NURS 353 Peds Neuro

top heavy

neck muscles and cervical spine underdeveloped

why are kids prone to head injury with falls

thin cranial bones

unfused sutures

why are kids prone to skull fracture and brain injury

brain is highly vascular

less CSF

why are kids prone to hemorrhage and trauma

4-5 years

when is myelination matured

infancy

when are pediatric seizures most common

Febrile seizure

sudden, rapid rise in temp leads to seizure

epilepsy

chronic seizure disorder

usually in older children

Dilantin

Phenobarbital

meds to give for seizures

gum dysplasia

what can dilantin cause

Advil

what is a good med to give for high fevers

stripping down

cool, wet washcloth

ice packs under armpits/groin

what can help when a child has a fever

give tylenol/advil early when kids starts to feel warm

what to educate caregiver on to prevent febrile seizures

tired, irritable, moody

gingival hyperplasia

side effects of dilantin

drowsy, headache, hyperactivity, dizziness, confusion

side effects of phenobarbital

Generalized tonic-clonic seizure

loss of consciousness, grand mal-convulsive, widespread activity

Partial seizure

simple, seizure affects on hemisphere of brain

twitching or movement of one part of body

Absence seizure

sudden loss of awareness

minor motor movement

Ativan or valium

what should you give after 5 mins of seizure activity

Bacterial meningitis

serious, life-threatening infection where germs get into CSF and there is inflammation of the meninges

protective membranes surrounding the brain and spinal cord

infants, kids less than 5 years old

who is at greatest risk for bacterial meningitis

otitis media

sinusitis

pneumonia

brain trauma

what can bacterial meningitis be secondary to

hard to console

piercing cry

listless

fever

vomiting

ant fontanel bulging

clinical manifestations of bacterial meningitis in the infant

fever

irritable

lethargic

combative

headache

back/neck pain

photophobia

nuchal rigidity

clinical manifestations of bacterial meningitis in the older child

rash, petechia, purpura

what is associated with meningococcal meningitis

Opisthotonos Posturing

most comfortable position due to spinal/neck pain with bacterial meningitis

curled on side and still

how do you want the child when withdrawing CSF

between two vertebrae

where do you draw CSF from

increased WBC
low glucose

increased protein

positive gram stain

positive culture

what does a lumbar puncture show of the CSF with bacterial meningitis

Contact and droplet precautions

what type of precautions should a pt with bacterial meningitis be on

viral meningitis

inflammatory process and pt does not appear as ill

glucose and protein normal

culture doesn’t grow bacteria

what does CSF show with viral meningitis

ABCs

cerebral edema

seizure control

antibiotics

steroids

fowler’s position (45-60)

nursing care with meningitis

Reye’s syndrome

acute swelling of the brain and liver damage

viral illness

use of aspirin

what is Reye’s syndrome associated with

no aspirin

what to educated caregivers on with Reye’s

Guillain-Barre syndrome

post-infectious polyneuritis

autoimmune response to some infectious process

body attacks myelin sheath or nerves

what happens in guillain-barre syndrome

deteriorating motor function

paralysis in ascending pattern

presentation of individual with guillain-barre

respiratory status

what is the biggest concern with guillain-barre syndrome

Immunoglobulin

treatment for guillain-barre seen a lot of the time that uses antibodies from healthy donors to block harmful antibodies attacking NS

Plasma Exchange (Plasmapheresis)

treatment for guillain-barre that removes antibodies from the blood that are attacking the nerves

Cerebral Palsy

non-progressive brain injury that effects movement, muscle tone, and posture

most common chronic disorder in childhood

congenital, hypoxic, or traumatic brain damage

what is cerebral palsy secondary to

Spastic

most common type of CP that involves one or both sides of the body

persistent hypertonia, scissoring

exaggerated DTR

persistent primitive reflexes

classifications of spastic CP

contractures and abnormal spinal curvatures

what does hypertonia in CP lead to

Dyskinetic CP

type of CP that involves abnormal involuntary movements that disappear during sleep and increase with stress

