Peds Final - Neuro Flashcards by Jane Daum

decorticate posturing

bring hands over the core (hands over chest)
better then decerebrate

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decerebrate posturing

hands bends at waist and turn away from body
away from core, very bad

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equilibrium of cranium

brain: 80%
CSF: 10%
Blood: 10%

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causes of increased ICP

tumors/lesions
hemorrhage
edema of cerebral tissue
accumulation of CSF in ventricles (hydrocephalus)
meningitis

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signs of ICP in children (very important to know)

headache, blurred vision, diplopia, pupils sluggish repines to light, seizure, nausea, forceful vomiting, lethargy, increased sleeping, declining school performance, declining motor function

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signs of ICP in infants (very important to know)

tense, bulging fontanel, separated craninal sutures, macewen (cracked pot) sign, irritable, high pitches cry, catlike cry, increased OFC, distended scalp veins, feeding changes, crying when held or rocked, setting sun eyes, taught, shiny skin over scalp

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later signs of ICP (very important to know)

-decreased LOC
-decreased motor response to command
-decreased sensory response to pain
-fixed & dilated pupils
-posturing

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very late sign of increased ICP (very important to know)

cushing’s triad ( SBP increases, HR & RR goes down & widening pulse pressure)

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emergent nursing interventions for a head injury

-ensure ABCs
-stabilize spine when indicated
-treat shock
-reduce ICP when indicated

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ongoing nursing interventions for a head injury

-frequent neuro assessments
-observe LOC & pupillary reactions
-vitals
-pain mgt cannot over treat do not sedate

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what pain meds should be given to a child w/ a head injury

ibuprofen or Tylenol
no opioids

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hydrocephalus

an excessive collection of cerebral spinal fluid in the ventricular system

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hydrocephalus therapeutic mgt

1) relief of pressure w/ shunt
2) treatment of the cause
3) treatment of complications
4) promote psychomotor development

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VP shunt

drains into the peritoneal cavity

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VP shunt precautions pre op

-prevent breakdown of scalp
-infection
-damage to spinal cord
-monitor ICP
-promote adequate nutrition
-keep eyes moist

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VP shunt precautions post op

-do not lay on side shunt was place
-bed rest (for flat then elevate to 15-30)
-montior VS, neuro, abdominal distention
-S/s of infection
-record developmental milestones

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what can kids with shunts not do

-join the army
-play contact sports

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what to do if shunt gets infected

1) remove shunt
2) insert external ventricular drain & monitor
3) IV antibiotics for several weeks
4) place new shunt once CSF is clear of infection

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what to do if shunt malfunctions

new shunt is inserted via surgery
d/t growth, tubing disconnecting or kinks

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parents education w/ shunts

do not pump it or drain it, just know the S/s of ICP or infections (then bring to ER)

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where do we want the drainage bag for an extra shunt

in line with the ear

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if we see excess drainage from an external shunt, what is the next best nursing action

call neuro surgery
we do not mess with the shunt

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what do we need to be mindful of when turning a shunt pt

that we are not doing jugular compression

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how often should we asses CSF for external shunts

every hour

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if there is a sudden increase or decrease in CDF output or poor waveform on ICP monitor, what is our next best nursing action

immediately ensure all stopcocks are turned the correct direction and all cords are plugged in appropriately, thorough and quick patient ass then call surgery

what type of skull fracture are we most concerned about

basilar because of proximity to structures surrounding the brain **high risk for infection/meningitis**

clinical manifestation of basilar fracture

raccoon eyes, battle sign (bruising behind ears) and drainage from nose & ears

how do you know if drainage from fracture is CSF

will contain glucose if it is tested and halos

therapeutic mgt for basilar fracture

-monitor drainage -do not do invasive procedures **no suction** -prevent infections

concussion

an alteration in mental status w/ or w/o loss of consciousness which occurs immediately after a traumatic blow to the head **dx made after structural injuries are ruled out**

hallmark signs of concussion

confusion and amnesia

when to seek treatment for possible concussion

-infant always -loss of LOC -won't stop crying -head & neck pain -vomits -difficult to wake up -difficult to console -**isn't walking normally** -unusual behavior -bleeding from nose or mouth or water glucose+ discharge

traumatic brain injury mgt

-establish ABCs -stabilize the neck & spine -frequent neuro assessment & v/s monitoring -hypertonic solutions to draw fluid into the vasculature & away from the brain -steroids to decrease inflammation & edema **IV, not just oral**

traumatic brain injury complications

-hemorrhage -infection (posttraumatic meningitis) -brain stem herniation -hypothalamic dysfunction

hypothalamic dysfunction manifestations

-syndrome of inappropriate antidiuretic hormone secretion -diabetes insipidus

traumatic brain injury: signs of progression

-mental status changes -mounting agitation -development of focal lateral neurological signs (eye changes, posturing) -marked changes in VS -cushing reflex -signs of brainstem involvement

meningitis

a syndrome caused by inflammation of the meninges of the brain & spinal cord

meningitis CM: newborn

-poor sucking -poor feeding -apnea -weak cry -diarrhea -tense fontanel -jaundice

meningitis CM: infants

-fever -poor feeding -nausea & vomiting -increased irritability -high pitched cry -seizures

meningitis CM: children

-fever -headache -nuchal rigidity -kernig's sign -opisthotonos -seizures -altered sensorium -projectile vomiting -petechial

Kernig Sign

1) flex knee to 90 degrees 2) flex hip to 90 degrees Sign: extension of the knee is painful or limited

brudzinski's sign

passive flexion of neck elicits hip & knee flexion

bacterial meningitis long term complications

blindness, intellectual disability, deafness, hydrocephalus, loss of extremities, cerebral palsy, seizures

bacterial meningitis dx

order LP: **results increased WBC, pressure & protein, decrease glucose & positive culture**

meningitis meds

antibiotic (for bacterial or while waiting for cultures), anticonvulsants, antipyretics + treatment of F&E imbalances **treat symptoms**

if we suspect meningitis, what is our first nursing action

put them in contact isolation followed by collecting blood work within 1hr & start abx **get blood before giving abx**

meningitis precaution

seizure

encephalitis CM

-caused by HSV1 -has nonspecific signs, fever, altered mental status, possible seizures -last few days or has severe CNS involvement causing long term comps or death **resembles meningitis**

encephalitis

inflammatory process of the CNS that can be caused by variety of organisms

encephalitis dx

based on clinical findings and ID of specific organism -CT scans -blood samples

encephalitis nursing mgt

-hospitalized for observation and supportive care -same care as for meningitis

Epilepsy

a chronic condition defined as two or more seizures episodes that were not caused by reversible medical condition

Epilepsy etiology

-genetic -structural / metabolic -unknown -febrile

febrile seizure treatment

if seizure lasts more than 5 minutes call EMS who will give a anti epileptic drug **do nothing if less than 5mins**

how can prolonged seizures be treated

a rescue sedative (rectal diazepam or intranasal midazolam) in ED or via EMS

if a febrile seizure is less than 5 minutes, what will their EEG show

no changes

Epilepsy therapeutic mgt

-meds **start w/ 1, titrate up if needed, add 2nd med if needed** -if multiple meds & still need more, place on ketogenic diet (not long term) -if still need more, place a vagus nerve stimulator -if all doesn't work, surgery

ketogenic diet

**high fat, low carb** restrict: french fries, buns, carbs give: full fat cheeses & yogurt & milk **give vitamin sups**

seizure meds

levetiracetam, carbamazepine, topiramate, lamotrigine, valproic acid

what do we observe during a seizure

-direction of eye movements -alteration of consciousness -unilateral/bilateral movements -duration of seizure