T3 - Neuro PPT (Josh) Flashcards
On the Glasgow Coma Scale, what score is poor?
8 or less
Glasgow Coma Scale measures for what?
- Eye opening
- Verbal response
- Motor response
– is very tough and covers the entire brain.
Dura mater
— is under the dura mater, thin, arteries and veins are suspended here
Pia arachnoid
– is very thin, lies under the arachnoid, and adheres to the surface of the brain.
Pia mater
CSF is found beneath the — and —
arachnoid
pia mater
Brain comprises — of body mass in infancy and — in adults.
15% in infants
3% in adults
In infants, a large proportion of blood volume is in –
the head
Why can brain tumors be missed in infants?
intercranial pressure can be less likely to be seen due to anterior fontanel
Reasons infants and young children are more susceptable to head injury
- top heavy
- large head in proportion to body
- excessive spinal mobility and immature muscles
Startle reflex
MORO
Stroke foot and toes curl
Plantar Reflex
Infant swings to the side that is stroked
Galant Reflex
— can reveal a spinal fluid leak.
Glucose test
Why do infants handle increased ICP better than adults?
fontanels
Space in scull is filled how?
Brain (80%)
CSF (10%)
Blood (10%)
Early signs of ICP
- Headache on awakening (w/out eating)
- Vomiting, personality changes, irritabilty, fatigue, gait change
- Double/Blurred vision. slow pupil reaction
- Seizures
- Increased head circumference, bulging fontanels
- LOC change
Late Signs of ICP:
Cushing’s Triad
Bradycardia
High BP
Slow breathing (bradynea)
Late Signs of CP:
Bradycardia
Widening pulse pressure
slow HR
LOC levels:
Falls asleep quickly
Lethargy
LOC levels:
Arousable w/ stimulation
Obtunded
LOC levels:
Deep sleep, responds to vigorous, repeated stimulation
Stupor
LOC levels:
No response to decerebrate posturing to pain
Coma
LOC levels:
eyes open, limbs spastic, no words, some swallow
Persistent Vegetative State (PVS)
How is brain death confirmed?
2 EEGs and 2 exams 24 hrs apart
What is the most important aspect of the physical exam for neuro probs?
Vital sign changes
Pinpoint pupils indicated…
MSO4 or poisoning
Fixed, dilated pupils mean…
brain herniation (med emergency)
Unilateral and dilated pupil means…
lesion on that side
impending herniation
Pupil’s in an unconscious child look like…
Doll’s Eyes (glassy)
— is always checked w/ neuro probs.
Glucose
Nursing intervention for unconscious child:
ABCs (suctioning ONLY as needed, if intubated)
Assessment
Pain control
ICP monitoring
Bowel functioning
Skin Care
To monitor ICP, what is used?
Ventricular Catheter
What is ICP treated w/ ?
mannitol
steroids
Signs of ICP:
- LOC change
- Headache
- Papilledema
- Doll’s eyes
- Pupillary changes
- V/S changes
- High pitched cry (infants)
Nursing Care for ICP
Avoid neck compression – keep head midline HOB elevated
Environment calm
Monitor ICP and treat as needed
Naso Gastric feedings
Hydration – 2/3 maintenance
Meds: Versed, antibiotics, anti-epileptics, barbiturates reduce brain oxygen need –
Pavulon, phenobarbital
Thermoregulation – NTE
Elimination – foley, stool softeners
Skin care – mouth care - artificial tears
What is the last sense to be lost in a coma?
hearing
— injuries account for the highest mortality.
— are twice as likely to be affected as —
Neurological
Boys
Girls
Head injuries can cause large blood loss why?
head is more vascular than adults
Coup is —
Contre-coup is —
Acceleration (bruising at point of impact)
Rebound brusing
Assessment for Head Injury
ABCs
Stabilize spinal cord
Evaluate for shock
Neuro exam
Neuro exam for Head injury includes:
LOC
Pupillary symmetry
Seizures
Test nasal discharge for GLUCOSE
Near drowning is more common in –
males less than 4 yrs
What is Hypoxic-Ischemic brain injury caused by near drowning?
survival 24 hours after incident
What happens in Hypoxic-Ischemic brain injury caused by near drowning?
Laryngospasm, swallow water, vomit, gasp, aspirate
Blood shunts to brain and heart
Hypoxia leads to brain damage
A characteristic sign of Shaken Baby Syndrome is —
Retinal Hemorrhage
– — results from initial impact in shaken baby syndrome
– — results from secondary impact as brain move backward in skull
Coup injury
Contrecoup injury
Most common head injury is —
Hallmark signs?
