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Peds exam 2 > Intracranial > Flashcards

Intracranial Flashcards

1
Q

what is included in the central nervous system

A

brain and spinal cord

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2
Q

what is included in the peripheral nervous system

A

cranial/peripheral/spinal nerves

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3
Q

what does the central nervous system do

A

autonomic nervous system (internal organs and glands) - fight or flight

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4
Q

what does the peripheral nervous system do

A

somatic nervous system (sense organs and voluntary muscles)- sensory input - motor output

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5
Q

what could be diagnosed with a lumbar puncture

A

meningitis/encephalitis, subarachnoid hemorrhage, demyelinating process (guillain-barre)

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6
Q

who should not get a lumbar puncture

A

coagulopathies, increased intracranial pressure, respiratory insufficiency with unsecured airway, hypotension, spinal abscess, status epilepticus

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7
Q

what should be considered when positioning someone for a lumbar puncture

A

maintain airway, open up space for the procedure

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8
Q

what should you assess after a lumbar puncture

A

vital signs, NV status, motor activity

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9
Q

what is a side effect from a lumbar puncture

A

headache

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10
Q

what does an intraventricular catheter with pressure reading

A

allows for drainage and monitoring for intracranial pressure

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11
Q

what is normal intracranial pressure and what is bad

A

normal 0-10 , 20 is devastating changes

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12
Q

what does the head of the bed need to be for increased intracranial pressure

A

15-30 degrees - head in midline

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13
Q

what are some safety precautions that should be followed for someone with intracranial pressure

A

alarms should be on at all time, cluster care

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14
Q

what is a electroencephalogram

A

electrodes placed on while impulses recorded it determines the electrical activity of the brain

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15
Q

what are the interventions for a electroencephalogram

A

may require sedation, minimize external stimuli

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16
Q

what can a electroencephalogram diagnosis

A

seizure disorders - 1hr-24hr monitor for seizure activity

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17
Q

what does a electromyography do

A

electrode placement, tests nerves in the muscles to see if anything is stopping the impulses to diagnosis muscle disorders - can be painful

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18
Q

what can a MRI diagnosis

A

inflammation, congenital abnormalities, hard/soft tissue and bone marrow, leg-calve paresthesia diagnosis

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19
Q

what are some interventions before receiving an MRI

A

remove all metal objects, sedation may be required

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20
Q

what do c-reactive protein and erythrocyte sedimentation rate determine

A

inflammation

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21
Q

what is normal c-reactive protein levels

A

less then 10

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22
Q

what are normal erythrocyte sedimentation rate levels in a newborn vs a child

A

newborn 0-2 and children 0-10

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23
Q

what is a pediatric glassgow coma scale of 9-15

A

unaltered state of consciousness

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24
Q

what is a pediatric glassgow coma score of 4-8

A

state of coma

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25
Q

what is a pediatric glassgow coma score of 3 or less

A

deep coma

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26
Q

what is alert state of consciousness

A

eyes are open, answering questions appropriate

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27
Q

what is lethargic state of consciousness

A

drowsing falls asleep easily

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28
Q

what is obtunded state of consciousness

A

may open there eyes to stimuli, appears confused

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29
Q

what is stupor state of consciousness

A

slower, absent verbal responses, only responds to painful stimuli

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30
Q

what is coma state of consciousness

A

doesnt respond to internal or external stimuli

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31
Q

when does the posterior fontanel close by

A

2 months

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32
Q

when does the anterior fontanel close by

A

12-18 months

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33
Q

when is bludging fontanel normal

A

during crying

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34
Q

what could sustained fontanel bludging mean

A

increased intracranial pressure

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35
Q

what is horizontal nystagmus

A

the eyes move rapidly and uncontrollably from side to side

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36
Q

what is vertical nystagmus

A

the eyes move rapidly and uncontrollably from up to down

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37
Q

what is horizontal nystagmus caused by

A

lesion of the brain stem, phenytoin use

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38
Q

what is vertical nystagmus caused by

A

brain stem dysfunction

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39
Q

what is sunsetting

A

see the whites of the eyes above the iris

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40
Q

what is sunsetting caused by

A

increased intracranial pressure

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41
Q

what are the cranial nerves

A

olfactory, optic, oculomotor, abducens, trigeminal, facial, acoustic, vagus, accessory, hypoglossal

