Peds ICP Disorders and Cerebral Dysfunction Flashcards
An increase in ICP may be caused by
tumors or other space-occupying lesions, accumulation of fluid with in the ventricular system, bleeding, or edema of cerebral tissues.
what is the earliest indicator of changes in neuro status
level of consciousness
levels of consciousness in order
*Full consciousness
*Confusion: Impaired decision-making
*Disorientation: To time and place
*Lethargy: Sluggish speech
coma assessment tool
*Glasgow Coma Scale (GCS)
(Eye, verbal, and motor response)
on the glasgow coma scale what is defined as a coma
8 or below
a score of 3 on the glasgow coma scale indicates
deep coma
Brain death requires
*Complete cessation of brain function
*Irreversibility of condition
Assessment Parameters for Increased ICP
-Assess pupil size and reactivity
-temp is often elevated
-HR can be rapid, slow and bounding, or feeble
-BP may be normal, elevated or very low
-RR is often slow, deep, and irregular
Clinical Manifestations of Increased ICP in Infants
*Irritability, poor feeding
*High-pitched cry, difficult to soothe
*Fontanels: Tense, bulging
*Cranial sutures: Separated
*Eyes: Setting-sun sign
*Scalp veins: Distended
setting sun sign
-eyes deviate downward with rim of sclera showing above iris
-may indicate hydrocephalus
Clinical Manifestations of Increased ICP in Children
*Headache
*Forceful vomiting
*Seizures
*Drowsiness, lethargy
*Diminished physical activity
*Inability to follow simple commands
Late Signs of Increasing ICP
*Bradycardia
*Decreased motor response to command
*Decreased sensory response to painful stimuli
*Alterations in pupil size and reactivity
*Extension or flexion posturing
*Decreased consciousness
*Coma
Special Diagnostic Procedures for Increased ICP
*Laboratory tests
*Electroencephalography (EEG)
*Assessment of evoked potentials (auditory and visual)
*Radiography (rule out skull fractures, dislocations; evaluate degenerative changes, suture lines)
*Computed tomographic (CT) scan
*Magnetic resonance imaging (MRI)
lumbar punctures contraindicated in
patients with increased ICP or infected skin over puncture site
Nursing Care of theUnconscious Child
*Emergency management
*Airway
*Reduction of ICP
*Treatment of shock
what medication is used for cerebral edema
Osmotic diuretics: Mannitol
Indications for ICP monitoring
*Glasgow Coma Scale score of less than 8
*Traumatic brain injury with abnormal CT scan
*Deteriorating neurologic condition
*Subjective judgment regarding clinical appearance and response
Cerebral Trauma
head injury (damage to the brain)
Three major causes of brain damage in childhood
*Falls
*Motor vehicle injuries
*Bicycle- or sports-related injuries
Concussion
*An alteration in neurologic or cognitive function with or without loss of consciousness
*Transient and reversible
*Results from trauma to the head
a concussion is generally followed by
amnesia and confusion
treatment for concussion
-keep them awake for as long as possible
-rest until symptoms resolve
-resume activities gradually
Epidural hemorrhage
*Bleeding between the skull and the dura
Classic clinical picture of epidural hemorrhage consist of
momentary unconsciousness, followed by a normal period, then followed with lethargy and coma due to blood accumulation in the epidural space and compression of the brain
Subdural hemorrhage
*Bleeding between the dura and the arachnoid membrane
presenting signs for subdural hemorrhage
irritability, vomiting, increased head circumference, bulging fontanels in infants, lethargy, coma, or seizures.
Cerebral edema
*Associated with traumatic brain injury
*Increased ICP with herniation
Cerebral edema peaks at
24 to 72 hours after injury and may account for changes in a child’s neuro status.
Therapeutic Management ofHead Trauma
-NPO until it is determined that vomiting will not occur.
-Sedating drugs are commonly held in the acute phase.
-Acetaminophen for headache.
Surgery
-Scalp lacerations are sutured.
Reye’s Syndrome
*A disorder defined as toxic encephalopathy associated with other characteristic organ involvement
Reye’s Syndrome is characterized by
*fever, profoundly impaired consciousness, and disordered hepatic function
most common cases of reyes syndrome follow
common viral illness (influeza and varicella)
what medication is associated with reyes syndrome
*aspirin therapy for fever and development of Reye’s syndrome
what is the definitive diagnosis for reye’s syndrome
liver biopsy
a build up of ammonia in reyes syndrome will cause
sudden behavioral shift
therapeutic management for reyes syndrome
*Early diagnosis and aggressive therapy
seizure disorders
“transient occurrence of signs and/or symptoms due to abnormal excessive and synchronous neuronal activity in the brain”.
seizures are determined by
site of origin
The manifestations of seizures
unconsciousness or altered consciousness, involuntary movements, and changes in perception, behaviors, sensations, and/or posture
Epilepsy
chronic brain disorder characterized by Two or more unprovoked seizures
partial seizure
a seizure that affects only one part or one side of the brain, local onset
generalized seizure
a seizure that affects both sides/hemispheres of the brain without local onset
goal for seizure disorders
*To control seizures or reduce the frequency and severity
Therapeutic Management of Seizure Disorders
-discovery and correction of cause
-medication (start at lowest dose possible) and gradually increase until seizures are controlled)
febrile Seizures
Seizures that result from sudden high fevers, particularly in children between 6mo. and 3 years
Hydrocephalus is caused by
*an imbalance in the production and absorption of CSF
hydrocephalus
accumulation of fluid in the spaces of the brain
myelomeningocele
hernia of the spinal cord and meninges
hydrocephalus is commonly associates with
myelomeningocele
Therapeutic Management of Hydrocephalus
*Ventriculoperitoneal shunt
Ventriculoperitoneal shunt
a tube used to drain fluid from brain ventricles into the abdominal cavity
when is a VP shunt at greatest risk for infection
1 to 2 months after shunt placement
treatment for shunt infection
Massive-dose antibiotics or shunt removal
what is the cardinal sign for shunt obstruction
headache
