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328 Pediatrics Exam 2 > Cerebral Dysfunction > Flashcards

Cerebral Dysfunction Flashcards

1
Q

Manifestations of increased intracranial pressure (ICP) in infants?

A
  • 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)
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2
Q

Manifestations of increased intracranial pressure (ICP) in children?

A
  • Drowsiness/indifference
  • Headache
  • Diplopia (double vision), blurred vision
  • Poor appetite
  • Nausea and Vomiting (not related to meals)
  • Seizures
  • Inability to follow simple commands
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3
Q

Late signs of increased intracranial pressure (ICP) in an infant and child?

A
  • Decreased consciousness
  • Bradycardia
  • Decreased motor response to pain
  • Alterations in pupil size and reactivity
  • Extension or flexion posturing (decorticate/decerebrate)
  • Papilledema (optic disc edema)
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4
Q

Nursing care for ICP?

A
  • 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
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5
Q

Nursing alerts for headaches (↑ ICP)?

A
  • 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)
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6
Q

What is meningitis?

A

Inflammation of the meninges (membrane that surrounds the brain and the spinal cord)

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7
Q

Meningitis etiology?

A
  • Bacterial
  • Viral
  • Fungal
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8
Q

Meningitis clinical manifestations?

A
  • Brudzinski’s sign
  • Kernig’s sign
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9
Q

Describe Brudzinski’s sign.

A

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

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10
Q

Describe Kernig’s sign.

A

Inability to straighten the leg when the
hip is flexed to 90 degrees

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11
Q

Meningitis diagnostic procedure?

A
  • 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
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12
Q

Bacterial Meningitis etiology?

A
  • H. influenzae
  • pneumococcal
  • streptococcal
  • Neisseria meningitis
  • Group B Strep
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13
Q

Viral Meningitis etiology?

A

Enteroviruses most common cause

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14
Q

Bacterial Meningitis diagnosis?

A
  • WBC > 1,000microL
  • Glucose low
  • Protein high (100-500mg/dL)
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15
Q

Viral Meningitis diagnosis?

A
  • WBC 10-500/microL
  • glucose is typically normal
  • protein typically normal (<150mg/dL)
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16
Q

Bacterial Meningitis treatment?

A

Antibiotics within 1 hour- 100% mortality if untreated

17
Q

Viral Meningitis treatment?

A

Symptomatic (e.g., Tylenol [Acetaminophen] or Ibuprofen [Motrin] for pain, fever)

18
Q

Bacterial Meningitis prevention?

A

Vaccine:

  • Haemophilus influenzae type B (Hib)
  • pneumococcal
  • meningococcal
19
Q

Viral Meningitis prevention?

A

No vaccines available

20
Q

Bacterial Meningitis isolation?

A

Notify health department to arrange follow-up of household and community contacts - depends on bacteria

21
Q

Viral Meningitis isolation?

A

Close contacts are not likely to develop viral meningitis.

22
Q

What are seizures?

A

Excessive and disordered neuronal discharge of electrical activity in the brain

23
Q

Seizure diagnosis?

A
  • EEG
  • CT
  • MRI
24
Q

Seizure ABC management?

A
  • Oxygen
  • Suction of secretions, vomitus
  • Turn on side
  • Do not put anything in the mouth
25
Q

Nursing considerations for a child experiencing a seizure?

A
  • 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
26
Q

Drug therapy for seizures?

A

anticonvulsants

27
Q

Side effects of anticonvulsants?

A
  • sedation
  • somnolence
  • dizziness
28
Q

Therapeutic management of seizures?

A
  • 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
29
Q

What is Hydrocephalus?

A

an imbalance in the production or absorption of CSF in the ventricles of the brain

30
Q

Hydrocephalus clinical manifestations?

A
  • Infancy
    • Head growth abnormal rate, bulging fontanel, setting sun sign, irritable, poor feeding
  • Childhood
    • Headache, irritable, lethargic, incoherent, confused
31
Q

Hydrocephalus surgical treatment?

A

Ventriculoperitoneal shunt (VP) - drains CSF into the peritoneal cavity (space around the abdominal organs) where is it absorbed into the bloodstream

32
Q

What is shunt infection?

A
  • Infection can cause the shunt to become blocked or cause inflammation, leading to ICP
    • Fever
    • Vomiting
    • Lethargy
33
Q

Shunt Infection treatment?

A
  • Antibiotic therapy
  • Removal of shunt, external ventricular drain (EVD)
34
Q

What is shunt malfunction?

A

Catheter disconnects or breaks due to:

  • Growth of child (increasing height)
  • Obstruction from scar tissue
  • Over-drainage or under drainage of CSF
35
Q

Shunt malfunction management?

A

surgery

328 Pediatrics Exam 2 (7 decks)

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