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M6 13-005

Exam 11: Pediatric Neurological Conditions

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.
Created by: jtzuetrong