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N396 Midterm > Neuro > Flashcards

Neuro Flashcards

1
Q

What is increased intracranial pressure?

A

Increased swelling of brain and brain doesn’t have enough room

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2
Q

What are conditions that produce increased ICP?

A
  • Cerebral trauma
  • Hydrocephalus
  • Brain tumor
  • Meningitis
  • Encephalitis
  • Intra-ventricular hemorrhage
  • Seizures/brain anoxia
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3
Q

What is the purpose of Glasgow coma scoring?

A
  • Used once child is able to verbalize
  • Main purpose is objective measure for neuro status
  • Looking for best response
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4
Q

Manifestations of ICP in infants and young children

A
  • Tense, bulging anterior fontanel (fontanels can also accommodate swelling which can be helpful but may disguise signs of illness)
  • High pitched cry
  • Increased head circumference
  • Irritability and restlessness
  • Change in feeding habits
  • Not comforted by usual methods
  • Sunset eyes
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5
Q

Manifestations of ICP in older children

A
  • Headache
  • Vomiting
  • Cognitive/personality changes
  • Diplopia and blurred vision
  • Anorexia, nausea, weight loss
  • Seizures
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6
Q

Late manifestations of ICP

A
  • Decreased LOC
  • Decreased motor response
  • Abnormal sensation to painful stimuli
  • Dilated pupils with decreased reactivity
  • Abnormal breathing patterns
  • Decorticate posturing: move in toward core
  • Decerebrate posturing: flaccid, hands out (WORSE)
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7
Q

What are signs of herniation?

A
  • Major decrease in LOC
  • Cushing’s Triad
  • Fixed and dilated pupils
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8
Q

What are the components of cushion’s triad?

A
  • Bradycardia
  • Irregular respirations
  • Increased SBP and widening pulse pressure
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9
Q

What is a nursing goal for increased ICP?

A

Prevent neurological deterioration

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10
Q

What are nursing interventions for increased ICP?

A
  • Frequent neuro assessment Q1 hour and Glasgow Coma Scoring
  • Infant: track head circumference, palpate fontanels, feedings
  • Maintain head midline (allows fluid to move out of brain via jugular veins)
  • Avoid suction, coughing, stimulation
  • Pain control
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11
Q

What is hydrocephalus?

A
  • Neurologic structural problem
  • May be congenital or acquired
  • Acquired causes: meningitis, head trauma, brain tumor
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12
Q

2 major types of hydrocephalus?

A
  1. Communicating: free flowing CSF not absorbed

2. Non-communicating: most common, blockage in ventricles prevent CSF prom entering subarachnoid space for absorption

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13
Q

Hydrocephalus Assessment

A
  • Complete neuro assessment
  • Head circumference ALWAYS: compare to tracked measurements, meningitis patients, trauma patients, patients with history of hydrocephalus
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14
Q

Nursing care for hydrocephalus

A
  • Frequent neuro checks
  • Safety r/t weight and size of head
  • Increased risk for skin breakdown
  • Surgical shunt must be placed (helps drain CSF)
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15
Q

Post-Op nursing care for shunts

A
  • Keep flat for 24 hours
  • Vital signs
  • Head circumference
  • Observe dressing
  • Neurological checks
  • Repeat radiology exams
  • Abdominal assessment
  • Safety: protect tract and dressing
  • Palpate and observe shunt and tract: tenderness, redness, swelling
  • High risk for shunt infection
  • Teaching
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16
Q

What are 2 major classes of seizures?

A
  • Partial

- Generalized

17
Q

What are 2 types of generalized seizures?

A
  • Absence

- Atonic

18
Q

What is therapeutic management for seizures?

A
  • Drug therapy
  • Ketogenic diet
  • Epilepsy surgery (reserved for incapacitating, refractory seizures)
19
Q

What are components of drug therapy for seizures?

A
  • Raise the threshold and prevent seizures
  • Begins with single drug at lowest dose
  • Drug blood levels needed
  • Dosage increase needed with growth
20
Q

What is a ketogenic diet?

A
  • High fat: 3-4 g fat for every 1 g carb and protein
  • Low carb
  • Low protein
  • Vitamin supplementation: vitamin D, calcium, iron, folic acid
  • Kids continue on anticonvulsants
21
Q

What is status epilepticus?

A

Continuous seizure lasting more than 5 minutes

22
Q

How do we treat status epilepticus?

A
  • Maintain ABC
  • IV admin of antiepileptics
  • Pre-hospital or home: diastat or midazolam
  • In-hospital: IV diazepam or lorazepam, IV loading with fosphenytoin
23
Q

Nursing management of seizure prior to seizure

A
  • Assure precautions are in place: suction and oxygen at bedside, padded rails, environmental safety
24
Q

Nursing management of seizure during seizure

A
  • Clear area of hazards
  • Place pillow/blanket under head
  • Ease child to floor if standing/seated
  • Turn to one side if vomiting and can suction outside of mouth
  • Can deliver blow by oxygen
  • Note time and areas involved
  • Note triggers
25
Q

Nursing management of seizure after seizure

A
  • Assess LOC
  • Assure clear airway
  • May apply oxygen
  • Vital signs
26
Q

What is CP?

A
  • Permanent, non-progressive abnormalities that lead to disorders of movement and posture
  • Neuro dysfunctional can range from minimal to severe
  • May occur in ante-pre or or post natal period from congenital or external factors
27
Q

What are associated complications of CP?

A
  • Contractures
  • Spasticity and dystonia
  • Scoliosis and kyphosis
  • Pain and discomfort
  • Dysphagia
  • Excess saliva
  • Low bone mineral density
  • Epilepsy
  • Sleep disturbance
  • Mental health issues
  • Sensory registering and processing
  • Visual and/or hearing impairment
  • Learning disability
  • Vomiting/reflux
  • Constipation
28
Q

Management of CP

A
  • Meds
  • Ortho surgical procedures
  • Speech/Language therapy
  • Nutrition
  • Mental health
  • Learning disability support
29
Q

Baclofen pump for CP

A
  • Surgically placed
  • Muscle relaxant
  • Intrathecal
  • Lasts 3-5 years
  • Complications: infection, overdose, broken catheter
30
Q

Key assessment areas for CP

A
  • Movement: fidgeting, asymmetrical, lack of movement or abnormal movement
  • Abnormal tone
  • Abnormal motor development
  • Feeding and communication difficulty
  • Abnormal cognitive and social development
  • May change over time
31
Q

Nursing diagnoses for CP

A
  • Impaired physical mobility
  • Impaired nutrition less than body requirements
  • Impaired comfort
  • Risk for impaired skin integrity
  • Psychosocial: delayed growth and development, risk for caregiver role strain
32
Q

Desired pt outcome for CP

A
  • Promote optimal motor, developmental, cognitive, nutritional, communication and social development of child with chronic neurological disorder
33
Q

High priority physiologic nursing interventions for CP

A
  • Inspect skin for signs of redness Q2 hours

- Place patient in maximal upright position for feeding during 3 meals and 2 snacks

34
Q

High priority psychosocial nursing interventions for CP

A
  • Contact child life specialist to request assessment for diversional activities
  • Collaborate with caregiver on schedule to determine care activities
35
Q

Patient/Family teaching for CP

A
  • Methods and schedule to maintain optimal mobility
  • Review meds esp to decrease spasticity and salivation
  • Signs and prevention of impaired skin
  • Anticipatory guidance for surgical procedures
  • Nutritional guidance including safe feeding methods
  • Caregiver self-care resources

N396 Midterm (4 decks)

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