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Peds Exam 3 > Week 9 lecture > Flashcards

Week 9 lecture Flashcards

1
Q

Clinical Manifestations in Children of ICP

A

Headache
Vomiting—w/ or w/o nausea
Seizures
Diplopia, blurred vision

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2
Q

Clinical Manifestations in Infants of ICP

A 
Irritability, poor feeding
High-pitched cry, difficult to soothe
Fontanels—tense, bulging
Cranial sutures—separated
Eyes—setting-sun sign
Scalp veins—distended
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3
Q

Behavioral Signs of Increasing ICP

A

Irritability, restlessness
Drowsiness, indifference, decrease in physical activity and motor skills
Complaint of fatigue, somnolence
Inability to follow commands, memory loss
Weight loss

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4
Q

Late Signs of Increasing ICP

A 
Decreased LOC
Decreased motor response to command
Decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Papilledema
Decerebrate or decorticate posturing
Cheyne-Stokes respirations
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5
Q

Levels of Consciousness

in Descending Order

A

Full consciousness
Confusion—impaired decision making
Disorientation—to time and place
Lethargy—sluggish speech
Obtundation—arouses with stimulation
Stupor—responds only to vigorous and repeated stimulation
Coma—no motor or verbal response to noxious stimuli
Persistent vegetative state—permanently lost function of cerebral cortex

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6
Q

Confusion

A

impaired decision making

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7
Q

Lethargy

A

Lethargy—sluggish speech

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8
Q

Obtundation

A

Obtundation—arouses with stimulation

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9
Q

Stupor—

A

Stupor—responds only to vigorous and repeated stimulation

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10
Q

Coma

A

Coma—no motor or verbal response to noxious stimuli

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11
Q

Persistent vegetative state

A

state—permanently lost function of cerebral cortex

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12
Q

Pediatric Glasgow Coma Scale

A

Three-part assessment
Eyes
Verbal response
Motor response

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13
Q

Pediatric Glasgow Coma Scale scores

A

Score of 15 = unaltered LOC
Score of 3 = extremely decreased LOC
(worst possible score on the scale)

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14
Q

Doll’s Head Maneuver

A

Rotate child’s head quickly to one side and then to the other.

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15
Q

positive - Doll’s Head Maneuver

A

Positive result—brainstem intact. Eyes move together in the direction opposite the head rotation

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16
Q

Negative result -Doll’s Head Maneuver

A

Brainstem dysfunction or damage to CN III (oculomotor)

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17
Q

on perform doll’s head

A

Only perform after spinal cord injury ruled out

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18
Q

Caloric Test is never…

A

Never performed on awake, conscious child

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19
Q

Caloric Test aka

A

oculovestibular response

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20
Q

Caloric Test

A

Irrigating external auditory canal with 10 ml of ice water over a period of approximately 20 seconds
HOB elevated 30-degree angle

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21
Q

Caloric Test normal response:

A

response—eyes move toward the side of stimulation.

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22
Q

Caloric Test abnormal response:

A

no response

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23
Q

Decorticate

A

flexion

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24
Q

decerebrate

A

extension

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25
Q

Special Diagnostic Procedures

A

Lab tests—glucose, CBC, electrolytes, blood culture if fever; evaluate for toxic substances, liver function
Imaging—CT, MRI, ultrasound
Lumbar puncture
EEG
X-ray (rule out skull fractures, dislocations; evaluate degenerative changes, suture lines)

26
Q

Assessment Parameters

A

LOC
Pupillary reaction
Vital signs
Frequency of assessment depends on condition—range from every 15 minutes to 2 hours

27
Q

Pain Management for the Comatose Child

A 
Signs of pain 
Increased agitation and rigidity
Pain increases ICP
Alterations in vital signs
Usually increase in HR, RR, and BP and decrease in oxygen saturation
Drug therapies
Opioids
Fentanyl + midazolam + vecuronium
Acetaminophen and codeine
28
Q

Respiratory Management

A

Airway management is primary concern
Cerebral hypoxia lasting more than 4 minutes will likely cause irreversible brain damage
CO2 causes vasodilation, increased cerebral blood flow, and increased ICP
May have minimal gag and cough reflexes
Risk of aspiration of secretions

29
Q

Indications for ICP monitoring

A

Glasgow Coma Scale score 8 with respiratory assistance
Deteriorating neurologic condition
Subjective judgment

30
Q

Types of ICP monitoring

A

Anterior fontanel pressure monitor
Intraventricular catheter
Subarachnoid bolt
Epidural sensor

