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M6 13-005
Exam 11: Pediatric Neurological Conditions
Term | Definition |
---|---|
Bacterial Meningitis | an inflammation of the meninges, the covering of the brain and spinal cord. |
Bacterial Meningitis: Most Common causative agent | H. influenza type b, Streptococcus pneumoniae and Neisseria meningitidis, which "are responsible for bacterial meningitis in 95% of children older than 2 months of age.” |
Bacterial Meningitis: Pathophysiology | Most common route of infection is vascular dissemination from a focus of infection elsewhere |
Bacterial Meningitis: Types | Bacterial. Tuberculosis. Viral. |
Any child who is ill and develops ____ or _____ rash may have meningococcemia and must receive medical attention immediately. | purpuric or petechial |
Bacterial Meningitis: Diagnostic Tests | Lumbar Puncture (spinal tap). Gram Stain & Culture of CSF. Hx & P. |
What is the most common causative agent of bacterial meningitis in children? | Streptococcus pneumoniae and Neisseria meningitidis |
What is the importance of clustering nursing care? | To allow maximum rest and keep stimulation to a minimum. |
Encephalitis. | inflammation of the brain. |
Encephalitis: Causative Agents | Togaviruses and herpes virus type 1 and 2. URI. Rubella or rubeola. Lead poisoning. Bacteria. Spirochetes. Fungi. (h) In rare instances can be a reaction to vaccinations such as diphtheria, tetanus and pertusis (DTP). |
Encephalitis: Residual Effects | Slowed speech, mental processing and motor ability. Brain damage. Mental retardation. Seizures. |
Which age group is most at risk for residual damage as a result of encephalitis? | Infants. |
Reye's Syndrome. | an acute non-inflammatory encephalopathy and hepatopathy, with no reasonable explanation for the cerebral and hepatic abnormalities. |
Reye's Syndrome: Etiology | Usually associated with a viral illness which may be quite mild (flu, chickenpox). Use of aspirin to treat symptoms associated with onset of syndrome. |
Reye's Syndrome: Definitive Diagnosis Test | LFT's Liver biopsy if diagnosis is questionable |
Reye's Syndrome: Stage I | Effortless vomiting. Lethargy and drowsiness. Liver dysfunction. Type 1 electroencephalogram (EEG). Follows commands. Papillary reaction brisk. |
Reye's Syndrome: Stage II | Disorientation. Combative. Delirium. Hyperventilation. Hyperactive reflexes. Appropriate responses to painful stimuli. Evidence of liver dysfunction. Type 1 EEG. Papillary reaction sluggish. |
Reye's Syndrome: Stage III | Obtunded. Coma. Hyperventilation. Decorticate rigidity. |
Reye's Syndrome: Stage IV | Deepening coma. Decerebrate rigidity. Loss of oculo-cephalic reflexes. Large and fixed pupils. Minimal liver dysfunction. |
Reye's Syndrome: Stage V | Seizures. Loss of deep tendon reflexes. Respiratory arrest. Flaccidity. Usually no evidence of liver dysfunction. |
Reye's Syndrome: Medical Treatment | Accurate intake and output is essential for adjusting fluid volume to prevent cerebral edema and hypovolemia. Vital signs including central venous pressures and/or cardiac output. |
What drug should not be given to a child to treat symptoms associated with chickenpox? | Aspirin. |
What should be monitored when caring for a child with Reye's syndrome? | Respirations, neuro status, vital signs and I & O. |
Sepsis or septicemia | refers to a generalized bacterial infection in the bloodstream that can progress to systemic inflammatory response syndrome (SIRS), shock, multiorgan system failure and death. |
Bacterial Meningitis: Medical Treatment | Cephalosporins |
What neonate/children are most at risk for developing sepsis? | Neutropenic, immunocompromised or in intensive care unit. |
Seizures are caused by | malfunctions of the brain’s electrical system that results from abnormal neural discharges. |
Epilepsy | a chronic seizure disorder with recurrent and unprovoked seizures. |
Epilepsy: May be caused by | Trauma. Hypoxia. Infections. Exogenous or endogenous toxina. Biochemical events such as hypoglycemia, hypocalcemia, and certain nutritional deficiencies. Fevers greater than 101.8 with rapid elevation. |
Partial seizures | caused by abnormal electric discharges from a foci limited to a more or less circumscribed region of the cerebral cortex. |
Simple partial seizures | simple symptoms and are accompanied by no alteration in consciousness call an aura. |
Complex partial seizures | involve complex symptoms and impairment of consciousness. It starts with an aura by then advances into generalized seizures, usually a tonic-clonic event |
Simple or complex seizures | secondarily generalized develop into generalized seizures, usually a tonic-clonic event. |
Generalized seizures | involve both hemispheres. Frequently loss of consciousness occurs and is the initial clinical manifestation. |
Epileptic Diet Children | Child may be placed on a ketogenic diet (severely restricts carbohydrates and protein intake and uses fat as the primary fuel to produce ketosis). |
Carbamazepine (Tegretol). Phenytoin (Dilantin). Valproic Acid (Depakote). | primary drugs prescribed for partial seizures and/or generalized tonic clonic seizures |
Ethosuzimide (Zarontin). Valproic Acid (Depakote). | drug of choice for absence seizures |
Status Epilepticus | (a) A continuous seizure that lasts more than 30 minutes or a series of seizures where the child does not regain a premorbid level of consciousness. Medical Emergency. |
What are some possible causes of seizures? | Birth injury, Epilepsy, infection, fever, dehydration, hypoglycemia, anesthetics, drugs and poisons. |
What should you document if you observe a child having a seizure? | Activity before seizure, body movements, change in color, respirations, muscle tone, incontinence, body parts involved, duration and appearance, behavior and LOC after the seizure. |