1. relieve pressure - VP shunt drains to peritoneal cavity extra is left to uncoil with growth 2. treat cause 3. treat complications 4. promote psychomotor dev

cerebral dysfunction Flashcards by Kaylee Lapinskie

dev differences

expandable skull
great blood volume
bbb more permeable
small epidural space = fewer hemorrhages
bulging fontanelles = increasing ICP (compensate until they decline rapidly)
more blood flow and oxygen consumption than adults
thinner and softer brain tissue

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assessment

history

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posturing

decerebrate = arms extended, wrists flexed back, arched back
decorticate = elbows bent and brought to chest

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increased ICP - causes

tumor/lesions, hemorrhage, edema of cerebral tissue, accumulation of CSF in ventricles

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increased ICP cm - children

HA, blurred vision, diplopia, pupils sluggish to light, seizure, n, forceful v, lethargy, increased sleeping, declining school performance, declining motor function (change in gait)

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increased ICP cm - infants

tense bulging fontanelles
separated cranial suture
macewen (cracked pot) sign
irritable
high pitch cry, catlike
increased head circumference
distended scalp veins
feeding change
cry when held or rocked
setting sun eyes
taught shiny skin over scalp

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late S of ICP

significant decrease in LOC
decreased motor response to command
decreased sensory response to pain
fixed and dilated pupils
decerebrate/decorticate posturing
cushings triad

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nc - unconscious child
emergent

ASSESS - subtle cues
ABCs, stabilized spine, treat shock, reduce ICP

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nc - unconscious child
ongoing

freq neuro assessment
LOC, pupillary reaction, VS
pain management -

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nc - unconscious child
pain signs

HR, BP
resp, ICP, nutrition and hydration, elimination, thermoregulation, positioning, hygiene, meds, stimulation, fam support

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hydrocephalus

too much fluid in ventricles
obstruction or not draining correctly
same s/s as ICP

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hydrocephalus tm

relieve pressure - VP shunt drains to peritoneal cavity
extra is left to uncoil with growth
treat cause
treat complications
promote psychomotor dev

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VP/VA shunt nc - preop

prevent breakdown of scalp, infection, damage to spinal cord
monitor for increased ICP
promote nutrition
keep eyes moist
prep child and fam for procedures

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VP/VA shunt nc - post op

bed rest with minimal handling (flat, no P on shunted side), later = elevate HOB 15-30
monitor: VS, neuro, abd distention, s/s infection
comfort, discharge teaching (s/s of increased ICP, s/s of infection), record dev milestones

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VP shunt complications - infection

shunt removed, external ventricular drain inserted and connected to collection bag
close monitoring of EVD, IV abx for several weeks, new shunt placed once CSF is clear of infection

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VP shunt complications - malfunction

new shunt insertion via surgery
can happen bc growth (doesnt uncoil correctly), tubing disconnects or kinks

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EVDs

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EVDs nc

dont turn side to side (increase ICP)
keep HOB 15-30
drainage level with tragus (or surgeons order)
assess CSF output every hour
dont change dressing
sudden increase or decrease in CSF output or poor waveform = all stopcocks in correct direction, cords plugged in, thorough and quick assess, call surgeon

TBI

scalp, skull, meninges, brain
result of mechanical force

TBI scalp laceration

superficial, will bleed alot

TBI skull fracture

linear = single crack
depressed = several fragments and pushes inwards
basilar

TBI - basilar skull fracture

break in base of skull, close to brainstem = serious
higher risk of secondary infection (meningitis, no invasive - no suction, high alert for fever, nothing up the nose)
raccoon eyes and battle sign, CSF leakage possible (nose and ears)

concussion

alteration in mental status with or without loss of consciousness - immediately after blow to head
diagnosed with rule out

concussion cm

confusion and amnesia!!
HA, dizzy, difficulty concentrating, vision change, sensitive to light and noise, n, drowsy, tinnitus, irritable, loss of consciousness, hyperexcitability

concussion - when to seek treatment

infant, lost consciousness, wont stop crying, head and neck pain, repeated v, difficult to awaken, difficult to console, change in gait, unusual behavior, bleeding from nose/mouth, watery glucose discharge from nose or ears

TBI - tm

ABCs, stabilized neck and spine, freq neuro and vs, hypertonic solution (mannitol, hypertonic saline = draw fluid into vasculature and away from brain), IV steroids to decrease inflam and edema

TBI - complications

TBI S of progression

mental status change, mounting agitation, dev of focal lateral neuro s (posturing, one eye changes), marked change in VS, cushing reflex, S of brainstem involvement

meningitis

inflam of meninges in brain and spinal cord less with abx and vaccines bacterial = bad, permanent damage viral = vanishing, not as bad

meningitis cm

poor suck and feed, apnea, weak cry, nvd, tense fontanelle, jaundice, fever, increased irritability, high pitch cry, seizures, HA, petechial or purpural racsh, altered sensorium, opisthotonos, kernig's sign, nuchal rigidity (brudzinski's)

meningitis tm

diagnose: LP = increased WBC (cloudy), P, protein, decreased glucose, + culture meds: abx if bacterial or until cultures return, anticonvulsants, antipyretics treat F+E imbalance

meningitis nc

isolation first! collect specimens, then abx ASAP prevent complications, seizure precautions and neuro checks, prevent increase in ICP, hydration and nutrition, support monitor for septic shock, circulatory collapse, dilutional hypoNa, long term sequelae prevention

encephalitis

inflammation usually caused by HSV1

encephalitis cm

non specific, fever, altered mental status, possible seizures can resemble meningitis, lasts few days, complete recovery or severe CNS involvement or death

encephalitis tm

diagnose: cm and organism ID, ct scan may show hemorrhagic area, blood samples hospitalized for observation supportive care

encephalitis nc

same as unconscious child and meningitis

reyes syndrome

encephalopathy with hepatic dysfunction no aspirin with flu/cold/varicella

epilepsy

abnormal electrical impulses in brain 2+ seizure episodes not caused by reversible med conditions

febrile seizure

>101, 6 mo - 5 yrs, w/o epilepsy, CNS infection, or met abn

febrile seizure tm

>5min = call EMS meds = rescue sedative (rectal diazepam or intranasal midazolam)

epilepsy tm

1. antiepileptic drugs (start with 1, may need multiple) 2. keto diet (high fat, low carb, supplement with vits) 3. vagus nerve stimulator -device under skin, use magnet? 4. surgery

keto diet

epilepsy nc - during seizure

1. observe (eye movement, LOC, uni/bilateral movement, duration) 2. protect - lower bed, protect head, turn on side, NPO, dont restrain 3. VS, oxygen if <90% 4. >5 min = rescue sedatives 5. call hcp and monitor

epilespy nc - long term

educate caregivers (rescue meds - always have and admin) avoid triggers (sress, sleep deprivation, flickering lights) safety (dont bathe/swim alone, helmet, no open flames, avoid climbing tall heights) support - balance autonomy and safety