Peds Test # 2 Neuro

Question 1

What are the 4 factors that influence ICP?

Answer 1

1) Pressures - Arterial, venous, intra-abdominal and intrathoracic
2) Posture
3) Temperature
4) Blood gasses (CO2)

Question 2

What are the 3 essential components that maintain ICP under normal conditions?

Answer 2

1) Brain tissue
2) Blood
3) CSF

Question 3

What are the 10 general SxS of ⬆ ICP?

Answer 3

1) Headache - Often continuous and happens in the morning
2) Vomiting - Often projectile and not preceded by nausea
3) Difficulty following commands
4) ⬇ pupillary response to light
5) Cushing’s Triad - bradycardia, hypertension & abnormal respiratory pattern
6) LOC Changes - i.e., disorientation & confusion
7) Posturing - decorticate and decerebate positions
8) ⬇ motor Fx and reflexes
9) Flaccid response to pain
10) Positive for Babinski reflex - Should not be present in children who can walk.

Question 4

Explain Decorticate Vs. Decerebate positioning

Answer 4

1) Decorticate - a) Cerebral cortex dysfunction
b) Draws extremities to the core
c) Arms abducted at shoulders and flexed on chest
d) Legs extended and adducted

2) Decerebate - a) Midbrain dysfunction
b) Arms & legs extended and pronated

Question 5

What are the categories used for scoring on the Glasgow Coma Scale and what is the score range?

Answer 5

1) Categories - Eye movement, verbal response , and motor response
2) Score Range - 3 to 15

Question 6

What are the 7 SxS of ⬆ ICP in an infant?

Answer 6

1) Bulging fontanel
2) ⬆ head circumference
3) Cranial sutures separated
4) High-pitched cry
5) Poor feeding
6) Vomiting
7) Irritability & restlessness

Question 7

What are the 7 SxS of ⬆ ICP in a child?

Answer 7

1) Headache
2) Diplopia
3) Mood swings
4) Slurred speech
5) Nausea and Vomiting - especially in the morning
6) Altered LOC
7) Papilledema - Late sign that could lead to blindness

Question 8

What are the 5 classes of meds used to treat ⬆ ICP?

Answer 8

1) Mannitol
2) Corticostoids
3) Barbituates
4) Antiseizure
5) Oxygen - PAO2 > 100 mmHg should be maintained

Question 9

What is Bacterial Meningitis?

Answer 9

Bacterial infection of the CNS (brain or spine)

Question 10

List the 6 SxS of Bacterial Menengitis.

Answer 10

1) Positive Kernig’s Sign (pain with extension of leg and knee)
2) Severe headache
3) Brudzinski’s Sign (flexion of the head causing flexion of the hips and knees)
4) Photophobia
5) ⬇ LOC
6) ⬆ ICP

Question 11

What 5 complications can rise from Bacterial Meningitis?

Answer 11

1) Bradycardia
2) Seizures
3) CN III Palsy (can’t move eye, results in diplopia)
4) Hypertensive Coma
5) Death

Question 12

What are the 5 different methods of diagnosing Bacterial Meningitis?

Answer 12

1) Blood culture
2) Lumbar puncture and analysis of CSF
3) X-ray
4) CT scan
5) MRI

Question 13

Why should you examine the fundus of the eyes before lumbar puncture for Bacterial Meningitis?

Answer 13

To identify presence of increased ICP

Question 14

Name three appropriate nursing diagnoses for a PT with bacterial meningitis.

Answer 14

1) Disturbed sensory pattern
2) Acute pain
3) Hyperthermia

Question 15

What are the 4 SxS of a viral Meningitis?

Answer 15

1) Headache
2) Fever
3) Photophobia
4) Stiff neck

Question 16

Describe Reyes Syndrome and list the 4 major effects it has on the body.

Answer 16

Reyes Syndrome is an acute, rapidly progressing encephalopathy causing:

1) Liver dysfunction
2) Cerebral edema > ⬆ ICP
3) Hypoglycemia
4) Shock

Question 17

What are the effects of Reyes Syndrome on the liver?

