Neurological Objective Flashcards
Identify the manifestations of increased intracranial pressure (ICP) in INFANTS
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
Identify the manifestations of increased intracranial pressure (ICP) in CHILDREN
Drowsiness/indifference
Headache
Poor appetite
Nausea and Vomiting (not related to meals)
Diplopia (double vision), blurred vision
Seizures
Inability to follow simple commands
LATE Signs of Increased ICP in Infants and Children
Decreased consciousness
Bradycardia
Decreased motor response to pain
Alterations in pupil size and reactivity
Extension or flexion posturing
Papilledema (optic disc edema)
Discuss nursing alerts for headaches
when to be alert
Progresses in frequency and severity over brief period (2-3 weeks)
Awakens child from sleep
*Occurs in early AM (upon arising)
Accompanied by unexplainable vomiting
Associated with change in gait, behavior, or personality
Intensified by vasalva maneuver (BM, cough)
Discuss the nursing management of a patient with increased intracranial pressure (ICP)
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
Bacterial Meningitis
what is it?
etilogy? 5
Acute inflammation of the meninges, caused by bacteria.
Etiology:
H. influenzae
pneumococcal
streptococcal,
Neisseria meningitis
Group B Strep
Bacterial Meningitis
transmission?
symptoms?
diagnosis?
isolation?
Transmission: Respiratory droplets
Symptoms are age dependent
Positive Kernig and Brudzinski Sign
Diagnosis: Lumbar puncture
Isolation: Droplet and Contact precautions
Bacterial Meningitis treatment and prevention
How is it treated?
Vaccines?
Treatment: Antibiotics within 1 hour- 100% mortality if untreated
Prevention: Haemophilus influenzae type B (Hib), pneumococcal, meningococcal vaccines.
prophylactic antibiotics: Depends on bacteria
Viral Meningitis
what is it?
most common cause?
Acute inflammation of the meninges, caused by viruses.
Etiology: Enteroviruses most common cause
Viral Meningitis
transmission?
symptoms?
diagnosis?
isolation?
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
CLINICAL MANIFESTATIONS OF MENINGITIS
Brudzinski Sign?
Kernig’s sign?
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
Treatment and prevention of viral meningitis
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.
Management of child during seizure
Medication
What to do during seizure?
Airway, Breathing, Circulation
-Oxygen
-Suction of secretions, vomitus
-Turn on side
-Do not put anything in the mouth
Establish IV access
Medication
-Diazepam administration (e.g., rectal, IV)
-Lorazepam IV
duration of seizure,
description of seizure
color change (pallor/cyanosis)
incontinent of urine
Therapeutic management of Seizures
Education?
Diet?
Vagus nerve?
Education- Do not stop abruptly-must wean medication!!!!!!!!!!!!
-Ketogenic diet (high fat, low carb, creates Ketosis)
Vagus nerve stimulation (device implanted) use of a device to stimulate the vagus nerve, which is a key part of the autonomic nervous system.
Hydrocephalus
Abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles (cavities) of the brain.
Causes Increased intracranial pressure -
