neuro Flashcards
signs of increased ICP in children
Headache
Blurred vision
Diplopia
Sluggish pupils
Seizures
Nausea/vomiting
Increased sleepiness
Decreased school performance and motor function
Signs of increased intracranial pressure in infants
bulging fontanelle
High-pitched cry
Increased head circumference
Irritable when picked up
Sunsetting eyes
late signs of increased ICP
Decreased LOC
sensory response to pain
Fixed/dilated pupils
Deceborate/decorticate posturing
Cushing’s triad
Increased blood pressure
Decreased heart rate, RR
Widening pulse pressure
emergent nursing care of increased ICP
Stabilize spine
Frequent neuro checks and VS - Q1 hour
THERMAL REGULATION
Head midline
IVF
Low stimulation
what should be given for pain instead of morphine for children with increased ICP
Tylenol or ibuprofen
hydrocephalus
Increased CSF in ventricular system
Results in increased head circumference
VP/VA shunts
VP – drains into perineal cavity, preferred
VA – used if peritoneal not available, drains into thoracic cavity
Preop shunts
prevent breakdown of scalp
Keep eyes moist
Monitor for increased ICP
post op shunts
Bedrest on opposite side – flat
Keep drainage level with patients tragus
Monitor for abdominal distention
Measure abdominal girth
Avoid contact sports
what to do in case of infection with shunts
external temporary drainage system
Keep at level of ear
Close monitoring
Possible IV antibiotics
when to contact HCP post shunt
Sudden increase or decrease in drainage
Poor wave form
Basilar skull fracture
Raccoon/battle eyes
CSF leakage out of ears
High risk for meningitis
basilar skull fracture Nursing Care
Monitor temperature
No invasive procedures, or suctioning
Test CSF for glucose
Private room
what are the hallmark signs of a concussion?
Confusion
Amnesia
when to seek treatment for a concussion
Infant
Loss of LOC
Complains of head, neck pain
Vomiting repeatedly
Difficult to awake, console
Abnormal walking
Bleeding from nose or mouth
Watery discharge from nose, or ears
Positive glucose
what type of medication can be used for brain injuries
Hypertonic solution – pools fluid away from brain
Steroids – decrease edema
symptoms of progressively getting worse with brain injuries
Mounting agitation
Eyes not tracking
Asymmetric changes
Cushing triad
Meningitis symptoms for a newborn
Poor feeding
Apnea, weak cry
Diarrhea
Jaundice
Tense fontanelle
meningitis symptoms for infants
Fever
Poor feeding
N/V
Seizures
Irritable
High-pitched cry
Meningitis for older kids
fever
Headache
Positive Kernigs/Brudzinski sign
Projectile vomiting
opisthotonos
Petechiae rash
what is used to diagnose meningitis?
Lumbar puncture
Increased WBC, protein
Decreased glucose
Positive culture
T/F lumbar puncture and cultures should be done after antibiotics given
False, before
nursing care for meningitis
Droplet, isolation. 24 hours.
Seizure precautions
Neuro checks Q1 hour
Prevention – vaccines
Encephalitis
Viral cause from HSV
Reyes syndrome
encephalopathy with hepatic dysfunction
Can be caused from aspirin therapy in children
what should be monitored especially with Reyes syndrome?
Abnormal coagulation
PT/PTT
Monitor for bleeding and liver function
Febrile seizures
caused by fever greater than 101°F
Without known epilepsy
when should treatment be initiated for seizures?
Greater than five minutes
medication regimen for seizures
Start with one low-dose, make a way up if needed
Antiepileptic - Keppra
diet for epileptic patients
If meds don’t work
Keto diet – high, fat, low carb, adequate protein
Supplemental vitamins
last resort for treatment for epilepsy
Vagus nerve stimulation
Implanted Magnet
nursing care for seizures
Observe time
Observe direction of eyes, LOC, movement
protect from injury, aspiration
Turn on side
No restraints or anything in the mouth
Blow by 02 less than 90%
when should a rescue drug be given for seizures?
Greater than five minutes
Call HCP
Stay at bedside
long-term education for seizures
Medic alert bracelet
Avoid triggers – stress, strobe, lights, sleep deprivation
Never alone in water
Wear a bike helmet
Avoid open flames and climbing Heights
