Neuro Flashcards
Increased ICP symptoms - infants 0-1 yr
tense, bulging fontanel
separated cranial sutures
increased fronto-occipital circumference
distended scalp veins
drowsiness, poor feeding
high-pitched cry, crying when disturbed “paradoxical irritability”
setting-sun sign - eyes open, iris downward = hydrocephalus
tid bits
Neuro assessment - pupils are a late sign
3 meningies. even a small volume of extra fluid is dangerous as it increases ICP because it normally has enough space for just enough fluid to prevent adhesion between the 2 membranes
GCS 13-15 is normal
9-12 mod head injury
<8 coma
Increased ICP - children
headache, n, forceful vomiting
diplopia, blurred vision
lethargy, indifference, drowsiness
sleeping more
less activity
decline in school
inability to follow simple commands
seizures
LATE signs of ICP
Bradycardia
pupil size change
pupil reactivity change
decreased motor response to command
decreased sensory response to pain stimuli
extension or flexion posture
Decorticate (flexion) – towards the core. Severe dysfunction of cerebral cortex or with lesions to corticospinal tracts above brainstem.
Decerebrate – out towards the air. Dysfunction at level of midbrain or lesions to brainstem.
Cheyne -stokes resps- period of apnea followed by increased depth+rate of resps (hyperventilation)
Papilledema- edema and inflamm of optic nerve
decreased consciousness
coma
Traumatic brain injury
causes: falls, MVA, bikes
physical characteristics of children putting them at risk of craniocerebral trauma:
-head is large and heavy
-incomplete motor development
-natural curiosity and exuberance
-young child vulnerable to acceleration-deceleration injury
Primary head injury: occur at time of trauma (ex. skull fracture, intracranial hematoma, contusions)
Subsequent complications: hypoxic brain injury, increased ICP, cerebral edema
predominant feature is diffuse brain swelling
Concussions
altered mental status with/without loss of consciousness
-occurs immediately after head injury dt stretching/compression/tearing of nerve fibers
Hallmark signs: confusion, amnesia
tx:
-usually resolve 7-10 days without complications
-rest until symps resolve
-resume activities gradually
Concussion: Complications
Epidural Hematoma
-hemorrhage into space between dura and skull
Subdural hemorrhage:
-bleeding between dura and arachnoid membrane
-dev slowly and spreads thinly/widely
Post-concussion syndrome:
-at least 3 of following:
-headache
-dizziness
-light sensitivity
-n, v
-diff concentrating, restlessness
fatigue
memory impairment
Head injury Assessment
ABC
stabilize neck and spine
NPO
GCS, pupils
Get medical attention if:
-injury is from high speed/great height/great force
-loss of consciousness
-amnesia
-severe headache that worsens or interferes with sleep
-vomiting
-swelling
-fluid leaking from ears/nose
Meningitis
acute inflammation of meninges and CSF
bacterial or viral. Bacterial is more virulent
HIB and meningococcal childhood vaccines
critical: is infant <1 month has fever, needs to be ruled out for meningitis
Causes:
-may occur secondary to other infections
-direct entry thru wounds, surgery
-passes thru blood stream and travels to CNS
Response:
-WBC accumulate and cover brain with thick white purulent discharge = edema, increased ICP, and hyperemic
most common complication: hearing loss
Meningitis clinical manifestations
infants:
-fever, poor feeding, increased ICP, paradoxical irritability, hyperextended neck
older children:
-fever, child, seizures, headache, hemorrhagic rash - very dangerous sign that disease is spreading to body = emergency. First presents as petichea, then purpura (purple blotchy nonblanchable rash)
Meningitis Dx and Tx
tests:
blood- CBC, C&S, electrolytes, clotting factors
Lumbar puncture - WBC, protein, glucose, gram-stain and culture
-if cloudy CSF = lots of WBC’s
-check for pressure
Tx:
start broad spectrum abx while waiting 24-48hrs for C&S results
meds:
-corticosteroids - reduce general inflammation
-antipyretics - reduce fever
-anticonvulsants - reduce risk for febrile seizures
Meningitis Nursing Management
elevate HOB, dark room
manage fluids, hydration
measure head circumference
ABC management
Seizure Disorders
Spontaneous hyper-excitation of neurological cells
Generalized tonic-clonic seizure:
-both hem
-tonic- eyes roll back, staring
-clonic- rigid, jerky movements
-post ictal stage- tired
Status Epilepticus:
-lasts more than 30 min or a series that the child does not regain LOC from
Febrile seizures:
-high risk for 6mon-5yrs
-do not recur in 24 hr period
-max height of fever is more important than its incline
seizure tx
In hospital:
0-5min
tx begins right away
-ABC’s, recovery position
-cardiac monitor and oximeter - put leads and oximeter on
-check blood glucose
-establish IV access
-Blood work - elect, toxicology, anti-seizure med levels
5 min - meds depending on IV access or not
-IV: lorazepam
-No IV:
Buccal, intranasal, or rectal
-repeat same drug ONCE if seizure persists 5 min after 1st dose
15-40 min; more meds
40-60 min: consider intubation
-consult ICU, neurology
-may give different 2nd line med once
At home:
remain calm, observe time, triggers, behavior at onset, type, behaviour after
ease child to floor
protect head with pillow
loosen clothes
turn head to side if vomiting
do not restrain, do not put anything in mouth
Neuromuscular Dysfunction
CP - cerebral pulsy
How would you explain to teachers what cerebral palsy is and what the cause might be?
def: a group of permanent disorders of movement and posture development causing activity limitation, which is attributed to non-progressive disturbances that occurred in the developing fetal/infant brain
prenatal causes: insufficient O2 and nutrients, teratogens
Perinatal causes: brain trauma, asphyxia, prematurity, sepsis
Childhood causes: head trauma, submersion injury, meningitis. shaken-baby syndrome
-includes motor and perception dysfunction
