neurological and neuromuscular

what are hallmark signs of neurological issues in children?

headache and visual changes

what is torticollis?

contraction of the head due to lack of mobility

how do you treat torticollis?

physical therapy

when should torticollis resolve?

around 1 year

when is the brain fully developed?

adolescent

what should you tell parents to do if you suspect their child has a head injury?

immediately go to the emergency room

which posturing is considered worse?

decerebrate

what kind of lesions are associated with decorticate posturing?

lesions above the brain stem

what kind of lesions are associated with decerebrate posturing?

lesion to the midbrain or brainstem

\

decorticate

decerebrate

what kind of head injury occurs at the moment of impact?

primary head injury

what is the term for a head injury that occurs due to the body’s response to trauma?

secondary head injury

what is a common cause of primary head injury?

shearing of small veins and arteries

what are common causes of secondary head injury?

resultant swelling (edema) or bleeding

what two symptoms following a head injury indicate immediate hospitalization?

listlessness and vomiting

what is the diuretic of choice to treat increased CSF due to a head injury?

mannitol

what should you monitor for when giving mannitol?

tachycardia and hypotension

when do concussions usually resolve by?

1-3 weeks

a child presents to the ER with signs and symptoms of a concussion. their parent states that they had a concussion before, but it was many years ago, so it doesn’t matter. is this true?

no (consecutive concussions can cause increased damage even when separated by many years)

what are nursing actions that should be taken when a child is diagnosed with a concussion?

elevated HOB and do neurological check at least every 4 hours

what should CSF drainage look like?

clear

who is at the greatest risk for getting bacterial meningitis?

newborns and infants

what are individuals with bacterial meningitis at risk for?

secondary complications (sequalae) - SIADH, hearing loss, neurologic/intellectual disorders, limb loss

VP shunt, recent infections, immunosuppression, cochlear implants, and trauma are all risk factors for -

bacterial meningitis

photophobia, nuchal rigidity, and petechiae and purpura are all signs associated specifically with -

bacterial meningitis

what is the glass rash test?

a glass is placed on the skin to see if the rash will disappear with pressure

what is a worse result for the glass rash test?

if the rash does not disappear with pressure

how does an individual with viral meningitis present?

similar to bacterial meningitis but less severe

is bacterial or viral meningitis more severe?

bacterial

what common cause of viral meningitis?

enterovirus

a patient presents with symptoms that indicate they have some form of meningitis. what is an initial treatment given until it can be determined which type of meningitis they have?

antibiotics (in case they have bacterial)

a patent presents with meningitis and has a high fever, marked LOC change, and severe nuchal rigidity - what type of meningitis do you suspect?

bacterial

a parents presents with meningitis and have a low grade fever, no LOC change, and is only having some nuchal rigidity - what type of meningitis do you suspect?

viral

what kind of isolation is an individual with meningitis placed on?

droplet

what should you prepare for following a meningitis diagnosis?

lumbar puncture, labs and blood culture, assess vital signs and LOC

what is a priority intervention for a patient with meningitis?

administration of antibiotics

what kind of seizures are common in children under two?

febrile seizures

why are febrile seizures common in children under two?

the hypothalamus is not fully developed - can not regulate temperature

an abnormal electrical impulse in 1 area of the brain is known as a -

partial or focal seizure

seizures that occur throughout the brain, have bilateral an symmetrical symptoms, and have conscious impairment are known as -

generalized seizures

seizures associated with high fevers are known as -

febrile seizures

what is status epilepticus?

a prolonged seizure that lasts for at least 15 minutes

a partial seizures that does not cause a change in LOC are called -

simple partial seizure

a partial seizure that causes a change in LOC are called -

complex partial seizures

what is the most important thing to be able to report about a seizure?

the duration

what is the number one concern during and following seizures?

airway

a patient seizes and has dramatic muscle contraction and loss of consciousness. following the seizure, they are confused and exhausted. what type of seizure is this?

tonic-clonic

a patient seizes and has a brief period of LOC change, what kind of seizure do you suspect?

absence

a patient is having a seizure and is having short periods of muscle contractions - what kind of seizure is this?

myoclonic

when are infantile spasms common?

first 8 months of life

an 4 month old has sudden, brief, and symmetric muscle contractions. they flex their head, extended their arms, and drew up their legs. what do you suspect this is?

infantile spasms

what is infantile spasms associated with?

developmental delays/intellectual disabilities

what may some doctors request before an EEG?

