Pediatric Neurological Conditions
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| Brain size of infant is ____% of adult size | 25%
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| Brain size of a 1yo is ____% of adult size | 50%
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| brain size of a 3 year old is ____% of adult size | 75%
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| Brain size of a 6 year old is ___% of adult size | 90%
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| Head circumference for a term infant is ____ cm | 34-35 cm
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| Head circumference of a 6mo old is ____ cm | 44 cm
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| Head circumference of a 1 yo is ____ cm | 47 cm
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| Sutures and fontanels stay open in infants to compensate for increases in ___ | ICP
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| Continuing separation of sutures may occur until ____ years of age | 10-12 yo
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| Papilledema - edema of the ____ is due to open sutures and fontanels | pupils
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| Premature closure of sutures and fontanels can cause a potential for ____ damage | neurologic
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| Head circumference at birth is ____" larger than circumference chest | 1" larger
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| T/F by one year of age the head and chest circumference are equal | True
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| myelinization of the CNS begins in utero or at birth | in utero (approx week 16)
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| Myelinization of CNS usually complete by ____ | puberty
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| Myelinization of CNS promotes progressive ____ and ____ motor development | progressive coordination and fine motor development
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| ____ is Increased accumulation of CSF in ventricles and compresses the brain | hydrocephalus
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| hydrocephalus occures in ___ / 1000 live births | 3-4/1000
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| If an infant is born with hydrocephalus, it can be because of a ____ infection | intrauterine (in the uterus = aka. womb)
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| Acquired hydrocephalus can be caused from what three things | infection, neoplasm and hemorrhage
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| Blockage outside ventricular system is ____ hydrocephalus | communicating
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| Communicating hydrocephalus happens when CSF is inadequately circulated or reabsorbed in the ____ space | subarachnoid space - subarachnoid hemorrhage
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| Flow of CNS obstruction within the ventricular system is ____ hydrocephalus | noncomunicating
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| noncommunicating hydrocephalus prevents CSF from ____ the subararachnoid space for reabsorption | reaching - stenosis of aqueduct of sylvius or Dandy-Walker Syndrome
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| ____ tumor causes increased CSF secretions which causes hydrocephalus | Choroid Plexus Tumor
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| Some manifestations of infant intercranial pressure (IICP) | head enlarge,nonpulsatile & bulgine anterior fontanel, scalp veins dilated, cranial sutures seperated, Macewen sign (sound of a cracked pot), Bossing of frontal bone, setting-sun eyes, changes in LOC, irritable, lethargic, opisthotonos(back arching)
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| What are some manifestations of infant intercranial pressure (IICP) | poor feeding, shrill, high pitched cry, developmental delay and seizures
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| Older child ICP Manifestations | HA/N/V, ataxia, strabismus, dipopia, pupil unequal response to light, papilledema, LOC change, Intellectual impairment and seizures
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| ____ is the late sign of IICP with manifestations of hypertension, bradycardia and apnea | Cushing's Triad
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| Diagnosis of hydrocephalus include ____ ultrasonography, measurement of ____ circumference, and____imaging studies | fetal ultrasonography, head circumference, neuroimaging studies
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| Neuroimaging studies include evaluation of size and position of ____ and subarachnoid spaces | ventricles
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| surgical management of hydrocephalus include correcting the ____ and shunt placement | correction of obstruction
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| Shunt the ventricles to the peritoneal cavity is called ____ | ventriculoperitoneal (VP) shunt
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| VP shunt is best for infants or children | infants
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| 4 Risks for VP shunt include | Bowel perforation, ascites, paralytic ileus and peritonitis
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| ____ shunt drains ventricles to the right atrium | Ventriculoatrial (VA) shunt
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| The VA shunt is best for infants or children | older child - rare
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| 4 Risks for VA shunt | Congestive heart failure, pulmonary edema, septicemia, and bacterial endocarditis
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| If a shunt is obstructed the manifestation would be increased ___ | ICP
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| Manifestations of a shunt infection include | signs of increased ICP, fever, stiff neck, wound or shunt tract inflammation and abdominal pain
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| Manifestations of a subdural hematoma due to shunt complication is rapid decreases in ____ pressure and ____ fontanel | rapid decrease in CSF pressure and depressed fontanel
