Peds Final - Neuro Flashcards
decorticate posturing
bring hands over the core (hands over chest)
better then decerebrate
decerebrate posturing
hands bends at waist and turn away from body
away from core, very bad
equilibrium of cranium
brain: 80%
CSF: 10%
Blood: 10%
causes of increased ICP
tumors/lesions
hemorrhage
edema of cerebral tissue
accumulation of CSF in ventricles (hydrocephalus)
meningitis
signs of ICP in children (very important to know)
headache, blurred vision, diplopia, pupils sluggish repines to light, seizure, nausea, forceful vomiting, lethargy, increased sleeping, declining school performance, declining motor function
signs of ICP in infants (very important to know)
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
later signs of ICP (very important to know)
-decreased LOC
-decreased motor response to command
-decreased sensory response to pain
-fixed & dilated pupils
-posturing
very late sign of increased ICP (very important to know)
cushing’s triad ( SBP increases, HR & RR goes down & widening pulse pressure)
emergent nursing interventions for a head injury
-ensure ABCs
-stabilize spine when indicated
-treat shock
-reduce ICP when indicated
ongoing nursing interventions for a head injury
-frequent neuro assessments
-observe LOC & pupillary reactions
-vitals
-pain mgt cannot over treat do not sedate
what pain meds should be given to a child w/ a head injury
ibuprofen or Tylenol
no opioids
hydrocephalus
an excessive collection of cerebral spinal fluid in the ventricular system
hydrocephalus therapeutic mgt
1) relief of pressure w/ shunt
2) treatment of the cause
3) treatment of complications
4) promote psychomotor development
VP shunt
drains into the peritoneal cavity
VP shunt precautions pre op
-prevent breakdown of scalp
-infection
-damage to spinal cord
-monitor ICP
-promote adequate nutrition
-keep eyes moist
VP shunt precautions post op
-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
what can kids with shunts not do
-join the army
-play contact sports
what to do if shunt gets infected
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
what to do if shunt malfunctions
new shunt is inserted via surgery
d/t growth, tubing disconnecting or kinks
parents education w/ shunts
do not pump it or drain it, just know the S/s of ICP or infections (then bring to ER)
where do we want the drainage bag for an extra shunt
in line with the ear
if we see excess drainage from an external shunt, what is the next best nursing action
call neuro surgery
we do not mess with the shunt
what do we need to be mindful of when turning a shunt pt
that we are not doing jugular compression
how often should we asses CSF for external shunts
every hour
if there is a sudden increase or decrease in CDF output or poor waveform on ICP monitor, what is our next best nursing action
immediately ensure all stopcocks are turned the correct direction and all cords are plugged in appropriately, thorough and quick patient ass then call surgery
what type of skull fracture are we most concerned about
basilar because of proximity to structures surrounding the brain high risk for infection/meningitis
clinical manifestation of basilar fracture
raccoon eyes, battle sign (bruising behind ears) and drainage from nose & ears
how do you know if drainage from fracture is CSF
will contain glucose if it is tested and halos
therapeutic mgt for basilar fracture
-monitor drainage
-do not do invasive procedures no suction
-prevent infections
concussion
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
hallmark signs of concussion
confusion and amnesia
when to seek treatment for possible concussion
-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
traumatic brain injury mgt
-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
traumatic brain injury complications
-hemorrhage
-infection (posttraumatic meningitis)
-brain stem herniation
-hypothalamic dysfunction
hypothalamic dysfunction manifestations
-syndrome of inappropriate antidiuretic hormone secretion
-diabetes insipidus
traumatic brain injury: signs of progression
-mental status changes
-mounting agitation
-development of focal lateral neurological signs (eye changes, posturing)
-marked changes in VS
-cushing reflex
-signs of brainstem involvement
meningitis
a syndrome caused by inflammation of the meninges of the brain & spinal cord
meningitis CM: newborn
-poor sucking
-poor feeding
-apnea
-weak cry
-diarrhea
-tense fontanel
-jaundice
meningitis CM: infants
-fever
-poor feeding
-nausea & vomiting
-increased irritability
-high pitched cry
-seizures
meningitis CM: children
-fever
-headache
-nuchal rigidity
-kernig’s sign
-opisthotonos
-seizures
-altered sensorium
-projectile vomiting
-petechial
Kernig Sign
1) flex knee to 90 degrees
2) flex hip to 90 degrees
Sign: extension of the knee is painful or limited
brudzinski’s sign
passive flexion of neck elicits hip & knee flexion
bacterial meningitis long term complications
blindness, intellectual disability, deafness, hydrocephalus, loss of extremities, cerebral palsy, seizures
bacterial meningitis dx
order LP: results increased WBC, pressure & protein, decrease glucose & positive culture
meningitis meds
antibiotic (for bacterial or while waiting for cultures), anticonvulsants, antipyretics + treatment of F&E imbalances
treat symptoms
if we suspect meningitis, what is our first nursing action
put them in contact isolation followed by collecting blood work within 1hr & start abx
get blood before giving abx
meningitis precaution
seizure
encephalitis CM
-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
encephalitis
inflammatory process of the CNS that can be caused by variety of organisms
encephalitis dx
based on clinical findings and ID of specific organism
-CT scans
-blood samples
encephalitis nursing mgt
-hospitalized for observation and supportive care
-same care as for meningitis
Epilepsy
a chronic condition defined as two or more seizures episodes that were not caused by reversible medical condition
Epilepsy etiology
-genetic
-structural / metabolic
-unknown
-febrile
febrile seizure treatment
if seizure lasts more than 5 minutes call EMS who will give a anti epileptic drug
do nothing if less than 5mins
how can prolonged seizures be treated
a rescue sedative (rectal diazepam or intranasal midazolam) in ED or via EMS
if a febrile seizure is less than 5 minutes, what will their EEG show
no changes
Epilepsy therapeutic mgt
-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
ketogenic diet
high fat, low carb
restrict: french fries, buns, carbs
give: full fat cheeses & yogurt & milk
give vitamin sups
seizure meds
levetiracetam, carbamazepine, topiramate, lamotrigine, valproic acid
what do we observe during a seizure
-direction of eye movements
-alteration of consciousness
-unilateral/bilateral movements
-duration of seizure
