A
B
C
D
100

How are cognitive impairments measured?

3 parts to intellectual disabilities

  • Intellectual functioning IQ of 70-75 or below

  • Functional impairment in disability of 10 adaptive skill areas

  • Younger than 18 at diagnosis 

100

Define ADHD and how to assess it.

No single cause; thought to be interaction between genes & environment

  • One of most common diagnosed childhood disorder

  • Affects self-regulation & executive function; social, cognitive, emotional, behavioral, and social functioning.


Core s/s: 

  • inattention, impulsivity, and hyperactivity in at least 2 settings


Diagnosed by specific DSM criteria but includes:

  • S/s begin before 12 years of age

  • Occur in 2 or more settings and interfere with school, work, or social functioning.

  • 3 types:

1. Predominantly Inattentive - at least 6 or more symptoms months

2. Predominantly Hyperactive/Impulsive - at least 6 or more at least 6 months

3. Combined Type - significant number of each

100

What are the major s/s of ICP?  When might you assess ICP?

S/s in INFANTS: 

• Irritability; poor feeding

• High-pitched cry; infant is difficult to soothe

• Fontanels are tense and bulging

• Cranial sutures are separated

• Eyes have the setting-sun sign

• Scalp veins are distended

• Increased occipitofrontal circumference


S/S in CHILDREN: 

• Headache

• Vomiting, with or without nausea

• Motor weakness, discoordination, and seizures

• Diplopia and blurred vision

• Irritability, restlessness, and behavioral changes

• Sleep alterations and somnolence

• Personality changes


Late S/s: 

• Bradycardia

• Decreased LOC (↓sensory & motor responses)

• Change in pupil size & reactivity

• Posturing (flexion or extension)

• Change in respirations; may have Cheyne-Stokes respiration



100

What medications are used as rescue medications to stop seizures?

4 Treatment options:

1. Drug therapy - anticonvulsant medications

  • oxcarbazepine, topiramate, valproic acid, phenobarbital

  • For emergency: rectal diazepam, intranasal midazolam,   buco clonazepam

2. Ketogenic diet - high-fat/low carb/adequate protein diet

3. Vagus nerve stimulation

4. Surgical therapy.

200

What is the difference between a developmental delay and a cognitive impairment?

Developmental Delay: Significant lag in development.  May catch up to peers.

Cognitive Impairment: Permanent 

200

What are some red flags for Autism?  How do we assess for Autism?

• Does not respond to name by 12 mo

• Does not point at objects

• Does not play Pretend

• Avoids eye contact

• Wants to be alone

• Can't understand feelings

• Delayed speech (Echolalia)

• Obsessive interests

• Gives unrelated answer to questions

• Upset by minor changes

• Unusual reactions to senses (to smell, sound, taste, touch/feel).

• Repetitive movements such as flapping hands, rocking, spinning in circles

• Fails to meet developmental milestones

• May excel in 1 particular area (e.g. art, music, math,memory



200

What is a Ventriculoperitoneal Shunt and when is it used?

A cerebral shunt that drains excess cerebrospinal fluid (CSF) [from the brain to end of abdomen] when there is an obstruction in the normal outflow or there is a decreased absorption of the fluid. Cerebral shunts are used to treat hydrocephalus.

200

How is a febrile seizure different from other seizures?  When does it occur? Any treatment necessary?

  • most common in children / account for half of all seizure in children 

  • occur at higher temperatures or as the fever continues to rise over 102.2 F

300

List common causes of hearing impairments

  • One of most common disabilities in the US (genetics or acquired)

  • Many causes are both pre & post-natal; congenital and acquired. 
  • Prevention includes: Prenatal care, avoiding ototoxic drugs, managing diabetes, avoiding alcohol & smoke exposure, routine immunizations, and minimizing noise pollution.  

300

How would you distinguish ADHD from absence seizures?

Your child's attention/memory can be regained in the case of ADHD, while those with absence seizures might need a moment to reorient themselves to what they were doing

300

Define a concussion. What are the major s/s and treatment options?

  • Transient & Reversible

  • Minor concussion - alteration in neurological or cognitive function w/ or w/o LOC

  • Minor concussion cared for at home 
  • Major concussions - more & more severe symptoms, take longer to resolve

  • S/s of concussions include:

  • HA, confusion, vomiting, amnesia, slower response times
  • Reasons to take child to ED

*Motor Vehicle Accidents

*Under 2 and fell greater than 3 feet; infants w/unwitnessed falls

*Any neuro changes: LOC, confusion speaking or walking, seizures

*Vomiting > 3 times

*Fluid leaking from ears or nose

*Infants with bulging fontanel

300

What is the difference between spina bifida occulta & cystica?  How is each treated?