impaired voluntary muscle control

bizarre twisting

tremors

exaggerated posturing

inconsistent muscle tone

classifications of dyskinetic CP

Ataxic type

CP with lack of balance and position sense

muscular instability

gait disturbances

classifications of ataxic CP

delayed gross motor development

what is the most common manifestation in all types of CP

early hand preference

poor sucking

examples of abnormal motor performance with CP

child reaching their maximum potential

what is the focus of clinical therapy for CP on

Baclofen

meds that help with spasticity

prevent injury

prevent physical deformity (braces/ROM)

promote mobility

adequate nutrition

relaxation

self-care/independence

how can we help children reach thier maximum potential

Muscular dystrophy

group of disorders that cause progressive degeneration and weakness of skeletal muscles

Duchenne

most common and most severe MD

infection or cardiopulmonary failure

what causes death in adolescences with duchenne

X-linked

half of all DMD cases are what type

dystrophin is absent in the muscles

gradual degeneration of muscle fibers

what is wrong in pt with DMD

2-6 years

when do symptoms of DMD begin

delays in further motor development

frequent falls

difficulties running, riding a bike, climbing stairs

initial signs of DMD

abnormal gait

walking ability ceases

pseudohypertrophy of calf muscles

cardiac problems

progressive signs of DMD

9-12 years

when does walking ability cease with DMD

weakned heart muscle

why are there cardiac problems with DMD

positioning

skin care

fluids

chest PT

bowel routine

ways to compensate for disuse syndrome with DMD

imbalance in the production and absorption of CSF in the

production of CSF exceeds absorption leading to dilation of ventricles

what is the imbalance in hydrocephalus

Congenital hydrocephalus

born with defects, associated with spina bifida

Acquired hydrocephalus

results from space-occupying lesions, hemorrhage, intracranial infection, dormant developmental defects

Communicating hydrocephalus

CSf flows freely but has impaired absorption within arachnoid space

Non-communicating hydrocephalus

obstruction to the flow of CSF through ventricular sys

most common form of hydrocephalus

bulging fontanels and irritability

first signs of hydrocephalus in infancy

head enlargement

frontal protrusion

eyes depressed downward

sluggish pupils

later signs of hydrocephalus in infancy

no head enlargement/bossing

major difference in clinical manifestations of hydrocephalus in older children

headache

morning vomiting

confusion

ataxia

visual defects

clinical manifestations of hydrocephalus in older children

Ventriculoperitoneal shunt

a pathway to divert excess fluid from ventricles to peritoneum

treatment for hydrocephalus

recurrent signs of increased ICP

what does a malfunction in the VP shunt cause

infection

what is the most serious complication of VP shunt

Neural tube

structure that develops into baby’s brain and spinal cord and the tissues that surround it

3-4 weeks gestation

when is the neural tube supposed to close

Encephalocele

outpouching in one are of the body

portion of the brain and its covering tissues protrude through opening in the skull

Spina Bifida Occulta

small gap/indent but no opening

usually does not affect the spinal cord

dimple or hair patch

external signs of spina bifida occulta

Meningocele

fluid-filled sac that protrudes outside the vertebrae

doesn’t affect ability to move

Myelomeningocele

fluid-filled sac, spinal cord and nerve roots protrude

affects mobility and sensation

muscle weakness/paralysis

urinary bowel problems

joint/bone deformity

what can happen with myelomeningocele

closure soon after birth

what does meningocele require

hydrocephalus

meningitis

spinal cord dysfunction

what should a child with meningocele be monitored for

closure within 2-3 days

shunting for hydrocephalus

antibiotics to prevent infection

multidisciplinary approach for myelomeningocele

apply sterile dressing, constantly moistened with saline

position in prone or side-lying position

what to do preoperatively with NTD

women of child-bearing age take 0.4 mg folic acid daily

how to prevent development of NTD

Craniosynostosis

premature closure of cranial sutures

deformity of skull

what can craniosynostosis cause

reconstructive surgery before age 1

what has better outcome with craniosynostosis

Plagiocephaly

fused coronal suture

Scaphocephaly

fused saggital suture

Trigonocephaly

fused metopic suture

lead poisoning

one of the most common pediatric problems in the U.S.

child exposed via contaminated food, air, drinking water