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;
167 Cards in this Set
- Front
- Back
|
How does a term newborn's brain compare to the weight of an adult brain? By age ___ the brain weighs about 90% as much as an adult's brain.
|
term newborn is 2/3 weight of adult
6 |
|
|
CSF is ___ml in an infant and ___ ml in an adult.
|
50, 150
|
|
|
Myelinzation of the central and peripheral nerves is ______, in that it changes as they grow.
|
progressive.
|
|
|
True or False: peripheral nerve are completely myelinized at birth.
|
false, not completely
|
|
|
____ matter is made of fibers and insulates the nerves that allow conduction of nerve impulses from one part of the body to another, facilitating communication. ____ matter consists of cell bodies and processing is done here.
|
white
grey |
|
|
Which is larger the anterior fontanel or the posterior? When does each close?
|
anterior is larger, closes at 18 months
posterior smaller, closes at 3 months |
|
|
Coordination and motor activities progress as ______ progresses.
|
myelinization
|
|
|
In a very young child, under 2 y, the myelinization process has not fully occurred so it is recommended to give them _____ ____ because the extra ___ helps with the myelinization process.
|
whole milk
fat |
|
|
After ___ to ___ months the child can be switched from whole milk to low/non fat milk
|
18-24
|
|
|
What age do children usually start showing dominant hand(handedness)?
|
18 months, then definitely by age 3
|
|
|
What can be a sign of focal legion in the neurological system?
|
showing handedness (dominant hand) before age 1
Babies usually tend to use the hand that is convenient at the time (i.e. if something is placed in front of the left hand, they use that one and vice versa) |
|
|
In general, when do reflexes present at birth usually disappear?
|
1 year
|
|
|
True or False: Neurological assessment of the child is limited to their developmental level.
|
true
|
|
|
When does the morrow reflex usually disappear?
|
5-6 months
|
|
|
When does the rooting reflex usually disappear?
|
3 months
|
|
|
When does the grasp reflex usually disappear?
|
2-3 months
|
|
|
When does the plantar grasp usually disappear?
|
8-9 months
|
|
|
When does the stepping reflex usually disappear?
|
3-4 months
|
|
|
The overall purpose of a neurological physical exam is to detect for the presence or absence of nervous system dysfunction. It helps to identify the location, type, or extent of nervous system _____, whether it is an ____ or ___ motor neuron_____. What are the 5 components of a neurological physical exam?
|
The overall purpose of a neurological physical exam is to detect for the presence or absence of nervous system dysfunction. It helps to identify the location, type, or extent of nervous system legion, whether it is an upper or lower motor neuron legion.
mental status & speech cranial nerves reflexes sensory system motor system |
|
|
What is involved in the neurologic assessment?
|
measure VS
LOC PERRLA Observe gross motor skills Observe fine motor skills Note mood & behavior Have normal developmental milestones been achieved? |
|
|
What is involved in observing gross motor skills?
|
hand grips & feet dorsiflexion & plantar flexion
Gait & coordination of movements |
|
|
what age should each fine motor skill be mastered?
grasp finger to nose holds pen/crayon like adult copies cross copies square prints name well |
thumb-finger/pincer grasp- 8 mo.
holds pen/crayon like an adult- 18 months (before this holds crayon, scribbles spontaneously with fist) copies cross & square- 4 y prints name well- 5-7 y finger to nose- 8-9 y |
|
|
What are some influencing factors that can alter a patient's LOC?
|
hypoxia
hypotension medications hypothermia hyperthermia |
|
|
What are the 2 methods of assessing LOC?
