T3 U8 NEURO Flashcards
what is the #1 sign of ICP?
change in LOC
manifestations of ICP in infants?
High pitch screech cry
Bulging fontanels
Sun setting eyes/pupils face down
late s/sx of ICP
Cushings Triad
HTN, BradyC & Irregular/shallow breath
how often to monitor V/S with ICP?
Q1hr
GCS with every set of vitals
how should a ICP pt be positioned in bed?
HOB 15-30 degrees
Head/neck midline
What interventions should be avoided with ICP pt?
Suctioning (vigorous)
Hypotonic IV solution
what should be preformed on an ICP pt in bed?
Passive ROM Q 2 hr
medication given for ICP
Mannitol (Osmitrol)
When to not use Mannitol?
In active bleed
Anuria
Don’t add blood products
side effects of mannitol?
HA
Blurred vision
HyperK
HyperNa
what is the criteria for I&O for mannitol
must be @ least 30-50mL/Hr
what is the action of barbituates in ICP?
VasoC in brain but VasoD in rest of body
monitor ______ when using barbs w/ ICP?
BP
Volume status
when is IPM (intracranial pressure monitoring) used?
GCS <8
Increased ICP or post op neuro surg
when is ICP considered elevated in children
greater than 15mmHg
what is the most common 1st time seizure in children?
Febrile
Last less than 15 min
Tend to “grow out of it”
an EEG monitors what
electrical activity in brain
what Hx questions should be asked r/t seizures?
Videogames/visuals
exercise
dehydration
What they were doing pre-seizure
what is the theraputic level for phenytoin?
10-20mg
for a child w/ Gen ton/clon seizures - what should be done immediately?
Time the seizure & note sequence of events
what statement about physical activites & seizures precautions is wrong?
the child can participate in sport/physical activities
what manifestations present with absence seizures?
Rapid eye blinking/staring into space
what is the initial drug of choice for treating staus epilepticus?
IV diazepam
what early sign of ICP would present in a TBI
slurred speech
a GCS level of 8 would indicate what LOC
severe impairment
what is the priority assessment for a PT with a TBI in acute phase?
monitor ICP
what should a seizure precaution client avoid in their diet?
excessive caffeine
which finding indicates immediate action by nurse in a post seizure pt? &why
postical N/V
@ risk for aspiration –> L Lat positoin
what should be the priority intervention for a PT with suspected encephalitis?
admin antiviral meds
what finding would a nurse associate with encephalitis?
Positive Kernig’s sign
Knee & hip flexed @ 90 degree= pain on extension
common vector/transmission of encephalitis?
Mosquitos
How to promote mobility/prevent contractures with cerebral palsy?
rom
what would present with spastic cerebral palsy?
hyperflexia
what can the nurse do to help a cerebral palsy PT thats having difficulty swallowing?
Offer thickened liquids & pureed foods
what is priority for the nurse to assess with a CP pt thats prescribed baclofen (Liorseal)?
s/sx of respiratory distress
what is the most common cause of bacterial meningitis?
S.Pneumoniae
s/sx of meningitis
fever
HA
Stiff neck
LOC changes
photophobia
s/sx of meningitis in INFANTS
bulging fontanelle
increased head circumference
High pitched cry
priority intervention for meningitis
IV & ABX
neuro status checks for meningitis occur how often?
Q2hr
new onset of seizures can be indicative of what neuro condition?
encephalitis
important to assess for encephalitis diagnosis
skin for lesions - mosquito bites
camping recently - exposure
brain biopsy is defintive
what is a complication of encephalitis the nurse should monitor for?
SIADH
water retention & low Na levels
prevention/help prevent encephalitis?
bugspray with deet in it
prenatal care for spina bifida?
400 mg folic acid
what does Meningocele SB include
meninges/CSF
neuro function normally isnt affected
Myelomeningocele involves what?
meninges protrude thru defect & contain spinal cord elements
most SB form
what other issues can myelomeningocele cause?
hip/joint deformities
impaired bowel/bladder function
how can you diagnose spinda bifida
ultrasounds at 12-14 wk of preg
serum testing of A feroprotein
prevention of spina bifida edu for mom
avoid sauna/hot tubs
closely monitor diabetes
priority nursing concern with spina bifida babies?
preventing infection/injury
cover defect with sterile non adhesive dressing
how should myelomeningocele (SB) be laid/taken care of
on stomach
no diaper (or not near the defect)
children with SB also often have what allergy
latex –> kiwi/banana
4 types of cerebral palsy
spastic
ataxic
athetoid/dyskinetic
mixed
how does spastic cerebral palsy present?
very tight
can’t pull arms down
contractures
how would Ataxic CP present?
messed up gait
how would A/D CP present
can’t make hands work the way they want to
manifestations of CP?
muscle rigidity
muscle spasticity
poor posture control
ataxia
vision/sensory impairments
edu for CP
encourage school enrollment
freq rest periods to reduce spasms
assistive devices
non traditional growth
meds for CP
Dantrolene to decrease spasms
Baclofen to relax muscles
how to maintain O2 with a TBI
oxygen with bag valve mask
after observation, what would the nurse assess next for TBI?
Palpate for fractures
s/sx of Basal skull fracture
CSF from nose/ears
hemotypanum (blood in ears)
mastoid ecchymosis
periorbital ecchymosis
what intervention is contraindicated with TBI? & why?
NG tube/suction
Run risk of aggitating undiscovered fractures
what is a hallmark sign of abusive head trauma
retinal hemorrhage
