Exam #4 - CNS Disturbance
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| Name the two most common types of neural tube defects | Anencephaly and spina bifida
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| What is a neural tube defect? | A defect where the neural tube does not close normally
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| What is the treatment for anencephaly? | No treatment; it is contraindicative to life
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| What is spina bifida occulta? | Spinal column is not closed all the way but there is no protrusion
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| What is spina bifida cystica? | The spinal cord is not closed all the way and a sac is protruding
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| What is meningocele? | Less severe form of spina bifida cystica where the protruding sac contains meninges and spinal fluid
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| What is myelomeningocele? | More severe form of spina bifida cystica where the protruding sac contains meninges, spinal fluid and nerves
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| What vitamin deficiency has been implicated in the development of spina bifida? | Folic acid
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| How much folic acid is normally contained in a multivitamin? | 0.4 mg
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| 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
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| What prenatal test can be used to identify NTD? | Alpha-feta protein testing of maternal blood
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| At what gestational period would the AFP test be done? | 16-18 weeks gestation
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| Where are the majority of myelomeningoceles located? | In the lumbosacral area
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| What other condition is experienced by 90% of infants with myelomeningoceles? | Hydrocephalus
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| When is the preferred surgery time period for treatment of myelomeningoceles? | Between 12 and 72 hours to prevent infection/trauma
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| There is a high correlation between an allergy to this product and the diagnosis of NTD | Latex
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| What position should an infant be laying in who has a myelomeningoceles? | Prone
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| Preoperatively, how is the myelomeningoceles cared for? | Keep sac moist with normal saline dressings and change q 2-4 hours
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| Postoperatively, how should the infant be positioned who had a myelomeningoceles? | Prone or side-lying and held upright
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| What complications are associated with a myelomeningoceles? | Urinary/bowel dysfunction
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| What procedure is used in the maintenance of urinary dysfunction in a child with myelomeningoceles? | Clean intermittent catheterization
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| What medications are used to treat urinary dysfunction in a child with myelomeningoceles? | Ditropan and Detral are used to treat overactive bladder
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| What is defined as the imbalance of production and absorption of cerebrospinal fluid? | Hydrocephalus
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| Name two reasons for the accumulation of CSF in the brain | Too much production of CSF and blockage of drainage of CSF (NTD)
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| Name two signs of hydrocephalus | Enlarged head circumference (95th percentile) and signs of increased intracranial pressure (ICP)
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| What can be used to drain the CSF fluid that builds-up in the head (hydrocephalus)? | Ventricular peritoneal shunt
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| 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
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| Name several signs of possible shunt malfunction in the treatment of hydrocephalus | Widening sutures, fever, malaise and irritability
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| This is a chronic disorder characterized by recurrent unprovoked seizures | Epilepsy
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| 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
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| This type of partial seizure is characterized by automatisms such as smacking the lips and repeating words over and over again | Complex partial (psychomotor)
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| Name the four types of generalized seizures | Tonic-clonic (grand mal), absence (petit mal), atonic (drop attacks) and myoclonic
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| What are some characteristics of a tonic-clonic seizure? | Intense muscular contractions, patient may be cyanotic or incontinent, confused afterwards
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| 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
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| 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
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| 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
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| Name two unclassified epileptic seizures | Infantile spasms and Lennox-Gestaut syndrome
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| 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
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| 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
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| In regards to seizures, what is the purpose of doing laboratory studies? | To rule-out infection and metabolic disturbances
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| What is the most useful diagnostic tool in diagnosing seizures? | EEG; specific seizures elicit specific EEG patterns
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| This diet, used in the treatment of seizures, involves high fat, low carbs or moderate protein intake | Ketogenic Diet
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| This type of therapy is the mainstay in the treatment/management of seizures | Drug therapy
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| This antiepileptic medication can cause allergic rashes, nausea, diplopia, blurry vision and drowsiness | Carbamazepine (Tegretol)
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| This antiseizure medication can cause rashes, sedation, nystagmus and ataxia | Phenytoin (Dilantin)
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| This barbiturate is used for sedation purposes in the treatment of seizures | Phenobarbital
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| This medication used to treat seizures can cause thrombocytopenia and negatively affect the liver | Valproic acid (Depakote)
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| Folic acid and vitamin D supplements are needed when taking these two medications used in the treatment of seizures | Phenytoin (Dilantin) and Phenobarbital
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| This type of seizure is one that continues for 30 minutes or more and does not respond to treatment | Status epilepticus
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| When treating status epilepticus, what is the priority intervention? | CAB - circulation, airway, breathing
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| Besides CAB, what is another essential intervention in the treatment of status epilepticus? | IV access until the IV antiepileptics can be administered
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| What medications might be given to someone experiencing status epilepticus before the IV antiepileptics are started? | Diazepam (Valium) of Lorazepam (Ativan)
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| 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
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