Exam 3: Cerebral Flashcards Preview

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Flashcards in Exam 3: Cerebral Deck (38):
1

what is the three part assessment of the glasgow coma scale?

eyes, motor, verbal

2

scoring of glasgow coma scale?

score of 15-great, unaltered LOC
score of 3- lowest, vegetative state

3

what are some clinical manifestations of ICP in babies?

poor feeds, irritability, sun-setting eyes, shrill cry, tense fontanels, macewen sign

4

what is macewen sign?

percussion of fontanels and getting cracked pot (resonant) sound may indicate separated sutures, or increased pressure

5

CM of ICP in children?

Headache

Vomiting, with or without nausea

Seizures

Diplopia, blurred vision

6

late signs of ICP?

-cheyyene-stokes breathing
-bradycardia
-papilledema
flexion/extension posturing

7

emergency management of child with ICP?

airway management
reduction of ICP
treatment of shock

8

pain therapy meds for ICP?

opioids, fentanyl, midozalam, acetaminiphen, codeine

9

ICP monitoring indications

glasgow coma scale< or = 8

10

Most common brain malformation
Bridge connecting 2 hemispheres of brain partially or completely missing
Normal intelligence with mild learning differences to severe mental retardation

agenesis

11

Head circumference 2 standard deviations below normal
Down’s, chromosomal abnormalities
Maternal substance abuse/viral exposure
Cognitive, motor, speech delays

microcephaly

12

Commonly associated with myelomeningocele

May not be apparent at birth

May appear after primary closure of defect

Results from disturbances in dynamics of CSF

HIDROCEPHALUS

13

Non-obstructive

Impaired absorption of CSF within subarachnoid space

Venous drainage insufficiency

Over production of CSF (rare)

Malfunction of arachnoid villi

communicating hydroceph

14

Obstructive

CSF flow through ventricular system is prevented

Most cases a result of developmental malformations

Other causes: neoplasms, infections, trauma

non-communicating hydroceph.

15

Hydrocephalus: Monitoring

head circ
ultrasound monitoring-ventricle size
fontanel tension

16

initial treatment of hydroceph

shunt, getting extra csf removed

17

Most common diagnosed neoplasm in infants

neoblastoma

18

neoblastoma: Primary sites

Abdomen, adrenal gland, chest or neck

19

S/S of neoblastoma

noted on palpation, incidental finding on radiograph, swelling/bruising around eyes

20

Acute inflammation of CNS
Decreased incidence following use of Hib vaccine
Can be caused by various bacterial agents:
Streptococcus pneumoniae
β-Hemolytic streptococci
Escherichia coli

bacterial meningitis

21

how is transmition of bacterial meningitis?

Droplet infection from nasopharyngeal secretions

22

definitive diagnostic test for bacterial meningitis?

lumbar test

23

nursing management for meningitis?

Droplet precautions
Supportive Care
Antibiotics
Hydration
Nutrition

24

Inflammatory process of CNS with altered function of brain & spinal cord

Variety of causative organisms:
viral most frequent

encaphilitis

25

Vector reservoir in United States for encephilitis

ticks and mosquitos

26

Clinical Manifestation of Severe Encephalitis

High fever

Disorientation, stupor, coma

Seizures, spasticity

Ocular palsies

Paralysis

27

Toxic encephalopathy associated with other characteristic organ involvement

Characterized by fever, profoundly impaired consciousness, and disordered hepatic function

reye's syndrome

28

Potential association between aspirin therapy for fever and development

reye syndrome

29

diagnosis of reye syndrome

Liver biopsy
Liver enzymes, ammonia level, coag. studies

30

patient teaching for someone with reye's

no use of ASA for anyone under age of 19

31

Malfunction of brain’s electrical system
Determined by site of origin
Most common neurologic dysfunctionin children
Occur with wide variety of CNS conditions

seizures

32

Cryptogenic seizures

no clear cause

33

Sudden momentary loss of muscle tone
Sudden fall to ground, often on face
Onset usually age 2-5 years
May or may not have loss of consciousness
Loss of awareness
Less severe—head droops forward several times
Interferes with learning/schoolwork

atonic

34

Sudden brief contractions of muscle group
May be single or repetitive
No loss of consciousness
Often occur with falling asleep
May be nonspecific symptom in many CNS disorders

myoclinic

35

meds for seizure child

ativan, valium, diastat gel

36

seizure lasting >30 minutes
or
series of seizures without regaining premorbid level of consciousness

status epilepticus

37

Transient disorder of childhood
Affect approximately 3% of children
Usually occur between ages 6 months and 3 years
Rare after age 5 years
Usually occur with temperatures > 101.8° F

transient

38

treatment of febrile seizures

Fever reduction
Seizure control if ongoing
Diazepam (IV or rectal)
Evaluate history (episodic and family)
Management:
Avoid tepid baths—usually ineffective
Antipyretics ineffective as preventive
Protect child from injury during seizure
Call 911 if seizure >5 minutes duration