Pediatric Neuro Flash Cards

What general problems may be present after repair of the meningocele?

Infection, impaired skin integrity, hydrocephalus

What complications is the child with a shunt at risk for developing?

Infection, meningitis, peritonitis, CSF leakage, hemorrhage, hematoma

What are the signs and symptoms of hydrocephalus in the child? The infant?

MacEwens sign, difficulty breathing holding head upright, prominent forehead, head enlargement

After explaining to the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching?

A. Feeling different from peers B. Poor self-image C. Cognitive delays D. Dependency C: Children with seizure disorders do not necessarily have cognitive delays. A, B, and D: Feelings of being different from peers, poor self-image, and dependency can put additional stress on a child trying to understand and manage chronic illness.

Tx for bacterial meningitis

- IMMEDIATE administration of ABX (choice depending on most likely bug) - steroids - LP - monitor ICP (mannitol if increased)

Signs and Symptoms of increased ICP

- decreasing level of consciousness (stupor or coma) - headache - decreased HR - decreased respirations - increased systolic BP - high pitched cry - vomiting - non-reacting pupils

Seizure precautions

- dim light - side rails up x 4 - padded side rails - keep oxygen readily available - keep harmful objects out of reach - maintain airway - nothing in mouth - monitor oxygen - IV meds - Give medication slowly

Types of seizures

-Partial; focal localized in one area -Partial Complex; LOC with change in behavior. Confusion. Origin is temporal lobe. -Partial Simple; Last for 5 min, child only remembers aura. Sx only on one side of body. No LOC. -Generalized; starts in all parts of the brain. -Tonic/Clonic; muscle spasms, LOC, contraction of limbs. Confusion. Bladder incontinence. -Atonic; Sudden drop to the floor, no LOC, No convulsions, "stare". Several times per day "petit mal" -Tonic/myoclonic/clonic; "grand mal". Stiffness.

Why are younger children predisposed to head injury?

1. head is proportionately larger and heavier 2. Thinner cranium 3. High water content 4. Less myelinated

How is meningitis diagnosed?

CBC, lumbar puncture to assess CSF, blood cultures

What is the nurse's specific role in care of a patient who experiences a seizure?

Maintain airway, open airway with a jaw thrust, administer O2, do not put anything in mouth, loosen restrictive clothing, position in a lateral position to prevent aspiration, medications such as Lorazepam or Diazepam as ordered, stay with child, document start and stop of seizure, protect child from injury (move hard objects away, lay child safely in bed or on floor).

Type of Spina Bifida

Meningocele - a protruding sac on the cervical, thoracic, or lumbar spine, the sac may be covered by a thin layer of skin. Myleomeningocele - there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed.

What are the common signs and symptoms of cerebral palsy?

Muscle rigidity, muscle spasticity, poor control of posture, ataxia

Different types of meningitis

Septic - caused by bacteria Aseptic - caused by a virus

Glasgow Coma Scale

eye opening, verbal response, motor response

Signs and symptoms of meningitis

fever, HA, stiff neck, lethargy, irritability, N/V

What is priority nursing care for the infant in the NICU with unrepaired myelomeningocele?

Using sterile technique, cover the defect in saline soaked gauze, maintain moisture to prevent drying, place newborn in prone position.

Hydrocephalus

accumulation of fluid in the spaces of the brain

In diagnosing seizure disorder, which of the following is the most beneficial?

A. Skull radiographs B. EEG C. Brain scan D. Lumbar puncture B: The EEG recognizes abnormal electrical activity in the brain. The pattern of multiple spikes can assist in the diagnosis of particular seizure disorders. A: Skull radiographs can distinguish fractures and structural abnormalities. C: Brain scans confirm space-occupying lesions. D: Lumbar puncture confirms problems related to cerebrospinal fluid infection or trauma.

persistent vegetative state

A condition in which a medical patient is completely unresponsive to psychological and physical stimuli and displays no sign of higher brain function, being kept alive only by medical intervention.

Which of the following signs and symptoms of increased ICP after head trauma would appear first?

A. Bradycardia B. Large amounts of very dilute urine C. Restlessness and confusion D. Widened pulse pressure C The earliest symptom of elevated ICP is a change in mental status. Bradycardia, widened pulse pressure, and bradypnea occur later. The client may void large amounts of very dilute urine if there's damage to the posterior pituitary.

Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele?

A. Complete exposure of spinal cord and meninges B. Herniation of spinal cord and meninges into a sac C. Sac formation containing meninges and spinal fluid D. B and C E. Spinal cord tumor containing nerve roots C: Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF). A: Meningocele doesn't involve complete exposure of the spinal cord and meninges; this is a massive defect that's incompatible with life. B: Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that protrudes through a defect in the vertebral arch. E: Tumor formation is not associated with this defect.

