Pediatric Neurology Content

Front 1

What two organs use the most oxygen? (in order)

Back 1

1. heart
2. brain

Front 2

Proper pediatric neuro exam when it comes to kids?

Back 2

1. moving eyes?
2. stick a tongue out?
3. PERRLA?
4. Get them to smile, frown, cough
5. How can they walk?
6. Sensations?

Front 3

What neuro checks occur in the hospital?

Back 3

1. level of consciousness?
2. motor function
3. vitals
4. pupil response

Front 4

What are some early signs of ICP?

Back 4

headache, nausea/vomiting, sunsetting eyes

Front 5

What are some late signs of ICP?

Back 5

1. LOC change
2. bradycardia
3. Posturing issues
4. fixed pupils

Front 6

What reflexes are good in an infant?

Back 6

1. Moro
2. Tonic Neck
3. Withdrawal

Front 7

When should babinski reflex stop occuring?

Back 7

12-24 months

Front 8

What causes decerebrate posture?

Back 8

damage to the upper brain stem

Front 9

what causes decorticate posture?

Back 9

damage to one or both corticospinal tract

Front 10

Nursing considerations for kids with increased ICP?

Back 10

1. room quiet and dimly lit
2. restrict visitors based on behavior
3. elevate HOB slightly (15-30)
4. Prevent straining for stool
5. seizure precautions
6. do not manage pain with sedative medication
7. Suction only as needed

Front 11

Respiratory management considerations for increased ICP?

Back 11

1. increased CO2 increases CBF, increasing ICF
2. CO2 that is too low will cause vasoconstriction and cause ischemia

Front 12

What kind of fluid maintenance for an ICP patient?

Back 12

2/3 the maintenance normally (overhydration a risk)

Front 13

Minor vs major head injury?

Back 13

Minor injury = may not lose consciousness, confusion, irritability
Severe = increased ICP, retinal hemorrhage, papilledema (swelling in back of eyes)

Front 14

Nursing care for head injury?

Back 14

1. ABCs
2. Pupil checks
3. Monitor LOC
4. NPO
5. No sedatives if possible
6. Have parents check LOC
7. Call MD if child vomits three or more times or LOC

Front 15

Immediate care for concussions?

Back 15

1. observe for vomiting, headaches, seizures
2. Change in mental status, behavior, gait
3. Recent memory amnesia

Front 16

What is post-concussion syndrome?

Back 16

1. Chronic headaches***
2. fatigue
3. sleep difficulties
4. photosensitivity

Front 17

What is the definition of a seizure?

Back 17

uncontrolled discharge of neurons that interfere with normal brain function

Front 18

What is a simple partial seizure?

Back 18

no loss of alertness or consciousness

Front 19

What is a complex partial seizures?

Back 19

1. Brief temporary alteration in brain function
2. Starts with aura

Front 20

Seizure vs. epilepsy?

Back 20

A seizure is a symptom, but epilepsy is a disease

Front 21

Most common type of seizure in kids?

Back 21

Febrile Seizures

Front 22

When do febrile seizures usually occur?

Back 22

Between 6month and 5 years

Front 23

Possible causes of febrile seizures in kids?

Back 23

Immature neurological system and recurrent infections

Front 24

Role of the nurse during a seizure

Back 24

1. safety
2. OBSERVE
3. changes in VS, respiratory, assessment

Front 25

Assessments during a seizure?

Back 25

1. patient actions
2. Level of consciousness
3. Eye movement
4. body movement

Front 26

What does the nurse do after a seizure?

Back 26

1. Take vitals
2. assess neuro with complete neurological exam
3. Document, document, document
4. contact MD

Front 27

Alternative seizure management options?

Back 27

1. ketogenic diet (high in fat, low in carbs)
2. Vagal nerve stimulator
3. Surgery

Front 28

What is status epilepticus?

Back 28

1. Single seizure of > 30 minutes
2. Series of seizures > 30 minutes without full recovery

Front 29

Treatment of Status Epilepticus in first 0-5 minutes?

Back 29

ensure safety, VS, O2 status

Front 30

Treatment of status epilepticus in 5-10 minutes?

Back 30

IV access, bloodwork, lorazepam, contact ICU team

Front 31

Treatment of status epilepticus >10 min?

Back 31

Fosphenytoin or Phenytoin

Front 32

Treatment of status epilepticus >30 min

Back 32

More drugs, possible intubation

Front 33

What is meningitis?

Back 33

an inflammation of the meningies of the brain

Front 34

How does meningitis typically start?

Back 34

infection somewhere else in the body travels to brain

Front 35

Which type of meningitis is preferable?

Back 35

Aseptic (viral) meningitis

Front 36

Describe aseptic (viral) meningitis?

Back 36

1. self-limiting
2. Symptom management instead of treatment
3. AKA chemical meningitis

Front 37

What are leading causes of bacterial meningitis?

Back 37

S. pneumonia and nisseria meningiditis

Front 38

What is the clinical presentation of meningitis for infants-2years?

Back 38

fever, decreased oral intake, irritability, a neuro cry, bulging fontanelle

Front 39

What is the clinical presentation of meningitis for 3-adolescent?

Back 39

**abrupt onset**, fever, chills, headache, seizure, extreme stiff neck,

Front 40

What are two positive signs for meningitis in children and adolescents?

