is treatment of choice, provide preoperative teaching: --Explain that head will be shaved --Describe ICU, dressings, IV lines, etc. --Identify child’s developmental level, and plan teaching accordingly ```
Assess family’s response to the diagnosis, and treat family appropriately After surgery; position client as prescribed by the health care provider. Monitor IV fluids and output carefully. Overhydration can cause cerebral edema and increased ICP. Administer steroids and osmotic diuretics as prescribed. Support child and family to promote optimum function postopertively.
68
BRAIN TUMORS
NCLEX Hint: Most postoperative clients with infratentorial tumors are prescribed to lie flat or turn to either side. A large tumor may require that the child not be turned to the operative side.
69
BRAIN TUMORS
NCLEX Hint: Suctioning, coughing, straining, and turning cause increased ICP.
70
BRAIN TUMORS
NCLEX Hint: Suctioning, coughing, straining, and turning cause increased ICP.
71
MUSCULAR DYSTROPHY Inherited disease of the muscles, causing muscle atrophy and weakness
A. The most serious and most common of the dystrophies is Duchenne muscular dystrophy, an X-linked recessive disease affecting primarily males. B. Duchenne muscular dystrophy appears in early childhood (ages 3 – 5 years). It rapidly progresses, causing respiratory or cardiac complications and death, usually by 25 years of age.
72
MUSCULAR DYSTROPHY Nursing Assessment: A. Waddling gait, lordosis B. Increasing clumsiness, muscle weakness C. Gowers sign: difficulty rising to standing position; has to “walk” up legs using hands D. Pseudohypertrophy of muscles (especially noted in calves) due to fat deposits
E. Muscle degeneration, especially the thighs, and fatty infiltrates (detected by muscle biopsy); cardiac muscle also involved F. Delayed cognitive development G. Elevated CPK and SGOT/AST H. Later in disease; scoliosis, respiratory difficulty, and cardiac difficulties I. Eventual wheelchair dependency, confinement to bed
73
MUSCULAR DYSTROPHY Nursing Diagnoses:
A. Impaired physical mobility R/T B. Chronic low self-esteem R/T
74
MUSCULAR DYSTROPHY Nursing Interventions: A. Provide supportive care B. Provide exercises (active and passive) C. Prevent exposure to respiratory infection
D. Encourage a balanced diet to avoid obesity E. Support family’s grieving process F. Support participation in the Muscular Dystrophy Association G. Coordinate with health care team: physical therapist, occupational therapist, nutritionist, neurologist, orthopedist, and geneticist

Pediatrics (24 decks)

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