|
Glasgow coma scale
AVPU A-alert & oriented V- respond to verbal P- respond to pain U- unresponsive |
|
|
Describe the Glasgow Coma Scale
|
Scores range 3-16
3- very bad, 15- little to no injury less than 8- intubate, severe brain injury. 9-12 moderate injury 13-15- mild brain injury/insult Described below starting with most oriented... EYE OPENING (4-Is there spontaneous eye opening? 3-only to speech? 2-only to pain? 1 none?) VERBAL RESPONSE (5-Oriented & converses normally? 4-Confused/disoriented? 3-Inappropriate words? 2-Incomprehensible Sounds? 1-No verbal response at all?) MOTOR RESPONSE (6-Obeys commands? 5-Localizes painful stimuli? 4-Withdrawal from painful stimuli? 3-Abnormal flexion to painful stimuli? 2-Abnormal extension to painful stimuli? 1-No motor response?) |
|
|
Pediatric Glasgow coma scale is similar to adult scale and is used for children under ___ y old. It measures:
Eye opening (4- spontaneous, 3-to speech, 2- to pain, 1- none) Verbal Response (5- coos, babbles, 4- irritable cry, 3-cries to pain, 2-moans to pain, 1- none) Motor Response (6- normal spontaneous movement, 5-withdraws from touch, 4-withdraws from pain, 3-abnormal flexion, 2-abnormal extension) |
2
|
|
|
The terms used to describe ____ include full consciousness, confusion, disorientation, lethargic, obtunded, stupor, and coma.
|
loc
|
|
|
_____ is when one sleeps unless aroused, once aroused has limited interaction with environment
|
obtunded
|
|
|
______ is when vigorous stimulation produces no motor or verbal response
|
coma
|
|
|
_______ is when one awakens easily but exhibits limited responsiveness
|
lethargic
|
|
|
____ is when one is awake, alert, oriented, and interacts with environment
|
full consciousness
|
|
|
____ is when the ability to think clearly and rapidly is lost.
|
confusion
|
|
|
___ is when one lacks ability to recognize place, person, time
|
disorientation
|
|
|
There can be ____ or _____ periods of confusion, disorientation etc.
|
There can be intermittent or continuous periods of confusion, disorientation etc.
|
|
|
Fixed and dilated pupils is a neuro _____.
|
emergency
|
|
|
_______ pupils suggest a narcotic overdose. What are some examples of meds that can cause this?
|
pinpoint
codeine fentanyl morphine Antipsychotic- thorazine can also cause pupil reactions |
|
|
____ ____ pupils suggest structural damage in the midbrain.
|
midpoint fixed
|
|
|
Dilated or large pupils indicate severe ____ or _____. Fixed and dilated is usually an ____ sign.
|
anoxia (severe hypoxia)
overdose ominous |
|
|
A brain injury tends to have 2 phases, a primary brain injury (the ______) and a secondary brain injury (the _____)which may be _____. Describe each.
|
primary- (Coup) caused by mechanical damage
secondary (Contrecoup) can be -cerebral hypoxia -increased ICP -decreased cerebral blood flow -infection Example: Primary injury- head hits windshield, shearing and twisting of bleed vessels causes: 2ndary injury- swelling, edema, increased ICP etc |
|
|
True or False: the primary injury is always worse than the secondary brain injury.
|
false, sometimes secondary is worse
|
|
|
Coup can be referred to as the ____ and the contracoup as the _______.
|
blow
counterblow |
|
|
The head is a "closed box" where the _____ must maintain constant. The brain makes up __%, the intravascular blood makes up __%, and the CSF makes up ___%. If there is an additional component, it is ___.
|
The head is a "closed box" where the volume must maintain constant. The brain makes up 90%, the intravascular blood makes up 5%, and the CSF makes up 5%. If there is an additional component, it is abnormal.
|
|
|
The ____-_____ Doctrine explains that with an increase in intracranial volume ( a more edematous brain occuring) the pressure-volume relationship shifts to a steep proportion as shown on a curve diagram. A ___ change in volume creates a ____ increase in pressure. Compensation does occur but there is a point when there is no more room for the brain to swell and and no room for displacing and there is increased ___. This leads to ....
|
TheMonro-Kellie Doctrine explains that with an increase in intracranial volume ( a more edematous brain occuring) the pressure-volume relationship shifts to a steep proportion as shown on a curve diagram. A small change in volume creates a large increase in pressure. Compensation does occur but there is a point when there is no more room for the brain to swell and and no room for displacing and there is increased ICP. This leads to a decrease in cerebral blood flow and compression of brain tissue. Then this leads to herniation of the brainstem. The pupils become fixed and dilated because there is too much unrelieved pressure.
|
|
|
Brain volume can increase with what 4 things?
|
BITE
bleed within brain Increased blood or CSF- due to blockage in outlet flow (usually a block in the shunt that was put in) Tumor Edema |
|
|
Pupil size assesses ____ ____.
|
cranial nerves
|
|
|
What is Cushing's Triad?
|
It is a response to increased ICP characterized by changes in vital signs.