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| _____ shunt revisions are expected during a lifetime | 5-7 revisions
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| Most common reason for shunt revisions is | child's growth (toddler and b4 puberty growth)
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| Pre operative VP shunt measurements | Vital signs, pupil reactivity and symmetry, fontanel's and suture lines, and head circumference
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| HOB preop and postop VP shunt is | Pre 30degrees post gradually elevate
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| post op VP shunt - too rapid decrease in CSF pressure may cause ____. | subdural hematoma
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| T/F the nurse may pump the shunt as the nurse sees the need | False - only if ordered by the physician
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| ___ is a neural tube malformation involving failure of the osseous (bony) spine to close | spina bifida (myelodysplasia)
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| Three examples of neural tube defects (NTD) | spina bifida (myelodysplasia), anencephaly, encephalocele
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| ____ is a bundle of nerves in a human embryo that develops into the brain and spinal cord | neural tube
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| ____ is absence of both cerebral hemispheres and the overlying skull | anecephaly
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| ____ is herniation of the brain and meninges through a defect in the skull | encephalocele
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| Spina Bifida ____ - Often no observable manifestations, Incomplete fusion– posterior vertebrae, Spinal cord & nerves—normal, Usually no serious neurological dysfunction | Spina Bifida Occulta
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| Spina Bifida ____ - the unfused portion of the spinal column allows the spinal cord to protrude through an opening in the overlying vertebrae. The meningeal membranes that cover the spinal cord may or may not form a sac enclosing the spinal elements | Spina Bifida Cyctica
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| Spina Bifida Cyctica can either meningocele or myelomeningocele the difference is ____ includes a portion of the spinal cord and nerves hanging out | myelomeningocele
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| spinal bifida cyctica myelomeningocele risk factors include: unknown, maternal ____ deficience and other factors such as ___ | maternal nutritional deficiency (folic acid) others such as genetic, maternal hyperthermia (hot tubs), antiepileptic drugs and maternal age (teenager or over 35)
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| spinal bifida cyctica myelomeningocele incidence: higher in boys or girls, higher in whites or blacks | white girls. (declined due to increase of folic acid in fortified foods)
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| sensitive period of neural tube closure is ____ weeks gestation | four
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| Usual location of spina bifita | lumbar or lumosacral
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| spina bifida cystica myelomeningocele prenatal diagnosis includes ____ scanning of uterus, elevated ____ levels from amniotic fluid and maternal serum and diagnostic tests | ultrasound scanning of the uterus, elevatd levels of alpha-fetoprotein
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| spina bifids cystica myelomeningocele postnatal diagnosis is based on the clinical manifestations and evaluation by what 4 methods | MRI, Ultrasound, CT, and myelography
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| spina bifita cystica myelomeningocele manifestations | paralysis, tethered spinal cord, orthopedic problems, bladder and bowel problems, hydrocephalus, skin problems, latex allergy and Chiari II - The cerebellar tonsils are elongated and pushed down through the opening of the base of the skull
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| Folic Acid is recommended at ____ mg daily for pregnant women to prevent spina bifida cystica myelomeningocele | 0.4mg daily - beginning one month prior to planned pregnancy
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| spina bifida cystica myelomeningoceal protection includes cover with ____ nonadherent dressing using ____ technique | sterile - sterile
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| Signs of infection of myelomeningocele sac included: elevated ____, irritability ____ rigidity and ____ WBC | elevated temperature, irritability, nuchal rigidity, and elevated WBC
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| Since hydrocephalus is a common manifestation with myelomeningocele nursing interventions include | serial measurement one or two times daily by marking head with marking pen and reporting acute increases and observing for signs of increased intercranial pressure
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| _____ is an inflammation of the meninges (infection of membranes and fluid) of the brain and spinal cord. | meningitis
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| ____ involved inflammation of the cerebral cortex | encephalitis
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| ____ is an inflammation of the meninges (infection of membranes and fluid of the brain and spinal cord) | Meningitis
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| ____ represents inflammation of both the meninges and the cortex of the brain | meningoencephalitis
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| a secondary infection to meningitis is | nasopharyngeal and middle ear infections
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| With meningitis, an infection enters the ____ and is carried to the meninges | bloodstream - from nasopharnyx, mastoid and middle ear infections
