Cerebral Dysfunction Flashcards
Manifestations of increased intracranial pressure (ICP) in infants?
- Irritability and/or restlessness
- Bulging, Tense Fontanel (Anterior)
- High-pitched cry
- Poor feeding or refusal to eat
- Vomiting
- Seizure
- Separated Cranial Sutures (sutures between the bones of the skull separate)
- Increased head circumference
- Setting-sun sign (downward deviation of eyes)
Manifestations of increased intracranial pressure (ICP) in children?
- Drowsiness/indifference
- Headache
- Diplopia (double vision), blurred vision
- Poor appetite
- Nausea and Vomiting (not related to meals)
- Seizures
- Inability to follow simple commands
Late signs of increased intracranial pressure (ICP) in an infant and child?
- Decreased consciousness
- Bradycardia
- Decreased motor response to pain
- Alterations in pupil size and reactivity
- Extension or flexion posturing (decorticate/decerebrate)
- Papilledema (optic disc edema)
Nursing care for ICP?
- Airway Breathing Circulation (ABCs)
- Ensure patent airway – suctioning, oxygen
- Elevate HOB to 30º, keep head midline
- Maintain normothermia – treat fever
- Frequent neuro checks using Glasgow Coma Scale
Nursing alerts for headaches (↑ ICP)?
- Progresses in frequency and severity over brief period (2-3 weeks)
- Awakens child from sleep
- Occurs in early AM (upon arising)
- Accompanied by unexplainable vomiting
- Associated with change in gait, behavior, or personality
- Intensified by vasalva maneuver (BM, cough)
What is meningitis?
Inflammation of the meninges (membrane that surrounds the brain and the spinal cord)
Meningitis etiology?
- Bacterial
- Viral
- Fungal
Meningitis clinical manifestations?
- Brudzinski’s sign
- Kernig’s sign
Describe Brudzinski’s sign.
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
Describe Kernig’s sign.
Inability to straighten the leg when the
hip is flexed to 90 degrees
Meningitis diagnostic procedure?
- Lumbar puncture: needle is inserted into the lumbar subarachnoid space to collect cerebrospinal fluid for diagnostic testing.
- May do MRI or CT prior to lumbar puncture
Bacterial Meningitis etiology?
- H. influenzae
- pneumococcal
- streptococcal
- Neisseria meningitis
- Group B Strep
Viral Meningitis etiology?
Enteroviruses most common cause
Bacterial Meningitis diagnosis?
- WBC > 1,000microL
- Glucose low
- Protein high (100-500mg/dL)
Viral Meningitis diagnosis?
- WBC 10-500/microL
- glucose is typically normal
- protein typically normal (<150mg/dL)
Bacterial Meningitis treatment?
Antibiotics within 1 hour- 100% mortality if untreated
Viral Meningitis treatment?
Symptomatic (e.g., Tylenol [Acetaminophen] or Ibuprofen [Motrin] for pain, fever)
Bacterial Meningitis prevention?
Vaccine:
- Haemophilus influenzae type B (Hib)
- pneumococcal
- meningococcal
Viral Meningitis prevention?
No vaccines available
Bacterial Meningitis isolation?
Notify health department to arrange follow-up of household and community contacts - depends on bacteria
Viral Meningitis isolation?
Close contacts are not likely to develop viral meningitis.
What are seizures?
Excessive and disordered neuronal discharge of electrical activity in the brain
Seizure diagnosis?
- EEG
- CT
- MRI
Seizure ABC management?
- Oxygen
- Suction of secretions, vomitus
- Turn on side
- Do not put anything in the mouth
Nursing considerations for a child experiencing a seizure?
- Establish IV access
- Medication
- Diazepam administration (e.g., rectal, IV)
- Lorazepam IV
- Monitoring of oxygenation, blood pressure, heart rate, respiratory rate
- Assessment/documentation: duration and description of seizure, color change (pallor/cyanosis), incontinent of urine
Drug therapy for seizures?
anticonvulsants
Side effects of anticonvulsants?
- sedation
- somnolence
- dizziness
Therapeutic management of seizures?
- Education
- Do not stop abruptly - must wean medication
- Ketogenic diet (high fat, low carb, creates Ketosis)
- Vagus nerve stimulation (device implanted) use of a device to stimulate the vagus nerve, which is a key part of the autonomic nervous system.
- Surgical therapy for underlying causes of seizures
What is Hydrocephalus?
an imbalance in the production or absorption of CSF in the ventricles of the brain
Hydrocephalus clinical manifestations?
- Infancy
- Head growth abnormal rate, bulging fontanel, setting sun sign, irritable, poor feeding
- Childhood
- Headache, irritable, lethargic, incoherent, confused
Hydrocephalus surgical treatment?
Ventriculoperitoneal shunt (VP) - drains CSF into the peritoneal cavity (space around the abdominal organs) where is it absorbed into the bloodstream
What is shunt infection?
- Infection can cause the shunt to become blocked or cause inflammation, leading to ICP
- Fever
- Vomiting
- Lethargy
Shunt Infection treatment?
- Antibiotic therapy
- Removal of shunt, external ventricular drain (EVD)
What is shunt malfunction?
Catheter disconnects or breaks due to:
- Growth of child (increasing height)
- Obstruction from scar tissue
- Over-drainage or under drainage of CSF
Shunt malfunction management?
surgery
