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Pediatrics > Pediatrics Test 2: Cerebral Dysfunction > Flashcards

Pediatrics Test 2: Cerebral Dysfunction Flashcards

0
Q

Why would someone not be able to have contrast?

A

If they are allergic to shellfish or iodine

If they have renal problems

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1
Q

What is a CT scan?

A

Three dimensional images
With or without contrast
Must be held still or sedated

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2
Q

How do renal problems affect contrast?

A

Toxic to kidneys

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3
Q

What is an MRI?

A 
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
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4
Q

During an MRI what should the patient not have on?

A

Implanted or loose metal objects

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5
Q

What are the different diagnostic tests for cerebral dysfunction?

A 
CT
MRI
EEG
Ultrasonography
Lumbar puncture
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6
Q

What is an EEG?

A

Electroencephalography
Non invasive test
Measures abnormal electrical brain activity
Read by neurologist
Don’t overnight so can see alert/asleep difference

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7
Q

What is ultrasonography?

A

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

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8
Q

What is a lumbar puncture?

A

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

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9
Q

What are the causes of increased intracranial pressure?

A 
Space occupying lesions such as tumors
Bleeding or hemorrhage 
Accumulation of fluid within the ventricular system as in hydrocephalus 
Cerebral edema
Trauma
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10
Q

What are the compensatory measures of IIP?

A

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

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11
Q

Clinical manifestation of infants with IIP?

A 
Tense, bulging fontanel
Irritability
High pitch cry
Increased head circumference
Distended scalp veins
Changes in feeding
Setting sun sign
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12
Q

What are the clinical manifesto on of children with IIP?

A

Vomiting
Headache
Double vision
Seizures

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13
Q

What are the late signs of IIP.

A 
Lowered LOC 
Decrease response to painful stimuli
Decerebrate or decorticating posturing
Pupillary change
Cheyne-stokes Respirations
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14
Q

What is the medical IIP management?

A

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

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15
Q

What are the nurse managements for IIP.

A

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

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16
Q

What Are head injuries a major cause of brain damage in?

A

Falls
Motor vehicle accident
Bicycle accident
Non-accidental trauma

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17
Q

What are the primary and secondary head injuries?

A

Primary: coup, hit in front and brain bounces to the back
Secondary: countrecoup, brain hits back of head

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18
Q

What are clinical manifestations of head injury?

A

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

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19
Q

With a head I jury when should you ek medical attention?

A 
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
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20
Q

What is the therapeutic management for head trauma?

A

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
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21
Q

What to do if have a head injury with severe injury or LOC

A 
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
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22
Q

What are observable signs of sports related concussion

A 
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
23
Q

What’s re reported signs of sports related concussion

A 
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
24
Q

What are signs of post-concussion syndrome?

A 
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
25
Q

What is bacterial meningitis?

A

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

26
Q

How can you prevent bacterial meningitis?

A

Immunizations ad prevention

27
Q

How do you diagnosis bacterial meningitis?

A

Lumbar puncture definitive diagnostic test:

Fluid pressure elevated
Elevated WBC 
reduced blood glucose
Increased protein concentration
Positive gram stain
Positive culture
28
Q

Clinical manifestation of bacterial meningitis in neonates?

A 
Refuse to feed
Poor sucking
Vomiting and diarrhea
Poor tone
Weak cry
Full, tense bulging fontanel
29
Q

Clinical manifestation of bacterial meningitis in infants and young children?

A 
Fever
Poor feeding
Vomiting
Marked irritability
Seizures
Bulging fontanel
NUCHAL RIGIDITY BIG SIGN
30
Q

Clinical manifestation of bacterial meningitis I. Children and adolescents

A
  • 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
31
Q

What is treatment and nursing measures for bacterial meningitis?

A 
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
32
Q

What is encephalitis?

A

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

33
Q

What are the clinical maintains of encephalitis?

A 
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
34
Q

What is Reyes syndrome?

A

Syndrome associated with severe encephalopathy, hepatic dysfunction, IIP, fever

Most follow common viral illness such as varicella or influenza

35
Q

What is significant about the clinical stages of Reyes Syndrome?

A

Try move throug the stage of increased neuro stages

36
Q

What is the treatment of Reye Syndrom

A

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

37
Q

What are seizure disorders caused by?

A

Altered neuronal activity and repetitive electric discharge of brain cells
Localized or generalized

Epilepsy is chronic disorder

Some caused by underlying disease

38
Q

What are partial seizures?

A

One hemisphere affected

39
Q

What is simple partial seizure disorder

A 
No loss of conscious
Alterations in motor function
Sweating
Vomiting
Flushing
Pupillary change
Sensory change
40
Q

What is the partial complex seizure disorder

A 
Consciousness is impaired 
Staring
Lip smacking
Chewing
Unusual hand movement: pill rolling
Amnesia
41
Q

What is a generalized seizure?

A

Entire brain involved

42
Q

What is generalized absence seizure

A 
Lack of awareness. 
Unresponsive 
Lat less then 15 seconds
Eye fluttering
Lip smacking
Blank stare
43
Q

What is generalized myoclonus seizure

A

No or brief LOC
Synchronous jerking of neck, shoulders, arms and legs
Less then 5 seconds

44
Q

What is a generalized tonic clonic seizure?

A 
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

45
Q

What is status elepticus seizures?

A

Unrelieved
Prolonged seizure longer then 15-20 seconds
Normal baseline in between

46
Q

Febrile seizure in seizure disorder?

A

Occur I. Association with fever, no underlying chronic illness x
Most common between 6 month - 3 yrs, rare after 5

47
Q

What s the history that needs to be taken with seizure disorders?

A 
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
48
Q

What is the treatment for seizures?

A 
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

49
Q

What are the triggering factors of seizures

A 
Changes in dark light patterns- flash camera, automobile light, strobe lights
Sudden loud noise
Startling movement
Temperature extremities
Dehydration
Fatigue
Menses
Constipation
Hypoglycemia
50
Q

What do anti-epileptic medications cause in seizure patients

A

Can heat intolerance and patients don’t sweat

51
Q

What s hydrocephalus

A

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
52
Q

What are clinical manifestations of hydrocephalus

A 
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
53
Q

What is treatment of hydrocephalus?

A

Surgical correction of underlying cause
Surgical placement of shunt to drain CSF from ventricle to extra cranial compartment
-prevent complications.
-surgical revisions periodically necessary

54
Q

What are nursing measures for hydrocephalus?

A 
Monitor for signs of ICP
post operative care
Skin carre: prevention and breakdown
Nutritional support
Family support and education

Pediatrics (10 decks)

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