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| Risk factors for Meningitis - age___, infection____, gender____, race____, season, maternal factors, CNS anomaly, neurosurgical procedures, head trauma & chronic conditions like sickle cell, diabetes and renal insufficiency | age - 6mo, infection bacterial or viral, males, african american
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| Clinical manifestations of meningitis - signs of increased intercranial pressure (IICP) include: | irritability, restlessness, poor feeding, A/N/V, bahavioral changes, decreased LOC and seizures
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| Clinical manifestations of meningitis irritation and inflammation include | fever, photophoia, nuchal rigidity, spinal rigidity, opisthotonos, kernigs sign, brudzinskis sign, and skin changes like petechias, purpura and poor perfusion
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| ____ sign is the appearance of involuntary lifting of the legs | Brudzinski's Sign
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| ____ sign is when the leg is fully bent in the hip and knee, and subsequent extension of the knee is painful | Kerning's Sign
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| ____ is a state of servere hyperextension and spasticity in which the head, neck and spinal column arch | opisthotonus
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| Bacterial meningitis CSF abnormalities: color____, cell count____, protein count____, glucose count ____ | color - cloudy and purulent, cell count elevated (polymorphonuclear leukocytes predominate), protein elevated, and glucose decreased less than 1/2 of the blood glucose
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| Meningitis antibiotic therapy begins ____ obtaining cultures and ____ results | begin after obtaining cultures and before results
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| Initial tx of meningitis | vancomycin or third generation cephalosporin
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| Based on culture results, a high dose IV for 7 days or longer of ____ | ampicillin, gentamicin, cefotaxime, ceftrizxodone, vancoymycin
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| To see if antibiotic therapy is working for meningitis a repeat lumbar puncture test is done until the CSF runs | clear
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| Prophylaxis tx for meningitis | Rifampin - may cause certain bodily fluids to become orange-red
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| ____ lessens meningeal inflammation and prevents deafness | Dexamethasone - administer b4 antibiotics
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| Comfort measure for meningitis includes elevating the ___, ____ pillow usage, and side lying due to ___ | HOB elevated, no pillow and side-lying more comfortable for nuchal rigidity
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| Decreased sensory stimulation for meningitis includes: ____ room, ____ lighting, ____ handling | quiet room, subdued lighting and gentle handling
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| T/F place a pt with meningitis in isolation immediately | true
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| Respiratory isolation of a pt with meningitis includes ____ hr, until ____ results are obtained and while ____ is having effect | continue at least 24 hours, until culture results are obtained and while antibiotic is having an effect
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| A pt with meningitis must have their fluid intake monitored to prevent further fluid ____ | fluid accumulation - related to cerebral edema, subdural effusion and SIADH
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| Fluid retention of a meningitis pt may cause ____ | seizures and coma
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| Sensoineural hearing loss occures ____% with pneumococcal diseases and ____% with meningococcal and Haemophilus disease BAER (Brain Stem Acoustical Evoked Response) | 30% with pneumococcal and 5-10% with meningococcal
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| Potential long-term sequelae (pathological condition resulting from) meningitis | deafness, blindness, paralysis, seizure disorder, hydrocephalus, mental retardation and learning disability
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| ____ is a group of symptoms with associated sudden transient alterations in brain function caused by excessive disorderly discharge of electrical impulses by neuronal tissue | seizure
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| ____ is a disorder of the CNS, caused by abnormal electrical discharges results in recurrent seizures | epilepsy
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| status epilepticus is a seizure that lasts ____ minutes or longer or is a ____ of seizures where intervals are too brief to allow child to regain consciousness between ea seizure | 30 minutes or longer - group
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| seizure risk factors | idiopathic, congenial defects, acute encephalopathy, metabolic disorders, ingestion of toxic substraces, head injury, environmental stimuli and high fever
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| ____ is the preseizure phase and consists of what | Preictal - timing, aura (if present) and environmental stimulants
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| ____ is the seizure phase and consists of what | ictal - time of onset, description of body movements, skin color, respiratory distress, incontinence, frothing secretions, automathisms, duration of seizure and meds
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| ____ is the post seizure phase and consists of what | Postictal - level of awareness, motor and speech ability, and reorientation and stabilizaiton time frame
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| The goals of antiepileptic drugs is to raise the critical ____ of seizures above the level of neuronal excitability | threshold
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| Antiepileptic drugs need to monitor ____ drug level, ____ count, and ____ function tests | serum drug level, blood count and liver function test.
