Neuro and Nueromuscular for N173 Final

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foxyt14
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265453
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Neuro and Nueromuscular for N173 Final
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2014-03-07 17:57:04
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Neuro
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Neurological and Nueromuscular problems for N173 final
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  1. What is meningitis?
    inflammation of the meninges from a CNS pathogen

    • edema
    • irritation
  2. Viral meningitis in a neonate
    doesn't exist
  3. Bacterial meningitis in the neonate
    • hypothermia
    • poor muscle tone
    • apnea
    • brady
    • tense fontanel
    • seizures
  4. Bacterial meningitis in the infant
    • irritability and progresses to lethargy
    • poor feeding
    • V
    • seizures
    • Fever
    • bulging fontanel (increased ICP)
    • decreased LOC
  5. Bacterial Meningitis in the child
    • headache
    • irritable
    • photophobia
    • sensitivity to sound
    • nuchal rigidity
    • seizures
    • fever
    • V
    • Increased ICP
  6. What is Nuchal rigidity for the person with meningitis
    • stiff neck
    • photophobia
    • headache
  7. 2 Tests done that confirm meningitis
    Brudzinski....flex neck, flex knee

    Kernig....flex hip, straight leg
  8. S/S of viral meningitis
    • it is less severe
    • irritable
    • poor feeding
    • low grade fever
    • slight headache
    • may have sensitivity to bright lights and noise
  9. How do you manage bacterial and viral meningitis?
    • Medical emergency
    • IV antibiotics
    • Droplet precautions
    • Seizure precautions
    • Assess LOC
    • Quiet dark room
    • Non narcotic analgesia
    • cardio respiratory monitor
  10. How do you manage herpes meningitis with meds?
    IV Acyclovir....need to minimize neurological damage
  11. How long are droplet precautions in place for a patient with bacterial meningitis?
    until they have completed 24 hours of antibiotics
  12. What do you frequently assess on a patient with meningitis?
    • LOC
    • ICP.....SEIZURES!!!
  13. Where may a person be who has meningitis?
    PICU....and by the nurses station
  14. Patient teaching for meningitis
    • Always get prompt treatment for otitis media and pneumonia.....
    • Get HIB vaccine
  15. If a person has H flu what are they at risk to get?  What med can be given to them to prevent?
    Rifampin/Cirpofloxacin
  16. Simple partial seizure
    • NO LOC change
    • twitching hand, face or muscle
    • sweating
    • vomiting
    • pupil changes
  17. Partial Complex Seizure
    • impaired consciousness
    • staring
    • lip smacking, chewing, unusual hand movements
    • amnesia
  18. Partial seizures
    only one part of brain is involved
  19. Generalized seizures
    • Entire brain and LOC changes are involved
    • big risk for injury
  20. 4 Generalized seizures
    • Absence
    • Tonic Clonic
    • Myoclonic
    • Atonic
  21. Absence Seizure
    • lasts less than 15 sec
    • lack of awareness and unresponsive during event
    • eye flutter
    • blank stare
    • abrupt onset
  22. Which seizure may be misinterpreted as day dreaming?
    Absence
  23. Myoclonic seizure
    • brief or no LOC change
    • sudden and lasts less than 5 seconds
    • jerking of neck, shoulders, arms and legs
  24. Tonic clonic seizure
    • aura before seizure
    • has 2 parts to it with a post-ictal phase
  25. Tonic
    • LOC change
    • muscle rigidity
    • apnea with cyanosis
    • bowel/bladder incontinence
    • pupil change
  26. Clonic
    • alternating contraction and relaxation of extremities
    • hyperventilation
    • eye deviation
    • drooling
  27. Post ictal phase
    • lethargy
    • confusion
    • unresponsiveness
    • amnesia
  28. Atonic seizure
    • sudden loss of tone....drop seizure
    • eyelid droop
    • head nod
  29. Status Epilepticus
    • a seizure that lasts more than 10-20 min
    • recurrent with no return to baseline
  30. How do you manage Status Epilepticus
    • Airway management is priority
    • Intubation-assist
    • paralytic to stop violent muscle contractions
    • 50mL bolus IV of 50% glucose for hypoglycemia
  31. Complications of Status Epilepticus
    • respiratory and cardiovascular complications
    • brain damage
    • hypoglycemia
  32. Meds given for status epilepticus
    • Diazepam
    • Phenytoin
    • Fosphenytoin
    • Lorazepam
  33. Seizure prevention
    • avoid triggers
    • maintain F/E balance
    • control hyperthermia
    • maintain therapeutic anticonvulsant levels
  34. Seizure management
    • position on side and open airway
    • blow by O2
    • Loosen clothing
    • call for assistance
    • observe and record
    • admin anticonvulsants
  35. What do I monitor when I give anticonvulsants?
    watch for decreased respirations
  36. What do I teach parents about seizure meds?
    That the dosage will need to be reevaluated with growth
  37. Hydrocephalus
    abnormal accumulation of CSF in the ventricles
  38. VP shunt
    used to reroute CSF from ventricles to the peritoneum when a person has hydrocephalus
  39. #1 complication for the VP shunt and how it treated?
    Infection