31
Q

Nursing Care for Child with Increased ICP

A

Pt positioning: HOB: 15-30 degrees, head kept midline,
Avoid activities that may increase ICP
Eliminate or minimize environmental noise
Suctioning issues-HYPEROXYGENATE
Nutrition and Hydration
IV administration of fluids and parenteral nutrition
Caution with overhydration
Later begin gastric feedings via NG or GT
Patient may continue to have risk of aspiration

32
Q

Medications (as Indicated) for ICP

A

Osmotic diuretics for cerebral edema
Antiseizure medications with or without sedatives
Paralyzing agents
Antipyretics

33
Q

Nursing Care Needs for ICP pt

A 
Elimination
Hygienic care
Position and exercise
Stimulation
Family support
DRY EYES: GIVE DROPS
DRY LIPS: OINTMENT
STOOL SOFTNERS: SKIN INTEGRITY
HEARING IS LAST SENSE TO GO: SOFT MUSIC
34
Q

Nursing Diagnoses for ICP

A

Disturbed Sensory Perception related to CNS impairment
Self-Care Deficits related to physical immobility, perceptual and cognitive impairments
Risk for Aspiration related to depressed sensorium, impaired motor function
Risk for Injury related to depressed sensorium

35
Q

Causes of head injury

A

Falls
Motor vehicle injuries
Bicycle injuries

36
Q

patho of head injury

A

Force of intracranial contents cannot be absorbed by the skull and musculoligamentous support of the head
Especially vulnerable to acceleration-deceleration injuries

37
Q

Concussion

A

Transient and reversible
Results from trauma to the head
Instantaneous loss of awareness and responsiveness lasting for minutes to hours
Generally followed by amnesia and confusion
Post concussion syndrome

38
Q

Contusion and Laceration

A

Terms used to describe visible bruising and tearing of cerebral tissue

39
Q

Coup—

A

bruising at the point of impact

40
Q

Contrecoup

A

Contrecoup—bruising at a site far removed from the point of impact

41
Q

Reye Syndrome (RS)

A

A disorder defined as metabolic encephalopathy associated with other characteristic organ involvement
Characterized by fever, profoundly impaired consciousness, and disordered hepatic function

42
Q

Reye Syndrome etiology

A

Believed to be mitochondrial insult induced by different viruses, drugs, exogenous toxins, and genetic factors
Most cases follow a common viral illness (usually influenza or varicella)
Potential association between aspirin therapy for fever and development of RS

43
Q

Patho of Reye Syndrome

A

Cerebral edema
Fatty liver changes
Neurologic changes

44
Q

Decorticate posturing

A

Flexion

cerebral cortex dysfunction; leisions above the brain stem

45
Q

Decerebrate flexion

A

extension; midbrain or brain stem damage

46
Q

POST concussion syndrome

A

headaches, memory issues, resolve with in 3 months

47
Q

3 repeated concussions

A

no more physical sports

48
Q

Reye’s DX

A

with liver biopsy

49
Q

RS prognosis

A

1/3 die or long term damage

50
Q

Nursing care of RS

A

I/O’s (for dehydration & cerebral edema), ICP, & PTT

51
Q 
CNS infections:
limited
difficult
labs
inflamation
A

CNS has limited response to injury
Difficult to distinguish etiology by looking at clinical manifestations
Lab studies required to identify causative agent
Inflammation can affect the meninges, brain, or spinal cord

52
Q

Bacterial meningitis Bugs

A

1 mo-3mo: group B strep & gram neg bacilli
3mo-10 yr: S. pneumonia
10yr-19yr: Neissera meningitis

53
Q

Bacterial meningitis: incidence

A

decreased with Hib vaccine

54
Q

meningococcal meningitis

A

occurs in epidemic form & only form readily transmitted by droplets from nasopharyngeal

55
Q

Bacterial meningitis: S/S

A

positive Kernig & Brudzinski

fever, chills, vomit, irritable, szrs.

56
Q

meningitis S/S infant

A

poor feeding
high pitched cry
bulging fontal

57
Q

Bacterial meningitis DX

A

LP

58
Q

Bacterial meningitis management

A

isolation, hydration, decrease ICP, antibiotics, ventilation szr precautions, systemic shock, temp mgmnt

59
Q

Bacterial meningitis prognosis

A

10-15% fatal

60
Q

Nursing considerations for Bacterial meningitis

A

infection precautions, keep room quiet, dark, more comfy without pillow, HOB slightly elevated, side lying cuz of nuchal rigidity

Peds Exam 3 (3 decks)

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