Week 12 Flashcards
How are we assessing a child’s LOC?
Through the us we of AVPU. A= Alert & Awake V= responsive to verbal stimuli P= responsive to painful stimuli U= unresponsive
Name at least 4 early signs & symptoms of increased intracranial pressure?
- headache
- Vomiting
- slight alteration of LOC
- slight changes in vital signs
- generalised seizures
- changes in pupils/visual disturbances
Name at least 2 late signs or symptoms of increased intracranial pressure?
- significant changes in LOC
- respiratory distress including shallow breathing and Cheyenne-stokes respirations
- Cushing’s triad = bradycardia, wide pulse pressure, increased systolic BP
What is PEARL?
Pupils equal and reactive to light
Name 4 signs and symptoms of increased ICP in an infant.
- high pitched cry
- tense bulging fontanelle
- dilated scalp veins
- widened sutures
- irritability
- increased head circumference
- vomiting, poor intake
What are seizures?
An abnormal electrical discharge in the brain that cause involuntary movement and behaviour and sensory alterations
Seizures can be categorised into 2 types. What are they?
- partial seizures
- generalised seizures
What are partial seizures?
Partial seizures are caused by abnormal activity in one brain hemisphere or a specific area of the cerebral cortex.
What are generalised seizures?
These are the result of diffuse electrical activity that begins in both brain hemispheres simultaneously, spreading throughout the cortex into the brainstem.
- movement and spasms are bilateral and symmetric
- the persons consciousness is impaired.
What is status epilepticus?
A prolonged continuous seizure of 20 minutes or 2 or more seizures without full return to baseline between episodes.
What is the management of an acute seizure?
- stay with the pt
- time the seizure
- protect from injury (especially the head)
- roll them onto the side after jerking stops or if vomit, food, secretions in mouth
- observe and monitor breathing
- gently reassure child and parents until recovered
List at least 5 things that should be documented about the seizure activity.
- what the child was doing before the seizure occurred.
- did they complain off any symptoms? (Headache, nausea)
- what movements was the child making?
- did the childs colour change?
- how long the seizure lasted
- did the child experience any memory loss or confusion?
- was the child lethargic, weak or uncoordinated when the child woke up?
- was the child aware of their surroundings or able to respond to questions?
- where the pupils dilated or deviated to one side?
- was the child incontinent?
- are they on any medication?
What is epilepsy?
It is a chronic disorder characterised by recurrent unprovoked seizures, secondary to underlying brain abnormality.
What is meningitis?
Meningitis is an inflammation of the meninges, caused by either bacterial or viral agents.
List 2 meningitis risk factors.
- immunosuppression
- a ventriculoperitoneal shunt
- cochlear implant
- central nervous system trauma
- recent sinus or ear infection
List the clinical manifestations of Meningitis.
- headache (most often frontal location)
- photophobia
- esotropia (eyes moving in opposite directions)
- nuchal rigidity
What is Kernig’s sign?
One of the physically demonstrable symptoms of meningitis.
Severe stiffness of the hamstrings occur causing an inability to straighten the leg when the hip is flexed to 90 degrees.
What is Brudzinski’s sign?
It is when severe neck stiffness causes a patients hips and knees to flex when the knock is flexed.
List the nursing care for Meningitis.
- infection control
- monitoring of hydration status
- monitoring for signs of shock
- management for acute pain & discomfort ie:fever, photophobia, irritability
- seizure management (if needed)
- reduce anxiety of caregivers = emotion support
When would we not perform a Lumbar puncture on a child?
A L.P may be delayed if the childs symptoms strongly suggest bacterial meningitis. Or when: -signs indicate raise ICP -coma -prolonged seizure (>30 minutes ) -haemodynamic instability
The nursing care of a child with meningitis centres on emergency treatment of the infection, and monitoring the child for?
- neurological complications
- respiratory status
- maintaining hydration
- administration of medications
- response to antibiotic therapy
- prevention of complications
High temperatures are not treated automatically with anti-pyrexial drugs such as paracetamol. Why?
It it thought that doing so possibly inhibits the body’s natural response to infection, thus increasing recovery time.
However the child’s temp should be monitored 2-4hrly rule out/understand any irritability/lethargy that the fever could induce.
