Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
|
Cranial Nerve 1:
|
Olfactory nerve-sensory
Transmits the sense of smell; Located in olfactory foramina in the Cribriform plate of ethmoid |
|
|
Cranial Nerve 2:
|
Optic Nerve-Purely Sensory
Transmits visual information to the brain; Located in optic canal |
|
|
Cranial Nerve 3:
|
Oculomotor nerve-mainly motor
Innervates levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique, which collectively perform most eye movements; Also innervates m. sphincter pupillae, as well as the muscles of the ciliary body. Located in superior orbital fissure |
|
|
Cranial Nerve 4:
|
Trochlear nucleus-
Innervates the superior oblique muscle, which depresses, rotates laterally (around the optic axis), and intorts the eyeball; Located in superior orbital fissure |
|
|
Cranial Nerve 5:
|
Trigeminal nerve Both Sensory and Motor
Receives sensation from the face and innervates the muscles of mastication; Located in superior orbital fissure (ophthalmic nerve - V1), foramen rotundum (maxillary nerve - V2), and foramen ovale (mandibular nerve - V3) |
|
|
Cranial Nerve 6:
|
Abducens nerve-Mainly Motor
nnervates the lateral rectus, which abducts the eye; Located in superior orbital fissure |
|
|
Cranial Nerve 7:
|
Facial nerve Both Sensory and Motor
Provides motor innervation to the muscles of facial expression, posterior belly of the digastric muscle, and stapedius muscle, receives the special sense of taste from the anterior 2/3 of the tongue, and provides secretomotor innervation to the salivary glands (except parotid) and the lacrimal gland; Located and runs through internal acoustic canal to facial canal and exits at stylomastoid foramen |
|
|
Cranial Nerve 8:
|
Vestibulocochlear nerve (or auditory-vestibular nerve or statoacoustic nerve)
Mostly sensory Senses sound, rotation and gravity (essential for balance & movement). More specifically. the vestibular branch carries impulses for equilibrium and the cochlear branch carries impulses for hearing.; Located in internal acoustic canal |
|
|
Cranial Nerve 9:
|
Glossopharyngeal nerve
sensory and motor Receives taste from the posterior 1/3 of the tongue, provides secretomotor innervation to the parotid gland, and provides motor innervation to the stylopharyngeus. Some sensation is also relayed to the brain from the palatine tonsils. Sensation is relayed to opposite thalamus and some hypothalamic nuclei. Located in jugular foramen |
|
|
Cranial Nerve 10:
|
Vagus nerve Both Sensory and Motor
Supplies branchiomotor innervation to most laryngeal and all pharyngeal muscles (except the stylopharyngeus, which is innervated by the glossopharyngeal); provides parasympathetic fibers to nearly all thoracic and abdominal viscera down to the splenic flexure; and receives the special sense of taste from the epiglottis. A major function: controls muscles for voice and resonance and the soft palate. Symptoms of damage: dysphagia (swallowing problems), velopharyngeal insufficiency. Located in jugular foramen |
|
|
Cranial Nerve 11:
|
Mainly Motor XI Accessory nerve (or cranial accessory nerve or spinal accessory nerve)
|
|
|
Cranial Nerve 12:
|
Hypoglossal nerve
Provides motor innervation to the muscles of the tongue (except for the palatoglossus, which is innervated by the vagus) and other glossal muscles. Important for swallowing (bolus formation) and speech articulation. Located in hypoglossal canal |
|
|
Generally children under the age of 2 require:
|
special evaluations since they are unable to respond to directions.
Since most of the information about the status of the brain is obtained by indirect measurements. We must use other means to evaluate. |
|
|
Levels of consciousness:
|
Full consciousness-situation between mind and world
Confusion-Lack of understanding; uncertainty. Disorientation-Loss of one's sense of direction, position, or relationship with one's surroundings. ... Lethargy-is a state of awareness describing a range of afflictions, usually associated with physical and/or mental weakness, though varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. Obtunded-is any measure of arousal other than normal Stupor-is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. Coma PVS-is a disorder of consciousness in which patients with severe brain damage who were in a coma progress to a state of partial arousal rather than true awareness. |
|
|
Glascow Scale
Eyes: |
Eyes (child) & ( infant)
4 Open spontaneously 3 Opens to speech 2 Opens to pain 1 No Response ______=total score (eyes) |
|
|
Glascow:
Motor: |
Motor (child)
6 Obeys commands 5 Localizes 4 Withdraws 3 Flexion 2 Extension 1 NO Response ______= Score(Motor) Motor (infant) 6 Spontaneous Mvmts 5 Withdraws to touch 4 Withdraws to pain Flexion (decorticate) Extension (decerebrate) NO Response |
|
|
Glascow
Verbal: |
Child- Verbal
5 Oriented 4 Confused 3 Inappropriate words 2 Incomprehensible words _______ = Score (verbal) Infant- Verbal 5 Coos and babbles 4 Irritable cry 3 Cries to pain 2 Moans to pain 1 NO response ____ = Total Score (Eyes, Motor, Verbal) |
|
|
Glascow
Interpretation: |
Total- 3-15
Minor Head Injury= 13-15 Moderate Head Injury= 9-12 Severe (Coma) = < =8 <=8 confers significant mortality risk |
|
|
Neuro Exam
Details: |
This includes assessment of vital signs, skin, eyes, reflexes, and motor function.
