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NSG 434 - Peds > Peds ICP Disorders and Cerebral Dysfunction > Flashcards

Peds ICP Disorders and Cerebral Dysfunction Flashcards

1
Q

An increase in ICP may be caused by

A

tumors or other space-occupying lesions, accumulation of fluid with in the ventricular system, bleeding, or edema of cerebral tissues.

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2
Q

what is the earliest indicator of changes in neuro status

A

level of consciousness

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3
Q

levels of consciousness in order

A

*Full consciousness
*Confusion: Impaired decision-making
*Disorientation: To time and place
*Lethargy: Sluggish speech

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4
Q

coma assessment tool

A

*Glasgow Coma Scale (GCS)
(Eye, verbal, and motor response)

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5
Q

on the glasgow coma scale what is defined as a coma

A

8 or below

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6
Q

a score of 3 on the glasgow coma scale indicates

A

deep coma

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7
Q

Brain death requires

A

*Complete cessation of brain function
*Irreversibility of condition

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8
Q

Assessment Parameters for Increased ICP

A

-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

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9
Q

Clinical Manifestations of Increased ICP in Infants

A

*Irritability, poor feeding
*High-pitched cry, difficult to soothe
*Fontanels: Tense, bulging
*Cranial sutures: Separated
*Eyes: Setting-sun sign
*Scalp veins: Distended

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10
Q

setting sun sign

A

-eyes deviate downward with rim of sclera showing above iris
-may indicate hydrocephalus

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11
Q

Clinical Manifestations of Increased ICP in Children

A

*Headache
*Forceful vomiting
*Seizures
*Drowsiness, lethargy
*Diminished physical activity
*Inability to follow simple commands

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12
Q

Late Signs of Increasing ICP

A

*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

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13
Q

Special Diagnostic Procedures for Increased ICP

A

*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)

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14
Q

lumbar punctures contraindicated in

A

patients with increased ICP or infected skin over puncture site

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15
Q

Nursing Care of theUnconscious Child

A

*Emergency management
*Airway
*Reduction of ICP
*Treatment of shock

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16
Q

what medication is used for cerebral edema

A

Osmotic diuretics: Mannitol

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17
Q

Indications for ICP monitoring

A

*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

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18
Q

Cerebral Trauma

A

head injury (damage to the brain)

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19
Q

Three major causes of brain damage in childhood

A

*Falls
*Motor vehicle injuries
*Bicycle- or sports-related injuries

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20
Q

Concussion

A

*An alteration in neurologic or cognitive function with or without loss of consciousness
*Transient and reversible
*Results from trauma to the head

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21
Q

a concussion is generally followed by

A

amnesia and confusion

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22
Q

treatment for concussion

A

-keep them awake for as long as possible
-rest until symptoms resolve
-resume activities gradually

23
Q

Epidural hemorrhage

A

*Bleeding between the skull and the dura

24
Q

Classic clinical picture of epidural hemorrhage consist of

A

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

25
Q

Subdural hemorrhage

A

*Bleeding between the dura and the arachnoid membrane

26
Q

presenting signs for subdural hemorrhage

A

irritability, vomiting, increased head circumference, bulging fontanels in infants, lethargy, coma, or seizures.

27
Q

Cerebral edema

A

*Associated with traumatic brain injury
*Increased ICP with herniation

28
Q

Cerebral edema peaks at

A

24 to 72 hours after injury and may account for changes in a child’s neuro status.

29
Q

Therapeutic Management ofHead Trauma

A

-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.

30
Q

Reye’s Syndrome

A

*A disorder defined as toxic encephalopathy associated with other characteristic organ involvement

31
Q

Reye’s Syndrome is characterized by

A

*fever, profoundly impaired consciousness, and disordered hepatic function

32
Q

most common cases of reyes syndrome follow

A

common viral illness (influeza and varicella)

33
Q

what medication is associated with reyes syndrome

A

*aspirin therapy for fever and development of Reye’s syndrome

34
Q

what is the definitive diagnosis for reye’s syndrome

A

liver biopsy

35
Q

a build up of ammonia in reyes syndrome will cause

A

sudden behavioral shift

36
Q

therapeutic management for reyes syndrome

A

*Early diagnosis and aggressive therapy

37
Q

seizure disorders

A

“transient occurrence of signs and/or symptoms due to abnormal excessive and synchronous neuronal activity in the brain”.

38
Q

seizures are determined by

A

site of origin

39
Q

The manifestations of seizures

A

unconsciousness or altered consciousness, involuntary movements, and changes in perception, behaviors, sensations, and/or posture

40
Q

Epilepsy

A

chronic brain disorder characterized by Two or more unprovoked seizures

41
Q

partial seizure

A

a seizure that affects only one part or one side of the brain, local onset

42
Q

generalized seizure

A

a seizure that affects both sides/hemispheres of the brain without local onset

43
Q

goal for seizure disorders

A

*To control seizures or reduce the frequency and severity

44
Q

Therapeutic Management of Seizure Disorders

A

-discovery and correction of cause
-medication (start at lowest dose possible) and gradually increase until seizures are controlled)

45
Q

febrile Seizures

A

Seizures that result from sudden high fevers, particularly in children between 6mo. and 3 years

46
Q

Hydrocephalus is caused by

A

*an imbalance in the production and absorption of CSF

47
Q

hydrocephalus

A

accumulation of fluid in the spaces of the brain

48
Q

myelomeningocele

A

hernia of the spinal cord and meninges

49
Q

hydrocephalus is commonly associates with

A

myelomeningocele

50
Q

Therapeutic Management of Hydrocephalus

A

*Ventriculoperitoneal shunt

51
Q

Ventriculoperitoneal shunt

A

a tube used to drain fluid from brain ventricles into the abdominal cavity

52
Q

when is a VP shunt at greatest risk for infection

A

1 to 2 months after shunt placement

53
Q

treatment for shunt infection

A

Massive-dose antibiotics or shunt removal

54
Q

what is the cardinal sign for shunt obstruction

A

headache

NSG 434 - Peds (17 decks)

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