Week 3 Cerebral Dysfunction Flashcards
An infant with ICP will have a _______
high pitched whimper
With a Nero assessment. ______ is most important
History
What is decorticate posturing?
Curling up protects the core
What is decerebrate posturing?
Curls outward
What is Kernig’s sign and what is it a positive indicator of?
Pain when the knees are bent up.
Positive for inflamed meninges
What is brudzinski’s sign and what is it positive for?
Pain when flexing the head forward. Positive for inflamed meninges
Changes in the _____ are critical indicators of Neuro problems
Glascow Coma scale.
What are five major cerebral dysfunctions in pediatric patients?
- Head injury
- Meningitis
- Seizure disorders
- Migraine
- Hydrocephalus
Why are head injurys in children wors than adults *anatomically speaking”
Because the skull of a child is softer and less rigid. Their skull doesn’t crack it caves.
Why can infants handle increased ICP better than children?
Because they don’t have fused skulls yet
During a neuro assessment of a patient with a head injury, changes in LOC A and )’s, neuro signs could indicate what four major things?
- Hypoxia
- Decreased perfusion
- Shock
- increased ICP
What is Cushing’s triad?
It is 3 signs that develop late in instances of increased ICP
What are the three parts of cushions triad?
- INcreased systolic BP (with widening pp)
- Bradycardia
- Irregular respirations (breathing center disrupted)
Why is it important to assess the temperature of a patient with a head injury?
Because thermoregulators may be disrupted from the brain injury and could lead to extreme fever
What is one major intervention for children in a coma?
Aggressive AROM
What are the three types of skull fractures?
Linear, Depressed, and Basilar
What are the possible complications of a linear skull fracture?
UNderline Brain injury
What are the possible complications of a depressed skull fracture?
- Bleeding
- Dural laceration
- tissue injury
- infection if open wound
When do most depressed skull fractures occur and why?
The summer time
-CHildren are using more blunt objects during play
How is a depressed skull fracture treated?
Surgical repair
What are three major indicators of a basilar skull fracture?
- CSF leaking from nose and/or ears
- Periorbital ecchymosis (raccoon eyes)
- Bruising behind ears (battle sign)
What is one main intervention for a basilar skull fracture?
Bed rest until CSF leak stops
What are the major complications of a basilar skull fracture?
- Meningitis
- Hearing loss
- facial paralysis
- vertigo
- tinnitus
All cases of meningitis are treated as ___ until confirmed otherwise
Bacterial
How does CSF appear in viral meningitis?
Clear
viral meningitis can be abrupt or _____
gradual
how is viral meningitis treated?
Through the treatment of the symptoms
What are the four major signs of viral meningitis in infants?
- Irritable
- Lethargic
- Vomiting
- Change in appetite
what are the major signs of viral meningitis in older children?
- Preceded by a nonspecific febrile illness
- Headache
- Muscle ache
- malaise
- N/V
- Photophobia
- nuchal/spinal rigidity
What are theree causes of Bacterial meningitis
- H-influenza
- Strep
- neisseria
How is H-influenza prevented?
Hib vaccine
What are some Bacterial meningitis specific signs in an infant?
- High-pitched cry
- Temp regulation failure
- Floppy baby
What are some signs/symptoms of Bacterial meningitis in infants
- poor/sick feeding
- Vomiting
- High pitched cry
- bulging fontanel
- Fever or hypothermia
- poor muscle tone
what are some signs/symptoms of Bacterial meningitis in older children
- Abrupt onset
- Fever/chills
- HA
- Nuchal rigidity (neck)
- Irritable
- agitation
- rash
- seizure
- drowsy + kerning or brudzinski’s sign
- Opisthotonus posture
What are the main nursing interventions involved with caring for a child with Bacterial/viral meningitis
- Minimize ICP by elevating HOB and monitoring fluids in, maybe an icepack on head
- Monitor of cereal edema
- Use antipyretics do not use opioids
- Monitor for complications
What is epilepsy?