Increase in systolic pressure Decrease in diastolic pressure Decrease in pulse Altered Respiratory Pattern |
|
|
When does Cushing's Triad occur? Is it a late sign or an early sign of increased ICP?
|
occurs just before or at time of brain stem herniation
late sign |
|
|
The pulse increases/decreases as the ICP increases/decreases.
|
decreases
increases |
|
|
How do respirations change in the Cushing's triad?
|
rate & quality change
initially, it slows as the ICP rises Then, rate becomes rapid & noisy Finally- state of apnea |
|
|
A late sign of increased ICP is ____ pulse _____.
|
A late sign of increased ICP is widening pulse pressure.
(difference between systolic and diastolic BP) |
|
|
Which is a sign of increased ICP: eyes deviated upward or eyes deviated downward?
|
downward
|
|
|
True or False: separation of cranial sutures is a sign of ICP
|
true
|
|
|
Which is a sign of increased ICP: increased head circumference or decreased head circumference ?
|
increased
|
|
|
Which is a sign of increased ICP: increased or decreased response to pain?
|
both a decreased or an increased response to pain can be signs of increased ICP
|
|
|
Which is a sign of increased ICP: low pitched or high pitched cry
|
high pitched
|
|
|
What 5 nonspecific signs of increased ICP can also be attributed to other causes?
|
poor feeding
vomiting lethargy bulging fontanel |
|
|
When should we assess the fontanel size?
|
When the baby's not crying
|
|
|
In a child, some signs of increased ICP include what 7 signs?
|
A span of madness!
MAD SPAN: Mood swings Ache in Head (headache) Diplopia- double vision Slurred speech Papilledema (after 48 h- late sign) Altered LOC Nausea & Vomiting |
|
|
________ is edema within the optic disc of the eye
|
papilledema
|
|
|
The goal of treating increased ICP is directed to the management of the underlying cause. We are trying to reduce the volume of the CSF, preserve cerebral metabolic function, and avoid situations that increase ICP. What are some nursing interventions for increased ICP?
|
To fix ICP, just ask the MAIN HOE!
Minimize metabolic demands Administer medications I & O and labs need to be monitored closely Nutrition- parenteral or enteral* Head in midline to promote venous drainage Oxygen as needed Elevate HOB at 30 degrees *they're usually NPO so these types of nutrition are important |
|
|
In managing increased ICP, minimize metabolic demands such as ___, ___, and ____. For every degree of temperature above normal, the ____ requirement increases by ____%.
|
In managing increased ICP, minimize metabolic demands such as fever, pain, and seizures. For every degree of temperature above normal, the oxygen requirement increases by 6%.
|
|
|
What labs should be monitored in managing increased ICP?
|
NA, K, Cl, bicarbonate (total CO2)
|
|
|
Which meds are regularly ordered for managing increased ICP?
|
lasix
mannitol- an osmotic diuretic that helps decrease pressure |
|
|
Sometimes a child with increased ICP will be deliberately put into a ___ state with medications so they decrease _____ ______ that could increase ICP.
|
Sometimes a child with increased ICP will be deliberately put into a COMA state with medications so they decrease METABOLIC DEMANDS that could increase ICP.
|
|
|
Medication management for increased ICP is aimed at controlling _______ to blow off excess CO2, evacuation of ______ if it's space occupying, correction of ______ ____ if a blockage (hydrocephalus) is present, anti-inflammatory's like ______, and correction of ______.
|
Medication management for increased ICP is aimed at controlling hyperventilation to blow off excess CO2, evacuation of hematoma if it's space occupying, correction of CSF increase if a blockage (hydrocephalus) is present, anti-inflammatory's like steroids- dexamethasone, and correction of coagulopathies.
|
|
|
A seizure is a _____, uncontrolled episode of behavior that results from an abnormal ___ ____ from the brain.
|
A seizure is a paroxysmal (violent & sudden), uncontrolled episode of behavior that results from an abnormal electrical discharge from the brain.
|
|
|
Effects of seizures on a child include altered ____, altered _____ or ______, and altered ______, mobility, or ____ tone.
|
Effects of seizures on a child include altered responsiveness (LOC), altered sensation or perception, and altered movements, mobility, or muscle tone.