Answer 17

1) Bleeding and poor clotting

2) ⬆ Ammonia levels

Question 18

The etiology of Reyes Syndrome is unknown, but what situations has been linked to its onset?

Answer 18

1) Viral illness in winter (i.e., chk pox & flu)

2) Administration of aspirin and salicylate with concurrent viral illness

Question 19

What are the 5 different ways to diagnose Reyes Syndrome?

Answer 19

1) LFT
2) Liver biopsy
3) Lumbar puncture
4) Serum ammonia level
5) Coagulation time

Question 20

Mild Reyes Syndrome is self limiting and resolves in days, but what are the SxS of Severe Reyes Syndrome?

Answer 20

1) ⬇ neuro fx
2) Cerebral edema > ⬆ ICP
3) N & V
4) Liver dysfunction

Question 21

What is used to treat ⬆ ammonia levels and bleeding/poor clotting in patients with Reyes’ Syndrome?

Answer 21

1) ⬆ Ammonia Levels treated with Neomycin

2) Bleeding/Clotting problems treated with vitamin k

Question 22

Explain Spina Bifida Occulta 
Vs. 
Menegocele 
Vs. 
Myelomenegocele

Answer 22

1) Spina Bifida Occulta - Invisible, no SxS, only defect in bony spine
2) Menegocele - No neuro SxS, Spinal defect with sac-like protrusion containing no spinal nerve.
3) Myelomenegocele - Neuro SxS, spinal defect, sac-like protrusions contains meninges, spinal fluid and nerves.

Question 23

Discuss the etiology of Spina Bifida

Answer 23

1) 70% - Insufficient folic acid in maternal diet (mothers need 400 mcg of folic acid daily before becoming pregnant and during pregnancy).
2) 30% - Unknown

Question 24

How is Spina Bifida diagnosed in utero?

Answer 24

ALpha Fetal Protein (AFP) Amniocentesis, which is a blood test

Question 25

What is Hydrocephalus and what are the common causes?

Answer 25

hydrocephalus is an accumulation of CSF within the ventricles of the brain. Athe most common causes are: 1) Meningitis complication 2) Obstruction of CSF flow btw the ventricles

Question 26

What are the 5 SxS of Hydrocephalus in an infant?

Answer 26

1) Irritability & Lethargy 2) ⬆ head circumference 3) Bulging fontanelles 4) separated suture lines 5) High-pitched cries

Question 27

What are the SxS of Hydrocephalus in a child?

Answer 27

1) Headache in the morning that is relieved by emesis or sitting upright 2) N & V 3) ⬇ LOC 4) ⬇ pupil response 5) Seizures 6) Irritability 7) Personality change

Question 28

Describe a Ventriculoperitoneal shunt

Answer 28

A shunt inserted into a ventricle and its tubing is tunneled through the skin to the peritoneum. The shunt valves open at a certain pressure and drains excessive CSF fluid.

Question 29

What is Cerebral Palsy

Answer 29

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

Question 30

Describe the 3 classifications of Cerebral Palsy.

Answer 30

1) Spastic - Most common, hypertonic, poor posture balance and coordination, may involve one or both sides. 2) Dyskinetic/Athetoid - Involuntary movements, early life = flaccid and limp while later life = slow writhing motions. 3) Ataxic - Wide based gait, rapid/repetitive movement, ⬇ fine motor control

Question 31

What are the SxS of Cerebral Palsy?

Answer 31

1) Persistent reflexes after 26 months 2) Developmentally delayed 3) Poor suck/tongue thrust 4) Spasticity 5) Scissoring of legs 6) Involuntary movements 7) Seizures 8) Sensory alterations

Question 32

What types of medications are used to manage symptoms of a cerebral Palsy?

Answer 32

1) Anticonvulsants | 2) Muscle Relaxants

Question 33

What is a LATE sign on ⬆ ICP in a child that could lead to blindness?

Answer 33

Papilledema

Question 34

What are the components of Cushing's Triad

Answer 34

1) Bradycardia 2) Hypertension 3) Abnormal respiration