Skin- look for any signs of injury Pupils- pinpoint with poisonings widely dilated and reactive are often seen after seizures widely dilated and fixed= paralysis of CNIII herniation of brain unilateral fixed- tumor on same side Sudden appearance of a fixed and dilated pupil(s) are a neurosurgery emergency |
|
|
Extension Posturing:
|
(decerebrate) rigid extension and pronation of arms and legs
|
|
|
Flexion postering:
|
abnormal flexion (decorticate) (rigididity) adduction of arms and feet
|
|
|
Nursing Care of the Unconscious Child:
|
V/S, respiratory effectiveness
Pupillary reaction and LOC Avoid pain, emotional stress or crying Maintain nutrition and hydration with IVFs – prevent over hydration Indwelling catheter Dexamethasone (Decadron) – reduce cerebral edema Mannitol – reduce pressure from edema Maintain skin integrity Mouth care BID Prevent eye irritation Thermoregulation Positioning and exercise Family support |
|
|
Mannitol –
|
reduce pressure from edema
|
|
|
Increased Intracranial Pressure (IICP)
Monroe Kelly: |
Alteration in cerebral blood flow
Alteration in cerebrospinal fluid Monroe – Kellie doctrine CSF production ↓ CSF absorption reduce mass by fluid displacement Failure may lead to herniation Sustained pressure + / > 20mm Hg Brain is tightly sealed with the bony cranium. The 3 components within the skull is the brain (80%), CSF (10%), and the blood (10%). Early symptoms are often very subtle and assume many patterns. See Box 28-1 p. 976 Monroe- Kellie:to maintain cerebral pressure and volume with normal range, changes in one or more of the contents of the cranium must be compensated for by changes in the other |
|
|
Neurological Dysfunction:
IICP – Etiologies |
Tumors
Accumulation of fluid within the ventricular system Bleeding or edema of cerebral tissues Hypoxia Seizure Activity Swelling may occur due to head trauma, infections, or a hypoxic episode. Accumulation may occur due to overproduction, malabsorption, or a communication problem within the system. ↓ LOC earliest sign, irritability, personality changes & fatigue Older child: HA, N&V especially in the AM, double or blurred vision, slurred speech, papilledema Young child: Increased head circumference, bulging fontanelles, hi-pitched cry, eyes deviated down, distended scalp veins |
|
|
Consciousness –
|
– ability to respond to sensory stimuli and have subjective
|
|
|
Deteriorating Function:
|
Tachycardia bradycardia
Cheyne-Stokes respirations or apnea Alterations in pupillary size and reaction Systolic hypertension, Widening pulse pressure Decorticate / Decerebrate posturing Stupor – responds to vigorous stimuli Coma – unconsciousness from which the child cannot be aroused |
|
|
Diagnostics:
|
CT, MRI
Lumbar puncture Labs: electrolytes, ABG’s, CBC, UA EEG-test to measure electrical brain activity Radiograph |
|
|
Treatment of IICP:
|
Remove the cause, reduce the ICP, reduce the volume of CSF, preserve cerebral function and avoid situations that ↑ ICP
Elevate the HOB 30 Hyperventilation with 100% O² to maintain PCO² between 30 and 35 mm Hg |
|
|
Intraventricular catheter –
|
catheter placed in the lateral ventricle or subarachnoid space.
