Card Set Information
Peds Exam II
Neuro on Exam II
What are THREE causes of Increased Intracranial Pressure?
Increased Brain Mass
Increased Cerebral Blood Volume
Obstruction of CSF (cerebral spinal fluid)
What are S/S of increased intracranial pressure?
widening pulse pressure
high pitched cry
bulging, non-pulsatile fontanele
What are the THREE signs of Cushing's triad?
What are FIVE ways to manage ICP?
Why do we use paralyzing agents to manage ICP?
It takes over respirations and conserves energy and decreases O2 demand.
What does the "bolt" do during ICP?
Gives ICP reading. DOES NOT DRAIN FLUID
What are general aspects of the neuro assessment?
What else is included in the neuro assessment?
Glasgow Coma Score (centered around altered mentation)
What does a UNILATERAL FIXED pupil signify
lesion on same side
What does a DILATED/NON-REACTIVE pupil signify?
What does a PINPOINT pupil signify?
What does a WIDELY DILATED pupil signify?
after seizure, eye trauma
What does a WIDELY DILATED & FIXED pupil signify?
paralysis of CNII
pressure from herniation
What do CONJUGATE pupils signify?
paired working together
movement of eyes in direction opposite head rotation
What does HIPPUS of the pupil signify?
rapid dilation, contraction of the pupil
What are the FIVE levels of consciousness?
: awake, alert, oriented, appropriate for age
: impaired decision making
: confusion regarding person, place, time, dec LOC
: limited spontaneous movement
: arousable with stimulation ONLY
What are THREE forms of LOC?
: deep sleep, responds to vigorous stimulation only
: no motor or verbal response
: permanently lost fx of cerebral cortex
What is decorticate posturing?
Abrnomal flexion to the core?
What is decerebrate posturing?
What is the etiology of Pediatric Neurological Problems?
Infexion (i.e. Meningitis)
Prenatal (Neural tube deficit, Downs)
Postnatal (brain tumor)
What is spina bifida occulta?
Failure of posterior archest to close. Not symptomatic. Tufts of hair.
What is spina bifida occulta
Defect in closure, exterior sacular protrusion, but not too bad.
What is meningocele?
Sac like cyst containing meninges, symptomatic, spinal cord is in tact.
What is meningomyelocele?
Spinal cord in sac with meninges. More serious.
What is encephalocele?
No compatible with life, looks like born with 2 heads.
What is anencephaly?
complete absence of brain. Can breath because brain stem is intact.
What is Monroe Kelly Hypothesis?
If manipulate any component of CNS, will see changes in other compartments.
What is hydrocephalous
Excessive accumulations of CSF within ventricles
What are two types of hydrocephalous?
: Problem with CSF being reabsorbed
: CSF flow is normal but becomes blocked->excessive accumulation of CSF.
What are clinical manifestations of hydrocephalous?
Abnormally enlarged head
shrill, high-pitched cry
How is hydrocephalous treated?
What are NI for VP Shunt?
Elevate HOB post-op
observe for s/s of increased ICP
observe for s/s of CSF infxn
try and keep off operative side
*If shunt is not working, don't want to leave it in body->disconnect it and connect it to ext. drain.
Follow specific orders on level and pressure, fluid replacement
What are the THREE types of meningitis?
What is the patho of meningitis?
local infxn that spreads to systemic circulation
Organisms invade underlying blood vessels and CSF
What are s/s of meningitis?
non-specific in younger children
dehydration (can be because haven't been feeling well for a while)
What are s/s of meningitis in older children?
may have classical symptoms as well as additional findings
+kernig's sign (flex hip and knee and extend leg)
+brudzinski sign (flexion at hips and knee)
How is meningitis diagnosed?
If 1 or 2 WBC in CSF->aggressive TX!
decreased glucose, increased protein
What is a NI for LP?
Resuscitation at fingertips
: babies and children at extreme knee chest position
How is meningitis treated?
Hydrate (though on fluid restriction)
What is meningococcemia?
Potentially life threatening->usually fatal.
Death can occur within hours
Incubation pd 2-10 days, spread via oral or nasal droplet
Watch for petachiae or rash
What is the etiology of seizures?
What are the classifications of seizures?
Generalized: simple partial, complex partial, tonic-clonic
What are febrile seizures?
Generalized seizures in children with febrile illness: the PEAK temp, rather than the rapidity of the fever
What are s/s of the febrile seizure?
generalized tonic-clonic seizure lasting a few minutes and self-limited
POST-ICAL (Confused for an hour)
What is tx for seizures?
: o2, sx, bvm
LP with 1st seizure
aggressive antipyretic therapy
parental reassurance, education
What are the qualifications for epilepsy surgery?
: 3-5 hospital stay weaned off meds (camera and EEG)
: single photon emission computed tomography. Localization of epilepsy to region of brain, measures blood flow to various regions.
: Helps to further localize sz focus with subdural electrodes placed, mapping by neurologist
: removes areas of sz foci (focal resection of total hemispherectomy)
What is craniosynotosis?
Premature closure of the cranial sutures?
Elongation of the skull (anterioposterior)
Etiology is unknown-not the result of impaired brain growth
What are s/s of craniosynotosis?
abnormal head shape
How is craniosynotosis diagnosed?
Inspect for symmetry
Palpate sutures, fontanelle, OFC (falls off chart)
May see papiledema
What is CP and what are risk factors?
Leading cause of childhood disability
Born at less than 32 weeks
What does prematurity have to do with CP?
Fragile brain vasculature
physical stresses of prematurity can compromise blood flow
Hemorrhage in germinal matrix
Parenchymal hemorrhage leads to periventricular leukolmalacia (PVL)->strong indicator of CP
What are some early ID of CP?
alteration in muscle tone, deep tendon reflexes
delay in acquistion of motor milestones
persistence of primitive reflexes
abnormal postural reactions
How can you predict CP in the NICU?
dominant asymmetrical tonic neck reflex
What is spastic CP?
tense, contracted muscles (most common type of CP)
What is athetoid CP?
constant uncontrolled motion of limbs, head, and eyes
What is rigidity CP?
tight muscles that resist the effort to make them move
What is ataxic CP?
poor sense of balance, often causes falls and stumbles
What is tremor CP?
uncontrollable shaking, interfering with coordination
What are clinical manifestations of CP?
delayed gross motor development
alterations of muscle tone
What are interventions for CP?
visual & auditory therapy