|
|
|
A ____ _____ seizure is caused by abnormal electrical discharges in the brain, with NO interruption on consciousness.
|
A simple partial seizure is caused by abnormal electrical discharges in the brain, with NO interruption on consciousness.
|
|
|
A simple partial seizure involves bilateral/unilateral localized motor and ____ impairment, an odd ___ or ____, _______ pain, feelings of ____, and _____ lasting from ___ seconds to several ______.
|
A simple partial seizure involves UNILATERAL localized motor and SENSORY impairment, an odd SMELL or TASTE, ABDOMINAL pain, feelings of fear, and TWITCHING lasting from 20 seconds to several minutes.
|
|
|
Simple partial seizures can occur at any ____ and are variable in _____.
|
age
frequency |
|
|
______ _____ seizures originates in a circumscribed portion of one cerebral hemisphere with impaired LOC.
|
complex partial
|
|
|
In a complex partial seizure, there is transient ____, feelings of ____, lip ____, eye _____, ____ing, _____ing, and ________ behaviors.
|
In a complex partial seizure, there is transient staring, feelings of fear, lip smacking, eye blinking, chewing, swallowing, and purposeless behaviors.
|
|
|
Complex partial seizures occur with children age ___ or older, and may occur how often? There is impaired ____ and mental ______.
|
Complex partial seizures occur with children age 3or older, and may occur 1-2 times per day? There is impaired LOC and mental disorientation.
|
|
|
The basic difference between simple partial and complex partial is the ____ in ____.
|
changes in LOC
|
|
|
In a ___ _____seizure, there is transient staring, feelings of fear, lip smacking, eye blinking, chewing, swallowing, and purposeless behaviors.
|
complex partial
|
|
|
A ____ ______ seizure involves UNILATERAL localized motor and SENSORY impairment, an odd SMELL or TASTE, ABDOMINAL pain, feelings of fear, and TWITCHING lasting from 20 seconds to several minutes.
|
simple partial
|
|
|
The onset of a ______ seizure starts at any age. There is involvement in both cerebral hemispheres.
|
absence
|
|
|
In an absence seizure, there is minor ___ _____, and a long/brief ___ of ________. How often do they occur?
|
in an absence seizure, there is minor MUSCLE TWITCHING, and a BRIEF LOSS OF CONSCIOUSNESS. They occur multiple times a day.
|
|
|
What type of seizure causes abrupt arrest of activity and altered LOC?
|
tonic clonic
|
|
|
Describe each phase of a tonic clonic seizure.
|
tonic phase- generalized stiffening of muscles
clonic phase- symmetric and rhythmic, alternating contraction and relaxation of major muscle groups , respirations irregular, may have incontinence postictal phase- period of confusion, lethargy, and sleep |
|
|
Which seizure(s) type and/or phase involves minor muscle twitching?
|
simple partial seizure
absence seizure |
|
|
Which seizure(s) type and/or phase involves incontinence?
|
tonic clonic-
clonic phase |
|
|
Which seizure(s) type and/or phase involves transient staring, lip smacking, and eye blinking?
|
complex partial
|
|
|
Which seizure(s) type and/or phase involves abdominal pain?
|
simple partial
|
|
|
Which seizure(s) type and/or phase involves unilateral localized motor and sensory impairment?
|
simple partial
|
|
|
Which seizure(s) type and/or phase involves generalized stiffening of muscles
|
tonic clonic-
tonic phase |
|
|
Which seizure(s) type and/or phase involves purposeless behaviors?
|
complex partial
|
|
|
Which seizure(s) type and/or phase involves symmetric and rhythmic, alternations between contraction and relaxation of major muscle groups and irregular respirations?
|
tonic clonic-
clonic phase |
|
|
Which seizure(s) type and/or phase involves twitching for 20 seconds to several minutes?
|
simple partial
|
|
|
Which seizure(s) type and/or phase involves fearful feeling?
|
simple partial
complex partial |
|
|
Which seizure(s) type and/or phase involves both cerebral hemispheres?
|
absence, possibly tonic clonic too?
|
|
|
Which seizure(s) type and/or phase does not involve an interruption in consciousness?
|
simple partial
|
|
|
Which seizure(s) type and/or phase involves abdominal pain?
