07 Neurological / Cognitive Disorder

Question 1

What is often a first sign of increased ICP (Intracranial Pressure)?

Answer 1

Level of Consciousness

Question 2

What does the pediatric glasgow coma scale assess for?

Answer 2

Eyes

Motor Response

Verbal Response

Score of 15 is unaltered LOC

Score of 3 is extremely decreased LOC

Question 3

What are some late signs of Cushing’s Triad/Refelx? (3)

Answer 3

Increased Systolic BP, widened pulse pressure

Bradycardia

Irregular Respirations

Question 4

What is the leading cause of injuries and death i nchildren?

Answer 4

Motor vehicles.

Motor behicles, falls and bike injuries are the 3 major causes for brain injury in children

Question 5

What are primary head injuries that may occur at the time of trauma? (4)

Answer 5

1. Concussion/Contusions
2. Skull Fracture
3. Intracranial Hematoma
4. Diffuse Injury

Question 6

What are subsequent complications of head injuries? (4)

Answer 6

1. Hypoxic brain injury
2. Increase ICP
3. Infection
4. Cerebral edema

Question 7

What is the most common head injury? What does it result from?

Answer 7

The most common head injury is concussion and results from trauma to the head.

Generally followed by amnesia and confusion.

Question 8

What is Second Impact Syndrome?

Answer 8

• Second injury before brain has time to heal
• Rapid and severe, life threatening swelling can occur
• Typically occurs when there’s concussion and brain gets injuried before it has time to heal

Question 9

The terms contusion and laceration are used to describe what?

Answer 9

visible bruising and tearing of cerebral tissue

Question 10

Coup describes

Answer 10

bruising at point of impact

Question 11

Contrecoup describes

Answer 11

bruising at site far removed from point of impact. Occurs in kids with big heads.

Question 12

What may cause hemorrhage with hypovolemic hypotension i older children?

Answer 12

Fracture on the underside of the skull that can tear the meningeal artery

Question 13

What exactly is meningitis?

Answer 13

Inflammation of meninges

Question 14

What are some differences between viral and bacterial meningitis?

Answer 14

Bacterial appearance is cloudy vs Viral’s Clear

Bacterial has increased protein, and decreased glucose, wehreas Viral levels are within the norm.

The bacterial meningitis is more dangerous than viral as well and may cause developmental complications

Question 15

What kind of bacterial agents causes meningitis?

Answer 15

• meningococci
• strep pneumococci
• haemophilius

Question 16

What is the primary source of bacterial meningitis infections?

Answer 16

Ear infections.

There’s drop infection from naspharyngeal secretions.

Question 17

What’s the main sign of meningitis?

Answer 17

Petechial or purpuric rash

Question 18

What are 3 main nursing interventions for meningitis? (3)

Answer 18

• universal and droplet infection control measures
• IV antibiotics
• Decrease environmental stimulation

Question 19

what is the most serious complication of meningitis?

Answer 19

Shock may occur resulting in peripheral circulatory collapse

Question 20

What are 3 main symptoms that occur with viral meningitis?

Answer 20

1. headache, irritability, nuchal rigidity
2. Low grade fever
3. Photophobia

Question 21

What is Reye Syndrome?

Answer 21

Toxic encephalopathy associated with hepatic organ involvement

Question 22

Reyes syndrome typically follows viral illness and is associated with the use of what meds?

Answer 22

associated with use of ASA

Question 23

What is plagiocephaly and what is it believed to be caused by?

Answer 23

Skul is progressively flattened and believed dto be caused by supine positioning.

Question 24

What is craniosynostosis?

Answer 24

Premature closure of single/multiple sutures of cranial vault, face and base of skull

May lead to increased ICP and brain damange

Management is surgical release of closed sutures.

Question 25

What is hydrocephalus?

Answer 25

Hydrocephalus is a symptom of an imbalance in the production and

absorption of cerebrospinal fluid in the ventricular system. Spinal

fluid accumulates resulting in compression of the brain against

surrounding rigid bony cranium and enlargement of the skull.

Question 26

What are treatments for hydrocephalus?

Answer 26

Mechanical shunting

}Shunt placed in lateral ventricle & drains into internal jugular vein or peritoneum.

}Shunts need to be revised as child grows and length of tube needs to be increased (common reason for revision). Shunts are also prone to malfunctioning and may require revisions.