  • spina bifida cystica - where lesion occurs = degree of impairment

  • spina bifida occulta - many not have observable s/s

  • Therapeutic Management:
    1. Surgical closure with in first 24-72 hours
    2. Neurologic and orthopedic assessments
    3. Management of any associated issues or complications

400

Describe sensorineural hearing loss.

  • Involves damage to the inner ear structure and/or auditory nerve.


    • Can be congenital defect or result of infection, ototoxic drugs, or excessive noise exposure

  • Results in distorted sounds, unable to distinguish sounds; affects comprehension

  • Cochlear implants for severe hearing loss

  • Early use (surgery by 18 months) encouraged to help with language development
  • Management: Lip reading, sign language; Other assistive devices

400

What is Reye Syndrome?  What may precede it? How is it treated?

  • Is an acute encephalopathy with hepatic dysfunction. Characterized by fever & profoundly impaired consciousness.

  • Often follows viral illness; typically varicella or influenza

  • Caution against giving aspirin during viral illnesses in children
  • Diagnosis: by liver biopsy.

  • Treatment is aggressive supportive therapy. Nursing care: need careful observation for an change in LOC or s/s of increased ICP

400

What are the major s/s of tetanus?  

  • S/s → progressive stiffness & tenderness of neck & jaw (“Lock jaw”), difficulty opening mouth, facial muscle spasm causing "sardonic smile

Later s/s → rigid abdomen, difficulty swallowing, respiratory involvement

400

What are the major s/s of Cerebral Palsy?  

  • A non-progressing brain anomaly or injury that occurred before, during, or shortly after birth.

  • Characterized by abnormal muscle tone, coordination, and posture issues.
    • May also have issues with sensation, perception, communication, cognition, and behavior depending on severity and location of the anomaly or injury.

    • Exact prenatal and perinatal causes unknown.

    • Post-natal causes include bacterial meningitis, viral encephalitis, child abuse, car accidents.

  • S/s: Persistent primitive reflexes

    • Poor head control after age 3 months

    • Stiff or rigid limbs

    • Arching back; pushing away

    • Floppy tone

    • Unable to sit without support at age 8 months → should be examined for CP

    • Clenched fists after age 3 months

500

What is sensory overload?  What interventions might one try?

Children with sensory processing challenges can be either overly sensitive or desensitized to a particular type of sensory input. This can have a negative effect on mood, the ability to perform daily functions, and learning.


Preventing Sensory Overload

  • Keep a diary of your child's behavior to identify sensory overload triggers

  • Be proactive to anticipate and prevent sensory overload

  • Use a quiet and calm voice when talking to your child

  • Use appropriate sensory-control tools such as noise-canceling earphones and sunglasses

500

What are the major s/s of meningitis?  What are the differences between the bacterial & viral forms?  What can prevent meningitis?  How do you test for it? Major treatment options?

  • Meningitis is an inflammation of the meninges (the membranes that cover the brain & spinal cord)

  • It can be either Bacterial or Viral cause


    • Bacterial typically more serious than viral forms

  • Decrease in cases since introduction of Hib, pneumococcal, and meningococcal vaccines


  • S/s → fever, headache, nausea, vomiting, irritability, anorexia, photophobia, confusion, back pain and nuchal rigidity (aka stiff neck). May have petechial or purpuric rash

  • Positive Kernig sign and Brudzinski sign


  • Diagnosis → Lumbar puncture definitive test

  • Management →  Isolation, antibiotics, maintain airway, reduce ICP, control temp, seizures, & shock.

  • Nursing care → Keep room quiet & decrease stimuli, may be more comfortable w/o pillow and side-lying because of nuchal rigidity, careful vitals, observe for changes in LOC.

500

Name different types of seizure disorders.   What are the major s/s of each?

  • Generalized Seizures

  • Tonic-Clonic (aka Grand Mal): occurs w/o warning, most dramatic, last 10-20 secs, eyes roll back, body stipend, apneic/cyanotic, increased salivation/ loss swallow reflex, fall to ground, jerking movement last 30 sec - 1hr, postictal state = appear to relax, vomiting, confused, poor coordination, bowl fxn, sleep for hours


  • Absence Seizures (aka Petit Mal): brief changes in LOC, goes unnoticed, abrupt onset, happens 20x a day, confused for ADHD, slight eye/facial twitching, amnesia for episode


  • Atonic (aka Drop Attacks): Sudden loss of muscle tone & control

  • Infantile Spasms: occur during the first 6-8 months of life, numerous daily seizures. no postictal stage 

  • Febrile Seizures: most common in children; brief but may last within 15 mins, can be simple or complex

M
e
n
u