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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
Special Diagnostic Procedures
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
Assessment Parameters
LOC Pupillary reaction Vital signs Frequency of assessment depends on condition—range from every 15 minutes to 2 hours
27
Pain Management for the Comatose Child
``` 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
Respiratory Management
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
Indications for ICP monitoring
Glasgow Coma Scale score 8 with respiratory assistance Deteriorating neurologic condition Subjective judgment
30
Types of ICP monitoring
Anterior fontanel pressure monitor Intraventricular catheter Subarachnoid bolt Epidural sensor
31
Nursing Care for Child with Increased ICP
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
Medications (as Indicated) for ICP
Osmotic diuretics for cerebral edema Antiseizure medications with or without sedatives Paralyzing agents Antipyretics
33
Nursing Care Needs for ICP pt
``` 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
Nursing Diagnoses for ICP
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
Causes of head injury
Falls Motor vehicle injuries Bicycle injuries
36
patho of head injury
Force of intracranial contents cannot be absorbed by the skull and musculoligamentous support of the head Especially vulnerable to acceleration-deceleration injuries
37
Concussion
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
Contusion and Laceration
Terms used to describe visible bruising and tearing of cerebral tissue
39
Coup—
bruising at the point of impact
40
Contrecoup
Contrecoup—bruising at a site far removed from the point of impact
41
Reye Syndrome (RS)
A disorder defined as metabolic encephalopathy associated with other characteristic organ involvement Characterized by fever, profoundly impaired consciousness, and disordered hepatic function
42
Reye Syndrome etiology
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
Patho of Reye Syndrome
Cerebral edema Fatty liver changes Neurologic changes
44
Decorticate posturing
Flexion | cerebral cortex dysfunction; leisions above the brain stem
45
Decerebrate flexion
extension; midbrain or brain stem damage
46
POST concussion syndrome
headaches, memory issues, resolve with in 3 months
47
3 repeated concussions
no more physical sports
48
Reye's DX
with liver biopsy
49
RS prognosis
1/3 die or long term damage
50
Nursing care of RS
I/O's (for dehydration & cerebral edema), ICP, & PTT
51
``` CNS infections: limited difficult labs inflamation ```
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
Bacterial meningitis Bugs
1 mo-3mo: group B strep & gram neg bacilli 3mo-10 yr: S. pneumonia 10yr-19yr: Neissera meningitis
53
Bacterial meningitis: incidence
decreased with Hib vaccine
54
meningococcal meningitis
occurs in epidemic form & only form readily transmitted by droplets from nasopharyngeal
55
Bacterial meningitis: S/S
positive Kernig & Brudzinski | fever, chills, vomit, irritable, szrs.
56
meningitis S/S infant
poor feeding high pitched cry bulging fontal
57
Bacterial meningitis DX
LP
58
Bacterial meningitis management
isolation, hydration, decrease ICP, antibiotics, ventilation szr precautions, systemic shock, temp mgmnt
59
Bacterial meningitis prognosis
10-15% fatal
60
Nursing considerations for Bacterial meningitis
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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