ch 30 cerebral dysfunction Flashcards by McKenna Michael

neuro system differences in children v adults

-brain growth reflected in head circumference
-cerebral blood flow and O2 consumption 2x as much as adults

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early S+S increased ICP

-headache
-vomiting
-irritability
-personality changes
-fatigue

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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

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S+S increased ICP in kids

-headache
-nausea
-forceful vomiting
-blurred vision
-seizures
-diminished physical and school performance
-increased sleeping, fatigue
-changes in personality

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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

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3 components of glasgow coma scale

-eye opening
-verbal response
-motor response

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score interpretations glasgow coma scale

highest = 15
coma = 8 “less than 8 intubate”
lowest = 3

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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

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common causes head injuries in children

-falls
-motor vehicle accident
-bicycle accident

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CHI

closed head injury

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types CHI

-concussion
-contusion and laceration
-fractures
-epidural hematoma
-subdural hematoma
-other lesions: subarachnoid, cerebral edema, posttraumatic syndrome

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nursing measures to reduce ICP

-calm environment, dark, queit
-elevated hob with head midline
-pad siderails in case of seizures

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med that help decrease ICP

mannitol (diuretic)

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potential complications of head injuries

-hemorrhage
-infection
-edema
-herniation through brainstem

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S+S epidural hematoma

-commonly w/ skull fracture
-arterial bleed
-fast bleed
-sometimes gain consciousness for short period of time
-usually unilateral

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S+S subdural hematoma

-venous bleed
-slower bleed
-with retinal hemorrhage
-usually bilateral

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S+S hydrocephalus

INFANTS
-rapidly increasing head circumference
-refusal to feed
-sleepiness

CHILDREN
-changes in personality
-developmental regression
-ataxia
-incontinence

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signs of progression of a head injury

-altered mental status
-increasing agitation
-development focal lateral neurologic signs
-marked changes in VS

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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