|
simple partial
|
|
|
Which seizure(s) type and/or phase involves an odd taste or smell?
|
simple partial
|
|
|
Which seizure(s) type and/or phase can occur at any age?
|
absence
simple partial |
|
|
Which seizure(s) type and/or phase involves a period of confusion, lethargy, and sleep?
|
tonic clonic- postictal phase
|
|
|
Which seizure(s) type and/or phase occurs multiple times a day?
|
complex partial
absence |
|
|
Which seizure(s) type and/or phase involves chewing and swallowing?
|
complex partial
|
|
|
Which seizure(s) type and/or phase involves impairment of LOC?
|
complex partial
absence tonic clonic |
|
|
Status Epilepticus is seizures lasting more than ___ ___, serial seizures with/without return to ______, and is a _____ _____.
|
Status Epilepticus is seizures lasting more than 30 minutes, serial seizures without return to baseline, and is a medical emergency.
|
|
|
Status Epilepticus requires prompt treatment and airway management. It can lead to ___ failure, hypertension/hypotension, and brain damage due to ____. There can also be issues with ____ because of the high metabolic demands.
|
Status Epilepticus requires prompt treatment and airway management. It can lead to respiratory failure, hypotension, and brain damage due to hypoxia. There can also be issues with hypoglycemia because of the high metabolic demands.
|
|
|
Febrile seizures occur in 2-5% of children. They occur between 6 months of age to 3 y, and are rare in children older than ___. There is a _____ tendency for these to occur and the temp is usually greater than ___ when they happen. The treatment involves reassuring the parents of the _____ nature of the seizure and alternate between _____ and ____. No further treatment is needed unless additional seizures occur.
|
Febrile seizures occur in 2-5% of children. They occur between 6 months of age to 3 y, and are rare in children older than 5. There is a FAMILIAL tendency for these to occur and the temp is usually greater than 38.8 C, 102 F when they happen. The treatment involves reassuring the parents of the BENIGN nature of the seizure and alternate between ibuprofen and tylenol. No further treatment is needed unless additional seizures occur.
|
|
|
Warning signs of a seizure about to happen
|
the "aura"
distinct taste, smell, fearful feeling |
|
|
Nursing interventions for seizures.
|
1. airway (turn on side)
2. suction & O2 PRN 3. Protect child from injury Remain calm and stay with child Provide time for child to recover. Reassure and provide support to child and family. Document when the seizure began, duration, warning signs (aura) that were expressed, clinical characteristics, LOC, and s/s when seizure stopped |
|
|
True or False: a febrile seizure is diagnosed based on clinical history.
|
true
|
|
|
Diagnosis for seizures involves an H & P with a focus on the _____ exam, ___ to define the type of focus and duration of seizure, a CBC, electrolytes, glucose, ______ medication levels, ______ogy screening, urinalysis, and possibly a ___ ___- culture and CSF analysis because it may be due to infectious disease like menningitis.
|
Diagnosis for seizures involves an H & P with a focus on the neurological exam, EEG to define the type of focus and duration of seizure, a CBC, electrolytes, glucose, anticonvulsant medication levels, toxicology screening, urinalysis, and possibly a lumbar puncture- culture and CSF analysis because it may be due to infectious disease like meningitis.
|
|
|
A brain scan involves injection of tiny amounts of ____ ____ to measure ______ tissue uptake.
|
radioactive
abnormal |
|
|
Describe Normal CSF in terms of color, odor, WBC, protein, glucose, and pressure
|
clear, odorless
WBC's 0-5 Protein 15-45 glucose 50-80 pressure 50-180 |
|
|
Describe abnormal CSF in terms of color, odor, WBC, protein, glucose, and pressure
Abnormal CSF can be an ____ process such as ______. |
turbid, cloudy
WBCs 1000-2000 protein 100-500 glucose lower than blood sugar pressure >180 infectious, meningitis |
|
|
Spina Bifida is a congenital defect characterized by incomplete ____ of the vertebrae and ____ ____ during embryonic development.
|
Spina Bifida is a congenital defect characterized by incomplete ____ of the vertebrae and neural tube during embryonic development.
|
|
|
The cause of spina bifida is unknown. What are some contributing factors?
