neurological disorder 2

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  1. DX lumbar puncture
    • Purpose: analyze CSF diagnose infection, hemorrhage, obstruction to CSF to
    • contraindicated: any infection at insertion site and incr ICP
    • apply emla 1 hr cream, sometimes consciously sedation
    • position them appropriately- hold the patient
    • needle in back L3-L$
    • strict aspestic tech
    • collect 3 tubes w/ 2-3ml CSF
    • analyze glucose/protein-, culture and sensitivity- last tube most clean
    • GLUCOSE: bacteria will feed on the glucose- low
    • Protein- will be high if bacteria
  2. Positioning for lumbar puncture
    • sit the baby up to back open- have them hold still
    • older kids lie them on their side- have them hold should not hurt. feel pinch
  3. Lumbar puncture: Nursing
    family/patient education: reduces fear and apprehension- explain what to expect during procedure

    • Nursing: Post procedure care:
    • lie flat for 30min- 1 hr as order or according to policy- bc we don't want air to go up to the brain. sometimes air gets introduce inside
    • increase fluids- to incr CSF
    • comfort measure and analgesia for headaches
    • encourage parents to comfort child
  4. DX testing
    • CT
    • Nursing
    • - protect from radiation exposure
    • - sedation necessary for children who cannot hold still

    • MRI
    • Nursing:
    • -assess for internal or external metal devices
    • - sedation for children who can't hold still
    • - assess for allergies if contrast is order
    • - encourage fluids if not contraindicated

    • Cerebreal angiography: visual of brain blood vessels
    • - assess allergy bc contrast
    • - after procedure- HOB up and incre fluids if u can

    • Head and Neck injury
    • nursing - helps identify ICP, skull defect etc

    • PET- similar to MRI/CT
    • EEG
  5. Febrile seizure
    • most common seizure of childhood
    • defined as generalized seizure lasting < 15 minutes that occurence in 24 hour period and is associated with fever without any CNS infection.
    • most often affects children <5 yrs 3m-5y
    • self limiting seizure
    • rapid rising seizure
    • most in boys
    • should have follow up with HCP
    • Complications are rare: motor coordination deficit, intellectual disability, behavior problems
  6. Febrile seizure; therapeutic management
    • HCP will:
    • determine cause of fever
    • provide fever control
    • seizure medications
    • - PO or rectal diazepam? generic name rectal if seizing
    • - safe and effective in terminating febrile seizure activity
    • - used in high risk children or those with anxious parents
  7. Febrile seizure: Assessment
    • monitor VS, incr risk with rapid raise in temp
    • 102.2 or 39c
    • S/S:
    • - stiffening of entire body, jerkingof arms and legs
    • - complete lack of response to any stimuli, loss of consciousness
    • - eyes deviated, staring, rolling back, moving back and forth
    • - urinary incontenience
    • - nosey breathing, labor, slower than normal
    • Documentation:
    • - onset and duration of procedure
    • - characterics of patients after the seizure: LOC, apnea, cynanosis, motor activity, incontinence
    • collect and document complete Hx as dx is based on hx and PE
    • determine source of fever
  8. febrile seizure: nursing management
    • initiates safety/seizure precautions: pad side rails, remove objects that can cause injury, have suction and o2 equipment available
    • parental support and reassurance
    • Provide family education:
    • - controlling fever- give med when suspected fever comes
    • - safety during seizure activity
    • - med teaching: po or rectal diazepam
    • - when to call HCP
    • - when to call 911
    • - all seizure activity needs prompted medical attention
  9. FS home care
    • family education: safety is key
    • main goals:
    • - protect airway and patient safety
    • - remain calm and with child
    • - remove objects from mouth
    • - remove funiture of sharp objects
    • - place child on side or abd clear mouth or suction bulb
    • - perform jaw thrust or chin lift for noisy or labored breathing
    • - do not restrain or try to stop seizure movements
    • - do not hold tongue or put anything in mouth
    • - document length, movement see other slide
    • Control fever and not PO meds until the child is stable and conscious
    • - give antipyretics- acteminophen suppositories
    • - remove clothing
    • - cool wash cloth neck and face
    • - sponge bath do not immerse seizing child in tub
  10. FS when to call 911
    • Call HCP:
    • after a brief repeated febrile seizure and follow home care

