Flashcards in Neurologic Dysfunction (Part 1) - Unit 3 Deck (79)
What are some differences between the head in adults and children?
Larger heads with weaker neck muscles (top heavy!), thinner cranial bones, less myelinated nerves that are easily injured, open fontanels in infants that can "pop off"
Can little little little kids say they're nauseous?
As myelination progresses, what disappears?
The primitive reflexes disappear.
Startle reflex - when does it disappear?
When does the palmar grasp disappear?
When does the plantar grasp disappear?
When does stepping disappear?
When does tonic neck (fencing - looks like they're gonna fence) disappear?
When does the babinski reflex disappear?
What are parts of the neuro assessment in children?
Family history (genetic component), health history (respiratory infection ---> meningitis?), physical exam (look at norms, maybe they're super talkative one day and then not!)
What are parts of the physical exam for neuro?
Size and shape of head, level of development, spontaneous activity, postural reflex activity, symmetry of movement (reach with one hand?), tremors, twitching, pupils, vitals, facial features (drooping? stroke?), cry (shrill = head injury), eye movement, lip smacking (seizure!), yawning (involves cranial nerve)
An increase in systolic blood pressure without change in diastolic pressure is referred to as: ???
A widened pulse pressure, which is a sign of increased intracranial pressure. Look at pupils!
Consciousness - most important indicator of neurologic dysfunction. T/F?
Consciousness - the ___ to sensory stimuli.
What are the two aspects of consciousness?
Alertness (arousal-waking state with the ability to respond) and cognitive power (ability to process stimuli).
What questions might we ask ask to assess consciousness for pediatrics?
"Do you know your parents? What meal is coming next?"
What is confusion?
Not oriented X3
What is delirium?
Confusion with fear and agitation
What is lethargy?
Sluggish speech, very sleepy, increase ICP, post-op, etc.
Obtunded - what is it?
Arouses with stimulation.
Stupor - what is it?
Slow response to vigorous stimuli, then returns to sleep - grunting happens, too.
Coma - what is it?
No response to painful stimuli.
Persistent vegetative state - what is it?
Permanent loss of cerebral cortex function, reflexive response - they may track your fingers across the room, it could just be a reflex.
Glasgow coma scale - what 3 parts does it cover? what does a score of 15 mean? 8? 3?
Covers eye opening, verbal response, and motor response. 15 = unaltered LOC.
8 or below = usually a coma.
3 = deep coma or death (brain death)
Eye opening - less than one year - what are the numbers?
4 - Spontaneous
3 - To shout
2 - to pain
1 - None
Verbal responses - 0 -2 years - what are the numbers?
5 - Babbles, coos appropriately
4 - Cries but is inconsolable
3 - persistent crying or screaming in pain
2 - grunts or moans to pain
1 - None
Motor responses -
6 - Spontaneous
5 - Localizes pain
4 - withdraws to pain
3 - Abnormal flexion to pain (decerebrate)
2 - Abnormal extension to pain (decorticate)
1 - None
What are parts of the emergency management of the unconscious child?
Airway, reduction of ICP (reduce stimuli, pain, don't try to wake up), treat shock.
Should parents who are arguing leave the room?