|
heredity
maternal folic acid deficiency environmental factors maternal use of anticonvulsants such as valproic acid ingestion by the mother. |
|
|
True or False: With spina bifida, there are varying degrees of renal dysfunction.
|
false, varying degrees of neurological dysfunction
|
|
|
What are some complications of spina bifida?
|
MUMICE
meningitis UTI mental retardation immobility cerebral palsy epilpesy |
|
|
What are some defects associated with spina bifida?
|
misshaped lower extremities
muscle atrophy hydrocephalus |
|
|
Diagnosis of spina bifida (2 things)
There is a 95% survival rate. |
US
elevated AFP |
|
|
spina bifida ____ involves no herniation of the spinal cord and meninges, you will see a ____ dimple or __ tuft.
|
spina bifida occulta involves no herniation of the spinal cord and meninges, you will see a pylonidal dimple or hair tuft.
|
|
|
Spina bifida ____ _____ is when there is a sac-like protrusion with the meninges and CSF.
|
Spina bifida cystica meningocele is when there is a sac-like protrusion with the meninges and CSF.
|
|
|
Spina bifida ___ _____ is when there is a sac-like protrusion with the meninges, CSF, nerve roots, and spinal cord
|
cystica myelomeningocele
|
|
|
In assessing for spina bifida at birth, look at the size, level, and nature of ____ ____ that you can visually see. Look at the _____ involvement in the lower ____ along with ___ and ____ function (this is hard because the baby is still in diapers!), and monitor for signs of hydrocephalus such as.. (3)
|
In assessing for spina bifida at birth, look at the size, level, and nature of tissue covering that you can visually see. Look at the nerve involvement in the lower limbs along with bladder and bowel function (this is hard because the baby is still in diapers!), and monitor for signs of hydrocephalus such as
-increased head circumference -leakage of CSF -widening of cranial sutures |
|
|
Immediate interventions for an infant with spina bifida include protecting from ____ and ____, use ____ ____ dressing on sac until ____, position to prevent pressure on ____ by placing in ___ position. ______ are often given prophylactically.
|
Immediate interventions for an infant with spina bifida include protecting from injury and infection, use moist sterile dressing on sac until surgery, position to prevent pressure on back by placing in prone position. Antibiotics are often given prophylactically.
|
|
|
Goals of surgery for spina bifida include: provide a normal ____ ____, control ______, and control _____.
|
Goals of surgery for spina bifida include: provide a normal anatomical barrier, control infection, and control hydrocephaly.
|
|
|
Kids with spina bifida may have bowel or _____ problems and need special training programs. They are prone to ____ allergies due to frequent in and out catheterization, they may have problems with self esteem, they will need orthopedic management such as _____, and schooling is based on their ___.
|
Kids with spina bifida may have bowel or bladder problems and need special training programs. They are prone to latex allergies due to frequent in and out catheterization, they may have problems with self esteem, they will need orthopedic management such as braces, and schooling is based on their IQ.
|
|
|
______ is the Greek term for water in the brain. It involves an imbalance of ___ production and _____. It causes ______ of the ventricles.
|
Hydrocephalus is the Greek term for water in the brain. It involves an imbalance of CSF production and absorption. It causes dilation of the ventricles.
|
|
|
Hydrocephalus can be c______, but it's rare, only 0.5-1% of the time. It is usually acquired from _____, _____, _____, ____ ____, or ______.
|
Hydrocephalus can be congenital, but it's rare, only 0.5-1% of the time. It is usually acquired from lesions, tumors, infection, intracranial bleed, or myelomeningocele.
|
|
|
In hydrocephalus, excessive ___ accumulates in the ventricles. The ventricles in the brain become dilated and the ____ is compressed against the ____. This results in enlargement of the head.
|
In hydrocephalus, excessive CSF accumulates in the ventricles. The ventricles in the brain become dilated and the brain is compressed against the skull. This results in enlargement of the head.
|
|
|
What are some signs of hydrocephalus in an infant? What is one in an older child?
|
bulging fontanels
split sutures increased head circumferance prominent scalp veins sunset eyes irritability high pitched cry poor feeding Older child may complain of headache. |
|
|
Medications for hydrocephalus include ____, _____, and _____.
|
diuretics- acetazolamid (diamox)
anticonvulsants antibiotics |
|
|
_______ taps are used in treatment of hydrocephalus until ____
|
Ventricular taps are used in treatment of spina bifida until surgery.
