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Nur-425

Exam #4 - CNS Disturbance

TermDefinition
Name the two most common types of neural tube defects Anencephaly and spina bifida
What is a neural tube defect? A defect where the neural tube does not close normally
What is the treatment for anencephaly? No treatment; it is contraindicative to life
What is spina bifida occulta? Spinal column is not closed all the way but there is no protrusion
What is spina bifida cystica? The spinal cord is not closed all the way and a sac is protruding
What is meningocele? Less severe form of spina bifida cystica where the protruding sac contains meninges and spinal fluid
What is myelomeningocele? More severe form of spina bifida cystica where the protruding sac contains meninges, spinal fluid and nerves
What vitamin deficiency has been implicated in the development of spina bifida? Folic acid
How much folic acid is normally contained in a multivitamin? 0.4 mg
How much folic acid should a woman take who has a history of a previous NTD? 4 mg daily beginning one month prior to conception
What prenatal test can be used to identify NTD? Alpha-feta protein testing of maternal blood
At what gestational period would the AFP test be done? 16-18 weeks gestation
Where are the majority of myelomeningoceles located? In the lumbosacral area
What other condition is experienced by 90% of infants with myelomeningoceles? Hydrocephalus
When is the preferred surgery time period for treatment of myelomeningoceles? Between 12 and 72 hours to prevent infection/trauma
There is a high correlation between an allergy to this product and the diagnosis of NTD Latex
What position should an infant be laying in who has a myelomeningoceles? Prone
Preoperatively, how is the myelomeningoceles cared for? Keep sac moist with normal saline dressings and change q 2-4 hours
Postoperatively, how should the infant be positioned who had a myelomeningoceles? Prone or side-lying and held upright
What complications are associated with a myelomeningoceles? Urinary/bowel dysfunction
What procedure is used in the maintenance of urinary dysfunction in a child with myelomeningoceles? Clean intermittent catheterization
What medications are used to treat urinary dysfunction in a child with myelomeningoceles? Ditropan and Detral are used to treat overactive bladder
What is defined as the imbalance of production and absorption of cerebrospinal fluid? Hydrocephalus
Name two reasons for the accumulation of CSF in the brain Too much production of CSF and blockage of drainage of CSF (NTD)
Name two signs of hydrocephalus Enlarged head circumference (95th percentile) and signs of increased intracranial pressure (ICP)
What can be used to drain the CSF fluid that builds-up in the head (hydrocephalus)? Ventricular peritoneal shunt
After placement of a ventricular peritoneal shunt, in what position should the child be placed? On the nonoperative side to monitor site; flat in bed
Name several signs of possible shunt malfunction in the treatment of hydrocephalus Widening sutures, fever, malaise and irritability
This is a chronic disorder characterized by recurrent unprovoked seizures Epilepsy
This type of partial seizure involves no loss of consciousness, motor activity symptoms on one side of the body, and sensory symptoms of a seizure like flashing light or buzzing sounds Simple (focal) seizure
This type of partial seizure is characterized by automatisms such as smacking the lips and repeating words over and over again Complex partial (psychomotor)
Name the four types of generalized seizures Tonic-clonic (grand mal), absence (petit mal), atonic (drop attacks) and myoclonic
What are some characteristics of a tonic-clonic seizure? Intense muscular contractions, patient may be cyanotic or incontinent, confused afterwards
What are some characteristics of an absence seizure? Very subtle, brief loss of consciousness that resembles day dreaming, onset is 4-12 years of age
What are some characteristics of an atonic seizure? Sudden momentary loss of muscle tone, may or may not lose consciousness, onset is 2-5 years
What are some characteristics of myoclonic seizures? Involves one extremity and that body part contracts, noticed as child goes in and out of wakeful state, mostly in school age and adolescent kids
Name two unclassified epileptic seizures Infantile spasms and Lennox-Gestaut syndrome
What are some characteristics of infantile spasm seizures? Rare; affects infants 6-8 months; symmetric muscle contraction; most have severe developmental delay associated with a cerebral anomaly; poor prognosis
What are some characteristics of Lennox-Gestaut syndrome? Mixed seizure type; might start out as infantile spasm; accompanied with severe developmental delay; onset is 1-10 years
In regards to seizures, what is the purpose of doing laboratory studies? To rule-out infection and metabolic disturbances
What is the most useful diagnostic tool in diagnosing seizures? EEG; specific seizures elicit specific EEG patterns
This diet, used in the treatment of seizures, involves high fat, low carbs or moderate protein intake Ketogenic Diet
This type of therapy is the mainstay in the treatment/management of seizures Drug therapy
This antiepileptic medication can cause allergic rashes, nausea, diplopia, blurry vision and drowsiness Carbamazepine (Tegretol)
This antiseizure medication can cause rashes, sedation, nystagmus and ataxia Phenytoin (Dilantin)
This barbiturate is used for sedation purposes in the treatment of seizures Phenobarbital
This medication used to treat seizures can cause thrombocytopenia and negatively affect the liver Valproic acid (Depakote)
Folic acid and vitamin D supplements are needed when taking these two medications used in the treatment of seizures Phenytoin (Dilantin) and Phenobarbital
This type of seizure is one that continues for 30 minutes or more and does not respond to treatment Status epilepticus
When treating status epilepticus, what is the priority intervention? CAB - circulation, airway, breathing
Besides CAB, what is another essential intervention in the treatment of status epilepticus? IV access until the IV antiepileptics can be administered
What medications might be given to someone experiencing status epilepticus before the IV antiepileptics are started? Diazepam (Valium) of Lorazepam (Ativan)
True or False. When someone is undergoing a seizure, the tongue should be prevented from obstructing the airway by putting something in the person's mouth False; nothing should be placed in the mouth; ensure a clear airway by placing the person on their side
Created by: ssbourbon