Pediatric Neurological Conditions
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| Brain size of infant is ____% of adult size | show 🗑
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| Brain size of a 1yo is ____% of adult size | show 🗑
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| brain size of a 3 year old is ____% of adult size | show 🗑
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| show | 90%
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| show | 34-35 cm
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| show | 44 cm
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| Head circumference of a 1 yo is ____ cm | show 🗑
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| show | ICP
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| show | 10-12 yo
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| Papilledema - edema of the ____ is due to open sutures and fontanels | show 🗑
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| Premature closure of sutures and fontanels can cause a potential for ____ damage | show 🗑
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| Head circumference at birth is ____" larger than circumference chest | show 🗑
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| show | True
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| show | in utero (approx week 16)
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| Myelinization of CNS usually complete by ____ | show 🗑
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| Myelinization of CNS promotes progressive ____ and ____ motor development | show 🗑
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| show | hydrocephalus
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| hydrocephalus occures in ___ / 1000 live births | show 🗑
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| show | intrauterine (in the uterus = aka. womb)
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| show | infection, neoplasm and hemorrhage
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| Blockage outside ventricular system is ____ hydrocephalus | show 🗑
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| show | subarachnoid space - subarachnoid hemorrhage
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| show | noncomunicating
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| show | reaching - stenosis of aqueduct of sylvius or Dandy-Walker Syndrome
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| ____ tumor causes increased CSF secretions which causes hydrocephalus | show 🗑
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| show | head enlarge,nonpulsatile & bulgine anterior fontanel, scalp veins dilated, cranial sutures seperated, Macewen sign (sound of a cracked pot), Bossing of frontal bone, setting-sun eyes, changes in LOC, irritable, lethargic, opisthotonos(back arching)
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| show | poor feeding, shrill, high pitched cry, developmental delay and seizures
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| show | HA/N/V, ataxia, strabismus, dipopia, pupil unequal response to light, papilledema, LOC change, Intellectual impairment and seizures
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| show | Cushing's Triad
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| Diagnosis of hydrocephalus include ____ ultrasonography, measurement of ____ circumference, and____imaging studies | show 🗑
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| Neuroimaging studies include evaluation of size and position of ____ and subarachnoid spaces | show 🗑
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| surgical management of hydrocephalus include correcting the ____ and shunt placement | show 🗑
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| Shunt the ventricles to the peritoneal cavity is called ____ | show 🗑
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| VP shunt is best for infants or children | show 🗑
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| 4 Risks for VP shunt include | show 🗑
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| show | Ventriculoatrial (VA) shunt
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| show | older child - rare
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| 4 Risks for VA shunt | show 🗑
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| show | ICP
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| show | signs of increased ICP, fever, stiff neck, wound or shunt tract inflammation and abdominal pain
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| Manifestations of a subdural hematoma due to shunt complication is rapid decreases in ____ pressure and ____ fontanel | show 🗑
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| _____ shunt revisions are expected during a lifetime | show 🗑
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| Most common reason for shunt revisions is | show 🗑
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| show | Vital signs, pupil reactivity and symmetry, fontanel's and suture lines, and head circumference
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| HOB preop and postop VP shunt is | show 🗑
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| post op VP shunt - too rapid decrease in CSF pressure may cause ____. | show 🗑
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| show | False - only if ordered by the physician
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| show | spina bifida (myelodysplasia)
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| Three examples of neural tube defects (NTD) | show 🗑
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| ____ is a bundle of nerves in a human embryo that develops into the brain and spinal cord | show 🗑
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| ____ is absence of both cerebral hemispheres and the overlying skull | show 🗑
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| show | encephalocele
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| Spina Bifida ____ - Often no observable manifestations, Incomplete fusion– posterior vertebrae, Spinal cord & nerves—normal, Usually no serious neurological dysfunction | show 🗑
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| Spina Bifida ____ - the unfused portion of the spinal column allows the spinal cord to protrude through an opening in the overlying vertebrae. The meningeal membranes that cover the spinal cord may or may not form a sac enclosing the spinal elements | show 🗑