    • Call 911:
    • - serious trouble breathing, stops breathing
    • - any injury occur
    • - this is the first one
    • - seizure last more than 5 mins
    • - cyanosis
    • - unresponsive to painful stimuli after seizure
  11. Intracanial Infections: meningitis
    • inflammation of the meninges most common infection of the CNS
    • encephalitis: inflammation of the brain
    • myelitis: inflammation of the spinal cord
    • Causes:
    • Bacteria:
    • - Streptococcuspneumoniae
    • - neisseria meningitis
    • - Hib
    • Virus: aspetic not contagious
    • TB: mycobacteriumtuberculosis (not seen very often, may see it from foriegn)
  12. Intracranial infection: bacterial meningitis
    • life threaten bacterial infection, imflammation of the meninges, potentially fetal
    • causes:
    • neonate: GBS most common, Group D strep, e.coli (transmitted in utero)
    • after neonatal: streppneomia, chlamydia,
    • most often it comes from something else in the body look at previous slide
    • bacteria invades brain tissues causing infection and inflammation of meninges
  13. meningitis: signs and symptoms
    • triad symptoms:
    • Fever
    • Headache
    • meningeal signs: nuchal rigidity, brudzinski and kernig
    • other: irritabilty, lethargy, seizure, convulsions
    • neonate: poor feeding, fever, hypothermia, shill cry, apnea, apathy, jaundice, bulging fontannals, pallor, hypotonia, hypoglycemia
    • infants and children: nuchal rigidity, opisthotonos, photophobia, altered senses, anorexia, N/V
    • addi s/s: petechia rash, projectile vomiting, chills, hypotension, diplopia, sunset eyes, alter mental status, coma
  14. To test irritation of meninges
    • important to know
    • Brudzinski sign: lift neck and knees comes up
    • Kernig sign: cant straighten leg bc meninges muscle spasm
    • opisthotonos: hyperextended legs and head. to relieve pain
  15. DX meningitis Lumbar puncture
    • to examine CSF
    • bacteria isolated and identifed
    • evidence of meningeal inflammation
    • blood culture, coagulation study, serum glucose, electrolytes
    • CBC
  16. long term complications
    nerve deafness, blindness, etc
  17. bacterial meningitis medical emergency therap management
    • medical emergency
    • detoriation is rapid occurs in less than 24 hours with out treatment
    • provide support and isolation precautions
    • meds;
    • - IV antibiotics immediately
    • - analgesia, antipyrectics non pharm measures
    • - corticordsteriods
    • - dopamine and other intropic agents
    • IV fluids
    • monitor blood gas level, provide oxygen
    • to decress ICP: burrow holes in cranium
  18. bacterial meningitis interventions
    • droplet precautions until 24hr of antibiotic
    • hypotherimia blankets
    • seizure precautions
    • monitor VS, I&O
    • frequent neuro checks
    • dark quiet enviroment
    • keep flat in bed move gently
    • admin antibiotics and meds as ordered
    • emotional support
  19. Aseptic viral meningitis
    • self limited, viral infection of meninges and spinal fluid with negative CSF bacterial cultures
    • causes: virus
    • - measles mumps herpes, echovirus, west nile virus
    • Assessment: abrupt or gradual onset
    • s/s: headache, fever, malaise, abd pain, nausea, vomiting, signs of meningeal irritation (less sick but check LP)
    • - leg or back pain, sore throat, chest pain, generalized muscle aches or pain
    • symptoms resolve spontaneously in 2-7
  20. viral meningitis
    • DX: CBC, cultures: viral, CSF, and throat, CT, MRI, EEG
    • thera: contact precautions, fever control, IVF position for comfort. antimicrobial spending results of LP
    • intervention: same as other, hand washing, teach low getting it
    • complication: no residual effect
  21. Structural defect: hydrocephalus
    • too much CSF
    • excessive CSF in ventricles or subarachnoid space. communicating (too much fluid but getting where it suppose to) or non communicating (something obstructing area)
    • Assessment:
    • - skull enlarging
    • - bulging fontennals