|
|
|
Surgeries for hydrocephalus include what 2?
|
Ventriculoperitoneal (VP) shunt
Atrioventricular (AV) shunt |
|
|
The surgical intervention for hydrocephalus is a placement of a _____ to drain ___ from the _____ to another part of the ___.
|
The surgical intervention for hydrocephalus is a placement of a shunt to drain CSF from the _____ to another part of the ___.
|
|
|
Nursing assessment for a shunt involves looking for... (what you might see if it becomes clogged)
|
vomiting
headache irritability fever redness along shunt line fluid around shunt valve |
|
|
A subdural hematoma is caused by shear ____ injury created by ____ than can cause ___ing of bridging ____ in space under the ___ ___.
|
A subdural hematoma is caused by shear force injury created by impact than can cause tearing of bridging vessels in space under the dura mater.
|
|
|
What can cause a subdural hematoma?(4)
|
falls
assaults MVA shaken baby syndrome |
|
|
What are the clinical manifestations of a subdural hematoma? (6)
|
V-SHARP
Seizures Headache Altered LOC Retinal hemorrhages (opthalmogic exam by dr) Pupil on side of injury is fixed & dilated Vomiting |
|
|
Subdural hematoma involves ____ blood and epidural hematoma involves _____ blood. Which requires a higher priority to get to the OR?
|
Subdural hematoma involves venous blood and epidural hematoma involves arterial blood. Epidural is worse, and requires a higher priority to get to the OR.
|
|
|
Treatment for a subdural hematoma involves first a ___ scan to confirm the diagnosis, then a _____ ____. Fifty percent will ____, 75% have ______. In treating these, doctors are tending to steer away from these taps and just get them straight to the OR and evacuate the hematoma. Monitor them closely and they will usually get antibiotics to prevent infection and usually do pretty well.
|
Treatment for a subdural hematoma involves first a CT scan to confirm the diagnosis, then a subdural tap. Fifty percent will die, 75% have seizures.
|
|
|
In a _____ ______ fracture, part of the skull is actually sunken in from trauma. This may occur with or without a ___ in the _____. What is needed to correct the deformity?
|
In a depressed skull fracture, part of the skull is actually sunken in from trauma. This may occur with or without a cut in the scalp. Surgical intervention is needed to correct the deformity.
|
|
|
What is the most serious type of skull fracture?
|
basilar skull fracture
|
|
|
A _____ ______ is caused by shear force injury created by impact than can cause tearing of bridging vessels in space under the dura mater.
|
A subdural hematoma is caused by shear force injury created by impact than can cause tearing of bridging vessels in space under the dura mater.
|
|
|
A basilar skull fracture involves a break in the bone at the base of the skull. The child will present with "Battle's Sign." What is this sign?
|
Child has bruises around eyes and a bruise behind the ear.
|
|
|
In a basilar skull fracture, there may be ___ _____ draining from the ____ or ____. These patients need close observation in the hospital.
|
In a basilar skull fracture, there may be clear fluid draining from the nose or ear. These patients need close observation in the hospital.
|
|
|
______ _____ is also known as static encephalotpathy.
|
cerebral palsy
|
|
|
Cerebral Palsy is an acute/chronic progressive/nonprogressive disorder of ___ and _____ characterized by difficulty in ____ muscles because of an abnormality in the ____ _____.
|
Cerebral Palsy is an chronic nonprogressive disorder of posture and movement characterized by difficulty in controlling muscles because of an abnormality in the motor system.
|
|
|
There are 5 classifications of cerebral palsy: dyskinetic, spastic, ataxic, rigid, and mixed. Which is most common?
|
spastic
|
|
|
In what type of injury will we see bruises around eyes and a bruise behind the ear? What is this sign called?
|
basilar skull fracture
Battle's Sign |
|
|
_____ cerebral palsy is characterized by slow, uncontrolled, involuntary movement involving all extremities.
|
Dyskinetic
|
|
|
_____ cerebral palsy is characterized by increased DTR, hypertonia, flexion, and contractures.
|
Spastic
|
|
|
_____ cerebral palsy is characterized by loss of coordination and equilibrium.
|
Ataxic
|
|
|
_____ cerebral palsy is characterized by tremors with rigidity of flexor and extensor muscles
|
Rigid
|
|
|
_____ cerebral palsy is characterized by a combination of any of the different types.
|
Mixed
|
|
|
Cerebral Palsy is related to prenatal, perinatal, and postnatal factors. What are some contributing prenatal factors that can contribute to it?