NPO

following a seizure, what are some interventions that can be made to maintain a patient airway?

jaw thrust, place on side, suction, O2

what medications can be given to a patient if their seizures to not resolve spontaneously?

benzodiazepines - diazepam and lorazepam

what is a common side effect of Dilantin?

bleeding gums

what is a side effect associated with phenobarbital?

vitamin D defiency

what is a newer, gentler drug used to treat seizures?

Keppra

impaired absorption of CSF resulting in excessive amounts of CSF within the cerebral ventricles -

hydrocephalus

an obstruction outside ventricular system causing decreased absorption of CSF is known as -

communicating hydrocephalus

impediment of CSF flow within ventricular system is known as -

non-communicating or obstructive hydrocephalus

what type of hydrocephalus is more common?

non-communicating or obstructive

what is a hallmark sign of hydrocephalus in infants?

bulging fontanels

a child with hydrocephalus’s head sounds hallow upon percussion, what is this called?

Macewen’s sign

headache and decreased visual acuity in an older child are signs of -

hydrocephalus

what is a common treatment for hydrocephalus?

surgical placement of a shunt

what is the priority NANDA associated with shunt placement to treat hydrocephalus?

risk for infection

when are infections associated with shunt placement most common?

within the first two months following shunt placement

a child has a shunt placed one week ago, what finding would be the most concerning for the nurse?

increased ICP (it shows that the shunt isn’t working properly)

what position should a child be placed in following the placement of a shunt?

on their non-operative side (prevents rapid CSF drainage and keeps pressure on valves)

what is the child at risk for if CSF drains to fast following shunt placement?

subdural hematoma

chronic non-progressive motor dysfunction caused by damage to the motor areas of the brain before, during, or after birth

cerebral palsy

what significantly increases a child’s risk for developing cerebral palsy?

low birth weight

when is the most common time to develop cerebral palsy?

during birth

abnormal posturing associated with cerebral palsy is called -

opisthotonos

an infant presents to their six month check up. the infant still has his startle reflex and has poor head control. what do you suspect?

cerebral palsy

a mother of a child with cerebral palsy asks if there is anything their child can take to help decrease the amount of twitchy they do. what could you suggest?

baclofen pump

a mother is worried because their child is uncontrollable movement in their legs and has not been successfully treated with alterative methods. what could you suggest?

rhizotomy (procedure to cut overactive nerves)

what are two surgeries associated with cerebral palsy?

Achilles tendon lengthening and hamstring release

what is important patient teaching that needs to be given following a rhizotomy?

the child needs to remain flat and should not bend or twist for at list 4 weeks

failure of the neural tube to close completely -

spinal bifida

when in gestation does spina bifida occur

week 4

the higher up the lesion occurs on a child with spina bifida -

the more deficits

what is an important consideration to make when taking care of a patient with spina bifida?

latex allergy

what is the diagnostic tool used to diagnosis spina bifida called?

transillumination

what dose transillumination do?

determines the structures within the sac

what type of spina bifida is normally asymptomatic?

occulta

what symptom can you see at birth that is associated with occulta spina bifida?

lack of movement in the legs

in what type of spina bifida do the meninges protrude and there is translucency seen?

meningocele

in which type of a spina bifida do you see both the meninges and spinal cord protrude, without translucency?

meningomyelocele

how should an infant with spina bifida be kept prior to surgery?

in prone position with moistened sterile gauze covering the area

what position should an infant with spina bifida be kept in postoperatively?

prone or on their side

what infection are infants with spina bifida prone to?

UTIs (frequent catheterization)

a genetic disorder that causes the progressive weakness and wasting of skeletal muscles -

spinal muscular atrophy

when is spinal muscular atrophy normally diagnosed?

within the 1st year

which type of spinal muscular atrophy is the most severe?

type 1

what is the most common cause of death in children with type 1 spinal muscular atrophy?

respiratory failure

Duchenne muscular dystrophy is only seen in -

males

what is the most common form of muscular dystrophy?

Duchenne muscular dystrophy