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42
Q

what is the function and assessment of the olfactory nerve

A

sensory- closes eyes and identify scent

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43
Q

what is the function and assessment of the optic nerve

A

motor- visual acuity

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44
Q

what is the function and assessment of the oculomotor nerve

A

motor- follow finger or object with eye

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45
Q

what is the function and assessment of the abducens nerve

A

motor- PERRLA

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46
Q

what is the function and assessment of the trigeminal nerve

A

motor- mastication - infant suck, child bite strength

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47
Q

what is the function and assessment of the facial nerve

A

motor- facial symmetry, expression

48
Q

what is the function and assessment of the acoustic nerve

A

sensory - weber/rhine, whisper test

49
Q

what is the function and assessment of the vagus nerve

A

motor- gag reflex

50
Q

what is the function and assessment of the accessory nerve

A

motor- head position while sitting

51
Q

what is the function and assessment of the hypoglossal nerve

A

motor - spontaneous tongue movement

51
Q

what is the function and assessment of the hypoglossal nerve

A

motor - spontaneous tongue movement

52
Q

what is the function of the cerebrospinal fluid

A

supplies nutrients and removes waste from brain and spinal cord, acts as a cushion for brain and spinal cord

53
Q

what is intracranial pressure

A

pressure in the CF and subarachnoid space - it has little room for compensation any increase in brain volume or movement in blood into the space causes increase intracranial pressure

54
Q

what are some early signs of increased intracranial pressure

A

headache, projectile vomiting, blurred vision, irritability, decreased GCS, sunsetting eyes, changes in LOC, cranial nerve dysfunction, seizures, high pitched cry

55
Q

what are some late signs of increased cranial pressure

A

cushings triad (hypertension, bradycardia, irregular respiratory pattern), decreased motor and sensory response, papilledema (edema of the eyes), posturing, fixed dilated pupils

56
Q

what is included in the nursing care of someone with increased intracranial pressure

A

baseline assessment, close monitoring, supportive care, 10-15 degrees for HOB (to support drainage), prevent secondary head injury, cooling environment, tepid bath, hypothermic blanket

57
Q

what should you assess when someone has increased intracranial pressure

A

vital signs, LOC, reflexes, pupil reaction, frequency

58
Q

what intervention should you never do when someone has increased intracranial pressure

A

position patient head lower then the body

59
Q

what kind of IV fluid does someone with increased intracranial pressure receive

A

normal saline, lactated ringers, or albumin

60
Q

what medications does someone with increased intracranial pressure get

A

antipyretics, acetaminophen, ibuprofen, phenytonin, mannitol

61
Q

what does the med mannitol do

A

osmotic diuretic reduces intracranial pressure by preventing reabsorption of water and loss of sodium in the urine

62
Q

why would someone have decorticate postural reflex

A

generally because of cerebral cortex injury

63
Q

why would someone have decerebrate posturing reflex

A

damage to the brain stem

64
Q

what is cerebral palsy

A

neurologic lesion secondary to damage to motor area, nonprogressive

65
Q

what is spastic cerebral palsy

A

hyperactive stretch reflex, muscle contractors

66
Q

what is athetoid (dyskinetic) cerebral palsy

A

involuntary uncoordinated motion, - constantly moving

67
Q

what is ataxic cerebral palsy

A

lack of coordination and balance – diagnosed when child is able to walk

68
Q

what is rigidity cerebral palsy

A

muscle rigidity not a lot of active movement

69
Q

what is mixed cerebral palsy

A

features of all of the other movement disturbances

70
Q

what are some physical examination of someone with cerebral palsy

A

delayed development, sensory alterations, speech, abnormal posturing, primitive reflexes, range of motion, muscle tone disturbances

71
Q

how is cerebral palsy diagnosed

A

neuro assessment, EEG, cranial xrays, ultrasounds, MRI, CT, metabolic, genetic testing

72
Q

what interventions are included for someone with cerebral palsy

A

mobility, nutrition, support, education, developmental needs, suction, medication, skin care, rest periods,

73
Q

what meds does someone wit cerbral palsy take

A

dantolene, baclofen, botox, diazepam

74
Q

what do you notice for someone with muscular dystrophy

A

gowers sign (gets up like an old man), muscular atrophy, developmental delays,

75
Q

what is the nursing management for someone with muscular dystrophy

A

mobility, maintaining cardiopulmonary function, quality of life, genetic testing, nutrition, may have to consider end of life choices

76
Q

what is spina bifida occulta

A

neural tube disorder that affects the spinal cord

77
Q

what are some ss of spina bifida occulta

A

normal begins asymptomatic, lumbosacral area, dimples, patches of hair

78
Q

what is a meningocele

A

less serious form of spina bifida cystica, meninges herniate through a defect in the vertebrae

79
Q

what is the treatment for meningocele

A

surgery to correct the lesion

80
Q

what is the assessment for meningocele

A

visible external sac, most are covered with skin and pose, neuro assessment,

81
Q

what is the nursing management for meningocele

A

report any evidence of leaking CSF, supportive care, prevent rupture of sac, monitor for symptoms of bladder dysfunction, monitor head circumfrence and for signs of increased ICP

