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47 Cards in this Set
- Front
- Back
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What is bacterial meningitis?
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brain becomes edematous with exudate with vascular dissemenation
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What causes bacterial meningitis?
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H Influenzae
S. Pneumonae Nessieria meningititis Usually preceded by URI or chicken pox |
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What are the s/s of bacterial meningitis?
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fever
chills HA vomiting nuchal rigidity kernig and brudinski + petechial or purpuric rashes shock |
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What is the nursing care for bacterial meningitis?
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LP for Dx
IV antibiotics ASAP reduction of IICP priority Control seizures through meds Management of shock Isolation for 24hrs after antibiotics admin Treat close family members Head midline and supine |
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What are the early s/s of ICP?
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HA
Vomiting dizziness bradycardia Widened pulse pressure HTN irritability sunset eyes seizures |
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What are the late s/s of IICP
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Cheyne stokes RR
decerebrate or decorticate posturing fixed and dilated pupils decreased motor and sensory responses |
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What are the s/s of meningitis for children 3mo - 2 yrs?
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Fever
poor feedings vomiting irritability seizures high pitched cry bulging fontanel nuchal rigidity |
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What is found on a LP that would indicate meningitis?
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Gram stain - organism
WBC - increased glucose - decreased protein - increased |
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Why is it important to monitor someone with IICP's fluid intake?
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to prevent cerebral edema or IICP
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How is meningitis prevented?
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Hib vaccine
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What is reye's syndome RS?
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toxic encephalopathy associated with organ involvement - mitochondrial insult usually caused by ASA overdose for viral infection
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What are the s/s of RS?
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cerebral edema
vomiting fever fatty changes in the liver |
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What is a seizure or epilepsy?
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seizure is an occasional excessive disorderly discharge of neuron activity
epilepsy is recurrent seizure activity which can be classified as partial (no LOC) or generalized (tonic or clonic) |
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What are the common seizure types?
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Febrile (benign)
Absence (blank facial expression) Tonic-Clonic (most dramatic) Myoclonic (muscle jerking) Atonic (drop attacks) Simple partial (one part of the brain, sensory s/s) Complex partial (no LOC both hemispheres) Status epileptics (emergency, prolonged seizures) |
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What is the diagnosis of seizures?
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video eeg monitoring
electrolytes, CBC, glucose, BUN LP, CT scan, MRI |
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What is the treatment for seizure disorders>
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Meds: dilantin, phenobarbital, depakote
Surgery ID triggers to avoid (flashing lights or repetitive motion objects) |
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What are some special considerations for dilantin?
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cause severe hyperplasia (good mouth care)
Check serum levels to individualize dosing IV dilantin is given in NS only (if given in dextrose, crystallization will be formed) |
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What are considerations for children with seizure disorders?
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may not be able to get a drivers licence
Meds can't be taken with street drugs, interfere with Birth control, and cause oily skin |
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What is hydrocephalus?
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imbalance between the production of CSF leading to IICP
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What are the s/s of hydrocephalus?
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bulging fontanels in infants
suture begin to separate in infants |
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What is the treatment for hydrocephalus?
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VP shunt to drain extra fluid from ventricle to peritoneal space
EVD used to drain CSF to a bag outside of the body when the shunt isn't working or infected |
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What is a Arnold -Chiari Malformation
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downward displacement of cerebellum causing:
HA Hydrocephalus neck pain choking extremity spasticity urinary frequency |
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What is craniosynostosis?
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premature closure of the cranial sutures
monitor for by measuring for this at 3 yrs old |
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What is plagiocephaly?
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asymmetrical head shape usually due to positioning leading to torticollis and brain development problems
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What is the treatment for plagiocephaly?
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encourage positioning on the abdomen
molding helmet may be needed |
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What are s/s to monitor at home after a head trauma?
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vomiting
HA slurred speech unequal pupils difficulty arousing fluid from ears |
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What are s/s of severe head injury?
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ABCs
close neuro assessment monitor ICP position supine with head midline seizure precaution fixed pupils (emergency) |
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What is a neural tube defect?
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incomplete closure of vertebrae and neural tube occurs at 4 weeks gestation
folic acid prevents |
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What is spina bifida occulta?
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where the vertebrae is only affected in the NTD
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What is spina bifiida cyctica?
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refers to an external sac of NTD
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Name the types of spina bidifa cystica?
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Meningocele - meninges and fluid in sac pop out of back
Myelomeningocele - meninges fluid AND nerves in sac (can lead to hydrocephalus) |
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What are the symptoms of spina bifida?
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depend on where the lesion occurs on the spinal column
can include paralysis incontinence and breathing difficulty |
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What is the treatment for spina bifida?
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surgery for external sac
preop care: keep sac protected and cover with wet sterile dressing, prone Postop care: keep prone, keep surgical site clean and dry, observe urination, may need cath high risk for hydrocephalus VP shunt |
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What are the long term issues with spina bifida?
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severity varies by typically need wheel chair, home cath, high risk for depression as teens
risk for latex allergy (myelomeningocele) |
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What are issues with VP shunt?
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HA
odor no drainage emergency if theres an issue |
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What is cerebral palsy?
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chronic nonprogressive abnormality of the motor cortex, basal ganglia or cerebellum
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What are the s/s of cerebral palsy?
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persistence of primitive reflexs
delayed motor skills abnormal posturing and spasticity feeding problems, high risk for pneumonia and seizures |
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What are primitive reflexes?
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tonic neck reflex or moros reflex
crossed extensor reflex |
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What is the management of cerebral palsy??
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Early identification
assist with proper positioning, developmental stimulation, special feeding, and seizure precautions frequent rest prone to falls supporting families |
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What are the types of cerebral palsy?
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Spastic
Athetoid Ataxic |
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What is the spastic cerebral palsy?
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inc DTR
exaggerated primitive reflexes gait crouched intoeing scissoring scoliosis contractures |
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What is the athetoid cerebral palsy?
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purposeless involuntary movements
uncontrollable movements of face and extremities with stress DTRs +2 |
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What is the ataxic cerebral palsy?
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rare disturbed coordination
unsteady gait DTR 1+ nystagmus lack of depth preception |
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What is Duchenne muscular dystrophy?
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degenerative muscle tone
x linked recessive spontaneous |
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What are the s/s of duchenne muscular dystrophy?
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presents at 3-5
dec in development of difficulty with balance or gross motor skills gowers sign (getting up by walking on legs) |
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What is the dx testing for duchenne muscular dystrophy?
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biopsy
EMG serum CPK (for MI) |
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WHat is the treatment for duchenne muscular dystrophy?
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steroids
PT bracing |
