Neurological and Musculoskeletal Diseases (WEDNESDAY)

Question 1

Identify the manifestations of increased intracranial pressure (ICP) in INFANTS

Answer 1

Irritability and/or restlessness

Bulging, Tense Fontanel (Anterior)

High-pitched cry

Poor feeding or refusal to eat

Vomiting

Seizure

Separated Cranial Sutures

Increased head circumference

Setting-sun sign (downward deviation of eyes) Cranial nerves III, IV, VI

Question 2

Identify the manifestations of increased intracranial pressure (ICP) in CHILDREN

Answer 2

Drowsiness/indifference
Headache
Poor appetite
Nausea and Vomiting (not related to meals)

Diplopia (double vision), blurred vision
Seizures
Inability to follow simple commands

Question 3

LATE Signs of Increased ICP in Infants and Children

Answer 3

Extension or flexion posturing (decorticate/decerebrate)

Papilledema (optic disc edema)

Decreased motor response to pain

Decreased consciousness
Bradycardia
Alterations in pupil size and reactivity

Question 4

Discuss the nursing management of a patient with increased intracranial pressure (ICP)

Answer 4

Airway Breathing Circulation (ABCs)
-Ensure patent airway - suctioning, oxygen

Elevate HOB to 30º, keep head midline

Maintain temp - treat fever

Frequent neuro checks using Glasgow Coma Scale

Question 5

Bacterial Meningitis
what is it?
etilogy? 5

Answer 5

Acute inflammation of the meninges, caused by bacteria.

Etiology:
H. influenzae
pneumococcal
streptococcal,
Neisseria meningitis
Group B Strep

Question 6

Bacterial Meningitis

transmission?
symptoms?
diagnosis?
isolation?

Answer 6

Transmission: Respiratory droplets

Symptoms are age dependent
Positive Kernig and Brudzinski Sign

Diagnosis: Lumbar puncture

Isolation: Droplet and Contact precautions

Question 7

Bacterial Meningitis treatment and prevention

How is it treated?
Vaccines?

Answer 7

Treatment: Antibiotics within 1 hour- 100% mortality if untreated

Prevention: Haemophilus influenzae type B (Hib), pneumococcal, meningococcal vaccines.

prophylactic antibiotics: Depends on bacteria

Question 8

Viral Meningitis
what is it?
most common cause?

Answer 8

Acute inflammation of the meninges, caused by viruses.

Enteroviruses

Question 9

Viral Meningitis

transmission?
symptoms?
diagnosis?
isolation?

Answer 9

Transmission: Respiratory droplets and fecal-oral route.

Symptoms are age dependent and may be less severe than bacterial meningitis. Resolves in 7-10 days.
Positive Kernig and Brudzinski Sign

Diagnosis: Lumbar puncture

Isolation: Droplet and Contact Precautions

Question 10

CLINICAL MANIFESTATIONS OF MENINGITIS

Brudzinski Sign?
Kernig’s sign?

Answer 10

Brudzinski’s sign. Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

Kernig’s sign: Inability to straighten the leg when the hip is flexed to 90 degrees

Question 11

Treatment and prevention of viral meningitis

Answer 11

Treatment: Symptomatic (e.g., Tylenol [Acetaminophen] or Ibuprofen [Motrin] for pain, fever)

No vaccines available to protect against viral meningitis

**Close contacts are not likely to develop viral meningitis.