Exam 3: Cerebral

Question 1

what is the three part assessment of the glasgow coma scale?

Answer 1

eyes, motor, verbal

Question 2

scoring of glasgow coma scale?

Answer 2

score of 15-great, unaltered LOC

score of 3- lowest, vegetative state

Question 3

what are some clinical manifestations of ICP in babies?

Answer 3

poor feeds, irritability, sun-setting eyes, shrill cry, tense fontanels, macewen sign

Question 4

what is macewen sign?

Answer 4

percussion of fontanels and getting cracked pot (resonant) sound may indicate separated sutures, or increased pressure

Question 5

CM of ICP in children?

Answer 5

Headache

Vomiting, with or without nausea

Seizures

Diplopia, blurred vision

Question 6

late signs of ICP?

Answer 6

-cheyyene-stokes breathing
-bradycardia
-papilledema
flexion/extension posturing

Question 7

emergency management of child with ICP?

Answer 7

airway management
reduction of ICP
treatment of shock

Question 8

pain therapy meds for ICP?

Answer 8

opioids, fentanyl, midozalam, acetaminiphen, codeine

Question 9

ICP monitoring indications

Answer 9

glasgow coma scale< or = 8

Question 10

Most common brain malformation
Bridge connecting 2 hemispheres of brain partially or completely missing
Normal intelligence with mild learning differences to severe mental retardation

Answer 10

agenesis

Question 11

Head circumference 2 standard deviations below normal
Down’s, chromosomal abnormalities
Maternal substance abuse/viral exposure
Cognitive, motor, speech delays

Answer 11

microcephaly

Question 12

Commonly associated with myelomeningocele

May not be apparent at birth

May appear after primary closure of defect

Results from disturbances in dynamics of CSF

Answer 12

HIDROCEPHALUS

Question 13

Non-obstructive

Impaired absorption of CSF within subarachnoid space

Venous drainage insufficiency

Over production of CSF (rare)

Malfunction of arachnoid villi

Answer 13

communicating hydroceph

Question 14

Obstructive

CSF flow through ventricular system is prevented

Most cases a result of developmental malformations

Other causes: neoplasms, infections, trauma

Answer 14

non-communicating hydroceph.

Question 15

Hydrocephalus: Monitoring

Answer 15

head circ
ultrasound monitoring-ventricle size
fontanel tension

Question 16

initial treatment of hydroceph

Answer 16

shunt, getting extra csf removed

Question 17

Most common diagnosed neoplasm in infants

Answer 17

neoblastoma

Question 18

neoblastoma: Primary sites

Answer 18

Abdomen, adrenal gland, chest or neck

Question 19

S/S of neoblastoma

Answer 19

noted on palpation, incidental finding on radiograph, swelling/bruising around eyes

Question 20

Acute inflammation of CNS
Decreased incidence following use of Hib vaccine
Can be caused by various bacterial agents:
Streptococcus pneumoniae
β-Hemolytic streptococci
Escherichia coli

Answer 20

bacterial meningitis

Question 21

how is transmition of bacterial meningitis?

Answer 21

Droplet infection from nasopharyngeal secretions

Question 22

definitive diagnostic test for bacterial meningitis?

Answer 22

lumbar test

Question 23

nursing management for meningitis?

Answer 23

Droplet precautions
Supportive Care
Antibiotics
Hydration
Nutrition

Question 24

Inflammatory process of CNS with altered function of brain & spinal cord

Variety of causative organisms:
viral most frequent

Answer 24

encaphilitis

Question 25

Vector reservoir in United States for encephilitis

Answer 25

ticks and mosquitos

Question 26

Clinical Manifestation of Severe Encephalitis

Answer 26

High fever

Disorientation, stupor, coma

Seizures, spasticity

Ocular palsies

Paralysis

Question 27

Toxic encephalopathy associated with other characteristic organ involvement

Characterized by fever, profoundly impaired consciousness, and disordered hepatic function

Answer 27

reye’s syndrome

Question 28

Potential association between aspirin therapy for fever and development

Answer 28

reye syndrome

Question 29

diagnosis of reye syndrome

Answer 29

Liver biopsy

Liver enzymes, ammonia level, coag. studies

Question 30

patient teaching for someone with reye’s

Answer 30

no use of ASA for anyone under age of 19

Question 31

Malfunction of brain’s electrical system
Determined by site of origin
Most common neurologic dysfunctionin children
Occur with wide variety of CNS conditions

Answer 31

seizures

Question 32

Cryptogenic seizures

Answer 32

no clear cause

Question 33

Sudden momentary loss of muscle tone
Sudden fall to ground, often on face
Onset usually age 2-5 years
May or may not have loss of consciousness
Loss of awareness
Less severe—head droops forward several times
Interferes with learning/schoolwork

Answer 33

atonic

Question 34

Sudden brief contractions of muscle group
May be single or repetitive
No loss of consciousness
Often occur with falling asleep
May be nonspecific symptom in many CNS disorders

Answer 34

myoclinic

Question 35

meds for seizure child

Answer 35

ativan, valium, diastat gel

Question 36

seizure lasting >30 minutes
or
series of seizures without regaining premorbid level of consciousness

Answer 36

status epilepticus

Question 37

Transient disorder of childhood
Affect approximately 3% of children
Usually occur between ages 6 months and 3 years
Rare after age 5 years
Usually occur with temperatures > 101.8° F

Answer 37

transient

Question 38

treatment of febrile seizures

Answer 38

Fever reduction
Seizure control if ongoing
Diazepam (IV or rectal)
Evaluate history (episodic and family)
Management:
Avoid tepid baths—usually ineffective
Antipyretics ineffective as preventive
Protect child from injury during seizure
Call 911 if seizure >5 minutes duration