Peds Unit 4 Neuro

Late signs of ICP

-Decreased LOC -Decreased motor response to command -Decreased sensory response to painful stimuli -Alterations in pupil size and reactivity -Papilledema -Decerebrate or decorticate posturing -Cheyne-Stokes respirations

Neonatal seizures

-Usually caused by underlying pathological process- perinatal asphyxia and intracranial hemorrhage most common causes -

Manifestations of bacterial meningitis in young children

Classic picture in older children rarely seen in children between 3 months and 2 years. Fever Poor feeding, vomiting Marked irritability Seizures, high pitched cry Bulging fontanel Nuchal rigidity possible

An 8-month-old boy is diagnosed as having cerebral palsy. Which finding would make you suspect that he has this? a) He has a strong Moro reflex when startled. b) He holds his back very straight when in a sitting position. c) He cries when held in a ventral suspension position. d) He bears weight on both feet when held upright.

Correct response: He has a strong Moro reflex when startled. Explanation: A Moro (startle) reflex typically fades by 5 to 6 months. Retained newborn reflexes are suggestive of cerebral palsy

The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which of the following clinical manifestations would likely have been noted in this child? a) Severe vomiting and confusion b) Shaking the head and pulling the ear c) High-pitched cry and nuchal rigidity d) Body stiffening and loss of consciousness

High-pitched cry and nuchal rigidity Explanation: Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? a) Sitting upright with the head flexed forward to the chest b) On her side with the head flexed forward and knees flexed to the abdomen c) Supine with arms and legs pronated and extended d) Prone with the arms flexed under the che

On her side with the head flexed forward and knees flexed to the abdomen Explanation: When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture

A panicked mother calls the physician's office and tells the nurse that her 5-year-old boy has just had a seizure. She says that the boy has a high fever. She asks the nurse what to do. Which of the following should the nurse tell the woman? a) Sponge the child with tepid water b) Administer oral acetaminophen c) Immerse the child in a bathtub of water d) Pour cold water over the child

Sponge the child with tepid water Correct Explanation: After a febrile seizure subsides, parents should sponge the child with tepid water to reduce the fever quickly. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? a) The child is not responding or eating well. b) The child's pupil reaction time is rapid and uneven. c) The child has a high-pitched cry. d) The fontanels are bulging or tense.

The child is not responding or eating well. Explanation: Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure

The nurse is caring for a child admitted with complex partial seizures. Which clinical manifestation would likely have been noted in the child with this diagnosis? a) The child was rubbing the hands and smacking the lips. b) The child had shaking movements on one side of the body. c) The child was dizzy and had decreased coordination. d) The child had jerking movements and then the extremities stiffened.

The child was rubbing the hands and smacking the lips. Explanation: Complex partial seizures, also called psychomotor seizures, change or alter consciousness. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body.

Choice Multiple question - Select all answer choices that apply. A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply. a) Negative Brudzinski sign b) Absent headache c) Complaints of stiff neck d) Vomiting e) Photophobia

• Complaints of stiff neck • Photophobia • Vomiting Explanation: In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting

Management of Increase ICP

-Diagnostic tests to identify causative factors. -Treatment is dependent on diagnosis -Monitoring ICP- may be invasive or noninvasive Goal: ICP < 15 mm Hg -Positioning -Hyperosmolar therapy -Thermoregulation -Pharmacologic management to include: analgesics, sedation, anticonvulsants -Prophylactic antibiotics if invasive monitoring -Airway management -Decreasing any stimuli that would increase ICP

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? a) "Did you use any medications like aspirin for the fever?" b) "What type of fluids did your child take when he had a fever?" c) "How high did his temperature rise when he was ill?" d) "Did you give your child any acetaminophen, such as Tylenol?"

Did you use any medications like aspirin for the fever?" Correct Explanation: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

Bacterial meningitis etiology

Pathogens usually come from a distant site of infection. It most commonly occurs after an upper respiratory infection or bacteremia accompanying otitis media, sinusitis, or mastoiditis. Pathogens may also enter through penetrating wounds or structural defects (neural tube).

Causes of Neural Tube Defects

Poor nutrition Folic acid deficiency Vitamin deficiencies Maternal obesity Maternal age Pregnancy history Birth order Socioeconomic status

Dx test of bacterial meningitis

is diagnosed though signs and symptoms, plus a CSF culture obtained by lumbar puncture. Analysis of the CSF also provides clues as to the etiology of meningitis. Cloudy CSF with a low glucose level and high protein count indicate bacterial meningitis. Blood cultures and cultures of the nasopharynx may also be done.

You care for a 4-year-old with meningitis. A primary nursing goal would be to a) provide an opportunity for therapeutic play. b) reduce the pain related to nuchal rigidity. c) inspect the teeth for obvious caries. d) increase stimulation opportunities to prevent coma.

reduce the pain related to nuchal rigidity. Correct Explanation: Irritation of the meninges causes pain on forward flexion of the neck.

Choice Multiple question - Select all answer choices that apply. An emergency department nurse performing triage on victims of a school bus accident conducts brief screening examinations to determine if any have neurologic deficits. Which of the following would the nurse include in this screening? Select all that apply. a) Sensory system b) Developmental milestones c) Cranial nerves d) Reflexes e) Cerebral function f) Cardinal fields of gaze

• Musculoskeletal disorders • Language disorders • Neurobehavioral disorders • Respiratory infections Explanation: Deficits commonly associated with cerebral palsy include musculoskeletal and reflexive deficits, neurologic deficits, gastrointestinal and nutritional problems, and other systemic complications including growth failure, genitourinary complaints, respiratory infections, and fatigue.

