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PEDS Unit 3 > Cerebral Dysfunction > Flashcards

Cerebral Dysfunction Flashcards

1
Q

What are the 6 steps for degeration of LOC?

A
  • Irritable but consolable
  • Irritable and inconsolable
  • Lethargic when left alone
  • Needs more stimulation to wake up
  • No response to touch
  • No response to pain
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2
Q

Re: LOC, define Lethargic

A
  • Drowsy but awakens with stimulation, slow to answer questions
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3
Q

Re: LOC, define Obtunded

A
  • Difficult to arouse, falls back to sleep in the absence of stimulation
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4
Q

Re: LOC, define Stuporous

A

Needs painful stimulus to arouse, only response might be to withdraw from the painful stimulus

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5
Q

Re: LOC, define Comatose

A

No purposeful movement or response (May still have reflexes intact)

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6
Q

Child with increased ICP exhibits changes in motor function. _____ movement will decrease, and _____ posturing may be observed

A
  • Purposeful
  • abnormal
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7
Q

Describe Decorticate posturing.

A
  • Flexion, or decorticate posturing, refers to flexion of upper extremities with elbows and wrists pulled up toward chin and extension of lower extremities.
  • Plantar flexion of feet may also be observed.
  • This type of posturing implies an injury to cerebral hemispheres.
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8
Q

Describe Decerebrate posturing.

A
  • Extension, or decerebrate posturing, involves extension of upper extremities with internal rotation of upper arm and wrist.
  • Lower extremities will extend, with some internal rotation noted at knees and feet.
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9
Q

Trauma results from physical forces from acceleration, deceleration or deformation.

Describe Coup vs Contrecoup

A
  • Coup- bruising at the point of impact – “head hits window”
  • Contrecoup- bruising at an alternate location – “brain hits back of head”
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10
Q

What is a basilar fracture and what are its s/s?

A
  • Basilar Skull Fracture (back of head trauma)
  • “Raccoon Eyes”
  • Hemotympanum
    • blood in the middle ear
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11
Q

What are the three components to head trauma?

A
  • Primary
    • The contusion or injury
  • Secondary
    • ICP as a result
  • Hematoma
    • Epidural - blood accumulates between the epidura and the skull
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12
Q

What is “Cushing’s Triad”?

A
  • A response to increased ICP
    • Decreased HR
    • Increased BP
    • Irregular breathing
  • This is a really late sign
  • We want to catch it early
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13
Q

What is the result of unchecked ICP?

A
  • Cerebral herniation
    • Pressure forces the brain out the skull hole
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14
Q

What are the early s/s of increased ICP in children?

A
  • Headache,
  • vomiting without nausea,
  • blurred vision,
  • seizures,
  • decreased LOC
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15
Q

What are the early s/s of increased ICP in infants?

A
  • Tense or bulging fontanel,
  • high-pitched cry,
  • changes in feeding,
  • vomiting,
  • irritability (which is a decrease in LOC)
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16
Q

What are the late s/s of increased ICP in infants and children?

A
  • Cushings Triad
    • Bradycardia,
    • irregular breathing,
    • widening pulse pressure,
  • alteration in pupil size or reactivity,
  • coma
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17
Q

What are our priorities for ICP?

A
  • Continual neural assessments!
  • Protect from injury
  • Medications/fluids
  • Family education
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18
Q

Treatment for ICP?

A
  • Abx if bacterial cause of ICP
  • Antiseizure if they’re seizing
  • Corticosteroids to reduce cerebral edema
  • Diuretic to decrease fluid
    • Restrict fluid
    • Watch I/O fluids
  • Only hypertonic solutions
    • Hypotonic will cross blood/brain barrier and increase ICP
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19
Q

What is our family education for ICP?

A
  • Watch for these things to know if you need to come in
  • Fever, vomiting, dizziness, blurred vision, loss of movement, slurred speech, seizures
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20
Q

What is hydrocephalus?

A
  • Brain is making too much CSF or not allowing it to drain
  • Either way, the result is too much CSF in head
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21
Q

Treatment for hydrocephalus?

A
  • Externalized Ventricular Drain (EVD)
  • Ventriculoperitoneal Shunt (VP Shunt)
  • Ventriculoarial Shunt (VA Shunt)
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22
Q

Whay do we raise and lower the EVD bag and what is the result of doing so?

A
  • Bag is raised or lowered to control how much CSF is desired to be drained
  • Low position, more drains
  • Higher position, less drains
23
Q

Where do the VP and VA shunts drain to?

A
  • VP Shunt - leads to peritoneal cavity
  • VA shunt- leads to atrial cavity
24
Q

Nursing Care for a Child s/p VP Shunt Placement

A
  • Continually monitor LOC
  • Monitor for s/s infection
  • Incision site care
25
Q

Key points of VP Shunt Malfunction and Infection

A
  • AN EMERGENCY!
  • Signs and symptoms of VP shunt malfunction are the same as for increased ICP
  • VP shunt infection-
    • Shunt malfunction will also occur in most cases
    • Add fever and abdominal pain to increased ICP s/s
26
Q

Nursing actions for VP shunt malfunction?

A
  • HOB up – head of bed
  • Seizure precautions
    • Side rails up
    • Clear area around pt
  • Call MD
  • Stay with the patient
  • If fever/abdominal pain: prepare for IV abx
27
Q

How is epilepsy dx’d?