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| Spina Bifida Cyctica can either meningocele or myelomeningocele the difference is ____ includes a portion of the spinal cord and nerves hanging out | show 🗑
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| spinal bifida cyctica myelomeningocele risk factors include: unknown, maternal ____ deficience and other factors such as ___ | show 🗑
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| show | white girls. (declined due to increase of folic acid in fortified foods)
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| show | four
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| Usual location of spina bifita | show 🗑
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| spina bifida cystica myelomeningocele prenatal diagnosis includes ____ scanning of uterus, elevated ____ levels from amniotic fluid and maternal serum and diagnostic tests | show 🗑
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| spina bifids cystica myelomeningocele postnatal diagnosis is based on the clinical manifestations and evaluation by what 4 methods | show 🗑
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| show | paralysis, tethered spinal cord, orthopedic problems, bladder and bowel problems, hydrocephalus, skin problems, latex allergy and Chiari II - The cerebellar tonsils are elongated and pushed down through the opening of the base of the skull
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| Folic Acid is recommended at ____ mg daily for pregnant women to prevent spina bifida cystica myelomeningocele | show 🗑
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| spina bifida cystica myelomeningoceal protection includes cover with ____ nonadherent dressing using ____ technique | show 🗑
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| show | elevated temperature, irritability, nuchal rigidity, and elevated WBC
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| Since hydrocephalus is a common manifestation with myelomeningocele nursing interventions include | show 🗑
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| show | meningitis
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| show | encephalitis
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| show | Meningitis
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| ____ represents inflammation of both the meninges and the cortex of the brain | show 🗑
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| a secondary infection to meningitis is | show 🗑
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| With meningitis, an infection enters the ____ and is carried to the meninges | show 🗑
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| Risk factors for Meningitis - age___, infection____, gender____, race____, season, maternal factors, CNS anomaly, neurosurgical procedures, head trauma & chronic conditions like sickle cell, diabetes and renal insufficiency | show 🗑
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| show | irritability, restlessness, poor feeding, A/N/V, bahavioral changes, decreased LOC and seizures
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| show | fever, photophoia, nuchal rigidity, spinal rigidity, opisthotonos, kernigs sign, brudzinskis sign, and skin changes like petechias, purpura and poor perfusion
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| show | Brudzinski's Sign
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| ____ sign is when the leg is fully bent in the hip and knee, and subsequent extension of the knee is painful | show 🗑
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| show | opisthotonus
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| show | color - cloudy and purulent, cell count elevated (polymorphonuclear leukocytes predominate), protein elevated, and glucose decreased less than 1/2 of the blood glucose
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| Meningitis antibiotic therapy begins ____ obtaining cultures and ____ results | show 🗑
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| Initial tx of meningitis | show 🗑
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| show | ampicillin, gentamicin, cefotaxime, ceftrizxodone, vancoymycin
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| show | clear
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| show | Rifampin - may cause certain bodily fluids to become orange-red
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| ____ lessens meningeal inflammation and prevents deafness | show 🗑
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| Comfort measure for meningitis includes elevating the ___, ____ pillow usage, and side lying due to ___ | show 🗑
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| Decreased sensory stimulation for meningitis includes: ____ room, ____ lighting, ____ handling | show 🗑
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| T/F place a pt with meningitis in isolation immediately | show 🗑
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| show | continue at least 24 hours, until culture results are obtained and while antibiotic is having an effect
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| show | fluid accumulation - related to cerebral edema, subdural effusion and SIADH
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| show | seizures and coma
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| show | 30% with pneumococcal and 5-10% with meningococcal
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| Potential long-term sequelae (pathological condition resulting from) meningitis | show 🗑
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| ____ is a group of symptoms with associated sudden transient alterations in brain function caused by excessive disorderly discharge of electrical impulses by neuronal tissue | show 🗑
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| ____ is a disorder of the CNS, caused by abnormal electrical discharges results in recurrent seizures | show 🗑
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| status epilepticus is a seizure that lasts ____ minutes or longer or is a ____ of seizures where intervals are too brief to allow child to regain consciousness between ea seizure | show 🗑
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| seizure risk factors | show 🗑
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| ____ is the preseizure phase and consists of what | show 🗑
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| show | ictal - time of onset, description of body movements, skin color, respiratory distress, incontinence, frothing secretions, automathisms, duration of seizure and meds
