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ABSN > Peds Final - Neuro > Flashcards

Peds Final - Neuro Flashcards

1
Q

decorticate posturing

A

bring hands over the core (hands over chest)
better then decerebrate

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2
Q

decerebrate posturing

A

hands bends at waist and turn away from body
away from core, very bad

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3
Q

equilibrium of cranium

A

brain: 80%
CSF: 10%
Blood: 10%

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4
Q

causes of increased ICP

A

tumors/lesions
hemorrhage
edema of cerebral tissue
accumulation of CSF in ventricles (hydrocephalus)
meningitis

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5
Q

signs of ICP in children (very important to know)

A

headache, blurred vision, diplopia, pupils sluggish repines to light, seizure, nausea, forceful vomiting, lethargy, increased sleeping, declining school performance, declining motor function

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6
Q

signs of ICP in infants (very important to know)

A

tense, bulging fontanel, separated craninal sutures, macewen (cracked pot) sign, irritable, high pitches cry, catlike cry, increased OFC, distended scalp veins, feeding changes, crying when held or rocked, setting sun eyes, taught, shiny skin over scalp

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7
Q

later signs of ICP (very important to know)

A

-decreased LOC
-decreased motor response to command
-decreased sensory response to pain
-fixed & dilated pupils
-posturing

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8
Q

very late sign of increased ICP (very important to know)

A

cushing’s triad ( SBP increases, HR & RR goes down & widening pulse pressure)

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9
Q

emergent nursing interventions for a head injury

A

-ensure ABCs
-stabilize spine when indicated
-treat shock
-reduce ICP when indicated

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10
Q

ongoing nursing interventions for a head injury

A

-frequent neuro assessments
-observe LOC & pupillary reactions
-vitals
-pain mgt cannot over treat do not sedate

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11
Q

what pain meds should be given to a child w/ a head injury

A

ibuprofen or Tylenol
no opioids

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12
Q

hydrocephalus

A

an excessive collection of cerebral spinal fluid in the ventricular system

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13
Q

hydrocephalus therapeutic mgt

A

1) relief of pressure w/ shunt
2) treatment of the cause
3) treatment of complications
4) promote psychomotor development

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14
Q

VP shunt

A

drains into the peritoneal cavity

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15
Q

VP shunt precautions pre op

A

-prevent breakdown of scalp
-infection
-damage to spinal cord
-monitor ICP
-promote adequate nutrition
-keep eyes moist

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16
Q

VP shunt precautions post op

A

-do not lay on side shunt was place
-bed rest (for flat then elevate to 15-30)
-montior VS, neuro, abdominal distention
-S/s of infection
-record developmental milestones

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17
Q

what can kids with shunts not do

A

-join the army
-play contact sports

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18
Q

what to do if shunt gets infected

A

1) remove shunt
2) insert external ventricular drain & monitor
3) IV antibiotics for several weeks
4) place new shunt once CSF is clear of infection

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19
Q

what to do if shunt malfunctions

A

new shunt is inserted via surgery
d/t growth, tubing disconnecting or kinks

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20
Q

parents education w/ shunts

A

do not pump it or drain it, just know the S/s of ICP or infections (then bring to ER)

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21
Q

where do we want the drainage bag for an extra shunt

A

in line with the ear

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22
Q

if we see excess drainage from an external shunt, what is the next best nursing action

A

call neuro surgery
we do not mess with the shunt

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23
Q

what do we need to be mindful of when turning a shunt pt

A

that we are not doing jugular compression

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24
Q

how often should we asses CSF for external shunts

A

every hour

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25
Q

if there is a sudden increase or decrease in CDF output or poor waveform on ICP monitor, what is our next best nursing action

A

immediately ensure all stopcocks are turned the correct direction and all cords are plugged in appropriately, thorough and quick patient ass then call surgery

26
Q

what type of skull fracture are we most concerned about

A

basilar because of proximity to structures surrounding the brain high risk for infection/meningitis

27
Q

clinical manifestation of basilar fracture

A

raccoon eyes, battle sign (bruising behind ears) and drainage from nose & ears

28
Q

how do you know if drainage from fracture is CSF

A

will contain glucose if it is tested and halos

29
Q

therapeutic mgt for basilar fracture

A

-monitor drainage
-do not do invasive procedures no suction
-prevent infections

30
Q

concussion

A

an alteration in mental status w/ or w/o loss of consciousness which occurs immediately after a traumatic blow to the head
dx made after structural injuries are ruled out