Concussion
Hallmarks signs:
- Amnesia
- Confusion
Which fracture has skin laceration and fracture?
Compound
Racoon eyes =
anterior basal fractures
sign of Basilar Skull fracture
Battle sign =
effusion of blood under ear
sign of Basilar Skull fracture
Signs of Basilar Skull fracture?
Racoon eyes
Battle Sign
Which fracture is traumatic separations of cranial sutures?
Diastatic
Children’s brains are – and – which leads to greater long term damage in brain injury.
thinner
softer
A unilateral dilated and reactive pupil is a sign of –
A fixed and dilated pupil is a sign of —
Bilateral fixed and dilated pupils are a sign of –
an intracranial mass.
impending brainstem herniation
brainstem herniation from increased ICP
Which posturing has arms curled up on chest?
Decorticate
- flexor posturing
Which posturing has arms to the side?
Decerebrate
- extensor posturing
Lesions ABOVE the brainstem are associated w/ — posturing.
Lesions of the brainstem are associated w/ – posturing
Decorticate
Decerebrate
What is Craniosynostosis?
premature closure of the sutures of the skull
- 18 mths
- surgical correction
- more common in males
Head shape abnormality that looks like a ‘cone-head’?
Craniosynostosis (aka craniostenosis)
Primary Craniosynostosis is —
Compound Craniosynostosis is –
one suture line is closed/absent
two or more suture lines are closed/absent
What is Positional Plagiocephaly?
flat occipatal part of skull due to child laying on back
What autosomal syndromes are related to Craniosynostosis?
Alpert Syndrome
Crouzon Syndrome
Patho of Craniosynostosis:
Premature closure or absence of sutures of the skull with normal brain growth can lead to displacement of cranial contents»_space;>
increased ICP»_space;>
decompensation»_space;>
seizures»_space;>
coma»_space;> death
Clinical manifestations of Craniosynostosis:
- no cranial symmetry
- exopthalmia
- strabismus
- increased ICP (headaches, irritability, high pitched cry, etc)
What treatment for Craniostenosis?
reconstructive surgery of the skull
In Craniostenosis, what is head shape dependent upon?
which sutures are involved
Pre-operative care for craniotomy?
- informed consent
- NPO
- Prophylactic meds (antibiotics, steroids for inflammation)
Post-op Nursing Responsibilities for Craniotomy?
Observe for signs (of periorbital edema; Changes in vision)
neuro assessment
Observe for signs of ICP
Cerebral edema
Surgical site care
Pain control
parent education
Why monitor HCT and Hgb following craniotomy?
head is very vascular
What is Microcephaly?
small skull size due to lack of brain growth
- 33 cm or less by 6 mths of age
Etiology of Microcephaly
Chromosomal Abnormality
Maternal infection (rubella)
Maternal alcholism
3rd trimester trauma
— is abnormal accumulation of fluid within ventricles.
Hydrocephalus
S/S of Hydrocephalus:
- Sunset Sign
- ^ head circumference
- high-pitched cry
- poor feeding if ICP too high
What is the biggest complication of shunt placement surgery?
infection
What is sunset sign?
eyes that look like sun late on the horizon (depressed)
it is a sign of Hydrocephalus
Causes of Hydrocephalus:
Obstruction caused by:
- hemorrhage
- meningitis
- tumors
- infection
S/S of Hydrocephalus
- bulging fontanels
- thinning of skull bones
- dilation of scalp veins
- frontal enlargement (bossing)
- depressed eyes (setting sun)
- irritability
- Shrill, high pitched cry
Cat scan reveals – ventricles.
enlarged
Which drugs can decrease the production of CSF until surgery for hydrocephalus?
Furosemide
Acetazolamide
The best and most effective treatment for Hydrocephalus is —
shunts
Most common type of Shunt is –
VP (Ventricular Peritoneal)
drains into peritoneum
When would a VA Shunt be used?
if patient’s had abdominal surgery
Types of Neural Tube defects:
Occulta (not visible)
Cystica (visible w/ sac-like protrusion)
Which type of Neural Tube defect has spinal fluid and nerves:
Meningocele
Myelomeningocele
Myelomeningocele
— is frequenly associated w/ hydrocephalus.
Spina Bifida
What is the biggest problem w/ myelomeningocele?
infection if it bursts
– encases meninges and spinal fluid with no neural elements
– contains meninges, spinal fluid and neural tissue (nerves)
Meningocele
Mylomeningocele
– is revealed w/ positive translumination (ie: the light shines through).
Meningocele
- b/c there are no nerves or neural elements
During pregnancy, eat foods rich in — and —
Folic Acid
Vit C (to absorb the FA)
- leafy greens
- citrus fruits