    • - distended veins
    • - thin shiny scalp skin
    • - irritable or lethargy
    • - high pitch cry
    • - sunset eyes
    • - unable to support head, head percussion crack pot sound
    • - vomiting not related to food intake
  22. hydrocephalus assess
    • medulla effect
    • rr, pulse lower
    • bp up
  23. hydrocephalus therap
    • goal: early identification to prevent brain damage
    • management depends on cause:
    • - overproduction: diurectic
    • - obstruction: tumor may have to do surgery
    • meds: anticonvulsants for possible seizure
    • - carbamazepine (tegratol)
    • ventriculoperitoneal shunt insertion: thin cather underneath the skin
    • drains fluids into peritoneum which is then absorbed into systemic circulation and excreted
  24. Hydrocephalus VP shunt
    • removes excess fluid
    • leaves extra tubing to accomodate for growth- babies
    • one way valve
  25. hydrocephalus interventions
    • assist with earl detection of hydrocephalus
    • measure HC < 3 yrs of age, plot on growth chart to detect deviations from normal
    • note symmetry of head
    • s/p VP shunt placement care
  26. VP shunt s/p placement: nursing intervention
    • prevent shunt occulsion: do not have child lie on side of shunt
    • lie flat: to prevent rapid decompression (not draining too fast), monitor closely, incre ICP
    • monitor of infection
    • supports child head upright
    • head skin care turn frequently
    • neuro checks and motor function for changes
    • monitor abdomen distension
    • teach parents s/s incr ICP
    • offer emotional support to fam
    • refer to national hydrocephalus founds
  27. Neural Tube disorder spina bifida "divided spine"
    • congential malformation that produces defects in the skull and or spinal column
    • (results from the failure of neurtube closing during emnyotic development)
    • Types:
    • - spina bida occult: cant see changes dimple, hair tuft
    • - soina bifida cystica: you can see it meningocele is coming out in the bubble has CSF, myelomenigocele (spinal cord coming out) higher up on the spine the worst pt will be
    • causes:
    • lack of folic acid
    • exposure teretogem
    • isolated birth defect
    • multiple malformation syndrom
  28. Neural tube disorder
    • complications
    • decr motor activity below the defect or paralysis
    • neurogenic bladder or bowel
    • CNS infection
    • hydrocephalus
    • death
    • add 400mcg to diet folic acid
    • risk of second child with NTD inc 1:20
  29. NTD DX
    • sonogram/ us
    • maternal alpha feto protein serus and amniocentesis
    • draw labs at 15w levels would be incr if baby had NTD
  30. Spina Bifida nursing assessment
    • occulta: hidden
    • observe: skin abnormalities over spinal defect.
    • hair tuft depression or dimple
    • soft fatty deposits, port wine nevi, foot weakness, bowel/bladder dysfunction
    • Cystica:
    • associated abnormalites
    • cyanosis, club foot knee contracture hydrocephalus, curvaure of spine, flaccid movements or paralysis or intellect disabilit
    • after birth observe and document spontaneous movements of lower extremities and for bladder/bowel disfunction
  31. Spina bifida thera man
    • utero: surgery fetoscopy surgery
    • after birth
    • surgical correction or closure of defect within 12-48 hrs
    • shunt placement hydrocephalus
  32. neural tube disorder interventions 2
    • nursing interventions: maintain latex precautions: genetic counseling
    • encourage folic acid
    • provide emotional support both pre op and post op
    • preopertive position on abdomen moist dressing on it
    • - obtain head CS, monitor I&O, monitor for infection, monitor bladder/bowel function
    • post op
    • on abdomen to not put pressure on wound
    • monitor sensation movement below site
    • prevent constipation, provide rom
    • teach family clean intermittent catherization
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neurological disorder 2
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