    antibiotics or removal of shunt
  40. #2 complication for the VP shunt and how is it treated?
    Malfunction/Dislodgment

    Revision
  41. What is CP
    impaired motor function as a result of a brain injury

    Chronic/Non progressive
  42. S/S of CP
    not dx till 2yo

    • poor feeding/weak sucking/FTT
    • Hypotonia..poor muscle tone
    • ABnormal posture
    • Ataxia gait
    • Persistent infant reflexes
    • Seizures
    • DD-motor
  43. Kids with CP will walk
    on their tip toes
  44. Goal for treatment of a kid with CP
    • maximize .......
    • potential locomotion
    • communication
    • self concept
    • independence
    • cognitive level
    • motor skills
  45. Meds for CP
    • Anticonvulsants
    • GERD
    • Muscular Spasticity (Baclofen)
  46. Nutritional support for a person with CP
    • possible NG/GT feeds
    • PT/OT to assist with sucking/swallowing/chew
  47. People with CP CAN have problems with
    • skin break down from braces/casts
    • aspiration from poor airway control/GERD
    • Trach
    • DD...special ed
  48. Genetic transmission of Muscular Dystrophy
    it is an x linked disorder

    females are the carriers and males get it
  49. Goal for management of Muscular Dystrophy
    • promote....
    • independence
    • self care for as long as possible
    • positive self concept
    • support cognitive development
    • prevent complications
  50. Big problem with Muscular Dystrophy
    end up not being able to walk/move

    need adaptive devices/wheelchairs

    skin breakdown/pressure ulcers
  51. Good exercise for kid with Muscular Dystrophy
    swimming
  52. Biggest problem for a kid with muscular dystrophy
    respiratory compromise

    • aspiration precautions
    • trach possible with progression of loss of muscle tone
  53. How will kids with MD eat?
    • assistance with swallowing from PT/OT
    • NG/G feeds
  54. Reyes Syndrome
    • get from giving aspirin to a kid with a virus
    • influenze, varicella, common cold
  55. Describe Reyes Syndrome
    • liver damage
    • encephalopathy
    • cerebral dysfunction
    • F&E imbalance
    • decreased LOC
    • Increased ICP
    • Respiratory dysfunction
  56. What contains aspirin?
    • anything with "acety"lsalicylate or "Salicy"lic
    • Alka Seltzer
    • Bayer
    • Kaopectate
    • Pepto Bismol
    • St. Joseph
    • Chewable aspirin
  57. Down Syndrome kids are missing
    Trisomy 21
  58. Congenital heart defects commonly seen with Downs
    ASD, VSD, PDA, TOF
  59. GI conditions seen with Downs
    • TEF
    • Pyloric Stenosis
    • Imperforated anus
    • Hirschprungs
  60. Psychiatric disorders seen with Downs kids
    • ADD
    • Anxiety
    • Depression
    • Dementia
  61. Goals for kids with MRCP
    • maximize potential
    • prevent secondary disabilities
    • have reasonable expectations
    • *Give parents confidence.....
    • show how to
    • let do....PRAISE
  62. What is craniostenosis
    it is a small head related to suture lines closing prematurely
  63. What will a baby with craniostenosis look like?
    • small head
    • narrow face
    • flattened contour
    • palpable ridge
  64. 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)
  65. What does the Glasgow coma scale measure?
    verbal and motor responses specific for a childs developmental level
  66. Glasgow Coma Scale scores
    1-2
    6
    8
    • 1-2 Severe head injury
    • 6 Monitor ICP
    • 8 Intubation/Ventilation
  67. 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....

    • obeys commands
    • localizes to pain
    • withdraws from pain
    • Flexes or extends with pain
    • no pain response

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