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OB/PEDs: Final > The Child with Alterations in Neurologic Function > Flashcards

The Child with Alterations in Neurologic Function Flashcards

1
Q

Anatomic Differences between Adult and Child

A

Child:
- top-heavy, head is large in proportion to body; neck muscles poorly developed; thin, cranial bones, not well developed; unfused sutures; skull expands until two years old. Prone to brain injury, and a skull fracture with falls.
- Excessive spinal mobility; immature muscles, joint capsule, and ligaments of cervical spine; wedge shaped, cartilaginous vertebral bodies; incomplete ossification of vertebral bodies. Greater risk for high cervical spine injury at C1-C2 level or vertebral compression fractures with falls
Adult:
- Head size proportional to body; neck muscles well developed; can reduce risk for brain injuries; sutures are ossified by age 12 years; no expansion of skull after five years.
- well developed muscles and ligaments, reduce spinal mobility; vertebral bodies completely formed and ossified

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2
Q

Alterations in Neurologic Function
Assessment

A
  • Level of consciousness- Glascow Coma Scale
  • Cognitive function
  • Pupils
  • Intracranial pressure: infection, trauma, crying, coughing, pooping
  • Fontanelles
  • Posturing & Movement
  • Neck Stiffness
  • Pain
  • Cranial nerves
  • Vital signs: fluctuate
  • Labs and imaging exams: CT/MRI of the head, CBC, CSF, blood culture
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3
Q

Pupil findings in various neurologic
conditions with altered consciousness.

A

A. A unilateral dilated and reactive pupil is associated with an intracranial mass.
B. A fixed and dilated pupil may be a sign of impending brainstem herniation.
C. Bilateral fixed and dilated pupils are associated with brainstem herniation from increased intracranial pressure.

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4
Q

What causes:
Increased Intracranial Pressure

A
  • Increased CSF Volume
  • Decreased CSF Drainage
  • Swelling
  • Infection (meningitis)
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5
Q

Early signs of increased intercranial pressure

A
  • Headache
  • Visual disturbances, diplopia
  • Nausea and vomiting
  • Dizziness and vertigo
  • Slight changes in vital signs
  • Pupils not as a Reactive or equal
  • Sunsetting eyes
  • Slight change in level of consciousness
  • Restlessness
  • Irritability
  • Bulging fontanelle
  • Wide sutures, increased head circumference
  • Dilated scalp veins
  • High-pitched, cat like cry
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6
Q

Late signs of increased intercranial pressure

A
  • significant decrease in level of consciousness
  • Seizures
  • Cushing’s triad
  • fixed and dilated pupils, papilledema
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7
Q

*Cushing’s triad s/s

A
  • Increased systolic blood pressure and widened pulse pressure
  • Bradycardia
  • Irregular respirations
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8
Q

Decorticate

A

Arms and feet flexed inward
brain injury/ swelling

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9
Q

Decerebrate

A

Arms and feet extended outward
severe brain damage

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10
Q

Kernig Sign

A

pain in neck upon extending leg= (+) Kernig sign = increased intracranial pressure

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11
Q

Brudzinski Signs

A

involuntary flex knees when putting chin to chest = (+) Brudzinski Sign= increased cranial pressure

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12
Q

Spinal Tap Positions

A
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13
Q

Brain Injury: Concussion

A

Alteration in mental status with or without loss of consciousness immediately after a head injury.

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14
Q

Brain Injury: Concussion
Nursing Considerations:

A
  • Rule out Child Abuse
  • VS
  • Neuro Status
  • Stabilize spine
  • Ocular Assessment
  • Prevent ICP
  • keep calm
  • ask parents if the kid has been behaving out of the norm
  • Resolves 1-3 weeks; afterwards its known as post concussion syndrome
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15
Q

Post concussion syndrome: s/s

A

> 3 weeks:
- headaches
- Sleep problems
- Appetite changes
- Fatigue
- Trouble concentrating
- Memory problems
- Depression or anxiety
- Sensitivity to light and noise
- Dizziness

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16
Q

Concussion Clinical Manifestations

A

Less than 5% loss consciousness
Most common signs/symptoms:
- Headache
- Dizziness
- Difficulty concentrating
- Confusion Symptoms usually resolve within 1-3 weeks

17
Q

Concussion theraputic management

A
  • Mild to moderate concussion can be cared for at home or clinic
  • **Strict bedrest and limited activity is contraindicated.
  • Severe injuries are hospitalized until they stabilize or neuro symptoms have diminished
  • Maintained on clear liquids - vomiting
  • I.V. If child is comatose
  • Careful monitoring of intake and output due to cerebral edema*
  • Neuro checks q 2 to 4 hours only while awake
18
Q

Submersion Injury

A

In children 1-4 yrs- leading cause of Accidental injury related death
- Can take place in any body of water
- Should be hospitalized for at least 24hrs Observation due to risk of respiratory compromise and cerebral edema (dry drowning)

  • Management: oxygenation, thermoregulation, monitor glucose, seizure prevention
  • Prognosis: depend on the length of submersion. Poor prognosis with Submersion greater than 5 min, no presence of sinus rhythm and poor neurologic assessment
19
Q

Febrile Seizures

A
  • most common type of childhood seizure
  • Seizure occurring with febrile illness in the absence of CNS infection.
  • The most important nursing intervention is to reassure parents of their benign nature and educate parents regarding protection of their child and meaningful observation during the event.
20
Q

Questions to ask about seizures

A

Just before the seizure:
- What was the child doing?
- Did the child complain of not feeling well? (Headache, nausea, vomiting, muscle pain, fever)
- Did the child suffer any trauma? Did the child get into any medication or poisons?
During the seizure :
- What movement of the arms and legs were seen?
- On one or both sides of the body or in one extremity only?
- Did the child exhibit any chewing or other type of automatic behavior?
- Were the pupils dilated or the eyes deviated to one side?
- Did the child color change? (Pale, red, blue)
- What is the child incontinent of urine or stool?
- What is the child aware of surroundings or able to respond to questions?
After the seizure:
- how long did the episode last?
- What is the child lethargic, week, or uncoordinated when waking up?
- Did the child have loss of memory or confusion?

21
Q

Hydrocephalus etiology

A

Etiology: *developmental malformation, CNS infection, cancer, trauma, myelomeningocele

22
Q

Hydrocephalus Nursing Management

A

*Daily head circumference, monitor suture lines and fontanels, irritability, lethargy, feeding issues, VS, altered Mental Status or LOC

23
Q

Hydrocephalus Treatment

A
  • Surgically remove the obstruction
  • Decrease swelling
  • Place a Ventral peritoneal (VP) shunt in the ventricle to divert CSF to the peritoneal cavity or right atrium of the heart
24
Q

Assessments of Shunt Function:
S/s of shunt not draining properly

A
  • Early morning headache on awakening
  • Vomiting with or without nausea
  • Papilledema
  • Lethargy and irritability
  • Confusion
  • Inability to follow commands
  • Signs of infection: Fever

OB/PEDs: Final (18 decks)

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