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TL Neurologic Peds
Pediatric Neurological Disorders
| Question | Answer |
|---|---|
| Common sign in meningitis – involuntary knee flexion in when child’s head is flexed | Brudzinski’s sign |
| Late sign of increased intracranial pressure consisting of increased systolic blood pressure, bradycardia, and irregular respirations | cushing’s triad |
| Bleeding between the dura and cranium | Epidural Hematoma |
| Pain or resistance when the leg is raised and knee flexed; common finding indicative of meningeal irritation | Kernig’s sign |
| Fibrous membrane that covers brain and lines vertebral canal | meninges |
| Stiffness of the neck or resistance to neck flexion often seen with infection of the CNS | Nuchal rigidity |
| Client positions self hyperextending the head and neck to relieve discomfort of meningeal irritation | Opisthotonus |
| When do the brain and spinal cord develop in the fetus? | first trimester |
| What kind of things can affect development of the brain and spinal cord during the first trimester? | Infection, substance abuse, dietary deficiency |
| When does the nervous system become mature? | Not at birth but as the number of glial cells and dendrites increase refinement continues until about 4 years of age |
| List levels of consciousness in decreasing order. | confusion, delirium, obtunded, stupor, coma |
| Define delirium. | disorientation without drowsiness; hallucinations or delusions, difficulty focusing, inability to rest/sleep, physical/autonomic overactivity |
| Define obtunded. | having diminished arousal and awareness, often as a result of intoxication, metabolic illness, infection, or neurological catastrophe |
| Define stupor. | decreased responsiveness to environment; arousable only with vigorous or unpleasant stimuli |
| Define coma | unarousable to painful stimuli |
| Define ICP | pressure within the cranium or skull that surrounds the brain |
| What is the normal range for ICP? | 4-12 mm |
| What three components contribute to normal ICP? | the brain, cerebrospinal fluid, and blood |
| What happens if any one of the components of ICP increases? | The other two have to compensate |
| What advantage does a young child have over an older one when it comes to increased ICP? | their sutures have not closed so their cranium can expand to a point if there is increased pressure |
| What score on the Glasgow coma scale would indicate that a person has no alteration in LOC? | 15 |
| What score on the Glasgow coma scale would indicate that a person is in a coma state? | 8 or below |
| What score on the Glasgow coma scale indicates that a person is in a deep coma? | 3 |
| What do we do if our patient does not respond to painful stimuli? | report immediately |
| Why is it important that the neurologic examination be documented in a fashion that can be reproduced by others? | This allows for comparison of the findings so that the observer can detect subtle changes in neurologic status that might not otherwise be apparent. |
| What do vital signs like pulse, BP and respiration tell us about altered consciousness? | Information about adequacy of circulation and possible underlying cause of altered consciousness |
| When would autonomic activity most disturbed? | In cases of deep coma or brainstem lesions |
| What are some possible causes of elevated temperature? | most frequently infectious process or heat stroke, also ingestion of certain drugs (salicylates, alcohol, and barbiturates) or intracranial bleeding especially subarachnoid hemorrhage, involvement of the hypothalamus (temperature may increase or decrease) |
| What cause of coma could produce hypothermia? | toxic origin |
| Define the Cushing reflex. | increasing systolic bp (widening pulse pressure) and slowing pulse – late sign of ICP |
| What are some possible causes of slow, deep breathing? | sedatives, after seizure, cerebral infection |
| What are some possible causes of slow, shallow breathing? | sedatives or opioids |
| What are the usual causes of deep and rapid respirations? | metabolic acidosis or abnormal stimulation of the respiratory center in the medulla caused by salicylate poisoning, hepatic coma, or Reye syndrome |
| Periodic or irregular breathing is an ominous sign of BLANK dysfunction. | brainstem (especially medullary – often precedes complete apnea) |
| What odor does a person’s breath have when they have ketosis? | fruity |
| What might you suspect if an unconscious person has fetid breath? | Hepatic failure |
| Define fetid. | Rank, Foul |
Created by:
Perseverandovercome
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