Tiffany is diagnosed with increased intracranial pressure (ICP); which of the following if stated by her parents would indicate a need for Nurse Charlie to reexplain the purpose for elevating the head of the bed at a 10 to 20-degree angle?

A. Help alleviate headache B. Increased intrathoracic pressure C. Maintain neutral position D. Reduce intra-abdominal pressure B: Head elevation decreases, not increases, intrathoracic pressure. A, C, and D: Elevating the head of the bed in a child with increased ICP helps to alleviate headache, maintain neutral position, and reduce intra-abdominal pressure, which may contribute to increased ICP.

Deya's child is scheduled for surgery due to myelomeningocele; the primary reason for surgical repair is which of the following?

A. To prevent hydrocephalus B. To reduce the risk of infection C. To correct the neurologic defect D. To prevent seizures B: Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis. A: Surgical repair does not help relieve hydrocephalus. In fact, some researchers believe that repair exaggerates the Arnold-Chiari malformation and decreases the absorptive surface for cerebrospinal fluid, leading to more rapid development of hydrocephalus. C: The neurologic deficit cannot be corrected. However, some surgeons believe that early surgery reduces risk of stretching spinal nerves and preventing further damage. D: Surgical repair of the sac doesn't prevent seizure disorder, an impairment of the brain neuron tissue.

During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute?

A. Limiting conversation with the child B. Keeping extraneous noise to a minimum C. Allowing the child to play in the bathtub D. Performing treatments quickly B-A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent over stressing the child, any treatments should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.

Reye's syndrome is a rare and severe illness affecting children and teenagers. Its development has been linked with the use of aspirin and which of the following?

A. Meningitis B. Encephalitis C. Strep Throat D. Varicella D: Reye's syndrome has been linked with the ingestion of aspirin in children with viral infections like varicella. A and C: There is no association between meningitis or bacterial infections such as strep throat and the development of Reye's syndrome. B: Encephalitis is a component of Reye's syndrome.

While examining a 2-year-old child, Nurse Galina sees that the anterior fontanel is open. She should:

A. Notify the doctor B. Look for other signs of abuse C. Recognize this as a normal finding D. Ask about family history of Tay-Sachs disease A: Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the doctor promptly of this finding. B and D: An open fontanel does not indicate abuse and is not associated with Tay-Sachs disease.

Janae has a seizure disorder; which of the following would be the lowest priority when caring for her?

A. Observing and taking down data on all seizures B. Assuring safety and protection from injuring C. Assessing for signs and symptoms of increased ICP D. Educating the family about anticonvulsant therapy C: Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority. A: Careful observation and documentation of seizures provide valuable information to aid prevention and treatment. B: Safety is always a priority in the care of a child with seizure disorder because seizures may occur at any given time. D: Improper administration of and incomplete compliance with anticonvulsant therapy can lead to status epilepticus; thus education is a priority.

The client is having a lumbar puncture performed. The nurse would plan to place the client in which position for the procedure?

A. Side-lying, with legs pulled up and head bent down onto the chest B. Side-lying, with a pillow under the hip C. Prone, in a slight Trendelenburg's position D. Prone, with a pillow under the abdomen A The client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen, and with the head bent down onto the chest. This position helps to open the spaces between the vertebrae.

Reye's syndrome is associated with what?

Administer of Aspirin to children during a viral illness

What is meningitis?

An inflammation of the fluid membranes (meninges) surrounding your brain and spinal cord. The swelling from meningitis typically triggers signs and symptoms such as headache, fever, and a stiff neck.

How does meningitis occur?

Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or — rarely — some surgeries

What are signs of increased intracranial pressure?

Early - headache, change in LOC, decreased GCS, irritability, decreased eye contact. Late - further decrease in LOC, bulging fontanelles, decrease in spontaneous movements, posturing, increased BP, irregular respirations, Cushings triad.

What position will prevent aspiration and increased intracranial pressure in the unconscious child?

HOB elevated

What nursing assessments assist to detect development of hydrocephalus?

Head circumference

What is one of the primary dangers of increased ICP?

ICP can lead to brain injury

When the patient experiences hyperthermia what interventions are employed to reduce the temperature?

Remove excess clothing, apply cool washcloths and a fan, apply ice packs under arms, around neck, and to groin.

What may lead to the shunt needing replaced?

Shunt malfunction, growing child

What factors contribute to constipation in the unconscious child?

Slower peristaltic function, no physical activity, inadequate fiber intake

Reye's syndrome

Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this.

Increased ICP

The pressure of CSF in the subarachnoid space between the skull and the brain. The cranium and vertebral body form a rigid container, holding the brain, blood, and CSF, if any contents increase an increase of ICP occurs.