LEVEL 7 > Cerebral dysfunction > Flashcards

Cerebral dysfunction Flashcards

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1
Q

CMs of Increasing ICP in infants

A

-irritability, poor feeding
-high pitched cry, difficult to soothe
-fontanels tense and bulging
- increased HC
-setting-sun eyes
-scalp veins distended

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2
Q

CMs of increasing ICP in children

A

headache
vomitting with or without nausea
seizures
diplopia, blurred vision

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3
Q

Behavioral signs of increasing ICP

A

-irritibility and restlessness
-drowsiness, indifference, decrease in physical activity and motor skills
-fatigue and sommolence
-inability to follow simple commands and memory loss
-weight loss
-progression from lethargy to drowsiness

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4
Q

Late signs of increasing ICP

A

-decreasing LOC
-decreasing motor response to command
-decreased sensory response to painful stimuli
-alterations in pupil size and reactivity
-papilledema (edema of the optic nerve)
-Cheyene-Stokes

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5
Q

Decorticate posturing

A

Arms positioned upwards

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6
Q

Decerebrate posturing

A

midbrain dysfunction, hands positioned downwards *worse

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7
Q

Cushing’s Triad

A

HTN with widening pulse pressure
Bradycardia
Respiratory depression

*Ominous signs of increasing ICP

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8
Q

LOC in descending order

A

Full consciouness
Confusion
Disoriented
Lethargy
Obtundation
Stupor
Coma
PVS

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9
Q

Obtundation

A

arouses with stimulation

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10
Q

Stupor

A

responds only to vigorous or repeated stimuli

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11
Q

Coma

A

No motor or verbal response

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12
Q

PVS

A

perm lost function of the cerebral cortex

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13
Q

Three parts of the Glasgow coma scale ?

A

Eyes
Verbal response
Motor respnose

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14
Q

What is the highest and lowest score you can get on the GCS?

A

15 is the highest (best) and 3 is the lowest

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15
Q

What is the nursing care for a child with ICP?

A

-Patient positioning - HOB increased
-Avoid activities that may increase ICP such as crying (may need to be sedated or paralyzed)
-eliminate environmental stimuli
-Suctioning issues - DO NOT unless absolutely necessary

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16
Q

What is the most common head injury in children?

A

concussion

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17
Q

What are 3 complications of head injuries in children?

A

Bleeds
Cerebral Edema
Posttraumatic syndromes (peak 24-72 hours after injury)

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18
Q

What are the hallmark signs of a head injury?

A

confusion and amnesia

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19
Q

What is an important factor in pain management for a child with a head injury?

A

Do not give more than just tylenol to avoid masking LOC changes

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20
Q

Bacterial Meningitis

A

Acute inflammation of CNS

-Children is most commonly pneumococcal or meningiococcal
-Infants are most likely strep and E.coli

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21
Q

Neonatal CMs of Bacterial Meningitis

A

more vague
irritability, weak cry
poor feeding
V&D
full fontanels
seizures
resp. irregularities
apnea

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22
Q

3 months - 2 years CMs Bacterial Meningitis

A

fever
poor feeding
vomiting
irritability
seizures
bulging fontanels
nuchal rigidity

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23
Q

Children and adolescents CMs Bacterial Meningitis

A

fever
HA
seizures
agitation
nuchal rigiditiy
photophobia
positive Kernig and Brudzinski signs

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24
Q

What is indicative of a positive Kernig sign?

A

If you raise a child’s leg with the knee flexed and then extend the child’s leg at the knee and resistance or pain is felt

