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Pediatrics-MJ > T3-Blueprint: Head Injuries > Flashcards

T3-Blueprint: Head Injuries Flashcards

1
Q

What are the normal percentages of head? What happens if one of these percentages changes?

A

Brain: 80%
CSF: 10%
Blood: 10%

Body has to adjust

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2
Q

What concerns might the nurse have about sedation in the acute head injury patient?

A

Interferes with the need to perform periodic neurological exams to assess for LOC and extent of injury

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3
Q

Why do infants handle ICP better?

A

Fontanels are not closed yet–more room for growth

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4
Q

What are signs of ICP?

A
  • Headache (on awakening, in absence of eating)
  • Vomiting
  • Personality changes
  • Irritability, fatigue
  • Gait changes
  • Double/blurred vision
  • Pupils react more slowly, then dilate and become fixed
  • Increased head circumference
  • Bulging fontanels
  • LOC: sleepy to coma (decreased recognition of parents)
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5
Q

What are late signs of ICP?

A
  • Cushings triad
  • Bradycardia
  • Increased BP
  • Irregular breathing
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6
Q

What is cushings triad (late sign of ICP)?

A

Bradycardia
High BP
Slow breathing

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7
Q

What does ICP monitoring tell?

A

Amount of pressure build up in head

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8
Q

What does a ventricular catheter do?

A

Surgical insertion that burrs a hole (external ventricular drain)…it drains excess CSP

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9
Q

What is the name of the catheter the surgeon can manipulate?

A

Bolt catheter

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10
Q

What are some treatments for ICP?

A
  • Mannitol
  • Steroids
  • Versed
  • Antibiotics
  • Anti-epleptics
  • Barbituates
  • Phenobarbital
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11
Q

Should we do neck compression for ICP? Explain

A

Avoid; keep the head midline and elevate HOB

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12
Q

How should environment be for child with ICP?

A

Calm environment

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13
Q

How should child eat if they have ICP?

A

NG feedings

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14
Q

How do we hydrate child with ICP?

A

2/3 maintenance–dont want to increase ICP even more by adding lots of extra fluids

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15
Q

Signs of ICP?

A
  • Headaches
  • Irritability
  • High pitched cry
  • Vomiting
  • Visual changes
  • Ataxia
  • Seizures
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16
Q

What is a neurological sign of ICP?

A

“Cat cry”

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17
Q

What are the 5 LOC states?

A
  1. Lethargy
  2. Obtunded
  3. Stupor
  4. Coma
  5. Persistent vegetative state
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18
Q

Falls asleep quickly

A

Lethargy

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19
Q

What is obtunded?

A

Arousable with stimulation

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20
Q

Deep sleep, responds to vigorous, repeated stimulation

A

Stupor

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21
Q

What is coma?

A

No response to decerebrate posturing to pain

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22
Q

Eyes open, limbs spastic, no words, some swallow

A

Persistent vegetative state

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23
Q

What are 3 parts to glasgow coma?

A
  1. Eye opening (up to 4 pts)
  2. Verbal response (up to 5 pts)
  3. Motor resposne (up to 6 pts)
24
Q

How is glasgow coma scored?

A

3-15

25
Q

What is a good glasgow coma score?

A

15

26
Q

What is a poor score for glasgow coma?

A

8 or less (3=worst)

27
Q

What is the last sense to be lost with coma?

A

Hearing

28
Q

What are nursing interventions for a child with an acute head injury?

A

Anti-inflammatory meds and pain management

29
Q

What are nursing interventions for the unconscious child?

A
  • ABC (only suction if needed)
  • Pain control
  • ICP monitoring
  • Bowel functioning
  • Skin care
30
Q

What are long term issues of a child with an acute head injury?

A

Physical problems

Cognitive impairments

31
Q

Premature closures of the sutures/absence of sutures

A

Craniostenosis

32
Q

Craniostenosis is the result for premature closure of the sutures/absence of sutures. What does that cause?

A

Increased ICP–> seizures, coma, death

33
Q

What are manifestations of craniostenosis? What age?

A

Early CORONAL sutures will show depression of the ORBITAL roof leading to visual changes like exophthalmia, strabismus, and other eye findings

18 months

34
Q

What is the mangement for craniostenosis?

A

Frequent positional changes in newborns and infants

35
Q

What is the treatment for craniostenosis?

A

Need surgical correction to realign cranial bones which relieves ICP pressure and helps cosmetic issues

36
Q

If craniostenosis is not treated, what happens?

A

Brain damage and mental retardation can occur

37
Q

What is the post-op for craniostenosis?

A
  • Emotional support
  • PRESSURE DRESSINGS
  • Careful monitor of Hct and Hgb!
38
Q

Small skull due to lack of brain growth

A

Microcephaly

39
Q

What are 5 etiologies for microcephaly?

A
  1. Cromosomal abnormality
  2. Radiation exposure in preg.
  3. Maternal infections like rubella or toxoplasmosis
  4. Maternal alcoholism
  5. 3rd trimester trauma, metabolic disorders, anoxia
40
Q

Hypoxic-ischemic brain injury: What are near drownings for infants and toddlers?

A

Infants: bath tub
Toddlers: toilet bowel

41
Q

What happens in hypoxic-ischemic brain injuries?

A
  • Laryngospasm
  • Swallow water
  • Vomit, gasp, aspirate
  • Blood shunts to the brain and heart
  • Hypoxia leads to brain damage!!!
42
Q

What happens in shaken baby syndrome?

A

Retinal hemorrhages

Torn subdural vessels

43
Q

What is the most common head injury?

A

Concussion

44
Q

What is the hallmark signs of concussion?

A

Amnesia

Confusion

45
Q

Cranial injury: What kind of fracture? Treatment?

Skin laceration and fracture

A

Compound–antibiotics and surgery

46
Q

Cranial injury: What type of fracture?

Result in dural year, hemorrhage into nose and middle ear

A

Basilar

47
Q

Cranial injury: What are 2 key signs of basilar fractures?

A
  1. Raccoon eyes

2. Battle sign

48
Q

Cranial injury–basilar fracture

What is raccoon eyes?

A

Anterior basal fractures!

Bilateral periorbital ecchymosis–associated with orbital fractures

49
Q

Cranial injury–basilar fracture

What is the battle sign?

A

Effusion of blood under ear

Retroauricular ecchymosis

Fracture of auditory canal/lower areas of the skull!

50
Q

Cranial injuries: What type of fracture?

Traumatic separations of cranial sutures

A

Diastatic

51
Q

Why do kids get cranial injury easier?

A
  • Insufficient musculoskeletal support of head
  • Thinner, softer brain
  • Thinner and compliant skull of younger children
52
Q

If a child has unilateral dilated pupils, what does this mean?

A

Intracranial mass

53
Q

If a child has a brainstem herniation what will their pupils be like?

A

Fixed and dilated

54
Q

What does it mean if a child has bilateral fixed and dilated pupils?

A

Brainstem herniation from increased ICP

55
Q

What kind of pupils for inter cranial mass?

A

Unilateral dilated

56
Q

What kind of injury if child has fixed and dilated pupils?

A

Brainstem herniation

57
Q

What kind of pupils will child have if they have a brainstem herniation from increased ICP?

A

Bilateral fixed and dialted

Pediatrics-MJ (61 decks)

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