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39 Cards in this Set

  • Front
  • Back
What is a seizure?
-a symptom of many disorders affecting the brain, not a disease itself: symptom of something gone awry
What are seizures czed by?
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
Manifestations of seizures in kids?
-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
What is epilepsy?
-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
What is an isolated seizure?
-just the 1 seizure
-must have an immediate precipitating factor
ex: motorcycle accident czs head injury then has seizure
-immediately following precipitating factor
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
Idiopathic czs of seizure disorders?
-most of the time seizures are idiopathic
- > 3 yrs
-no known cz
-strong genetic component
Acquired czs of seizure disorders?
-< 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
What is a partial seizure?
electrical discharge in limited areas of brain movements, behaviors depend on area of brain involved
3 things that comprise a simple partial seizure?
-preservation of awareness
-memory
-consciousness
What does a complex partial seizure consist of?
-impairment of awareness, memory or consciousness.
-aura
What is a tonic clonic seizure?
-generalized seizure
-loss of consciousness
-no memory of seizure
-absence
-ages 4 & 14
-usually <30 secs, daydreaming
Manifestations of tonic clonic seizure?
-tonic: stiffening phase,cry or shriek, loss of consciousness, fall
-clonic: jerking phase, bowel & bladder incontinence
-ictal phase: gradual return of consciousness
What are atonic/akinetic seizures?
-2-5 years
-sudden loss of muscle tone w/ drop
-frequent reoccurence
-risk of injury
What are myoclonic jerks?
-sudden brief contracture of a muscle group
-no postictal state
What are infantile spasms?
-6-18 months
-boys < girls
-prognosis for normal intelligence is poor
-jackknife (salaam) appearance
What are febrile seizures?
-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
Parental education for febrile seizures?
-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
Subjective health history of a child for seizure disorder?
-prenatal, perinatal, neonatal
-Developmental assessment:
*language
*learning
*behavior
*motor assessment
-headaches, stomachaches
Subjective health history of family for seizure disorder?
-seizures
*febrile or others
-learning probs
-neurologic dz
What are you looking for when doing a neurological assessment of the developmental differences of an infant?
-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
What are you looking for when creating a clear baseline for comparison during your neurological assessment?
-LOC
-temp
-BP & pulse
-resp status w/ O2 sats: brain inf can be very low or after a seizure
-pupil size
-skin
When making a clear baseline for comparison what are you assessing about LOC?
-changes in behavior, amnesia
-signs of infection, meningismus (stiff neck)
When making a clear baseline for comparison what are you assessing about pupil size?
-fixed > 5 min means brain stem dysfunction & is a neurological emergency
When making a clear baseline for comparison what are you assessing about skin?
-needle marks,ticks, petechiae, odor, visible CSF leak (head injury, may see leaking out of ear)
Motor function for neurological assessment?
-spontaneous mvmt, pain response
-symmetry, hypo- or hypertonic, combative
-posturing
-primitive reflexes emerge & reflect the area of the brain involved
What type of dysfunction is decorticate posturing?
cerebral cortex dysfunction
What type of dysfunction is decerebrate posturing?
midbrain dysfunction
Signs of increased intracranial pressure in infants?
-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)
Signs of increased intracranial pressure in children?
-headache
-vomiting
-seizures
-diplopia
Late signs of increased ICP?
-decreased LOC
-fixed, dilated pupils, papilledema
-posturing
-Cushing's Triad
What is Cushing's Triad?
-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
What is are the 3 parts of the glasgow coma scale?
-eye opening
-motor response
-response to auditory or visual stimulus
How is the glasgow coma scale scored?
-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
What is meningitis?
infl of the meninges & spinal nerves
Meningeal inflammation causes?
-h/a: will prob have very bad h/a, infant will be crying
-cerebral edema
-ICP
Spinal nerve inflammation czs?
-stiff neck (meningismus): czed by infl of nerves themselves
What can bacterial meningitis initially lead to?
-hearing loss: CN VIII damage
-obstructive hydrocephalus: CSF pathways blocked
-brain ischemia: vasculitis & thrombophlebitis
Meningitis symptoms > 2 yrs old?
-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