allows for monitoring pressure and drainage. Sterile closed system. |
|
|
Subarachnoid screw or bolt -
|
bolt placed in the subarachnoid space
|
|
|
Bacterial Meningitis:
|
Causes: H.flu type B, strep, neisseria
H. flu appear in autumn or winter Pneumococcal / Meningococcal in late winter and early spring S&S CNS: irritability to coma, fever, severe HA, poor eating habits, change in LOC, nuchal rigidity, confusion, tense bulging fontanels, seizures |
|
|
Bacterial Meningitis
Meningococcal – |
petechial rash, rapid deterioration to septic shock
DX: LP – glucose low, protein high, cell count high Management: Antimicrobial (ampicillin or Chloramphenicol IV for 8 to 10 days), Gent and Amp for infants |
|
|
Bacterial Meningitis
Nursing Care: |
Hydration, ventilation (droplet isolation), reduce IICP, control seizures and temperature, correct anemia, treat complications
Keep room quiet Reassess neuro and LOC status frequently Identify contacts needing prophylactic treatment Teaching regarding meds (rifampin) |
|
|
Nonbacterial Meningitis
|
Caused by a virus
S&S: H/A, malaise, fever, GI upset, abdominal pain, back and leg pain, chest pain, generalized muscle aches DX: LP TX: symptomatic |
|
|
Encephalitis:
Reye Syndrome: |
A toxic encephalopathy associated with an enlarged dysfunctional liver and cerebral edema
Causes: chickenpox, measles, flu S&S: fever, profoundly impaired consciousness, impaired hepatic function DX: Elevated ammonia level, liver biopsy DX early and treat aggressively Family should be aware to avoid ASA Refer to support group |
|
|
Seizure Disorders:
|
Result from paroxysmal discharges in cortical neurons and are symptoms of abnormal brain function
Causes: tumors, infections, medications, lead poisoning, genetic factors, trauma, hypoxia |
|
|
Types of Seizures
Myoclonic (Infantile spasms) |
6 to 8 months, large percentage retarded
|
|
|
Types of Seizures
Simple Partial (focal) - |
- caused by abnormal electrical discharges; no loss of consciousness
|
|
|
Types of Seizures
Complex partial (psychomotor) – |
preceded by aura, feelings of anxiety, abd pain, unusual taste or odor, staring, posturing, mental confusion, purposeless activities, lip smacking, chewing, and/or sucking; lasts 1 to 5 minutes; followed by sleep
|
|
|
Types of Seizures
Absence (petit mal) – |
a brief loss of consciousness, blank facial experssion, rapid eye blinking, unresponsiveness and staring spells. Last 5 to 30 seconds.
|
|
|
Types of Seizures
Tonic-Clonic (grand mal) – |
most common. Occur without warning or may have an aura. Steady muscle contraction, followed by muscle jerks, foaming at the mouth, incontinence. Followed by lethargy, sleep, no recall; tonic = few seconds/ clonic = < 5 minutes
|
|
|
Diagnostics & Management:
Seizures: |
DX: history, EEG, Brain scan, Chemistry blood profile, LP
Management: eliminate cause, anticonvulsants meds, monitoring serum levels, provide for safety, teach compliance, referral to support groups |
|
|
Phenytoin) Dilantin:
|
Side effects: gum hyperplasia, hirsutism,(razonism is the excessive hairiness on women in those parts of the body where terminal hair does not normally occur or is minim) ataxia, (s a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction. The term "dystaxia" is a rarely used synonym.gastric distress, anemia and sedation
Therapeutic levels = 10-20 ug/ml |
|
|
Valproic Acid (Depakene)
|
Side effects: sedation, N&V, indigestion
Adverse effects: hepatic failure, aplastic anemia Therapeutic serum levels = 50 – 100 ug/ml |
|
|
Febrile Seizure
|
Occurs in young children with fever without any documented infection
Triggered by rapid rise in fever unUsual after 5 years No good diagnostic tests, R/O meningitis Nursing interventions: Reduce temperature Family teaching |
|
|
Status Epilepticus:
|
Unremitting seizure state lasting > 10 minutes or a series of seizures lasting > 30 min. without regaining consciousness
True emergency May result in brain damage and / or death Most important function is to maintain respiratory status. ABG=aterial, blood gas Maintain respiratory status Treat cause if known Diazepam (Valium) or lorazepam (Ativan) IV, orally or rectally Phenobarbital IV as second line IM not given Give Valium direct |
|
|
Hydrocephalus
|
Accumulation of CSF within the ventricular system
Result = compression of brain against the skull May be congenital, acquired or of unknown etiology |
|
|
Hydrocephalus
Communicating = Noncommunicating= Management: |
impaired absorption of CSF within the subarachnoid space
obstruction of flow with the ventricles that prevents circulation around the spinal cord and subaracnoid space Rarely from overproduction of CSF due to tumor of the choroid plexus Symptoms vary by age Diagnostics include: head circumference measurement, CT. MRI and lumbar puncture Prevent further accumulation Ventriculoperitoneal shunt to bypass fluid from the ventricles to the peritoneal cavity Ventriculoatrial shunt more common in older children |
|
|
Hydrocephalus
Assessment |
Head circumference
Palpate fontanel for size, bulging, tenseness and cranial suture separation Assess for irritability, personality changes, feeding difficulties Note HA, N&V Decreased c/o when sitting upright |
|
|
Cerebral Palsy (CP)
Spastic |
hypertonicity, poor control, impaired fine and gross motor skills.