Back 40

Kernig and brudzinski

Front 41

What is a kernig sign?

Back 41

Resisting leg extension past 90 degrees

Front 42

What is a brudzinksi sign?

Back 42

Lifting head and watching the legs move too

Front 43

CSF labs for bacterial meningitis?

Back 43

1. WBC = elevated
2. Elevated Protein
3. Decreased glucose
4. Positive Gram Stain
5. Turbid/Cloudy

Front 44

CSF labs for viral meningitis?

Back 44

1. WBC slightly elevated
2. Protein normal
3. Glucose normal
4. Negative gram stain
5. Clear CSF color

Front 45

Nursing care for pediatric meningitis?

Back 45

1. Isolation procedures
2. STAT antibiotics
3. LP/CSF culture
4. IV access for antibiotics, fluids, rescue meds
6. Monitor for ICP w/ nursing care for ICP
7. Temp control

Front 46

When is the only time you do not use 2/3 maintenance for a neuro disorder?

Back 46

patient is in shock

Front 47

What is a really really bad sign in meningitis?

Back 47

Meningitis and petechiae

Front 48

Pathophysiology of Spina Bifada?

Back 48

Failure of neural tube to close at 28 days gestation

Front 49

What complication occurs in 85% of spina bifida patients?

Back 49

hydrocephalus

Front 50

What is the clinical manifestation of a neural tube deficit at the thoracic or lumbar 1-2 level?

Back 50

paralysis of legs w/ sensory loss in trunk and lower body

Front 51

What is the clinical manifestation of a neural tube deficit at the Lumbar 3 level?

Back 51

child can flex hips, extend knees, w/ ankle and toe paralysis

Front 52

What is the clinical manifestation of a neural tube deficit at the Lumbar 4-5 level?

Back 52

1. flex hips, extend knee
2. weak or absent ankle extension
3. hip extension

Front 53

What is the clinical manifestation of a neural tube deficit at the Sacral level?

Back 53

1. mild weakness in ankles an toes
2. possible bladder and bowel function deficit

Front 54

What is spina bifida occulta?

Back 54

nothing comes through, just a deficit in vertebra

Front 55

What is a menigomvelocele or mvleomeningocele?

Back 55

Protrusion of spinal cord in sac through skin

Front 56

What is a meningocele?

Back 56

just a sac goes through skin

Front 57

Nursing care for spina bifida before repair?

Back 57

1. Avoid rectal temps
2. prevent infection
3. cover sac in sterile, moist, non-adherent dressing
4. Prepare for surgical repair in first 24 hrs

Front 58

Immediate spina bifida post-op nursing considerations?

Back 58

1. prone/side-lying
2. Pain management
3. Infection
4. Hydration/Nutrition
5. Neurologic checks

Front 59

What is hydrocephalus?

Back 59

A symptom of different issues involving cerebral circulation and CSF

Front 60

Pathophysiology of hydrocephalus?

Back 60

An imbalance of production and absorption of CSF due to infection, trauma, anatomy or lesion

Front 61

Difference between communicating and non-communicating hydrocephalus?

Back 61

Communicating = no obstruction of flow within ventricles
Non-communicating = CSF flow obstruction

Front 62

What are the types of shunts?

Back 62

1. Ventriculoperitoneal shunt = occur in young children allowing for growth
2. Ventriculatrial = for older children and young children with abdominal conditions preventing VP

Front 63

What contraindicates a ventriculatrial shunt?

Back 63

CV issues or an elevated CSF production

Front 64

Where does a ventricularial shunt run from?

Back 64

brain ventricle to right atrium

Front 65

What are the major complications with ventricle shunts?

Back 65

**Infections**, malfunctions, perforations

Front 66

Nursing care for kids with shunts?

Back 66

1. monitor neurologic status and VS
2. child on back or non-operative side
3. observe for increased ICP
4. Patient education

Front 67

What percentage of cerebral palsy patients do not have intellectual disabilities?

Back 67

70%

Front 68

What is cerebral palsy?

Back 68

1. permanent disorders of development of movement and posture
2. attributed to nonprogressive disturbances that occur in the developing fetal or infant brain

Front 69

What are common causes of CP?

Back 69

1. Prenatal Injury
2. Perinatal Incidents
3. Childhood complications

Front 70

CP vocab words involving movement disorders?

Back 70

1. spastic = muscle tightness
2. ataxic = low muscle tone and tremors
3. dyskenisia/atheoid = mixed muscle tone

Front 71

CP terms for locational symptoms?

Back 71

1. hemiplegia = leg, arm, and trunk paralysis on one side
2. Diplegia = Paralysis bilaterally
3. Quadriplegia = below the neck

Front 72

CP clinical manifestations of the Gross Motor?

Back 72

1. poor head control
2. delayed motor skills
3. hand preference before preschool
4. abnormal posture
5. Persistent infant reflexes
6. Orthopedic issues

Front 73

CP clinical manifestations of the behavioral/intellectual difficulties?

Back 73

1. 70% of chilren with CP have normal intelligence
2. ADHD/poor attention symptoms
3. drooling, feeding issues

Front 74

Nursing care for patients with CP?

Back 74

1. Educate family, friends
2. refer/know the proper resources
3. early intervention
4. injury prevention
5. medications for spasticity