Child with Neurologic Alteration Flashcards
CNS is composed of ________
brain and spinal cord
Myelinization of the nerves begins in the ____ of gestation and is completed by ________.
3rd month; adolescence
Brain and spinal cord are covered by the _______.
meninges
CSF surrounds the _____ and ________.
brain and spinal cord
Brain consists of three sections
cerebrum, cerebellum and brainstem
There are _______ pairs of never
12
Testing of the cranial nerves can indicate ______ and _____ of CNS injury
location and degree
Auto regulation is also known as ______.
This process allows ______ to change in diameter in response to changes in _____ ______ ______.
self-regulation; cerebral arteries ; cerebral perfusion pressure.
auto regulation can be impaired by _____,______,_____.
trauma , ischemia and ICP
What is increased intracranial pressure (IICP)
Results in disturbance in the auto-regulation of the pressure exerted by the blood, brain, CSF, and other space-occupying fluid/mass within the CNS
ICP is defined as pressure sustained at _____mm hg or ____ for _____ minutes or longer
20; higher ; 5
What causes IICP?
_______ or ______ of CSF
Space occupying ____-_____,______
overproduction or malabsorption;
lesion-tumor, hematoma ;
infection and head trauma
Manifestations of IICP in infant are?
poor feeding or vomiting, irritability, restlessness or lethargy bulging fontanel** high-pitched cry Increased head circumference** separation of cranial sutures*** distended scalp veins eyes deviated downward ***late sign increased or decreased sings to pain ***
IICP manifestations for child are ?
Headache diplopia mood swings slurred speech papilledema - after 48 hours altered LOC N/V especially in the AM
Neuro Examination
GCS assesses ___,____,____
eye opening, verbal response and motor response.
GCS ranges from ___ to ____
15 to 3
GCS of 15 indicates
no change in LOC
a GCS of 3 indicates
deep coma and poor prognosis
Neuro Exam - Behavior such as _______
parent’s reporting child isn’t acting like himself
Neuro Exam - decreased response to _____ stimuli is a significant sign of alteration in level of consciousness
painful
Neuro Exam- pupil eval
Compression of the ____ cranial nerve, results in pupil _____ with _____ or ____ constriction
3rd
dilation
sluggish or absent
Neuro Exam- Pupil Eval
a fixed _____ pupil is an ominous sign of an ____ child
other signs include ____ and ______
dilated ; unconscious
ptosis ; ovoid pupil
Neuro exam Motor Function
A child with increased ICP exhibits changes in motor function. _______ movement will decrease and ____ posturing may be observed
purposeful ;abnormal
Neuro exam - motor function
Flexion also known as
Plantar ______
decorticate posturing
** hug the upper extremities and extension of the lower extremities
flexion
NE- motor function
extension or ______
extension of the upper extremities with _____ rotation
lower extremities will ____ with _____ rotation
a change from flexion to extension indicates
decerebrate posturing
internal of the upper arm and wrist
extend with internal of kneed and feet
deterioration
Vital- neuro exam
Cushing response
_______ systolic BP with _____ pulse pressure
_____cardia and a change in _______ rate and pattern.
this is usually present just _____ or at the time of brain stem herniation.
The body is trying to ______
increased;widened
brady; respiration;
before
compensate
this is a late sign
Standard terms for LOC
Full consciousness
awake, alert, oriented, interacts with environment
Confused
lacks ability to think clearly and rapidly
delirous
impairment of reality with hallucination possible
disoriented
lacks ability to recognize place or time or person
obtunded
sleeps and once aroused has limited interaction with environment
stupor- requires ____ to arouse
requires stimulation to arouse
Coma vigorous stimulation produces no _____
response
in child with ICP avoid ____ and position _____ with HOB elevated to ____ degrees
closely monitor for ____ levels
stimulation ; midline;30
glucose
fluid for ICP
NS with child with hypovolemia and osmotic diuretic (mannitol or hypertonic saline , sedation and analgesia and anticonvulsant meds. hyperventilation if there is signs of cerebral herniation
Spina bifida is a ______
classified as _____ closure of the _____
congenital NTD
incomplete closure of the vertebrae
Spina bifida occulta
spina bifida cystica
closed in lower lumbar area
