Pediatrics Test 2: Cerebral Dysfunction Flashcards
Why would someone not be able to have contrast?
If they are allergic to shellfish or iodine
If they have renal problems
What is a CT scan?
Three dimensional images
With or without contrast
Must be held still or sedated
How do renal problems affect contrast?
Toxic to kidneys
What is an MRI?
Magnetic resonance imaging With or without contrast Greater detail then CT scan For cranial images can visualize cerebral arteries and venous sinuses Must hold still or be sedated
During an MRI what should the patient not have on?
Implanted or loose metal objects
What are the different diagnostic tests for cerebral dysfunction?
CT MRI EEG Ultrasonography Lumbar puncture
What is an EEG?
Electroencephalography
Non invasive test
Measures abnormal electrical brain activity
Read by neurologist
Don’t overnight so can see alert/asleep difference
What is ultrasonography?
Can detect carotid lesions or changes in carotid blood flow and velocity
Detect intra ventricular hemorrhage
Ned’s to hold still
Newborns have open anterior Fontanels
What is a lumbar puncture?
Allows aspiration of cerebral spinal fluid from subarachnoid space of spinal cord
Done in order to analyze cerebral spinal fluid
Can analyze CSF and pressure
Curve their back to separate bones
What are the causes of increased intracranial pressure?
Space occupying lesions such as tumors Bleeding or hemorrhage Accumulation of fluid within the ventricular system as in hydrocephalus Cerebral edema Trauma
What are the compensatory measures of IIP?
Limitation of blood flow to brain
Displacement of CSF to spinal cord
Increased absorption or decreased production of CSF by withdrawing water from brain tissue into blood and eliminating via the renal system
Clinical manifestation of infants with IIP?
Tense, bulging fontanel Irritability High pitch cry Increased head circumference Distended scalp veins Changes in feeding Setting sun sign
What are the clinical manifesto on of children with IIP?
Vomiting
Headache
Double vision
Seizures
What are the late signs of IIP.
Lowered LOC Decrease response to painful stimuli Decerebrate or decorticating posturing Pupillary change Cheyne-stokes Respirations
What is the medical IIP management?
Subdural or ventricular tap: drain fluid for relief
Hyperventilation via medical ventilator: decrease demands and cerebral edema
Medications including antibiotics, corticosteroids, osmotic diruetics, barbiturates, anticonvulsants
What are the nurse managements for IIP.
Elevate head of bed 15-30 degree with head midline to move fluid into spinal cord
Manage pain
Avoid Valsalva’s maneuver and painful stimuli
What Are head injuries a major cause of brain damage in?
Falls
Motor vehicle accident
Bicycle accident
Non-accidental trauma
What are the primary and secondary head injuries?
Primary: coup, hit in front and brain bounces to the back
Secondary: countrecoup, brain hits back of head
What are clinical manifestations of head injury?
Brief LOC immediately after injury
Headache
Bleeding from nose or watery discharge from nose
Dizziness
Ataxia: unstable on feet
Blurred or double vision
Vomiting
Behavioral change: confusion, irritability, restless, agitation
Lethargy, stupor, coma
Change in pupillary size and reaction to light and equality
With a head I jury when should you ek medical attention?
Ch.d LOC or vomit more then 3 times Injury at high speed Fall higher then height of child From great force Under suspicious circumstances Sever headache Fluid leaking from nose or ear swelling above or in front of ear Difficult to arose Confused and not acting normal Pupils dilated or unequal Infant with bulging fontanel Bruising below eye
What is the therapeutic management for head trauma?
Mild to moderate concussion with no LOC
- check q2h for responsiveness
- wake sleeping child to assure normal arousability
- follow up with medical provider as directed
What to do if have a head injury with severe injury or LOC
Stabilize head and neck Support airway management need Assess vitals Assess and manage IIP I&O IV NPO until no vomiting Surgical options Bed rest wi head of bed elevated Rehabilitation Education and support
What are observable signs of sports related concussion
Dazed and stunned Confused Forgets plays Unsure of game, score, etc. Moves clumsy Answers questions slowly Loses conscious Behavior or personality change Forgets events prior to hit Rogers event after hit
What’s re reported signs of sports related concussion
Headache Nausea Balance problems or dizzy double or fuzzy vision Sensitivity to light or noise Feeling sluggish Feeling foggy Change in sleep pattern Concentration or memory problems
What are signs of post-concussion syndrome?
Chronic headache Fatigue Sleeping difficulties Personalities change Sensitivity to light or noise Dizziness when stand quick Deficits in short term memory, problem solving and general academic function
What is bacterial meningitis?
Acute inflammation of the meninges and CNS
leading cause in children older then 2 months is streptococcus pneumoniae
Leading cause of neonates is group B strep and e. Coli
Epidemic is meningococcal meningitis
Sudden onset causing serious infection within 24 hours
How can you prevent bacterial meningitis?
Immunizations ad prevention
How do you diagnosis bacterial meningitis?