A
  • w/ two or more unprovoked seizures with no precipitating s/s
28
Q

How is epilepsy manged?

A
  • Multi-drug treatment
  • Ketogenic diet
29
Q

How is the drug treatment for epilepsy developed?

A
  • Start with one drug and increase dose over time until we get the desired effect
  • If sfx, we’ll back off dose until sfx are gone, but still need to make up for what we just took away, so…
  • We add a second drug and increase dose until desired effect (no seizures)
30
Q

What does the ketogenic diet consist of for epileptics?

A
  • Normal protein, high fat, low carb
  • Puts them in ketogenic state where body burns fat for glucose
31
Q

What are some triggers for seizures?

A
  • Sudden loud sound
  • Fatigue
  • Dehydration
  • Flashes of light/ rapid changes in light/dark
  • Extreme/abrupt temperature changes
32
Q

Sometimes, HCP wants to see the seizure on the monitors, to do this, they’ll ask the parents to…

A
  • keep the child up all night and then admit in the morning.
  • Hope is they’re so tired it triggers the seizure so that the right med/procedures can be developed from there
33
Q

What are absence seizures?

A

A seizure where the pt just checks out for a few seconds and then just comes right back to normal

34
Q

What is the continuing medication management over time for epilepsy/seizures?

A
  • Monitor therapeutic levels
  • Increase dosage as child grows
  • Add second medication ONLY if needed
  • Avoid abrupt discontinuation—gradual dose reduction
  • Family to keep Diastat (rectal diazepam) available at all times
35
Q

What are the considerations for Diastat use?

A
  • If seizure lasts more than 5 mins, then this is used to stop the seizure
  • If < then 5 and typical for the child, don’t use and family will keep track of episodes
  • Educate family to TAKE THE CAP off before they stick it up their kid’s ass!
  • If used, you’ll need to take kid to HCP for f/u
36
Q

If children are seizure free for more than 2 years, the HCP may try to reduce their dose over about 3 months to see if they’ve outgrown their seizures. What is the key thing to remember about timing before doing this?

A

It must be done before or well after puberty to due to hormonal chaos

37
Q

What are febrile seizures?

A
  • seziures triggered by fever
  • usually of >102°
  • occur between 6 months and 3 years of age
  • Febrile seizures do not cause any problems
38
Q

Treatment for febrile seizures, while in hospital?

A

Pt will be given IV or rectal diazepam

39
Q

What is the family teaching regarding febrile seizures?

A
  • Febrile seizures are scary but benign
  • There are no studies that show that attempts to lower temperature will prevent sz
  • If seizure lasts more than five minutes call 911
  • Safety
40
Q

True or False

Tylenol can be used to treat fever and avoid febrile seizures.

A
  • False
  • If its gonna happen, its gonna happen regardless of Tylenol
41
Q

What is our nursing care for the child with a seizure disorder?

A
  • Protect from injury
  • Know what happens for the individual child
  • Medicate (if applicable)
  • Family educaion
42
Q

What is Meningitis and why is it life threatening?

A
  • It is an inflammation of the meniges around the brain and spinal cord
  • inflammation can be baterial or viral
    • may also be caused by some medications
  • Its proximity to the brain and spinal cord is why it is life threatening
43
Q

If there is ICP present with meningitis, do we do the LP? why or why not?

A
  • Thats a big fat NO!
  • It can cause cererbral herniation
44
Q

If we can’t do the LP for meningitis, what is our alternate course of action?

A

Assume its bacterial and administer abx

45
Q

What are the long term complications of meningitis?

A
  • Deafness
  • Seizure disorder
  • Hydrocephalus
  • Cognitive Deficits
46
Q

What is the treatment for meningitis?

A
  • Rapid admin of antibiotics
47
Q

If petechiae is present with meningitis, what does it indicate and what are our immediate actions?

A
  • Sure sign that menengitis is caused by the neisseria bacteria
    • Only form that can be transmitted by droplets
  • Get into proper gear precautions
  • Get the abx
  • Treat quickly or it can turn into meningocoxemia - which leads to sepsis
48
Q

What is the tx for Viral (Aseptic) Meningitis?

A
  • Treatment is just manage s/s and sequelae
  • Sequelae = whatever happens after
  • Sometimes given anti-virals
49
Q

What is encephalitis?

A
  • “Inflammation of the brain”
  • Most often caused by viral infection
50
Q

What is the treatment for encephalitis?

A

Treatment is supportive and the same as with any child with decreased LOC or meningitis

51
Q

What are some causes of encephalitis?

A

Rabies, HSV, ebstein barr, varicella, mesquito virus, measles/mumps

52
Q

Long term considerations for encephalitis?

A
  • Even if s/s are controlled, the condition can have devatating effects
  • There will be rehab to do, could have severe brain injuries that will take a lot of work to fix
  • Long term f/u to take care of this
53
Q

What is responsible for the dramatic decline of bacterial meningitis?

A

The Hib (Haemophilus influenzae type B) vaccine in 1990

54
Q

What are two things that can be triggered when you have CNS trauma or illness and what are the key points of each?

A
  • SIADH
    • Oversecretion of ADH
    • Fluid retention and hypotonicity
    • Decreased sodium levels
  • Diabetes Insipidus
    • Posterior pituitary hypofunction
    • Under Secretion of ADH
    • Uncontrolled diuresis

PEDS Unit 3 (9 decks)

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