Module 6 and 9

What are the two components of the Peripheral Nervous System (PNS)?

Somatic (voluntary) and Autonomic (involuntary).

What do afferent nerve fibers do?

Carry nerve signals from body receptors to the brain.

What do efferent nerve fibers do?

Carry information from the brain to the body.

What bodily functions does the Autonomic Nervous System (ANS) control?

Heart rate, digestion, breathing, urination, and salivation.

What is the role of the Sympathetic Nervous System?

"Fight or flight" response.

What is the role of the Parasympathetic Nervous System?

"Rest and recuperation" response.

hat does the Central Nervous System (CNS) consist of?

The brain and spinal cord.

What are the three sections of the brain?

Cerebrum, Cerebellum, Brainstem.

What does the brainstem control?

Houses 12 cranial nerves and controls automatic functions like heart rate, respiration, and consciousness.

What are ventricles and their function?

Produce CSF (cerebral spinal fluid), which nourishes and cushions the brain and spinal cord.

Name the spinal cord sections.

Cervical, Thoracic, Lumbar, Sacral, Coccygeal.

What do ascending tracts do?

Carry sensory information to the brain.

What do descending tracts do?

Carry information from the brain to the body.

What are reflexes?

Involuntary movements in response to a stimulus.

Where do reflexes occur?

At the brainstem or spinal cord level.

What do Deep Tendon Reflexes (DTR) communicate between?

Central and peripheral nerves.

What does a decreased DTR response indicate?

Problem with the peripheral nervous system.

What does a brisk or exaggerated DTR response indicate?

Problem with the central nervous system.

What are primitive reflexes in newborns?

Brainstem-controlled "survival reflexes" present in full-term infants that usually disappear within months.

What might an absent primitive reflex at birth indicate?

Sensory/motor process issues.

What does persistence of primitive reflexes suggest?

Inadequate frontal lobe suppression.

Give examples of primitive reflexes in newborns.

Palmar, Babinski, Rooting, Moro (startle).

What physical measurements and observations are important in a physical assessment?

Head circumference, muscle tone abnormalities, muscle atrophy or wasting, large or clustered neurocutaneous lesions.

What are examples of dysmorphic features to assess?

Low-set ears, flat nasal bridge, abnormal eyelid crease.

Which cranial nerve abnormalities should be assessed?

Vision, hearing, and tongue use.

What genetic disorders might be documented during assessment?

Examples include Down syndrome.

What knowledge is required for a general assessment?

Knowledge of normal development and age-appropriate norms.

What prenatal and birth history details are included in a general assessment?

Pregnancy history, gestational age, viral infections during pregnancy, birth weight, Apgar scores.

What general health and developmental information is important?

General health and developmental milestones.

What behavioral concerns should be evaluated?

Interactions, aggression, repetitive behaviors.

What social factors are important in general assessment?

Social history and socioeconomic status.

What causes Spina Bifida during fetal development?

Folic acid deficiency during spinal cord development.

hat are the three types of Spina Bifida?

Cystica (Myelomeningocele), Meningocele, Occulta.

: Describe Cystica (Myelomeningocele) type of Spina Bifida.

Spinal cord and nerves are exposed outside the body, causing partial or complete paralysis; surgery does not correct neurological deficits; lack of nerve endings in sphincter leads to incontinence.

Describe Meningocele type of Spina Bifida.

A cyst-like sac covers the spinal cord; may not cause disability; surgery does not correct neurological deficits.

Describe Occulta type of Spina Bifida.

Malformed vertebrae with normal spinal cord and nerves; may present as a sacral dimple in neonates.

What are common signs and symptoms of Spina Bifida?

Paralysis of legs and bowel/bladder control issues (incontinence).

What nursing interventions are important for Spina Bifida?

Educate parents about surgery limitations (does not correct deficits) and provide multidisciplinary care (OT, PT, Neurology, Social Work, Speech Therapy).

What is Anencephaly?

A neural tube defect where most of the brain does not develop; may include missing brain matter and skull segments.

How common is Anencephaly and what is the typical outcome?

Affects 3 in 10,000 live births; infants typically die shortly after birth.

: How can Anencephaly be prevented?

Adequate folic acid intake (400 mg daily).

What is Encephalocele?

A portion of the brain protrudes through an opening in the skull.

: What factors affect the severity of Encephalocele?

The location and size of the protrusion.

What are common locations for Encephalocele protrusions?

Midline groove in the skull, between forehead and nose, back of the skull.

What is Microcephaly?

A condition where head circumference is more than two standard deviations below normal; brain is underdeveloped and stops growing.

When is Microcephaly apparent?

May be apparent at birth or become noticeable as the child grows.

What causes or is associated with Microcephaly?

Down syndrome, chromosomal abnormalities, metabolic disorders, maternal substance abuse, maternal infections (CMV, Zika virus, rubella, chickenpox).

What are the outcomes of Microcephaly?

Cognitive, motor, and speech delays; dysmorphic facial features; growth retardation or dwarfism.

What happens in Hydrocephalus?

CSF collects abnormally causing enlargement of ventricles (ventriculomegaly) and increased pressure on brain tissues.

What are the two main types of Hydrocephalus?

Congenital (blockage before birth) and Acquired (occurs at or after birth).

What is Communicating Hydrocephalus?

Flow between ventricles is not impaired; CSF blocked after leaving ventricles.

What is Non-communicating Hydrocephalus?

CSF is blocked in narrow channels draining to ventricles; also called obstructive hydrocephalus.

What is Hydrocephalus ex vacuo?

Occurs after injury, cancer, trauma, or stroke causing brain tissue shrinkage.

What is Normal Pressure Hydrocephalus?

Common in elderly with symptoms like walking difficulties, memory problems, and bladder control issues.

