ch 30 cerebral dysfunction Flashcards
neuro system differences in children v adults
-brain growth reflected in head circumference
-cerebral blood flow and O2 consumption 2x as much as adults
early S+S increased ICP
-headache
-vomiting
-irritability
-personality changes
-fatigue
S+S increased ICP in infants
-inconsolability
-bulging fontanels
-high pitched cry
-macewen sign (“cracked pot sound”)
-increased sleeping, fatigue
-poor feeding
-vomiting
-sun setting eyes
S+S increased ICP in kids
-headache
-nausea
-forceful vomiting
-blurred vision
-seizures
-diminished physical and school performance
-increased sleeping, fatigue
-changes in personality
late S+S increased ICP in infants/kids
-bradycardia
-decreased motor response to command
-decreased sensory response to painful stimuli
-alterations in PERRLA
-extension/flexion posturing
-decreased LOC
-coma
3 components of glasgow coma scale
-eye opening
-verbal response
-motor response
score interpretations glasgow coma scale
highest = 15
coma = 8 “less than 8 intubate”
lowest = 3
screenings/tests to determine brain function
-blood test (including drug test)
-lumbar puncture
-EEG
-auditory and visual evoked potential tests
-CT and MRI
-nuclear brain scan
common causes head injuries in children
-falls
-motor vehicle accident
-bicycle accident
CHI
closed head injury
types CHI
-concussion
-contusion and laceration
-fractures
-epidural hematoma
-subdural hematoma
-other lesions: subarachnoid, cerebral edema, posttraumatic syndrome
nursing measures to reduce ICP
-calm environment, dark, queit
-elevated hob with head midline
-pad siderails in case of seizures
med that help decrease ICP
mannitol (diuretic)
potential complications of head injuries
-hemorrhage
-infection
-edema
-herniation through brainstem
S+S epidural hematoma
-commonly w/ skull fracture
-arterial bleed
-fast bleed
-sometimes gain consciousness for short period of time
-usually unilateral
S+S subdural hematoma
-venous bleed
-slower bleed
-with retinal hemorrhage
-usually bilateral
S+S hydrocephalus
INFANTS
-rapidly increasing head circumference
-refusal to feed
-sleepiness
CHILDREN
-changes in personality
-developmental regression
-ataxia
-incontinence
signs of progression of a head injury
-altered mental status
-increasing agitation
-development focal lateral neurologic signs
-marked changes in VS
signs of brainstem involvement in head injury
-deep/rapid/gasping breaths
-slowing of pulse
-extreme fluctuations in BP
S+S leaking CSF from head injury
-bleeding from ears/nose
-watery discharge from nose
-nose discharge positive for glucose
S+S bacterial meningitis infants
-fever or hypothermia
-poor feeding
-bulging fontanel
S+S bacterial meningitis children
-sudden onset headache
-fever
-vomiting
-severe headache with irritability
potential complications bacterial meningitis
encephalitis
coma
death
SIADH
Dx bacterial meningitis
spinal tap - takes 72 hrs for result to come back
Tx bacterial meningitis
-broad spectrum Abx before spinal tap results come back (vancomycin)
-increase hob
-seizure precautions
-limit stimulation
-IV fluids (limit), meds, Abx
-isolation precautions, PPE, pink arm band
types cerebral infections
-nonbacterial meningitis
-TB meningitis
-brain abscess
-encephalitis
-rabies
-reyes syndrome
-HIV encephalopathy
infection of membranes that surround brain and spinal cord
meningitis
inflammation of brain
encephalitis
2+ unprovoked seizures
epilepsy
meds to stop seizures
valium
diazepam
nursing interventions after seizure
-seizure precautions
-immediate med (-pam)
-blood draw (serum levels Na, med levels, CBC)
-VS (fever)
-neuro checks q1h
types seizures
-partial
-generalized (tonic clonic)
-atonic/akinetic
what is period post-seizure called
postictal
Dx seizures and epilepsy
EEG
Tx/management seizures and epilepsy
-meds
-ketogenic diet
potential side effects of seizure control meds
-allergic drug rash
-sleepiness
-change in mood/behavior
-vision changes
-ataxia
seizure lasting greater than 30 mins
status epilepticus
nursing interventions status epilepticus
-admin diazepam
-ensure safety
-time length of seizure
considerations with taking phenytoin/phenobarbitol
-don’t take with milk
-vit d and folic acid supplements
types headaches
-acute
-acute recurrent (migraine)
-chronic progressive
-chronic nonprogressive
seizure triggers
-video games
-flashing
-loud noises
increased ventricular fluid putting pressure on brain
hydrocephalus
S+S hydrocephalus in infant
-*head enlargement
-bulging fontanels
-“setting sun eyes”
-poor feeding
-lethargy
Tx hydrocephalus
-VP shunt
S+S hydrocephalus in children
-increased ICP
-headache with awakening
-irritable, confused, lethargic
complications with VP shunt in Tx of hydrocephalus
-infection
-malfunction
-herniation of brain if pressure not relieved
