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39 Cards in this Set
- Front
- Back
What is a seizure?
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-a symptom of many disorders affecting the brain, not a disease itself: symptom of something gone awry
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What are seizures czed by?
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czed by too many neurons firing at once: simple definition of seizures, over excitement of electricity which czs misfire
-genetic overlay: tend to run in fams especially if no obvious cz |
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Manifestations of seizures in kids?
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-Involves parts of brain cannot perform normal tasks
*sensations: may have odd sensation, crawly feeling on skin, stomachache, deja-vu *awareness *behavior: irritability, change in behavior *may last few seconds to minutes *normal state |
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What is epilepsy?
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-chronic seizure disorder
-recurrent seizures must appear spontaneously: at least 2 is typical but can have 1 w/ high chance of another -no immediate precipitating factor: person just has seizure w/o obvious medical cond, going on at time -two or more seizures |
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What is an isolated seizure?
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-just the 1 seizure
-must have an immediate precipitating factor ex: motorcycle accident czs head injury then has seizure -immediately following precipitating factor |
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Seizure disorder or isolated seizure?
-brain tumor -alcoholic intoxication -cocaine overdose -head trauma -pregnant woman w/ hypertension -hypoglycemia electrolyte imbalances -infections |
-brain tumor: seizure disorder had 1 & likely to have another
-alcoholic intoxication: don't have seizure disorder yet, isolated -cocaine overdose: isolated -head trauma: could be isolated but need to wait & see if it czs addt'l seizures -pregnant woman w/ hypertension: isolated -hypoglycemia electrolyte imbalances: isolated -infections: isolated but could become seizure disorder |
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Idiopathic czs of seizure disorders?
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-most of the time seizures are idiopathic
- > 3 yrs -no known cz -strong genetic component |
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Acquired czs of seizure disorders?
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-< 2 yrs
-highest incidence time in childhood -birth injuries: during birth or before birth, mother may have ingested alcohol czing permanent brain probs -hypoxia -hemorrhage -congenital defects -acute infections |
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What is a partial seizure?
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electrical discharge in limited areas of brain movements, behaviors depend on area of brain involved
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3 things that comprise a simple partial seizure?
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-preservation of awareness
-memory -consciousness |
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What does a complex partial seizure consist of?
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-impairment of awareness, memory or consciousness.
-aura |
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What is a tonic clonic seizure?
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-generalized seizure
-loss of consciousness -no memory of seizure -absence -ages 4 & 14 -usually <30 secs, daydreaming |
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Manifestations of tonic clonic seizure?
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-tonic: stiffening phase,cry or shriek, loss of consciousness, fall
-clonic: jerking phase, bowel & bladder incontinence -ictal phase: gradual return of consciousness |
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What are atonic/akinetic seizures?
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-2-5 years
-sudden loss of muscle tone w/ drop -frequent reoccurence -risk of injury |
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What are myoclonic jerks?
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-sudden brief contracture of a muscle group
-no postictal state |
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What are infantile spasms?
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-6-18 months
-boys < girls -prognosis for normal intelligence is poor -jackknife (salaam) appearance |
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What are febrile seizures?
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-tylenol at beginning of seizure does not stop seizure, seizure meds will assist
-6 mo- 5 yr. 18 mo* -4% of kids, boys > girls, FH -begins on fever rising -most don't progress to seizure disorder |
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Parental education for febrile seizures?
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-benign
-little risk of brain damage, epilepsy: < 5% chance of developing epilepsy -protecting & observing -length of seizure - 5 min call 911: > 5 min, should call 911 -antipyretics NOT helpful in prevention -seizure meds ARE helpful but NOT recommended: bc of side effects of meds |
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Subjective health history of a child for seizure disorder?
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-prenatal, perinatal, neonatal
-Developmental assessment: *language *learning *behavior *motor assessment -headaches, stomachaches |
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Subjective health history of family for seizure disorder?
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-seizures
*febrile or others -learning probs -neurologic dz |
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What are you looking for when doing a neurological assessment of the developmental differences of an infant?
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-primitive reflexes are normal
*replaced by purposeful mvmts w/ age *persistence, re-emergence indicates pathology *failure to attain milestones is problematic *often have very subtle neurologic signs *obtain pregnancy & health history |
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What are you looking for when creating a clear baseline for comparison during your neurological assessment?
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-LOC
-temp -BP & pulse -resp status w/ O2 sats: brain inf can be very low or after a seizure -pupil size -skin |
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When making a clear baseline for comparison what are you assessing about LOC?
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-changes in behavior, amnesia
-signs of infection, meningismus (stiff neck) |
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When making a clear baseline for comparison what are you assessing about pupil size?
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-fixed > 5 min means brain stem dysfunction & is a neurological emergency
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When making a clear baseline for comparison what are you assessing about skin?
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-needle marks,ticks, petechiae, odor, visible CSF leak (head injury, may see leaking out of ear)
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Motor function for neurological assessment?
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-spontaneous mvmt, pain response
-symmetry, hypo- or hypertonic, combative -posturing -primitive reflexes emerge & reflect the area of the brain involved |
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What type of dysfunction is decorticate posturing?
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cerebral cortex dysfunction
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What type of dysfunction is decerebrate posturing?
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midbrain dysfunction
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Signs of increased intracranial pressure in infants?
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-tense or bulging fontanel (if have assume fluid on brain, may be due to infection)
-separated sutures -head circumference, high pitched cry -distended scalp veins, irritability -setting sun eyes (eyes deviated down czed by incr pressure or irritation to brain stem) |
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Signs of increased intracranial pressure in children?
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-headache
-vomiting -seizures -diplopia |
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Late signs of increased ICP?
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-decreased LOC
-fixed, dilated pupils, papilledema -posturing -Cushing's Triad |
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What is Cushing's Triad?
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-sign of brain herniation when brain herniates from high to low pressure
-pts don't live with this condition -irregular respirations -systolic BP w/ wide pulse pressure -bradycardia |
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What is are the 3 parts of the glasgow coma scale?
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-eye opening
-motor response -response to auditory or visual stimulus |
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How is the glasgow coma scale scored?
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-score of 3 to 15
-7 or above have good chance of recovery -best to involve parents to get most accurate assessment -under 5 years, may have lower scores bc they just don't understand the questions |
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What is meningitis?
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infl of the meninges & spinal nerves
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Meningeal inflammation causes?
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-h/a: will prob have very bad h/a, infant will be crying
-cerebral edema -ICP |
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Spinal nerve inflammation czs?
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-stiff neck (meningismus): czed by infl of nerves themselves
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What can bacterial meningitis initially lead to?
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-hearing loss: CN VIII damage
-obstructive hydrocephalus: CSF pathways blocked -brain ischemia: vasculitis & thrombophlebitis |
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Meningitis symptoms > 2 yrs old?
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-most meningitis is in kids under 5 yrs (bc starting school, immune system is not where it should be, haven't had vaccines)
-abrupt onset w/ fever, chills, headache, vomiting -nuchal rigidity (stiff neck) + Kernig (inability to straighten leg/hip to 90 degrees), + Brudzinski signs (when pull neck up, kid pulls knees up) -cyanotic extremities, stupor, seizures, coma -photophobia: light sensitivity -concurrent pneumonia: S. pneumonia -petechiae and/or purpuric rash. arthritis: N meningitidis |