31
Q

hallmark signs of concussion

A

confusion and amnesia

32
Q

when to seek treatment for possible concussion

A

-infant always
-loss of LOC
-won’t stop crying
-head & neck pain
-vomits
-difficult to wake up
-difficult to console
-isn’t walking normally
-unusual behavior
-bleeding from nose or mouth or water glucose+ discharge

33
Q

traumatic brain injury mgt

A

-establish ABCs
-stabilize the neck & spine
-frequent neuro assessment & v/s monitoring
-hypertonic solutions to draw fluid into the vasculature & away from the brain
-steroids to decrease inflammation & edema IV, not just oral

34
Q

traumatic brain injury complications

A

-hemorrhage
-infection (posttraumatic meningitis)
-brain stem herniation
-hypothalamic dysfunction

35
Q

hypothalamic dysfunction manifestations

A

-syndrome of inappropriate antidiuretic hormone secretion
-diabetes insipidus

36
Q

traumatic brain injury: signs of progression

A

-mental status changes
-mounting agitation
-development of focal lateral neurological signs (eye changes, posturing)
-marked changes in VS
-cushing reflex
-signs of brainstem involvement

37
Q

meningitis

A

a syndrome caused by inflammation of the meninges of the brain & spinal cord

38
Q

meningitis CM: newborn

A

-poor sucking
-poor feeding
-apnea
-weak cry
-diarrhea
-tense fontanel
-jaundice

39
Q

meningitis CM: infants

A

-fever
-poor feeding
-nausea & vomiting
-increased irritability
-high pitched cry
-seizures

40
Q

meningitis CM: children

A

-fever
-headache
-nuchal rigidity
-kernig’s sign
-opisthotonos
-seizures
-altered sensorium
-projectile vomiting
-petechial

41
Q

Kernig Sign

A

1) flex knee to 90 degrees
2) flex hip to 90 degrees
Sign: extension of the knee is painful or limited

42
Q

brudzinski’s sign

A

passive flexion of neck elicits hip & knee flexion

43
Q

bacterial meningitis long term complications

A

blindness, intellectual disability, deafness, hydrocephalus, loss of extremities, cerebral palsy, seizures

44
Q

bacterial meningitis dx

A

order LP: results increased WBC, pressure & protein, decrease glucose & positive culture

45
Q

meningitis meds

A

antibiotic (for bacterial or while waiting for cultures), anticonvulsants, antipyretics + treatment of F&E imbalances
treat symptoms

46
Q

if we suspect meningitis, what is our first nursing action

A

put them in contact isolation followed by collecting blood work within 1hr & start abx
get blood before giving abx

47
Q

meningitis precaution

A

seizure

48
Q

encephalitis CM

A

-caused by HSV1
-has nonspecific signs, fever, altered mental status, possible seizures
-last few days or has severe CNS involvement causing long term comps or death
resembles meningitis

49
Q

encephalitis

A

inflammatory process of the CNS that can be caused by variety of organisms

50
Q

encephalitis dx

A

based on clinical findings and ID of specific organism
-CT scans
-blood samples

51
Q

encephalitis nursing mgt

A

-hospitalized for observation and supportive care
-same care as for meningitis

52
Q

Epilepsy

A

a chronic condition defined as two or more seizures episodes that were not caused by reversible medical condition

53
Q

Epilepsy etiology

A

-genetic
-structural / metabolic
-unknown
-febrile

54
Q

febrile seizure treatment

A

if seizure lasts more than 5 minutes call EMS who will give a anti epileptic drug
do nothing if less than 5mins

55
Q

how can prolonged seizures be treated

A

a rescue sedative (rectal diazepam or intranasal midazolam) in ED or via EMS

56
Q

if a febrile seizure is less than 5 minutes, what will their EEG show

A

no changes

57
Q

Epilepsy therapeutic mgt

A

-meds start w/ 1, titrate up if needed, add 2nd med if needed
-if multiple meds & still need more, place on ketogenic diet (not long term)
-if still need more, place a vagus nerve stimulator
-if all doesn’t work, surgery

58
Q

ketogenic diet

A

high fat, low carb
restrict: french fries, buns, carbs
give: full fat cheeses & yogurt & milk
give vitamin sups

59
Q

seizure meds

A

levetiracetam, carbamazepine, topiramate, lamotrigine, valproic acid

60
Q

what do we observe during a seizure

A

-direction of eye movements
-alteration of consciousness
-unilateral/bilateral movements
-duration of seizure

ABSN (150 decks)

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