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| show | Postictal - level of awareness, motor and speech ability, and reorientation and stabilizaiton time frame
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| show | threshold
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| Antiepileptic drugs need to monitor ____ drug level, ____ count, and ____ function tests | show 🗑
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| Lorazepam (ativan) and Diazepam (valium) are ____ medications for status epileptis | show 🗑
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| show | remain calm, look at time seizure started, ease child to floor, loosen clothing, observe seizure activity
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| show | Do not restrain childs movements and do not force anything between teeth
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| Seizure percausions and available equipment: | show 🗑
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| show | Seizure lasts more than 5 min, Difficulty breathing afterwards, Difficulty awakening, Signs of injury, Pupils are not equal after , Vomits cont 30 min after ended (possible acute problem), Pregnancy or other medical ID, A second seizure
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| ____ medication is used for seizure control | show 🗑
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| A ____ seizure is associatd with a fever | show 🗑
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| Frebrile seizures occure with acute ____ illnesses | show 🗑
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| show | lasts less than 15 minutes and do not recur
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| show | Before 5yo. usually bt 3mo and 3yr
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| show | reduce fever and lumbar puncture for sepsis work up. reassure partents that it is a benign condition
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| show | False
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| show | far from medical facility
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| Call 911 if seizure lasts more than ____ minutes | show 🗑
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| Incident of cerebral palsy is ___ per 1000 live births | show 🗑
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| show | Cerebral Palsy
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| show | labor - can get between prenatal period and up to 2yo
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| Most common etiology for Cerebral Palsy is neonatal ____ | show 🗑
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| ____ Cerebral Palsy includes: Hypertonicity, Poor Control (Posture, Balance, Coordinated motion), Persistent primitive reflexes, Exaggerated deep tendon reflexes, Contractures—later | show 🗑
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| ____ Cerebral Palsy includes: Athetosis (slow, writhing movements), (Extremities, trunk, neck, facial muscles, tongue ), Abnormal involuntary movements (Choreoid—involuntary, irregular, jerky random movements, Dystonic—disordered muscle tone) | show 🗑
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| show | Ataxic Cerebral Palsy
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| Physical signs as an early warning to Cerebral Palsy includes: | show 🗑
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| show | Excessive irritability, No smiling by age 3 months, Feeding difficulties, Persistent tongue thrusting, Frequent gagging or choking with feeding, After 6 months of age, tongue pushing soft food out of the mouth
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| show | Learning Disabilities and Mental Retardation, Visual Deficits, Hearing Deficits, Communication Deficits, Seizures, Feeding and Eating Problems, Bowel and Bladder Problems
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| show | privide high caloie diet, supplement vitamins, minerals and protein, and maintain hydration status
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| show | meticulous oral hygiene, visit dentist at least every 6 mo, and close monitoring if on phenytoin
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| Antispasmodic meds for Cerebral Palsy include | show 🗑
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| show | monitor sites of potential skin alteration, keep sites clean and dry, and change position at least every 2 hours
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| Cerebral Palsy patients usually die due to ____ illness | show 🗑
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| show | Encephalopathy
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| show | Encephalopathy
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| ____ is an increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement. | show 🗑
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| _____is a decreased tension in muscle tone. A lack of muscle tone inhibits proper movement as the muscle is not developed or is too soft to support the body | show 🗑
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| show | contracture
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| show | spastic cerebral palsy
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| ____The involuntary functioning of an organ or other body structure that is not under conscious control | show 🗑
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| show | ataxia
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| show | Strabismus
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| _____is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. | show 🗑
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| show | Diplopia
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| show | Macewen sign
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| ___ sounds hollow or like a cracked pot? | show 🗑
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| Cushing's Triad is the late sign of IICP with manifestations of ____,____, & ____? | show 🗑
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| show | Frontal bossing is an unusually prominent forehead, sometimes associated with a heavier than normal brow ridge
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| show | Clinical manifestations of meningitis irritation and inflammation
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