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Peds Neuro

Neurologic D/O

Menigitis definition Inflamm of meningnes, viral or bacterial. Bacterial more dangerous
Meningitis risk factors Viral illnesses, URI (otitis media, tonsillitis), immunosuppression, injuries (penetrate head wound and skull fracture), overcrowded living sit
Meningitis s/sx (newborns) Poor muscle tone, weak cry, poor feeding, fever/hypothermia, no illness at irth but progresses within few days
Meningitis s/sx (2mo-2yrs) Seizures c. high-pitched cry, fever and irritabilty, bulging fontanels, nuchal rigidity, poor feeding, vomiting
Meningitis s/sx (2 yrs-teen) Seizures (initial sign), nuchal rigidity, + Brudzinski sx (Flexion of ext c. deliberate flex of neck), Kernig's sx (resist extension of leg from flexed position), fever, chills, HA, petechia/rash, chronic ear drainage
Meningitis other sx Photophobia, progressive drowsiness, delirium, stupor, coma (may initially be irritable and restless)
Meningitis lab tests Blood C&S to ID broad-spec antibiotic. CBC, CSF collection (elevated WBC, protein, decreased glucose, increased CSF pressure, cloudy CSF -bac, clear if viral)
Meningitis Dx procedures CF analysis: best test. Collect c. lumbar puncture.
Lumbar puncture considerations Empty bladder first. Place in fetal position if young, older kids can be sitting. Admin sedatives as Px. Apply local anesthetic, monitor site for hematoma/infxn.
T or F: with Meningitis start antibiotics stat and later adjust for specific microbe T
Dexamethasone can be used for _____ Initial reduction if increased ICP and herniation
Meningitis pt. education Encourage remain in bed for 4-8hr in flat position to prevent leakage and spinal HA. CT scan or MRI to detect increased ICP or abscess
The presence of petechia or purpuric rash for Meningitis pt. requires Immediate medical attention
T or F: pt. c. Meningitis on standard precautions F. On droplet
How long pt. on isolation for Meningitis/ Continue for 24h after first antibiotic given
Other RN considerations for Meningitis NPO status if pt. decreased LOC (advance to clear->diet pt. toelrates when improved LOC). Decrease environ stimuli, minimize exposure to bright light, keep room cool, position w/o pillow and slightly elevate HOB. Seizure precautions.
How to reduce incidence of Meningitis Hop and pneumococcal vaccines
Meningitis complications 10-15% bacterial fatal; encephalitis, meningoccemia, may have lifetime neuro deficit.
Head trauma: 3 major causes in order of importance Falls, MV injuries, bicycle injuries
Majority of deaths from falls at what age? Majority of bike accidents? Falls: 0-4 yrs. Bicycle: 5-19 yrs
Head trauma s/sx Altered mental status w/ or w/o loss of consciousness. Skull fracture, shaering or tissue, and prolonged effects.
Head trauma signs of increased ICP Severe HA, deteriorating LOC, restlessness, irritability, agitation; dilated/fixed or constrcited/fixed, slow to react, or nonreactive pupils, altered breathing (deep fast, intermittent gasping), abnormal posturing
Decorticate Arms, wrists, fingers flexed and bent inward onto chest. Legs extended and abducted. Dysfunction of cerebral cortex
Decerebrate Backward arching of head and arms c. legs rigidly extended and toes downward. Dysfunction c. midbrain
Cushing's reflex Late sign of head trauma, s/sx: severe HTN c. widening pulse pressure, bradycardia, irregular resp
GCS of 0-8 Severe head injury and coma
GCS of 9-12 Moderate head injury
GCS of 13+ Minor head trauma
Head trauma lab tests ABGs, ETOH/drug screen, CBC c. differential
Head trauma Dx procedure Cervical spine films (r/o spine injury), CT or MRI of head, ICP (expected 10-15 mmHg)
Head trauma complications: Risk of epidural/subdural hematoma, herniation, infxn, edema, Cushing triad, coma
Head trauma care: Stabilize spine, neuro Ax, mecha vent if needed, give O2 so sat >95%, hyperventilate to keep PaCO2 30-35 mmHg, HOB @ 30, minimize endotrach/PO suction, avoid cough/straining
Head trauma care environ: Calm, restful environ, conserve energy, restrain ext to prevent pulling tubes, turn q2h
Concussion will have immediate or delayed HA, fatigue, vomiting, seizures. All need to be reported
T or F: subtle behavioral changes noticable day of concussion T
Hallmarks of concussion: Confusion, amnesia (usu immediately after concussion)
WA state law re: concussion If pt. return to play before brain heals original concussion, may get 2nd concussion syndrome. Need written approval from MD trained in concussion Tx/eval before returning to sports
Post concussion syndrome Sequela to brain injury: HA, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration, memory impariment. Typically develop within days and resolve in 3 mo.
Clinical sx of post concussion syndrome Loss of consciousness, posttraumatic amnesia, disorientation or other mental status change
Posttraumatic seizures occur in... Children who survive head injury, more common in younger than ppl > 16yrs
Anoxic brain injury definition Decreased neuro function r/t birth injury or submersion trauma
40% of submersion injuries occur in children of what age/ Younger than 5 years. Top-heavy toddlers esp.
Anoxic brain injury, primary problem is Hypoxia d/t global cell damage. Others include aspiration and hypothermia
Anoxia of less than ___ has good prognosis Less than 5 min
All children c. submersion injury should be hospitalized ____ for observation 12-48h d/t respiratory compromise or cerebral edema showing later
Created by: choel