Neuro Flashcards
VP shunts discharge instruction
no contact sports, no army
monitor for s/s infection or increased ICP or shunt misfunction (headache, vomiting, ICP, poor vision)
never flush shunt at home
post op care of shunts
leave child flat and midline until cleared by neuro
leave drainage bag at level of ear
basilar skull fracture
most risky fx due to close proximity to surrounding brain stem
high risk of secondary infection (meningitis)
do not stick anything up the nose
raccoon eyes and battle sign
leakage of CSF is possible, test any nasal drainage for glucose and blot drainage on a 2x2 and if CSF will have a yellow ring around drainage
treatment of TBI
Establish ABC’s
stabilize neck and spine
frequent neuro checks and monitor v/s
give HYPERTONIC solutions (mannitol) to draw fluid away from brain
steroids to decrease inflammation and edema
how do you know if a head injury is getting worse?
mental status changes
mounting agitation
development of focal lateral neurological signs
marked changes in vital signs, Cushing reflex (increased BP, decreased HR, widened pule pressure)
signs of brainstem involvement
decreased motor response
fixed and dilated pupils
decerebrate( worse) of decorticate posturing
manifestations of ICP in infants
high pitched cry macewen (cracked-pot) sign increased head circumference setting sun eyes more fussy when picking up child than when laying down
how can an unconscious child with a brain injury tell you they are in pain?
increased BP and low HR
nursing care of the unconscious child with a brain injury (emergent)
ABC’s
stabilize spine when indicated
treat shock
reduce ICP
nursing care of the unconscious child with brain injury (ongoing)
frequent neuro checks
observe LOC and pupillary reaction
vital signs
pain management
nursing care of unconscious child (general)
monitor for pain ( decreased BP, increased HR)
monitor respirations, ICP
nutrition and hydration
thermoregulation
positioning
stimulation (decrease stimuli, lower lights and decrease sound)
treating pain with brain injury
treat cautiously and try to avoid sedating medications
manifestations of ICP in children
headache blurred vision diplopia pupils are sluggish to light seizure nausea forceful vomiting lethargy increased sleeping declining school performance decline in motor function
meningitis
inflammation of meninges of brain and spinal cord
immunization MMR decreases risk
diagnosed with LP
diagnosis of meningitis
LP shows increased WBC, pressure, cultures and protein and decreased glucose (fluid will be cloudy)
how do you treat meningitis
diagnose, antibiotics after lab collection, anticonvulsants and antipyretics. Start antibiotics within 1 hour
