Intracranial Flashcards
what is included in the central nervous system
brain and spinal cord
what is included in the peripheral nervous system
cranial/peripheral/spinal nerves
what does the central nervous system do
autonomic nervous system (internal organs and glands) - fight or flight
what does the peripheral nervous system do
somatic nervous system (sense organs and voluntary muscles)- sensory input - motor output
what could be diagnosed with a lumbar puncture
meningitis/encephalitis, subarachnoid hemorrhage, demyelinating process (guillain-barre)
who should not get a lumbar puncture
coagulopathies, increased intracranial pressure, respiratory insufficiency with unsecured airway, hypotension, spinal abscess, status epilepticus
what should be considered when positioning someone for a lumbar puncture
maintain airway, open up space for the procedure
what should you assess after a lumbar puncture
vital signs, NV status, motor activity
what is a side effect from a lumbar puncture
headache
what does an intraventricular catheter with pressure reading
allows for drainage and monitoring for intracranial pressure
what is normal intracranial pressure and what is bad
normal 0-10 , 20 is devastating changes
what does the head of the bed need to be for increased intracranial pressure
15-30 degrees - head in midline
what are some safety precautions that should be followed for someone with intracranial pressure
alarms should be on at all time, cluster care
what is a electroencephalogram
electrodes placed on while impulses recorded it determines the electrical activity of the brain
what are the interventions for a electroencephalogram
may require sedation, minimize external stimuli
what can a electroencephalogram diagnosis
seizure disorders - 1hr-24hr monitor for seizure activity
what does a electromyography do
electrode placement, tests nerves in the muscles to see if anything is stopping the impulses to diagnosis muscle disorders - can be painful
what can a MRI diagnosis
inflammation, congenital abnormalities, hard/soft tissue and bone marrow, leg-calve paresthesia diagnosis
what are some interventions before receiving an MRI
remove all metal objects, sedation may be required
what do c-reactive protein and erythrocyte sedimentation rate determine
inflammation
what is normal c-reactive protein levels
less then 10
what are normal erythrocyte sedimentation rate levels in a newborn vs a child
newborn 0-2 and children 0-10
what is a pediatric glassgow coma scale of 9-15
unaltered state of consciousness
what is a pediatric glassgow coma score of 4-8
state of coma
what is a pediatric glassgow coma score of 3 or less
deep coma
what is alert state of consciousness
eyes are open, answering questions appropriate
what is lethargic state of consciousness
drowsing falls asleep easily
what is obtunded state of consciousness
may open there eyes to stimuli, appears confused
what is stupor state of consciousness
slower, absent verbal responses, only responds to painful stimuli
what is coma state of consciousness
doesnt respond to internal or external stimuli
when does the posterior fontanel close by
2 months
when does the anterior fontanel close by
12-18 months
when is bludging fontanel normal
during crying
what could sustained fontanel bludging mean
increased intracranial pressure
what is horizontal nystagmus
the eyes move rapidly and uncontrollably from side to side
what is vertical nystagmus
the eyes move rapidly and uncontrollably from up to down
what is horizontal nystagmus caused by
lesion of the brain stem, phenytoin use
what is vertical nystagmus caused by
brain stem dysfunction
what is sunsetting
see the whites of the eyes above the iris
what is sunsetting caused by
increased intracranial pressure
what are the cranial nerves
olfactory, optic, oculomotor, abducens, trigeminal, facial, acoustic, vagus, accessory, hypoglossal
what is the function and assessment of the olfactory nerve
sensory- closes eyes and identify scent
what is the function and assessment of the optic nerve
motor- visual acuity
what is the function and assessment of the oculomotor nerve
motor- follow finger or object with eye
what is the function and assessment of the abducens nerve
motor- PERRLA
what is the function and assessment of the trigeminal nerve
motor- mastication - infant suck, child bite strength
what is the function and assessment of the facial nerve
motor- facial symmetry, expression
what is the function and assessment of the acoustic nerve
sensory - weber/rhine, whisper test
what is the function and assessment of the vagus nerve
motor- gag reflex
what is the function and assessment of the accessory nerve
motor- head position while sitting
what is the function and assessment of the hypoglossal nerve
motor - spontaneous tongue movement
what is the function and assessment of the hypoglossal nerve
motor - spontaneous tongue movement
what is the function of the cerebrospinal fluid
supplies nutrients and removes waste from brain and spinal cord, acts as a cushion for brain and spinal cord
what is intracranial pressure
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
what are some early signs of increased intracranial pressure
headache, projectile vomiting, blurred vision, irritability, decreased GCS, sunsetting eyes, changes in LOC, cranial nerve dysfunction, seizures, high pitched cry
what are some late signs of increased cranial pressure
cushings triad (hypertension, bradycardia, irregular respiratory pattern), decreased motor and sensory response, papilledema (edema of the eyes), posturing, fixed dilated pupils
what is included in the nursing care of someone with increased intracranial pressure
baseline assessment, close monitoring, supportive care, 10-15 degrees for HOB (to support drainage), prevent secondary head injury, cooling environment, tepid bath, hypothermic blanket
what should you assess when someone has increased intracranial pressure
vital signs, LOC, reflexes, pupil reaction, frequency
what intervention should you never do when someone has increased intracranial pressure
position patient head lower then the body
what kind of IV fluid does someone with increased intracranial pressure receive
normal saline, lactated ringers, or albumin
what medications does someone with increased intracranial pressure get
antipyretics, acetaminophen, ibuprofen, phenytonin, mannitol
what does the med mannitol do
