Neuro Ch. 15

Question 1

Anterior fontanelle closes by age

Answer 1

9-18 mos

Question 2

Bulging fontanelle may be caused by what? (4)

Answer 2

increased ICP, infection, tumor, trauma

Question 3

Cause of depressed fontanelle?

Answer 3

DHN, hypovolemia

Question 4

CPP formula

Answer 4

CPP=MAP-ICP

Question 5

Some Signs of seizure activity in infants? (3)

Answer 5

starring, lip smacking, eye blinking

Question 6

What can cause ipsilateral pupil dilation?

cranial nerve

Answer 6

herniation and compression of cranial nerve CNIII

Question 7

Three causes of bilateral pupil dilation?

Answer 7

bilateral CNIII compression, anoxia, stimulant ingestion

Question 8

widened pulse pressure and bradycardia signs of

Answer 8

increased ICP

Question 9

What type of visual acuity assessment should be used on a patient older than 4 years?

Answer 9

tumbling Es

Question 10

Visual acuity assessment <3 yo

Answer 10

ID shapes, colors and objects

Question 11

What is the criteria for Status Epilepticus?

Answer 11

1. general tonic-clonic sze > 5 min.
2. 2 or more sze occurring w/in 5 min. w/o return to baseline

P. 154

Question 12

Hydrocephalus signs

Answer 12

1. downward divergence of eyes (sun-setting eyes)
2. seizures
3. poor feeding

Question 13

Cerebral blood flow is regulated by what two parameters that control vasoconstriction and dilation?

Answer 13

O2 and Co2

Question 14

How does O2 affect cerebral blood flow

Answer 14

O2 <50mm Hg = vasodilation, increasing cerebral blood flow

Question 15

How does CO2 affect cerebral blood flow

Answer 15

CO2< causes constriction

Question 16

How does cerebral blood flow affect ICP

Answer 16

When CBF ^, ICP^

Question 17

What are two adverse outcomes of status epilepticus in regards to growth and development?

Answer 17

increases morbidity and developmental issues

Question 18

What are some Treatment for seizures, including safety and medications?

Answer 18

1. recovery position, 2. padding/safety, 3. manage fever, 4. benzos, 5. versed, 6. rectal valium

Question 19

For status epilecticus >15-30 min. treatment? (3 interventions)

Answer 19

1. phenobarbitol, 2. intubation, 3. ketamine/propofol

Question 20

DC teaching for seizures

Answer 20

1. call 911 for cyanosis, not breathing, no pulse, sze >5 min, 2nd seizure w/o returning to baseline

Question 21

Treatments for ^ ICP

Answer 21

1. hypertonic saline, 2. mannitol, ^ HOB

Question 22

What is Papilledema? What condition can it be seen in?

Answer 22

swelling of the optic nerve seen in ^ ICP

Question 23

What do Posterior headaches require disgnostically?

Answer 23

require further investigation

Why?

Question 24

2 Types of brain injury

Answer 24

primary, secondary

Question 25

A Primary brain injury is caused by what type pf mechanism?

Answer 25

mechanical injury

Question 26

What is a Secondary brain injury? Name several sources of secondary injury? (5)

Answer 26

hypoxemia, hypotension, ^ ICP, < CPP, cerebral edema

Question 27

A TBI can affect what four categories with residual signs and symptoms?

Answer 27

1. thinking & memory, 2. physical, 3. mood, 4. sleep

Question 28

What is Secondary impact syndrome? What harm can the second impact cause?

Answer 28

2nd TBI sustained prior to healing of 1st TBI, changes structure and function of the brain

Question 29

Describe the relationship between CO2 levels and cerebral blood flow.

Answer 29

^ CO2 causes dilation that ^ CBF | Conversely, a decrease in CO2 causes vasoconstriction that decreases CBF and decreases ICP.

Question 30

FOUR Score measurments

Answer 30

1. Eye response 2. Motor response - voluntary 3. Brainstem reflex - pain relfex 4. Respiration

Question 31

FOUR Score Eye response criteria

Answer 31

``` 4- eyes open, tracking or blinking on command 3- eyes open, but no tracking 2- eyes open to loud voice 1- eyes open to pain 0- eyes closed to pain ```

Question 32

FOUR Score Motor Response Criteria

Answer 32

``` 4- thumb, fist or peace sign 3- localizes pain 2- flexes to pain 1- extends topain 0- no response or general myoclonic response ```

Question 33

FOUR Score Brainstem response

Answer 33

``` 4- pupil and corneal reflexes present 3- one pupil wide and fixed 2- pupil or corneal reflexes absent 1- pupil AND corneal reflexes absent 0- Absent pupil, corneal and cough ```

Question 34

FOUR Score Respiration measurements

Answer 34

``` 4- regular breathing pattern 3- cheyne-stokes 2- irregular 1- triggers vent above base rate 0- apnea or breaths at vent rate ```