ch 30 cerebral dysfunction

Question 1

neuro system differences in children v adults

Answer 1

-brain growth reflected in head circumference
-cerebral blood flow and O2 consumption 2x as much as adults

Question 2

early S+S increased ICP

Answer 2

-headache
-vomiting
-irritability
-personality changes
-fatigue

Question 3

S+S increased ICP in infants

Answer 3

-inconsolability
-bulging fontanels
-high pitched cry
-macewen sign (“cracked pot sound”)
-increased sleeping, fatigue
-poor feeding
-vomiting
-sun setting eyes

Question 4

S+S increased ICP in kids

Answer 4

-headache
-nausea
-forceful vomiting
-blurred vision
-seizures
-diminished physical and school performance
-increased sleeping, fatigue
-changes in personality

Question 5

late S+S increased ICP in infants/kids

Answer 5

-bradycardia
-decreased motor response to command
-decreased sensory response to painful stimuli
-alterations in PERRLA
-extension/flexion posturing
-decreased LOC
-coma

Question 6

3 components of glasgow coma scale

Answer 6

-eye opening
-verbal response
-motor response

Question 7

score interpretations glasgow coma scale

Answer 7

highest = 15
coma = 8 “less than 8 intubate”
lowest = 3

Question 8

screenings/tests to determine brain function

Answer 8

-blood test (including drug test)
-lumbar puncture
-EEG
-auditory and visual evoked potential tests
-CT and MRI
-nuclear brain scan

Question 9

common causes head injuries in children

Answer 9

-falls
-motor vehicle accident
-bicycle accident

Question 10

CHI

Answer 10

closed head injury

Question 11

types CHI

Answer 11

-concussion
-contusion and laceration
-fractures
-epidural hematoma
-subdural hematoma
-other lesions: subarachnoid, cerebral edema, posttraumatic syndrome

Question 12

nursing measures to reduce ICP

Answer 12

-calm environment, dark, queit
-elevated hob with head midline
-pad siderails in case of seizures

Question 13

med that help decrease ICP

Answer 13

mannitol (diuretic)

Question 14

potential complications of head injuries

Answer 14

-hemorrhage
-infection
-edema
-herniation through brainstem

Question 15

S+S epidural hematoma

Answer 15

-commonly w/ skull fracture
-arterial bleed
-fast bleed
-sometimes gain consciousness for short period of time
-usually unilateral

Question 16

S+S subdural hematoma

Answer 16

-venous bleed
-slower bleed
-with retinal hemorrhage
-usually bilateral

Question 17

S+S hydrocephalus

Answer 17

INFANTS
-rapidly increasing head circumference
-refusal to feed
-sleepiness

CHILDREN
-changes in personality
-developmental regression
-ataxia
-incontinence

Question 18

signs of progression of a head injury

Answer 18

-altered mental status
-increasing agitation
-development focal lateral neurologic signs
-marked changes in VS

Question 19

signs of brainstem involvement in head injury

Answer 19

-deep/rapid/gasping breaths
-slowing of pulse
-extreme fluctuations in BP

Question 20

S+S leaking CSF from head injury

Answer 20

-bleeding from ears/nose
-watery discharge from nose
-nose discharge positive for glucose

Question 21

S+S bacterial meningitis infants

Answer 21

-fever or hypothermia
-poor feeding
-bulging fontanel

Question 22

S+S bacterial meningitis children

Answer 22

-sudden onset headache
-fever
-vomiting
-severe headache with irritability

Question 23

potential complications bacterial meningitis

Answer 23

encephalitis
coma
death
SIADH

Question 24

Dx bacterial meningitis

Answer 24

spinal tap - takes 72 hrs for result to come back

Question 25

Tx bacterial meningitis

Answer 25

-broad spectrum Abx before spinal tap results come back (vancomycin)
-increase hob
-seizure precautions
-limit stimulation
-IV fluids (limit), meds, Abx
-isolation precautions, PPE, pink arm band

Question 26

types cerebral infections

Answer 26

-nonbacterial meningitis
-TB meningitis
-brain abscess
-encephalitis
-rabies
-reyes syndrome
-HIV encephalopathy

Question 27

infection of membranes that surround brain and spinal cord

Answer 27

meningitis

Question 28

inflammation of brain

Answer 28

encephalitis

Question 29

2+ unprovoked seizures

Answer 29

epilepsy

Question 30

meds to stop seizures

Answer 30

valium
diazepam

Question 31

nursing interventions after seizure

Answer 31

-seizure precautions
-immediate med (-pam)
-blood draw (serum levels Na, med levels, CBC)
-VS (fever)
-neuro checks q1h

Question 32

types seizures

Answer 32

-partial
-generalized (tonic clonic)
-atonic/akinetic

Question 33

what is period post-seizure called

Answer 33

postictal

Question 34

Dx seizures and epilepsy

Answer 34

EEG

Question 35

Tx/management seizures and epilepsy

Answer 35

-meds
-ketogenic diet

Question 36

potential side effects of seizure control meds

Answer 36

-allergic drug rash
-sleepiness
-change in mood/behavior
-vision changes
-ataxia

Question 37

seizure lasting greater than 30 mins

Answer 37

status epilepticus

Question 38

nursing interventions status epilepticus

Answer 38

-admin diazepam
-ensure safety
-time length of seizure

Question 39

considerations with taking phenytoin/phenobarbitol

Answer 39

-don’t take with milk
-vit d and folic acid supplements

Question 40

types headaches

Answer 40

-acute
-acute recurrent (migraine)
-chronic progressive
-chronic nonprogressive

Question 41

seizure triggers

Answer 41

-video games
-flashing
-loud noises

Question 42

increased ventricular fluid putting pressure on brain

Answer 42

hydrocephalus

Question 43

S+S hydrocephalus in infant

Answer 43

-*head enlargement
-bulging fontanels
-“setting sun eyes”
-poor feeding
-lethargy

Question 44

Tx hydrocephalus

Answer 44

-VP shunt

Question 45

S+S hydrocephalus in children

Answer 45

-increased ICP
-headache with awakening
-irritable, confused, lethargic

Question 46

complications with VP shunt in Tx of hydrocephalus

Answer 46

-infection
-malfunction
-herniation of brain if pressure not relieved