What are common signs and symptoms of Hydrocephalus?

Rapid head circumference increase, bulging fontanel, vomiting, irritability, lethargy, high-pitched cry, seizures, sunsetting eyes, unequal/sluggish pupils, bradycardia followed by tachycardia, hypertension, apnea, headache, increased ICP.

What nursing interventions are important for Hydrocephalus?

Surgical correction with VP shunt, neuro and ICP assessment, head circumference monitoring, BP monitoring, checking for shunt drainage.

How to recognize VP shunt malfunction?

Changes in level of consciousness (LOC), lethargy, and other neurological changes.

How do sleep disorders commonly affect children?

They affect rest, behavior, and learning ability.

What is Insomnia?

Problems going to sleep and problems staying asleep.

What is Hypersomnia?

Excessive sleepiness

What is Narcolepsy?

Excessive sleepiness with daytime sleep attacks.

What is Sleep Apnea and its common treatment in children?

Obstructive sleep apnea; common reason for adenoidectomy.

What are Limb Movement Disorders during sleep?

Periodic jerking and restless leg syndrome with pain.

What are Parasomnias?

Night terrors, sleepwalking, and REM sleep disorder where dreams are acted out.

What are some types of Focal Seizures?

Temporal Lobe, Juvenile Myoclonic, Benign Rolandic, Dravet Syndrome, Panayiotopoulos Syndrome, Landau-Kleffner Syndrome, Electrical Status Epilepticus in Sleep.

What are some types of Generalized Seizures?

Febrile Seizures, Lennox-Gastaut Epilepsy, Infantile Spasms, Status Epilepticus.

How are seizure disorders typically diagnosed?

Using MRI and EEG to monitor electrical brain activity.

What medication is commonly used for seizure prevention, and what are important nursing considerations?

Dilantin (phenytoin); requires routine blood work and has increased bleeding risk (gums, falls). Emphasize medication adherence.

What nursing actions are important during and after a seizure?

Note seizure start and stop times, maintain airway, assist to safe side position, monitor for lethargy and confusion post-seizure, identify fever source in febrile seizures.

How is status epilepticus treated if seizure lasts longer than 20 minutes?

Rectal diazepam can be administered.

Describe Focal Seizures.

Partial seizures involving one brain area, then spreading to the body.

What characterizes Temporal Lobe Seizures?

Most common focal type, often drug resistant, associated with memory and mood disorder risks.

What are features of Juvenile Myoclonic Seizures?

Rapid jerks of arms and legs, typically early in the morning, photosensitive triggers.

What is Benign Rolandic Seizure Syndrome?

Occurs in boys, involves twitching, numbness, or tingling in face and tongue.

What is Dravet Syndrome?

A rare genetic epileptic encephalopathy.

What is Panayiotopoulos Syndrome?

Early onset occipital seizures often misdiagnosed.

What is Landau-Kleffner Syndrome?

Infrequent seizures that occur mostly during sleep.

What is Electrical Status Epilepticus in Sleep?

Continuous seizures during sleep causing dysphasia and slow learning.

What defines Generalized Seizures?

: Involve both hemispheres with loss of consciousness.

Name types of generalized seizures.

Tonic-clonic (rigid jerking), Myoclonic (brief jerks), Atonic (loss of muscle tone), Absence (loss of awareness without movements).

What are Febrile Seizures?

Convulsions triggered by high body temperature in children 3 months to 5 years old.

: What is Lennox-Gastaut Epilepsy?

A condition with multiple seizure types.

What are Infantile Spasms?

Myoclonic epilepsy occurring between 3-12 months old.

Define Status Epilepticus.

A state of continuous seizure lasting usually 30 minutes or longer.

What is syncope?

Brief loss of consciousness and posture due to decreased blood flow to the brain.

What causes syncope?

Autonomic nervous system issues, vasovagal (bear down), orthostatic hypotension, psychogenic (panic attack), metabolic (glucose).

What are common signs and symptoms (S/sx) of syncope?

Loss of consciousness, falling.

What are nursing interventions for syncope?

Supportive care, monitoring, identify cause, and try to prevent future events.

How common are headaches in children?

75% of children report experiencing headaches.

What types of headaches are common in children?

Tension headaches and migraine headaches.

What are the signs and symptoms (S/sx) of headaches and migraines?

Pain without vomiting, can last several hours or days, blurriness, dizziness, malaise, flashing lights.

: What nursing interventions are important for headaches and migraines?

Educate parents about diet, fluid intake, stress, sleep deprivation, and medication adherence (Beta blockers, anti-epileptics, antidepressants, triptans, antiemetics, analgesics).

What causes pediatric stroke (CVA)?

Trauma, illness, neonatal hemorrhage, malformations in brain structures or vessels, infection or illness (e.g., meningitis, encephalitis, sickle cell).

What are common signs and symptoms of pediatric stroke?

Facial droop, problems walking, talking, numbness or tingling in arms or legs.

What are nursing interventions for pediatric stroke?

Reduce residual effects, multidisciplinary approach, routine screening for hydrocephalus, neuro checks.

: What is meningitis?

A common, life-threatening infection causing inflammation of the brain and spinal cord.

What can happen if bacterial meningitis is left untreated?

Encephalopathy leading to death.

What diagnostic test is commonly used for meningitis?

Lumbar puncture (LP), with cloudy CSF indicative of infection.

What are common signs and symptoms of meningitis?

Stiff neck, severe headache, photosensitivity, sudden high fever, bulging fontanels, altered mental status.

What nursing interventions are important for meningitis?

: Identify causative agent, administer antibiotics, frequent neuro checks, educate parents about possible long-term deficits (sensorineural hearing loss, learning problems, intellectual disability, seizures).