82
Q

what is a myelomeningocele

A

most severe form of neural tube defects, causes hydrocephalus risk

83
Q

how do you treat mylomeningocele

A

surgery

84
Q

what are some ss of myelmeningocele

A

intellectual deficits, seizures, spinal function stops where yelomeningocele begins, visable sac protruding from spinal area,

85
Q

what test are done for myelomeningocele

A

blood test detect alpha feta protein, MRI, CT, myelography, neuro status,

86
Q

what is the nursing care for myelomeningocele

A

positioning to prevent increased ICP and help respiratory support, warmth, keep lesion clean, promote elimination, promote nutrition, watch for latex allergy, maintain skin integrity

87
Q

what is hydrocephalus

A

possibly congenital, excess CSF in the ventricles of the brain, usually caused by obstruction in the flow of CSF between ventricles

88
Q

what are some ss of bacterial and viral meningitis

A

high fever, severe headache, nausea vomiting, stiff neck

89
Q

what are some ss specific to bacterial meningitis

A

cloudy CSF, seizure, purple skin rash, coma

90
Q

what are some ss specific to viral meningitis

A

clear CSF

91
Q

what kind of precautions should be in place for meningitis

A

droplet

92
Q

what are some interventions for meningitis

A

send CSF for culture and start antibiotics, decrease stimulation, dim lights, decrease noise, seizure precaution, fever managment, NPO if NV, treat all members of home,

93
Q

what are threes signs of meningeal irritation

A

kernigs sign, brudinskis sign, and brudzinski neck sign

94
Q

what is a focal seizure

A

one hemisphere of the brain involved, describe based on impairment of consciousness (focal unaware or complete partial seizures and focal aware seizure also called simple partial seizure

95
Q

what is a generalized seizure

A

involves the entire brain, includes absense, tonic, clonic, tonic-clonic, myoclonic and atonic seizures

96
Q

how are seizures diagnosed

A

EEG

97
Q

what meds are used for seizures

A

phenytonin, phenobarbital, valporic acid, topiramate

98
Q

what are some treatments for seizures

A

surgrey, ketogenic diet, vagal nerve stimulator

99
Q

what is reye syndrome

A

extremely rare, 15yr or younger occurs after recovering from viral illness then taking asprin

100
Q

what does reye syndrome cause

A

brain swelling, liver failure and death

101
Q

what are some ss of reye syndrome

A

changes in mental status, lethargy, irritability, confusion, hyperreflexia

102
Q

what should you assess for reye syndrome

A

recent viral illness, severe and continous vomiting, changes in mental status, hyperreflexia, elevated liver enzymes

103
Q

what is the nursing management for reye syndrome

A

early recognition, maintain cerebral perfusion, manage increased ICP, safety measures for altered LOC, educate, positioning, hemorrohage risks, seizure risk

104
Q

what are some ss of brain tumors

A

headaches, seizures (convulsions), personality/memory changes, NV, fatigue, drowsiness, sleep problems,

105
Q

what is a neuroblastoma

A

embryonic neural crest cell, most common in the abdomen, by time of diagnosis in late childhood it has already metastasized

106
Q

what should you assess for a neuroblastoma

A

abdominal assessment, bowel, bladder, neurologic symptoms, bone pain, anorexia, lymphadenopathy, cough, difficulty breathing, hepatomegaly, spenomegaly

107
Q

what diagnostics are used for neuroblastoma

A

CT, MRI, chest xray, bone scan, skeletal survey, 24 hour urine collection

108
Q

how is absorption different in children

A

mostly affects neonate and infant below 3 has less acidity so things break down slower, slow immature gut

109
Q

how is distribution different in children

A

until age 2 the child needs higher dose of water soluble med bc the body is 70% water, and less fat soluble meds, immature blood brain barrier

110
Q

how is metabolism different in children

A

less then 2 have immature/slow liver processing, over 2 have high metabolism

111
Q

what are baclofen meds for

A

Skeletal muscle relaxant, treats painful spasms and decrease spasticity in children with motor neuron lesions

112
Q

what is the purpose of antibiotics and what are the nursing interventions

A

purpose: treats bacterial meningitis, and shunt infections, interventions: check for allergies, monitor serum levels

113
Q

what is the purpose of anticonvulsants and what are the nursing interventions

A

purpose: decrease hyperexcitability of nerves to prevent seizures, interventions: maintain seizure precaution, taper off

114
Q

what is the purpose of benzodiazepines and what are the nursing interventions

A

purpose: minor sedative prevents or slows CNS, interventions: rectal for to stop prolonged seizure in children, monitor sedation level

Peds exam 2 (8 decks)

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