osmotic diuretic reduces intracranial pressure by preventing reabsorption of water and loss of sodium in the urine
why would someone have decorticate postural reflex
generally because of cerebral cortex injury
why would someone have decerebrate posturing reflex
damage to the brain stem
what is cerebral palsy
neurologic lesion secondary to damage to motor area, nonprogressive
what is spastic cerebral palsy
hyperactive stretch reflex, muscle contractors
what is athetoid (dyskinetic) cerebral palsy
involuntary uncoordinated motion, - constantly moving
what is ataxic cerebral palsy
lack of coordination and balance – diagnosed when child is able to walk
what is rigidity cerebral palsy
muscle rigidity not a lot of active movement
what is mixed cerebral palsy
features of all of the other movement disturbances
what are some physical examination of someone with cerebral palsy
delayed development, sensory alterations, speech, abnormal posturing, primitive reflexes, range of motion, muscle tone disturbances
how is cerebral palsy diagnosed
neuro assessment, EEG, cranial xrays, ultrasounds, MRI, CT, metabolic, genetic testing
what interventions are included for someone with cerebral palsy
mobility, nutrition, support, education, developmental needs, suction, medication, skin care, rest periods,
what meds does someone wit cerbral palsy take
dantolene, baclofen, botox, diazepam
what do you notice for someone with muscular dystrophy
gowers sign (gets up like an old man), muscular atrophy, developmental delays,
what is the nursing management for someone with muscular dystrophy
mobility, maintaining cardiopulmonary function, quality of life, genetic testing, nutrition, may have to consider end of life choices
what is spina bifida occulta
neural tube disorder that affects the spinal cord
what are some ss of spina bifida occulta
normal begins asymptomatic, lumbosacral area, dimples, patches of hair
what is a meningocele
less serious form of spina bifida cystica, meninges herniate through a defect in the vertebrae
what is the treatment for meningocele
surgery to correct the lesion
what is the assessment for meningocele
visible external sac, most are covered with skin and pose, neuro assessment,
what is the nursing management for meningocele
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
what is a myelomeningocele
most severe form of neural tube defects, causes hydrocephalus risk
how do you treat mylomeningocele
surgery
what are some ss of myelmeningocele
intellectual deficits, seizures, spinal function stops where yelomeningocele begins, visable sac protruding from spinal area,
what test are done for myelomeningocele
blood test detect alpha feta protein, MRI, CT, myelography, neuro status,
what is the nursing care for myelomeningocele
positioning to prevent increased ICP and help respiratory support, warmth, keep lesion clean, promote elimination, promote nutrition, watch for latex allergy, maintain skin integrity
what is hydrocephalus
possibly congenital, excess CSF in the ventricles of the brain, usually caused by obstruction in the flow of CSF between ventricles
what are some ss of bacterial and viral meningitis
high fever, severe headache, nausea vomiting, stiff neck
what are some ss specific to bacterial meningitis
cloudy CSF, seizure, purple skin rash, coma
what are some ss specific to viral meningitis
clear CSF
what kind of precautions should be in place for meningitis
droplet
what are some interventions for meningitis
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,
what are threes signs of meningeal irritation
kernigs sign, brudinskis sign, and brudzinski neck sign
what is a focal seizure
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
what is a generalized seizure
involves the entire brain, includes absense, tonic, clonic, tonic-clonic, myoclonic and atonic seizures
how are seizures diagnosed
EEG
what meds are used for seizures
phenytonin, phenobarbital, valporic acid, topiramate
what are some treatments for seizures
surgrey, ketogenic diet, vagal nerve stimulator
what is reye syndrome
extremely rare, 15yr or younger occurs after recovering from viral illness then taking asprin
what does reye syndrome cause
brain swelling, liver failure and death
what are some ss of reye syndrome
changes in mental status, lethargy, irritability, confusion, hyperreflexia
what should you assess for reye syndrome
recent viral illness, severe and continous vomiting, changes in mental status, hyperreflexia, elevated liver enzymes
what is the nursing management for reye syndrome
early recognition, maintain cerebral perfusion, manage increased ICP, safety measures for altered LOC, educate, positioning, hemorrohage risks, seizure risk
what are some ss of brain tumors
headaches, seizures (convulsions), personality/memory changes, NV, fatigue, drowsiness, sleep problems,
what is a neuroblastoma
embryonic neural crest cell, most common in the abdomen, by time of diagnosis in late childhood it has already metastasized
what should you assess for a neuroblastoma
abdominal assessment, bowel, bladder, neurologic symptoms, bone pain, anorexia, lymphadenopathy, cough, difficulty breathing, hepatomegaly, spenomegaly
what diagnostics are used for neuroblastoma
CT, MRI, chest xray, bone scan, skeletal survey, 24 hour urine collection
how is absorption different in children
mostly affects neonate and infant below 3 has less acidity so things break down slower, slow immature gut
how is distribution different in children
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
how is metabolism different in children
less then 2 have immature/slow liver processing, over 2 have high metabolism
what are baclofen meds for
Skeletal muscle relaxant, treats painful spasms and decrease spasticity in children with motor neuron lesions
what is the purpose of antibiotics and what are the nursing interventions
purpose: treats bacterial meningitis, and shunt infections, interventions: check for allergies, monitor serum levels
what is the purpose of anticonvulsants and what are the nursing interventions
purpose: decrease hyperexcitability of nerves to prevent seizures, interventions: maintain seizure precaution, taper off
what is the purpose of benzodiazepines and what are the nursing interventions
purpose: minor sedative prevents or slows CNS, interventions: rectal for to stop prolonged seizure in children, monitor sedation level
