Neuro and Nueromuscular for N173 Final
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Neuro and Nueromuscular for N173 Final
Neurological and Nueromuscular problems for N173 final
What is meningitis?
inflammation of the meninges from a CNS pathogen
Viral meningitis in a neonate
Bacterial meningitis in the neonate
poor muscle tone
Bacterial meningitis in the infant
irritability and progresses to lethargy
bulging fontanel (increased ICP)
Bacterial Meningitis in the child
sensitivity to sound
What is Nuchal rigidity for the person with meningitis
2 Tests done that confirm meningitis
Brudzinski....flex neck, flex knee
Kernig....flex hip, straight leg
S/S of viral meningitis
it is less severe
low grade fever
may have sensitivity to bright lights and noise
How do you manage bacterial and viral meningitis?
Quiet dark room
Non narcotic analgesia
cardio respiratory monitor
How do you manage herpes meningitis with meds?
IV Acyclovir....need to minimize neurological damage
How long are droplet precautions in place for a patient with bacterial meningitis?
until they have completed 24 hours of antibiotics
What do you frequently assess on a patient with meningitis?
Where may a person be who has meningitis?
PICU....and by the nurses station
Patient teaching for meningitis
Always get prompt treatment for otitis media and pneumonia.....
Get HIB vaccine
If a person has H flu what are they at risk to get? What med can be given to them to prevent?
Simple partial seizure
NO LOC change
twitching hand, face or muscle
Partial Complex Seizure
lip smacking, chewing, unusual hand movements
only one part of brain is involved
Entire brain and LOC changes are involved
big risk for injury
4 Generalized seizures
lasts less than 15 sec
lack of awareness and unresponsive during event
Which seizure may be misinterpreted as day dreaming?
brief or no LOC change
sudden and lasts less than 5 seconds
jerking of neck, shoulders, arms and legs
Tonic clonic seizure
aura before seizure
has 2 parts to it with a post-ictal phase
apnea with cyanosis
alternating contraction and relaxation of extremities
Post ictal phase
sudden loss of tone....drop seizure
a seizure that lasts more than 10-20 min
recurrent with no return to baseline
How do you manage Status Epilepticus
Airway management is priority
paralytic to stop violent muscle contractions
50mL bolus IV of 50% glucose for hypoglycemia
Complications of Status Epilepticus
respiratory and cardiovascular complications
Meds given for status epilepticus
maintain F/E balance
maintain therapeutic anticonvulsant levels
position on side and open airway
blow by O2
call for assistance
observe and record
What do I monitor when I give anticonvulsants?
watch for decreased respirations
What do I teach parents about seizure meds?
That the dosage will need to be reevaluated with growth
abnormal accumulation of CSF in the ventricles
used to reroute CSF from ventricles to the peritoneum when a person has hydrocephalus
#1 complication for the VP shunt and how it treated?
antibiotics or removal of shunt
#2 complication for the VP shunt and how is it treated?
What is CP
impaired motor function as a result of a brain injury
S/S of CP
not dx till 2yo
poor feeding/weak sucking/FTT
Hypotonia..poor muscle tone
Persistent infant reflexes
Kids with CP will walk
on their tip toes
Goal for treatment of a kid with CP
Meds for CP
Muscular Spasticity (Baclofen)
Nutritional support for a person with CP
possible NG/GT feeds
PT/OT to assist with sucking/swallowing/chew
People with CP CAN have problems with
skin break down from braces/casts
aspiration from poor airway control/GERD
Genetic transmission of Muscular Dystrophy
it is an x linked disorder
females are the carriers and males get it
Goal for management of Muscular Dystrophy
self care for as long as possible
positive self concept
support cognitive development
Big problem with Muscular Dystrophy
end up not being able to walk/move
need adaptive devices/wheelchairs
skin breakdown/pressure ulcers
Good exercise for kid with Muscular Dystrophy
Biggest problem for a kid with muscular dystrophy
trach possible with progression of loss of muscle tone
How will kids with MD eat?
assistance with swallowing from PT/OT
get from giving aspirin to a kid with a virus
influenze, varicella, common cold
Describe Reyes Syndrome
What contains aspirin?
anything with "acety"lsalicylate or "Salicy"lic
Down Syndrome kids are missing
Congenital heart defects commonly seen with Downs
ASD, VSD, PDA, TOF
GI conditions seen with Downs
Psychiatric disorders seen with Downs kids
Goals for kids with MRCP
prevent secondary disabilities
have reasonable expectations
*Give parents confidence.....
show how to
What is craniostenosis
it is a small head related to suture lines closing prematurely
What will a baby with craniostenosis look like?
Treatment for craniostenosis
Surgery with endoscope that opens the skull at prematurely closed suture lines followed by the use of a "molding helmet" (done <3mo old)
What does the Glasgow coma scale measure?
verbal and motor responses specific for a childs developmental level
Glasgow Coma Scale scores
1-2 Severe head injury
6 Monitor ICP
If I am trying to do a Glasgow on a child that is intubated, unconscious or preverbal....what do I do?
do the motor part of the scale....
localizes to pain
withdraws from pain
Flexes or extends with pain
no pain response