Chronic seizure disorder
What are the two types of seizures?
Generalized and focal
What is a generalized seizure?
One that occurs in both hemispheres of the brain
What is a focal seizure?
one that occurs in on hemisphere of the brain
What are some causes of seizure disorder in infants?
- perinatal hypoxia
- hypoglycemia
- cong. diseases
- infections
- metabolic or degenerative diseases
- drug withdraw
What are some causes of seizures in older children?
- Febrile infections
- Head injury
- Lead toxicity
- Drugs
- Genetic disorder
- neoplasms(tumor)
What does the term tonic-clonic mean
Also known as a grand mal seizure.
What are the characteristics of a tonic-clonic seizure?
Loss of consciousness occurs first and lasts about 10 to 20 seconds, followed by muscle convulsions that usually last for less than two minutes.
What are some characteristics of focal seizures?
Can be motor or non-motor
- each person is different
- can cause odd behaviors or uncontrolled movements
- can cause blank stares
- can cause emotions
- Sensory distortions
- Basically, they can be anything
What are some major assessment data to collect from a patient with a seizure disorder?
- Order of events and duration
- Participatory events
- What body parts are involved
You also need to ask what normally happens ____ the seizure? Why?
After
because some patients will have decreased LOC, motor, speech, and orientation after. this puts them at a high risk for injury
A patient is have a seziure. What do you do?
- Help them to the ground of standing
- Place them in the rescue position
- Protect their airway
- Protect their head/neck
- Wait of the seizure to end
What is one very important consideration about drug administration for seziure medications?
TheyApr have a very short window of administration and need to be given as close to the time prescribed as possible
Aprox ____ of migraine sufferers have their first attack before ____
20% 5th birthday
How does a migraine appear in children 5 and under?
- They look ill
- have abdominal pain
- vomit
- strong need to sleep
- irritable
- they cry or rock
- seak somewhere dark and quiet
How do migraines appear in children 5-10?
- Headache
- nausea
- abdominal cramp
- vomiting
- Photo, phono, osmophobia
- need to sleep
- pale with dark circles
- tearing
- thirst
- sweating
- swollen
- increased urination
- diarrhea
What are some teaching points for migraines?
Keep a diary of triggers
the child may outgrow them. it happens
What is the main reason we measure child head circumference?
to detect hydrocephaly
What causes hydrocephaly?
50% is idiopathic
the rest is associated with meningitis, trauma, intraventricular hemorrhage, or myelomeningocele
What is the patho of hydrocephaly?
It is an imbalance of the production and absorption of CSF. this overproduction causes increased buildup in the brain in leads to increased ICP
WHat are the two types of hydrocephaly
Communicating and non-communicating
What is communicating hydrocephaly
Normal production of CSF with under absorption
what is non-communicating hydrocephaly?
CSF traped in ventricles
What are the s/s of hydrocephaly in infants?
Splitting sutures, bulging fontanels, irritability, and increased head circumference
what are the s/s of hydrocephaly in older children?
- Setting sun eyes
- seizures
- irritability
- increased head circumference
What is the treatment for hydrocephaly?
Ventro peritoneal shunt
Why do we NEVER give children under 18 aspirin?
BEcause it can cause Reye syndrome
What is Reye syndrome?
A rare syndrome caused by the interaction of a virus and aspirin. The interactions causes Metabolic encephalopathy and fatty liver
What are the key nursing management for Reye syndrome?
- PReventions
- Strict I’s and O’s
- Control cerebral edema
- When the child wakes up they may have mental defects from brain damage
What is Guillian Barre?
An inflammatory syndrome associated with immunizations and viruses
What is the patho of guillian barre?
Acute inflammatory demyelinating neuropathy occurs.
Causing reduced motor function and reflexes in a distal to proximal pattern until total paralysis occurs.
How is Guillian Barre treated?
IV immune globulin (very expensive)
What are the nursing managements for Guillian Barre?
- IV meds
- Prevent complications from immobility
- monitor respiratory status
- Nutritional support
- Emotional support