Manifestation of ICP in a child

-Headache in am that decreases with vomiting or lessens throughout day -Diplopia Papilledema (after 48 hours) -Mood swings -Slurred speech -Altered level of consciousness, lethargy, somnolence (late signs) -Nausea and vomiting especially in the morning -Headache with Valsalva maneuver

Developmental Manifestations of Increased Intracranial Pressure in infants

-Poor feeding or vomiting -Irritability or restlessness, disturbed sleep patterns -Resistance to being held or comforted -Lethargy -Bulging fontanel, delayed closure of anterior fontanel -High-pitched cry -Increased head circumference -Separation of sutures -Distended scalp veins -Eyes deviated downward (setting-sun sign) -Increased or decreased response to pain -Developmental delays

Long term neural tube management

1. Educate the family on care to include skin care, bowel and bladder training, physical therapy, symptoms of increased ICP 2. Assist with referrals for orthopedic care 3. Encourage the family to promote activities that are age appropriate for growth and development 4. Educate family and have an awareness of high potential to develop latex allergies. Avoid exposure when caring for these children.

Immediate neural tube defect managment

1. Protect from injury and infection 2. Pre-op: Maintain a sterile, constantly moistened saline dressing on the sac to prevent drying out 3. Post-op: Keep the infant prone to prevent pressure on the wound and infections. 4. Monitor fontanels and head circumference 5. Monitor ICP 6. Provide protective barriers to protect site from urine and stool.

A nurse is caring for a 6-year-old boy with Guillain-Barré syndrome who has been in the hospital with this condition for 3 weeks now. Which of the following interventions should the nurse be implementing to prevent deep vein thrombosis in this child? a) Having the boy perform leg exercises b) Administration of total parenteral nutrition c) Insertion of an indwelling urinary catheter d) Applying support stockings

Applying support stockings Correct Explanation: Treatment of Guillain-Barré syndrome is supportive until the paralysis peaks at 3 weeks and then is followed by gradual recovery. All patients should be given subcutaneous fractionated or unfractionated heparin and support stockings until they are able to walk independently to prevent deep vein thrombosis. An indwelling urinary catheter is usually inserted to monitor urine output. Enteral or total parenteral nutrition may be used to support protein and carbohydrate needs. Because the boy would likely still be paralyzed at 3 weeks, he would not be able to perform leg exercises

The nurse is observing a group of children diagnosed with various types of cerebral palsy. One of the children has an awkward and wide-based gait. The nurse recognizes this characteristic as common in which type of cerebral palsy? a) Rigidity cerebral palsy b) Spastic cerebral palsy c) Athetoid cerebral palsy d) Ataxic cerebral palsy

Ataxic cerebral palsy Correct Explanation: Ataxic cerebral palsy is essentially a lack of coordination caused by disturbances in the kinesthetic and balance senses; it is characterized by an awkward and wide-based gait. Athetoid cerebral palsy is marked by involuntary, uncoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion; the whole body is in a state of slow, writhing muscle contractions whenever voluntary movement is attempted. Rigidity cerebral palsy is uncommon and is characterized by rigid postures and lack of active movement. Spastic cerebral palsy is characterized by scissoring caused by severe hip adduction

The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. What type of seizure do these symptoms indicate the child is experiencing? a) Simple partial sensory seizures b) Absence seizures c) Simple partial motor seizures d) Complex partial seizures

Complex partial seizures Explanation: Complex partial seizures, also called psychomotor seizures, begin in a small area of the brain and change or alter consciousness. They cause memory loss and staring. Nonpurposeful movements such as hand rubbing, lip smacking, arm dropping, and swallowing may occur. Following the seizure the child may sleep or be confused for a few minutes. The child is often unaware of the seizure. Simple partial sensory seizures may include sensory symptoms called an aura (a sensation that signals an impending attack) involving sight, sound, taste, smell, touch, or emotions (a feeling of fear, for example). The child may also have numbness, tingling, paresthesia, or pain. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. The child may have blinking or twitching of the mouth or an extremity along with the staring. Immediately after the seizure, the child is alert and continues conversation but does not know what was said or done during the episode

Manifestations of bacterial meningitis in neonates

Extremely difficult to diagnose Manifestations vague and nonspecific Child well at birth but within a few days begins to look and behave poorly Refuses feedings or poor sucking ability Vomiting and diarrhea Poor tone Lack of movement Weak cry Full, tense, bulging fontanel may appear late in course of illness, neck usually supple Irritability Seizures A tendency for opisthotones

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: a) The child is in status epilepticus. b) The child's history indicates she has infantile seizures. c) The child may begin to have absence seizures every day. d) The child is having generalized seizures.

The child is in status epilepticus. Correct Explanation: Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall

Pediatric glasgow coma scale

Three-part assessment Eyes Verbal response Motor response Score of 15 = unaltered LOC Score of 3 = extremely decreased LOC (worst possible score on the scale)

Manifestations of bacterial meningitis in children and adults

Usually abrupt onset Fever, chills Vomiting Alterations in sensorium Irritability, agitation May develop: photophobia, delirium, hallucinations, aggressive behavior, drowsiness, stupor, coma Nuchal regidity; may progress to opisthotonos Positive Kernig and Brudzinski signs

Choice Multiple question - Select all answer choices that apply. The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Administer acetaminophen for headache. b) Wake the child every one to two hours to check level of consciousness. c) Observe for and report to provider any double or blurred vision. d) Observe and report any vomiting that occurs within six hours. e) Check the pupil reaction to light every 15 minutes for two hours.

Wake the child every one to two hours to check level of consciousness. • Observe and report any vomiting that occurs within six hours. • Observe for and report to provider any double or blurred vision. Explanation: The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The child's pupils are checked for reaction to light every four hours for 48 hours