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| Lorazepam (ativan) and Diazepam (valium) are ____ medications for status epileptis | abortive medications - the second round is cerebyx
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| Nuring actions of a Tonic-Clonic seizure include: remaining ____, note ___ seizure began, gently ease child to ____ in side lying position, loosen constricting ____, observe and document ____ and report to physcian | remain calm, look at time seizure started, ease child to floor, loosen clothing, observe seizure activity
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| What two nursing actions are not done during a Tonic-Clonic seizure | Do not restrain childs movements and do not force anything between teeth
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| Seizure percausions and available equipment: | cardiorespiratory and pulse oximeter, suction and O2 avail, & padded siderails
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| Call for medical assistance for a seizure pt if the seizure lasts more than ____ min, difficulty ____ afterwords, difficulty awakening, signs of injury, pupils are not ____ after seizure, vomits continuously ____ min after, pregnancy or a ____ seizure | Seizure lasts more than 5 min, Difficulty breathing afterwards, Difficulty awakening, Signs of injury, Pupils are not equal after , Vomits cont 30 min after ended (possible acute problem), Pregnancy or other medical ID, A second seizure
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| ____ medication is used for seizure control | Dilantin - causes gum hyperplasia
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| A ____ seizure is associatd with a fever | Febrile seizure
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| Frebrile seizures occure with acute ____ illnesses | viral like URI and GI infections
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| A frebrile seizure lasts less than ____ min and do not ____ within a 24-hr period | lasts less than 15 minutes and do not recur
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| Age of febrile seizure usually befor ____ yo | Before 5yo. usually bt 3mo and 3yr
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| ER mgt of febrile seizure include ____ fever and ____ puncture for sepsis work-up | reduce fever and lumbar puncture for sepsis work up. reassure partents that it is a benign condition
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| T/F continuous anticonvulsants are recommended for febrile seizures | False
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| Tx to abort febrile seizures may be needed for families that live ___ | far from medical facility
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| Call 911 if seizure lasts more than ____ minutes | five
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| Incident of cerebral palsy is ___ per 1000 live births | 1.5-3
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| ____ is the most common permanent physical disability in childhood | Cerebral Palsy
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| Cerebral Palsy is brain insult or injury in the early periods of brain development and is most common before the onset of ____ | labor - can get between prenatal period and up to 2yo
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| Most common etiology for Cerebral Palsy is neonatal ____ | neonatal encephalopathy
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| ____ Cerebral Palsy includes: Hypertonicity, Poor Control (Posture, Balance, Coordinated motion), Persistent primitive reflexes, Exaggerated deep tendon reflexes, Contractures—later | Spastic Cerbral Palsy
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| ____ Cerebral Palsy includes: Athetosis (slow, writhing movements), (Extremities, trunk, neck, facial muscles, tongue ), Abnormal involuntary movements (Choreoid—involuntary, irregular, jerky random movements, Dystonic—disordered muscle tone) | Dyskinetic Cerebral Palsy
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| ____ Cerebral Palsy includes: Unstable, wide based gait, Rapid, repetitive movements performed poorly, Uncontrolled arm movements when the child reaches for objects | Ataxic Cerebral Palsy
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| Physical signs as an early warning to Cerebral Palsy includes: | Poor head control after 3 months of age, Stiff or rigid arms or legs, Pushing away or arching back, Floppy or limp body posture, Inability to sit up without support by 8 months. Use of only one side of the body, or only the arms to crawl, Persistent primi