|
|
|
Cerebral Palsy (CP)
Dyskinetic: |
slow, involuntary abnormal movements, of hands, feet arms and legs.
|
|
|
Cerebral Palsy (CP)
Ataxic |
balance and depth perception being off. Unsteady wide gate.
|
|
|
Cerebral Palsy (CP)
nursing care |
Assistance
Safe environment Rest periods Age appropriate mental activities Refer to therapists Promote self-concept Support groups |
|
|
Spina Bifida
|
Congenital (during 4th wk) neural tube defect resulting in incomplete closure of the vertebrae and neural tube
Linked to maternal folic acid deficiency 1to 5: 1000 births and varies by geographic location |
|
|
Spina Bifida
occulta |
may show only in a small tuft of hair, a dimple. A hemangioma or a lipoma in the lower lumbar or sacral area. Incomplete closure of the vertebra at L5 and S1. May have no sensory or motor loss.
|
|
|
Spina Bifida
Cystica |
is incomplete closure with varying degrees of neural tissue involvement. Meningocele is m saclike protrusion filled with spinal fluid and meninges. Most severe is filled with these and nerve roots and spinal cord.
|
|
|
Spina Bifida
Diagnostics |
AFP levels at 16 to 18 wks gestation
If abnormal, amniocentesis and fetal US CT and myelography done after delivery |
|
|
AFP
|
is a protein which is made by all unborn babies. AFP can be measured in the mother's blood. When there is too much or too little AFP in the mother's blood, it is a signal to the doctor to check the pregnancy more carefully. The AFP screening test identifies women who may be further along, or not as far along, in their pregnancy as they thought. It can also pick up twins and help to identify women who may be at risk of having a premature delivery or a low birth weight baby. The test can also identify women who are carrying a fetus with a neural tube defect, or other severe birth defects such as a kidney or abdominal wall defect.
|
|
|
myelography
|
is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. The procedure often involves injection of contrast medium into the cervical or lumbar spine, followed by several X-ray projections. A myelogram may help to find the cause of pain not found by an MRI or CT.
|
|
|
Spina Bifida
Management |
Surgical closure
Decreases risk of infection, morbidity and mortality In-utero surgical closure growing in popularity |
|
|
Spina Bifida
Nursing Care |
Measurement of the sac, head circumference
Palpate anterior fontanel for fullness Assess tone and movement of lower extremities Prone position, hip flexion and ankle support |
|
|
Spina Bifida
Assessment |
V/S, temp every 1 to 2 hours
Monitor for infection (irritability, lethargy, nuchal rigidity) Sterile saline dressing over the sac to maintain moisture, change when soiled Record appearance of sac |
|
|
Guillain Barre Syndrome
Patho-physiology- |
Patho-physiology- immune-mediated disease associated with a number of viral and bacterial infections, or the administration of certain vaccines
S&S: rapid onset with flu-like symptoms, muscle tenderness/weakness, progressive paralysis, urinary incontinence/retention, and respiratory failure DX: history, CSF findings, electromyogram TX: Primarily supportive.respiratory status, prevention of contracture, maintain nutrition, rehab program, reassurance, support group. Nursing care |
|
|
Electromyogram
|
s a technique for evaluating and recording the electrical activity produced by skeletal muscles.[1] EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells[2
Associated with mono, CMV, rubella, mumps, gastroenteritis, Lyme disease, H-pylori Occurs usually within 10 days of infection- changes in spinal and cranial nerves consist of inflammation and edema with rapid demyelization of nerve roots. 3 phases a) Acute- starts when symptoms start. B) plateau- syms remain constant without further deterioration may be days to weeks. C) recovery- begins to improve and progress to optimal recovery. May take weeks to months. CSF usually shows increased protein concentration EMG shows acute muscle denervation. Tx: Ventilator support if needed. IV infusion of Immune globulin, steroids, [plasmaphoresis Nursing- focused on preventing complications, positioning, respiratory status, fear and anxiety, Passive ROM, nutrition. |
|
|
Migraine (vascular) –
|
may be mild to severe; may have an aura; throbbing pain with N&V, photophobia
|
|
|
Tension headaches –
|
usually more generalized; band-like pain; may last for days or weeks
Relieve triggers Educate the family Acetominophen or ibuprophen Triptans not recommended |
