Neurological Ppt Flashcards
ICP manifestations: Infant
Irritability
Poor feeding
High pitched cry
Difficult to soothe
Tense, bulging fontanels
ICP manifestations: children
Headache, nausea, forceful vomiting
Seizures
Drowsiness, lethargy
Diminished physical activity
Inability to follow simple commands
Late signs of ICP in children
Bradycardia
Decreased motor response to command
Decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Extension or flexion posturing
Decreased LOC
Coma
ICP positioning
Avoid neck compression
Provide alternating pressure mattress
Elevate HOB 30°
Avoid extreme flexion, extension, or rotation of the head and maintain head in neutral, midline position.
Activities that can increase ICP
Suctioning/ gagging
Nasal suctioning in contraindicated
Administer stool softener to prevent straining (Valsalva maneuver)
ICP nursing considerations
Eliminate or minimize environmental noise
Cluster care and provide adequate rest periods
Primary concern for comatose child
Airway management
Pain assessment of comatose child
Increased agitation and rigidity - signs of pain
ICP is increased by pain
Alterations in vital signs ( increase in HR, Temp, RR, BP. Decreased O2 saturation)
Types of skull fractures
Linear, depressed, comminuted, basilar, open, growing.
Linear skull fracture
Most common, no treatment needed
Depressed skull fracture
Skull appears to be sunken and may protrude into the brain cavity.
Immediate medical intervention if required.
Comminuted skull fracture
Break or splinter of the bone into more than two fragments
Usually seen in high impact MVAs
Open skull fracture
Fracture in which the skin is cut open and the bone is seen with the naked eye
Growing skull fracture
A rare complication of pediatric head trauma that results in delayed onset neurological deficits and cranial defects
Head trauma management
Nothing given by mouth at first
Monitor for signs of ICP (vomiting, HA, seizure)
Hydrocephalus cause
Imbalance in the production and absorption of CSF
-build up of fluid in the ventricles
- malfunctioning shunt
Associated with myelomeningocele
Hydrocephalus treatment
Ventriculoperitoneal shunt will be surgically placed
Once placed, The nurse should position the child flat on the unoperated side to prevent the rapid reduction of intracranial fluid and to protect the child from injuring the operative site.
Shunt infections
Infections include septicemia, bacterial endocarditis, wound infection, shunt nephritis, meningitis. 
Treatment includes massive dose antibiotics or shunt removal
Bacterial meningitis PPE precautions 
Droplet
Bacterial meningitis expected findings
Cloudy color,
elevated WBC count,
decreased protein content,
decreased glucose content,
positive Gram stain
Non-bacterial meningitis findings 
Clear color,
slightly elevated WBC,
normal or slightly elevated protein content,
normal glucose content,
negative Gram stain
Prevention of meningitis
Bacterial meningitis prevention is through hib and pneumococcal conjugate vaccines.
Management of meningitis
Droplet isolation precautions, maintained for 24 to 48 hours after the initiation of IV antibiotics
Measurement Of head circumference and fontanelles in newborns and young children for presence of or changes in bulging
Decrease environmental stimuli,
Provide comfort measures such as keeping the room cool and maintain safety
Pharmacological management of meningitis
Client remains on isolation precautions for 24 to 48 hours after initiation of IV antibiotics,
Dexamethasone (steroids)
Analgesics (acetaminophen with codeine)
Reyes syndrome findings
Bleeding and ecchymoses due to problems with blood coagulation.
Characterized by fever, profoundly impaired consciousness in disordered hepatic function
Cause of Reyes syndrome
Potential association exists between aspirin therapy for fever and development of Reyes syndrome
Cranial deformities and suture ossification/closure 
6-8 weeks of age the posterior fontanelle will close
18-24 months of age the anterior fontanelle close
Drug therapy management of seizures
IV fosphenytoin is often used to treat seizures instead of IV phenytoin because of possible complications in drug interactions associated with IV phenytoin. 
