NeuroPeds

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Author:
madelynlee
ID:
69300
Filename:
NeuroPeds
Updated:
2011-02-27 18:49:44
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Neuro
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Description:
Neurological Alterations Across the Lifespan: Pediatrics
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  1. nervous system consists of
    • brain
    • SC
    • nerves
  2. largest part of the brain is what and consists of what
    • cerebrum
    • 2 hemispheres and several lobes
  3. frontal lobe controls...
    • personality
    • emotions
    • complex intellectual fxn
    • voluntary mvmt
  4. parietal lobes ctrl...
    sensory inputs (pain, pressure, temp)
  5. temporal lobes ctrl...
    • taste
    • smell
    • hearing
    • speech
    • language
  6. occipital lobe ctrls...
    vision
  7. cerebellum ctrls...
    • motor coordination
    • posture
    • equilibrium
  8. brain stem regulates...
    resp. and cardiac fxns
  9. difference btw brain of child vs adult
    • top heavy; head is larger in prop. to body
    • neck musc not well dev
    • thin cranial bones
    • highly vascular brain
    • excessive spinal mobility
    • immature musc, joint capsules & ligaments of cervical spine
  10. confusion def
    disoriented to time, place, person
  11. delirium def
    state of confusion, fear, agitation, anxiety
  12. obtunded def
    limited response to the envt; i.e. child falls asleep unless given verbal or tactile stimulation
  13. stupor def
    response to rigorous stimulation only
  14. coma def
    the child cannot be aroused
  15. name 5 altered states of consciousness
    • confusion
    • delirium
    • obtunded
    • stupor
    • coma
  16. clinical manifestations of decline in a child's LOC (6)
    • awake, alert, appropriate
    • slight disorientation
    • restless, fussy, irritable
    • drowsy but responds to loud and/or painful stim
    • unresponsive
    • decorticate or decerebrate posturing
  17. dx'ic lab tests for child neuro
    • CBC
    • blood chem
    • clotting factor
    • blood cultures
    • toxicology assessment of blood and urine
    • UA/UC
  18. dx'ic tests for child neuro
    • lumbar puncture
    • EEG
    • CT
    • MRI
    • skull xray
  19. remember what 3 things re: ped GCS
    • eye opening
    • verbal response
    • motor response
  20. what is most important aspect of GCS in a child and why
    motor response; because children cannot control their reflexes, though they may keep their eyes shut when you ask them to open them b/c they're afraid, etc.
  21. RN assess what re: ped neuro (MAIN 4 TO KNOW)
    • responsiveness
    • airway
    • breathing
    • circulation
  22. most common injury in childhood is...
    head trauma
  23. TBI causes what in a child (3)
    • intellectual impairment
    • szs
    • physical disability
  24. primary vs secondary head trauma
    • primary = occurs at time of insult
    • secondary = body's response to initial injury d/t hypoxia, hemmorage, edema
  25. mild head injury
    • remains conscious, OR
    • loses consciousness for less that 5 min.
    • child may have amnesia re: event
  26. moderate head injury
    • loses consciousness for 5-10 min.
    • child may have amnesia re: event
    • HA
    • N/V
  27. severe head injury
    • unconscious more than 10 min.
    • may show signs increased ICP
    • changes in resp efforts/periods of apnea
    • tachycardia (blood loss, hypoxia, pain)
  28. RN assessment re: head trauma - what 3 things in particular
    • collaborate
    • prevent complications
    • promote recovery
  29. SC injury - complete vs incomplete
    • complete = irreversible; lose all sensory, motor, autonomic fxn below level of injury
    • incomplete = involves varying degrees of sensory, motor, and autonomic fxn
  30. s/s hypovolemic shock
    • tachycardia
    • increased RR
    • weak peripheral pulses
    • pallor
    • cold extremities
  31. s/s neurogenic shock
    • hypotension
    • bradycardia
    • warm and dry extremities
  32. s/s spinal shock
    • flaccid, areflexic extremities
    • hypotension
    • bradycardia
    • flushed, dry skin
    • loss of sphincter ctrl w/ urinary retention
  33. injury from what vertebrae = high risk for autonomic dysreflexia
    • T6 and above
    • sometimes as low as T10
  34. s/s spinal cord injury
    • hypovolemic shock
    • increased ICP
    • resp depression
    • neurogenic shock
    • spinal shock
  35. SCIWORA
    • "spinal cord injury w/o radiographic abn"
    • initial films or CTs show no bony deformity and child is believed free of injury, BUT profound or progressive paralysis comes on stat or w/in 48 hrs
  36. spinal cord injury how dx
    • by observation
    • neuro exam
    • radiologic studies (CT, xray, MRI)
  37. cerebral palsy is caused by (3)
    • brain anoxia (pre-,peri-,post-natal)
    • premature
    • low weight
  38. cerebral palsy def
    • non-progressive
    • motor and posture dysfxn
    • may have cog. and lang. delays
  39. s/s cerebral palsy
    • delay in fine and gross motor skills
    • poor vision
    • hearing loss
    • cog. deficits
    • speech/lang. delays
  40. higher incidence of cerebral palsy in who (2)
    • premature infants
    • twins
  41. assess all children at each health care visit for...
