Neurological Ppt

Question 1

ICP manifestations: Infant

Answer 1

Irritability
Poor feeding
High pitched cry
Difficult to soothe
Tense, bulging fontanels

Question 2

ICP manifestations: children

Answer 2

Headache, nausea, forceful vomiting
Seizures
Drowsiness, lethargy
Diminished physical activity
Inability to follow simple commands

Question 3

Late signs of ICP in children

Answer 3

Bradycardia
Decreased motor response to command
Decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Extension or flexion posturing
Decreased LOC
Coma

Question 4

ICP positioning

Answer 4

Avoid neck compression
Provide alternating pressure mattress
Elevate HOB 30°
Avoid extreme flexion, extension, or rotation of the head and maintain head in neutral, midline position.

Question 5

Activities that can increase ICP

Answer 5

Suctioning/ gagging
Nasal suctioning in contraindicated
Administer stool softener to prevent straining (Valsalva maneuver)

Question 6

ICP nursing considerations

Answer 6

Eliminate or minimize environmental noise
Cluster care and provide adequate rest periods

Question 7

Primary concern for comatose child

Answer 7

Airway management

Question 8

Pain assessment of comatose child

Answer 8

Increased agitation and rigidity - signs of pain
ICP is increased by pain
Alterations in vital signs ( increase in HR, Temp, RR, BP. Decreased O2 saturation)

Question 9

Types of skull fractures

Answer 9

Linear, depressed, comminuted, basilar, open, growing.

Question 10

Linear skull fracture

Answer 10

Most common, no treatment needed

Question 11

Depressed skull fracture

Answer 11

Skull appears to be sunken and may protrude into the brain cavity.
Immediate medical intervention if required.

Question 12

Comminuted skull fracture

Answer 12

Break or splinter of the bone into more than two fragments
Usually seen in high impact MVAs

Question 13

Open skull fracture

Answer 13

Fracture in which the skin is cut open and the bone is seen with the naked eye

Question 14

Growing skull fracture

Answer 14

A rare complication of pediatric head trauma that results in delayed onset neurological deficits and cranial defects

Question 15

Head trauma management

Answer 15

Nothing given by mouth at first
Monitor for signs of ICP (vomiting, HA, seizure)

Question 16

Hydrocephalus cause

Answer 16

Imbalance in the production and absorption of CSF
-build up of fluid in the ventricles
- malfunctioning shunt
Associated with myelomeningocele

Question 17

Hydrocephalus treatment

Answer 17

Ventriculoperitoneal shunt will be surgically placed
Once placed, The nurse should position the child flat on the unoperated side to prevent the rapid reduction of intracranial fluid and to protect the child from injuring the operative site.

Question 18

Shunt infections

Answer 18

Infections include septicemia, bacterial endocarditis, wound infection, shunt nephritis, meningitis. 
Treatment includes massive dose antibiotics or shunt removal

Question 19

Bacterial meningitis PPE precautions 

Answer 19

Droplet

Question 20

Bacterial meningitis expected findings

Answer 20

Cloudy color,
elevated WBC count,
decreased protein content,
decreased glucose content,
positive Gram stain

Question 21

Non-bacterial meningitis findings 

Answer 21

Clear color,
slightly elevated WBC,
normal or slightly elevated protein content,
normal glucose content,
negative Gram stain

Question 22

Prevention of meningitis

Answer 22

Bacterial meningitis prevention is through hib and pneumococcal conjugate vaccines.

Question 23

Management of meningitis

Answer 23

Droplet isolation precautions, maintained for 24 to 48 hours after the initiation of IV antibiotics
Measurement Of head circumference and fontanelles in newborns and young children for presence of or changes in bulging
Decrease environmental stimuli,
Provide comfort measures such as keeping the room cool and maintain safety

Question 24

Pharmacological management of meningitis

Answer 24

Client remains on isolation precautions for 24 to 48 hours after initiation of IV antibiotics,
Dexamethasone (steroids)
Analgesics (acetaminophen with codeine)

Question 25

Reyes syndrome findings

Answer 25

Bleeding and ecchymoses due to problems with blood coagulation.
Characterized by fever, profoundly impaired consciousness in disordered hepatic function

Question 26

Cause of Reyes syndrome

Answer 26

Potential association exists between aspirin therapy for fever and development of Reyes syndrome

Question 27

Cranial deformities and suture ossification/closure 

Answer 27

6-8 weeks of age the posterior fontanelle will close
18-24 months of age the anterior fontanelle close

Question 28

Drug therapy management of seizures

Answer 28

IV fosphenytoin is often used to treat seizures instead of IV phenytoin because of possible complications in drug interactions associated with IV phenytoin.