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25
What is indicative of a positive Brudinski sign?
Flexing the child's head while in supine and if the knees and hips flex involuntarily
26
How is Bacterial Meningitis diagnosed ?
Lumbar puncture
27
Treatment of Bacterial Meningitis
ABX- broad spectrum first till organism is detected
28
How can you prevent Bacterial Meningitis?
Hib and pneumococcal vaccine
29
Non bacterial Meningitis (Aseptic Meningitis)
-causative organisms are mainly viruses (measles, mumps, herpes, and leukemia) -onset is abrupt
30
What are the manifestations of nonbacterial meningitis?
HA fever malaise 1-2 days before back and leg pain sore throat photophobia generalized aches N&V
31
Treatment of Aseptic Meningitis
symptomatic care with Tylenol and Ibuprofen *treat as a bacterial until culture comes back
32
Encephalitis
inflammatory process of the CNS caused by a variety of organisms
33
What are some clinical manifestations of Encephalitis?
acute onset of a febrile illness with fever HA signs of a URI malaise N&V Neuro signs (confusion, behavior changes, speech or motor dysfunctions, alterations in reflexes, and seizures)
34
What is the nursing considerations of Encephalitis?
Monitor CR function- airway, secretions, pulse ox, ABGs, HR, BP, UO, color, cap refill ICP monitoring - ICU Seizure precautions Prevent complications from immobility Reorient child Educate parent
35
Where is the cerebral spinal fluid secreted from ?
choroid plexus *Hydrocephalus occurs from the failure to absorb or the obstruction of flow
36
Communicating Hydrocephalus
impaired absorption of CSF within the subarachnoid space; acquired from post infectious meningitis, hemorrhage
37
Noncommunicating hydrocephalus
obstruction to flow of CSF through the ventricular system; obstruction from infection, hemmorrhage, tumor or structural deformity
38
What are the CMs of hydrocephalus?
enlargement of the head before cranial sutures have fused Non specific symptoms: HA, lethargy, drowsiness, N&V, loss of appetite, diplopia, and change in VS
39
What are some perameters to monitor for a child with hydrocephalus?
daily head circ, fontanelle tension, symptoms of increased ICP, and diagnose with CT, MRI, prenatal US
40
When a VP shunt is placed where does fluid get reabsorbed?
the peritoneal cavity
41
What are potential complications of a VP shunt?
infection, mechanical blockage, kinking, or a valve breakage
42
What are the signs and symptoms of a shunt malfunction?
increased ICP worsening neuro status fever and inflammation of tract, and abdominal pain
43
Reye's syndrome
toxic encephalopathy associated with other organ involvement
44
Characteristics of Reye's syndrome?
fever profoundly impaired LOC disordered hepatic function *commonly follows varicella or flu
45
What is the diagnostic evaluation for Reye's?
elevated ammonia, liver biopsy; staging criteria
46
What is the management of Reye's ?
early recognition, ICU care, artificial ventilation, sedated and paralyzed, monitor ICP
47
What are the general signs of a seizure?
Change in LOC, involuntary movements, posturing, changes in perception, behaviors or sensations
48
What are the characteristics of epileptic seizures?
2 or more unprovoked seizures, chronic, secondary to underlying brain dysfunction
49
Major causes of seizures in children
anoxia, acute infections, typically idiopathic
50
Partial seizures
caused by abnormal electrical activity in a specific area of the cerebral cortex (no loss of conciousness)
51
Generalized seizures
result of diffuse electrical activity that begins in one area of the brain and spreads through the cortex into the brainstem (tonic clonic, bilateral, symmetrical, incontinent)
52
Unclassified seizures
example is febrile
53
3 Phases of a generalized seizure
Tonic: unconciousness and continuous muscular contractions Clonic: alternating muscular contraction and relaxation Postictal period: Decrease in LOC, variable length of time (can be several hours continue assessing)
54
Absense seizures
brief loss of conciousness, minimal or no change in muscle tone (4-12 yo)
55
Characteristics of Absense seizures
sudden onset of up to 20 per day no warning/aura 5-10 seconds long lip smacking, twitching, slight hand movements may drop object, rarely falls no incontinence *often misdiagnosed as daydreaming or ADD
56
Atonic Seizures
sudden momentary loss of muscle tone sudden fall to ground, often on face. Less severe can be head droops forward several times
57
Myoclonic seizures
sudden brief contractions of muscle groups, may be single or repetitive, no LOC, often occur when falling asleep, may be mistaken as a startle reflex *NO postictal phase
58
Infantile spasms
-onset 6-8 months -usually associated with mental retardation -possibly caused by a disturbance of central neurotransmitter regulator at specific phases of development
59
Characteristics of Infantile spasms
-specific spike seen on EEG -Jackknife position: head and kneck flex forward; knees drawn up *can have up to 200 seizures a day
60
Febrile seizures
-usually in tempratures higher than 101.8 (rapid rising) -seizure occurs when tempreture is rising, not after -usually over before arriving in the ER -generalized tonic clonic seizures lasting less than 15 minutes
61
Management of Febrile seizures
-avoid tepid baths -ineffective -vigorous use of antipyretics -protect child from injury during seizure -call 911 if seizure is greater than 5 minutes in duration
62
Status Epilepticus
seizure lasting greater than 30 minutes or series of seizures without regaining premorbid level of consciousness Maintain airway, IV access and meds
63
Status Epilepticus medications
Diastat (prefilled rectal syringe) Versed (intranasal) IV ativan or Valproic acid IV loading with phenytoin for ongoing management
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Common seizure triggers
changes in dark light patterns, sudden loud noises, extreme temprature changes, dehydration, fatigue, stress, and anxiety
65
When should you discontinue pharmacologic seizure management?
-seizure free for two years -normal EEG -avoid during puberty or when subject to frequent infections -recurrence possible within 1st year
66
Craniosynostosis
premature closure at birth or one or more cranial sutures; most have normal brain development
67
Microcephaly
intrauterine exposure to toxins causing mild hyperkinesis and motor impairment. -decerebration, complete unresponsiveness, autistic behavior
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