    dev delays
  42. clinical manifestations of cerebral palsy
    • poor head ctrl
    • clenched hands after 3 mos of age
    • increased musc tone (stiffness)
    • decreased musc tone (floppy/limp)
    • arching of back
    • inability to sit up bu 8 mos
    • feeding probs (gag/choke when fed)
    • favoring one side of the body
    • increased irritability, crying
    • scissoring of the legs
    • pointing toes
    • tremors or szs
    • exaggerated started reflex
    • failure to smile by 3 mos
  43. how dx cerebral palsy
    • medical hx to identify the cause
    • brain imagery (CT, MRI)
    • genetic tests
    • metabolic tests
  44. don't give cerebral palsy dx until what age
    2 yrs
  45. NIs for cerebral palsy most want what for the child
    • maintain mobility
    • maintain maximum joint ROM
    • optimize musc ctrl, balance
    • optimize communication
    • ADLs
  46. phenol blocks are effective how long for a cerepral palsy pt
    3-8mos
  47. how do you give baclofen to a cerebral palsy pt
    • oral
    • intrathecal - after 4 yrs old
  48. meds to give cerebral palsy pt
    • dantrolene sodium
    • baclofen
    • diazepam
    • phenol blocks
    • botulinum toxin A (botox) injections
  49. dental hygeine is esp impt for who
    cerebral palsy pts
  50. 2 surgeries for cerebral palsy pts
    • orthopedic - to acheive better leg mvmt and gait ctrl, correct extremity deformities
    • neurological - selective dorsal rhizotomy to improve PROM, spasticity and gait
  51. complementary therapies for cerebral palsy pt
    • hippotherapy
    • Euromed Adeli Suit (Poland)
    • massage therapy
    • music therapy
    • aqua therapy
  52. hippotherapy does what
    improves strength, balance, and posture
  53. cerebral palsy - when is underweight vs. overweight a problem
    • underweight in infancy
    • overweight in late childhood and adolescence
  54. diet concerns for cerebral palsy pts
    • some ppl don't feel the food/drink in their mouth
    • lifelong risk for ASPIRATION
    • tactile defensiveness
    • under/overwt.
  55. s/s hydrocephalus
    • disproportionately large head
    • prominent scalp veins
    • translucent skin on forehead
    • wide, palpable suture lines
    • restlessness
    • irritability
    • diminished LOC
    • sluggish pupils
  56. hydrocephalus caused by
    • infection
    • hemorrhage
    • tumor
    • structural deformity
  57. hydrocephalus
    imbalance in the production and absorption of CSF
  58. tests to help dx hydrocephalus
    • CT
    • MRI
    • skull xray
    • ultrasound
    • echoencephalograph
  59. shunting devices are...
    to divert excess CSF from head into blood stream (because it goes to BVs on its own anyway)
  60. pre-op hydrocephalus do what
    • measure head circumference
    • watch for s/s increased ICP
    • asses respirations
    • I/O
    • monitor nutritional status
  61. post-op hydrocephalus do what
    • VS
    • neuro check
    • sleep pattern
    • I/O
    • skin integrity
    • BS
    • s/s infection
    • s/s increased ICP
  62. spina bifida develops when
    during first 28 days gestation
  63. cause of spina bifida
    • unknown, but...
    • envtal exposure to chemicals and meds
    • maternal nutrition may play role
    • folic acid esp
  64. spina bifida def
    neural tube defect that affects head and spinal column - incomplete closure
  65. clinical manifestations of spina bifida
    • higher deformity = greater neurological dysfxn
    • sac-like protruding from neonate's back
    • LE partially or completely paralyzed
    • B & B sphincters may be affected
    • renal impairment
    • faulty kidney innervation
    • orthopedic complications (flexion or extension contractures)
    • hydrocephalus is common
  66. meningomyelocele
    spina bifida is the generic term used to describe "
  67. post-op spina bifida pts RN do what
    • VS
    • s/s infection
    • hyrdocephalus
    • increased ICP
    • watch for CSF leakage
  68. NIs for spina bifida
    • prevent infection
    • assess neuro
    • preserve neurologic and urologic fxn
    • provide meticulous skin care
  69. how care for infant w/ spina bifida
    place infant in prone position, cover defect w/ sterile dressing moistened with NS preoperatively

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