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| Behaviroal signs as an early warning to Cerebral Palsy include: | Excessive irritability, No smiling by age 3 months, Feeding difficulties, Persistent tongue thrusting, Frequent gagging or choking with feeding, After 6 months of age, tongue pushing soft food out of the mouth
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| Associated problems with Cerebral Palsy include | Learning Disabilities and Mental Retardation, Visual Deficits, Hearing Deficits, Communication Deficits, Seizures, Feeding and Eating Problems, Bowel and Bladder Problems
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| nutritional enhancement for Cerebral Palsy include: | privide high caloie diet, supplement vitamins, minerals and protein, and maintain hydration status
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| strategies to promote dental health of a cerebral palsy pt include | meticulous oral hygiene, visit dentist at least every 6 mo, and close monitoring if on phenytoin
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| Antispasmodic meds for Cerebral Palsy include | Dantrolene, Balcofen, Valium and Botulinum Toxin Type A
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| Cerebral Palsy maintance of skin integrity include | monitor sites of potential skin alteration, keep sites clean and dry, and change position at least every 2 hours
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| Cerebral Palsy patients usually die due to ____ illness | respiratory
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| __is a term for any diffuse disease of the brain that alters brain function or structure. | Encephalopathy
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| ___ may be caused by infectious agent (bacteria, virus, or prion), metabolic/mitochondrial dysfunction, brain tumor/ICP, prolonged exposure to toxic elements | Encephalopathy
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| ____ is an increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement. | Hypertonicity
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| _____is a decreased tension in muscle tone. A lack of muscle tone inhibits proper movement as the muscle is not developed or is too soft to support the body | Hypotonicity
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| A muscle____is a permanent shortening of a muscle or tendon in the human body in response to continued hypertonic stress exerted on that muscle or tendon, such as constant spasticity. | contracture
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| Contractures are most often seen in the tightest muscles of people with conditions like ____ | spastic cerebral palsy
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| ____The involuntary functioning of an organ or other body structure that is not under conscious control | automatisms
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| ____is a neurological sign and symptom consisting of gross lack of coordination of muscle movements | ataxia
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| _____is a condition in which the eyes are not properly aligned with each other. AKA Crossed Eyes | Strabismus
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| _____is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. | Papilledema (or papilloedema)
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| ____commonly known as double vision, is the simultaneous perception of two images of a single object. These images may be displaced horizontally, vertically, or diagonally (i.e. both vertically and horizontally) in relation to each other. | Diplopia
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| ____A sign to detect hydrocephalus & brain abscess. Percussion (tapping) on the skull at a particular spot (near the junction of the frontal, temporal & parietal bones) yields an unusually resonant sound in the presence of hydrocephalus/a brain abscess. | Macewen sign
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| ___ sounds hollow or like a cracked pot? | Macewen sign
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| Cushing's Triad is the late sign of IICP with manifestations of ____,____, & ____? | hypertension, bradycardia and apnea
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| _____is an unusually prominent forehead, sometimes associated with a heavier than normal brow ridge | Frontal bossing is an unusually prominent forehead, sometimes associated with a heavier than normal brow ridge
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| fever, photophoia, and skin changes like petechias, purpura and poor perfusion are all clinical manifestationsof ___ irritation and inflammation? | Clinical manifestations of meningitis irritation and inflammation
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