|
CHAIR RIDGE
Congenital anomalies Hemorrhage (intracranial) Anoxia Intrauterine ischemic event Rubella infection in first trimester RH & ABO incompatibility Intrauterine ischemic event Diabetes Mellitus & PIH Genetics Exposure to maternal infection such as toxoplasmosis, cytomegalovirus |
|
|
What are some contributing perinatal factors that can contribute to cerebral palsy? (factors that occur during or shortly after labor)
|
PPP LAB
Precipitous delivery Prolonged labor Prematurity Low birth weight Asphyxia Birth trauma |
|
|
What are some postnatal contributing factors to cerebral palsy?
|
PITS
Poisoning Infections Trauma Stroke |
|
|
Manifestations of cerebral palsy depend on the type. About half of the cases show some degree of _____ _____. They may also show other problems such as ____, ____ & ____ loss, g_______ r______, and ______ problems.
|
Manifestations of cerebral palsy depend on the type. About half of the cases show some degree of mental retardation. They may also show other problems such as epilepsy, hearing & vision loss, gastroesophageal reflux, and emotional problems.
|
|
|
The therapeutic management for cerebral palsy involves early ______ and ______ to maximize the child's abilities. It involves a multidisciplinary team approach.
|
early recognition & intervention
|
|
|
In explaining the development of cerebral palsy to parents, it is best to explain that it most likely occurred due to _____ episodes when he or she was a critically ill ____ infant.
|
In explaining the development of cerebral palsy to parents, it is best to explain that it most likely occurred due to hypoxic episodes when he or she was a critically ill premature infant.
|
|
|
True or False: cerebral palsy is usually diagnosed at birth
|
false, usually not until age 2 or older
|
|
|
What are the earliest signs of cerebral palsy?
|
abnormal muscle tone- hypertonicity and developmental delays.
|
|
|
To help decrease muscle tone and spasticity, a muscle relaxer such as _____ may be administered via the oral or interthecal route.
|
Baclofen
|
|
|
Which is the most important intervention to help families of children with cerebral palsy (CP)?
-reversing the degenerative processes -identifying the underlying cause -promoting optimal cognitive & physical functioning -assisting with finding counseling services |
-promoting optimal cognitive & physical functioning
|
|
|
Reye's Syndrome (RS) is a toxic _______ associated with characteristic organ involvement- the _____ and the ____.
|
Reye's Syndrome (RS) is a toxic encephalopathy associated with characteristic organ involvement- the liver and brain.
|
|
|
Reye's Syndrome follows a ____ illness, (usually 1-3 days after) and is linked with the use of ____ during this time.
|
Reye's Syndrome follows a VIRAL illness, (usually 1-3 days after) and is linked with the use of ASPIRIN during this time.
|
|
|
The pathophysiology or Reye's Syndrome involves damaged ___ cells that disrupt the uria cycle, leading to hyperammonemia/ hypoammonemia, hyperglycemia/hypoglycemia, and increased/decreased serum fatty acids leads to encephalopathy. The fatty degeneration of the _____ leads to excess ___ in the blood.
|
The pathophysiology or Reye's Syndrome involves damaged LIVER cells that disrupt the uria cycle, leading to hyperammonemia, hypoglycemia, and increased serum fatty acids leads to encephalopathy. The fatty degeneration of the kidneys leads to excess uria in the blood.
|
|
|
Manifestatinos of Reye's Syndrome include:
|
Fever
Vomiting Lethargy Rapid changes in LOC Seizures Progresses to coma Respiratory failure |
|
|
Ecotrin, Excedrin, and Alka Seltzer, Peptol Bismol all contain ______.
|
aspirin
always teach parents to check labels! be aware of aspirin hidden in various medications. |
|
|
What is the tx for Reye's Syndrome?
|
supportive tx
ventilator monitor ICP IV glucose for hypoglycemia |
|
|
What is the prognosis for Reye's Syndrome?
|
varies depending on stage
Stage 1 (lethargy) - Stage V (coma) |