Lumbar puncture definitive diagnostic test:
Fluid pressure elevated Elevated WBC reduced blood glucose Increased protein concentration Positive gram stain Positive culture
Clinical manifestation of bacterial meningitis in neonates?
Refuse to feed Poor sucking Vomiting and diarrhea Poor tone Weak cry Full, tense bulging fontanel
Clinical manifestation of bacterial meningitis in infants and young children?
Fever Poor feeding Vomiting Marked irritability Seizures Bulging fontanel NUCHAL RIGIDITY BIG SIGN
Clinical manifestation of bacterial meningitis I. Children and adolescents
- petechial/purpurin rash - meningococcal infection. Blueberry rash is common
- joint involvement - meningococcal and H. Influenza infectio
- seizure is first sign
Fever and chill Headache Vomiting Irritability and agitation Nuchal rigidity Photophobia, delirium, hallucination, stupor, coma, and aggressive behavior
What is treatment and nursing measures for bacterial meningitis?
Antibiotics Respiratory isolation: 24 hrs post antibiotic Vital signs and neuro check IV fluid NPO I&O Comfort measures: quiet, dark room, rest, pain meds * report to health department
What is encephalitis?
Inflammatory process of CNS produces altered function or various portions or brain and spinal cord
Caused by bacteria, spirochetes, fungi, Protozoa, helminths
MOST COMMON CAUSE IS VIRUS
What are the clinical maintains of encephalitis?
Malaise Fever Headache Dizzy Apathy Lethargy Neck stiffness N/V Ataxia Tremors Hyperactivity Speech difficulties Altered mental status Stupor Seizures Disorientation Spasticity Coma Ocular pansies Paralysis
What is Reyes syndrome?
Syndrome associated with severe encephalopathy, hepatic dysfunction, IIP, fever
Most follow common viral illness such as varicella or influenza
What is significant about the clinical stages of Reyes Syndrome?
Try move throug the stage of increased neuro stages
What is the treatment of Reye Syndrom
Assess respiratory, circulation, neuro status
Oxygen and airway support
IV
I&O
Nutritional support
Each family t avoid using salicylate/ASA with suspected varicella or Influenza
Teach not to use aspirin
What are seizure disorders caused by?
Altered neuronal activity and repetitive electric discharge of brain cells
Localized or generalized
Epilepsy is chronic disorder
Some caused by underlying disease
What are partial seizures?
One hemisphere affected
What is simple partial seizure disorder
No loss of conscious Alterations in motor function Sweating Vomiting Flushing Pupillary change Sensory change
What is the partial complex seizure disorder
Consciousness is impaired Staring Lip smacking Chewing Unusual hand movement: pill rolling Amnesia
What is a generalized seizure?
Entire brain involved
What is generalized absence seizure
Lack of awareness. Unresponsive Lat less then 15 seconds Eye fluttering Lip smacking Blank stare
What is generalized myoclonus seizure
No or brief LOC
Synchronous jerking of neck, shoulders, arms and legs
Less then 5 seconds
What is a generalized tonic clonic seizure?
Aura precedes: for telling of what's to come, tunnel vision Relaxation Lethargy Confusion Unresponsive
Tonic: loc, muscle rigidity, crying out, clench jaw, cyanosis, loss bladder and bowel, fixed dilated pupil
Clonic: alert ate period of concentration and relaxation, hyperventilation, drooling, eyes rolled back
What is status elepticus seizures?
Unrelieved
Prolonged seizure longer then 15-20 seconds
Normal baseline in between
Febrile seizure in seizure disorder?
Occur I. Association with fever, no underlying chronic illness x
Most common between 6 month - 3 yrs, rare after 5
What s the history that needs to be taken with seizure disorders?
Description of event What time did it occur How long did it last What happened right before When it was over what happened How long was the post ictal period Any aura describe each seizure
What is the treatment for seizures?
Protect from injury Turn to side Provide supplemental oxygen Do not restrain Loosen constricting clothing Do not place in child mouth Obtain assistance if needed
Primary for tonic cloning
What are the triggering factors of seizures
Changes in dark light patterns- flash camera, automobile light, strobe lights Sudden loud noise Startling movement Temperature extremities Dehydration Fatigue Menses Constipation Hypoglycemia
What do anti-epileptic medications cause in seizure patients
Can heat intolerance and patients don’t sweat
What s hydrocephalus
Passive dilation of lateral and third ventricles
Symptoms of either
- impaired absorption of CFS within subarachnoid space
- obstruction to the flow of CFS within the ventricles
What are clinical manifestations of hydrocephalus
Abnormal head circumference and growth Bulging Fontanels and separated sutures Dilated scalp veins Macewan sign: tap on it and sound like cracked pot Thinning skull bones Depressed signs Setting sun sign Irritability Lethargy Vomiting
What is treatment of hydrocephalus?
Surgical correction of underlying cause
Surgical placement of shunt to drain CSF from ventricle to extra cranial compartment
-prevent complications.
-surgical revisions periodically necessary
What are nursing measures for hydrocephalus?
Monitor for signs of ICP post operative care Skin carre: prevention and breakdown Nutritional support Family support and education
