Peds ICP Disorders and Cerebral Dysfunction

Question 1

An increase in ICP may be caused by

Answer 1

tumors or other space-occupying lesions, accumulation of fluid with in the ventricular system, bleeding, or edema of cerebral tissues.

Question 2

what is the earliest indicator of changes in neuro status

Answer 2

level of consciousness

Question 3

levels of consciousness in order

Answer 3

*Full consciousness
*Confusion: Impaired decision-making
*Disorientation: To time and place
*Lethargy: Sluggish speech

Question 4

coma assessment tool

Answer 4

*Glasgow Coma Scale (GCS)
(Eye, verbal, and motor response)

Question 5

on the glasgow coma scale what is defined as a coma

Answer 5

8 or below

Question 6

a score of 3 on the glasgow coma scale indicates

Answer 6

deep coma

Question 7

Brain death requires

Answer 7

*Complete cessation of brain function
*Irreversibility of condition

Question 8

Assessment Parameters for Increased ICP

Answer 8

-Assess pupil size and reactivity
-temp is often elevated
-HR can be rapid, slow and bounding, or feeble
-BP may be normal, elevated or very low
-RR is often slow, deep, and irregular

Question 9

Clinical Manifestations of Increased ICP in Infants

Answer 9

*Irritability, poor feeding
*High-pitched cry, difficult to soothe
*Fontanels: Tense, bulging
*Cranial sutures: Separated
*Eyes: Setting-sun sign
*Scalp veins: Distended

Question 10

setting sun sign

Answer 10

-eyes deviate downward with rim of sclera showing above iris
-may indicate hydrocephalus

Question 11

Clinical Manifestations of Increased ICP in Children

Answer 11

*Headache
*Forceful vomiting
*Seizures
*Drowsiness, lethargy
*Diminished physical activity
*Inability to follow simple commands

Question 12

Late Signs of Increasing ICP

Answer 12

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

Question 13

Special Diagnostic Procedures for Increased ICP

Answer 13

*Laboratory tests
*Electroencephalography (EEG)
*Assessment of evoked potentials (auditory and visual)
*Radiography (rule out skull fractures, dislocations; evaluate degenerative changes, suture lines)
*Computed tomographic (CT) scan
*Magnetic resonance imaging (MRI)

Question 14

lumbar punctures contraindicated in

Answer 14

patients with increased ICP or infected skin over puncture site

Question 15

Nursing Care of theUnconscious Child

Answer 15

*Emergency management
*Airway
*Reduction of ICP
*Treatment of shock

Question 16

what medication is used for cerebral edema

Answer 16

Osmotic diuretics: Mannitol

Question 17

Indications for ICP monitoring

Answer 17

*Glasgow Coma Scale score of less than 8
*Traumatic brain injury with abnormal CT scan
*Deteriorating neurologic condition
*Subjective judgment regarding clinical appearance and response

Question 18

Cerebral Trauma

Answer 18

head injury (damage to the brain)

Question 19

Three major causes of brain damage in childhood

Answer 19

*Falls
*Motor vehicle injuries
*Bicycle- or sports-related injuries

Question 20

Concussion

Answer 20

*An alteration in neurologic or cognitive function with or without loss of consciousness
*Transient and reversible
*Results from trauma to the head

Question 21

a concussion is generally followed by

Answer 21

amnesia and confusion

Question 22

treatment for concussion

Answer 22

-keep them awake for as long as possible
-rest until symptoms resolve
-resume activities gradually

Question 23

Epidural hemorrhage

Answer 23

*Bleeding between the skull and the dura

Question 24

Classic clinical picture of epidural hemorrhage consist of

Answer 24

momentary unconsciousness, followed by a normal period, then followed with lethargy and coma due to blood accumulation in the epidural space and compression of the brain

Question 25

Subdural hemorrhage

Answer 25

*Bleeding between the dura and the arachnoid membrane

Question 26

presenting signs for subdural hemorrhage

Answer 26

irritability, vomiting, increased head circumference, bulging fontanels in infants, lethargy, coma, or seizures.

Question 27

Cerebral edema

Answer 27

*Associated with traumatic brain injury *Increased ICP with herniation

Question 28

Cerebral edema peaks at

Answer 28

24 to 72 hours after injury and may account for changes in a child's neuro status.

Question 29

Therapeutic Management ofHead Trauma

Answer 29

-NPO until it is determined that vomiting will not occur. -Sedating drugs are commonly held in the acute phase. -Acetaminophen for headache. Surgery -Scalp lacerations are sutured.

Question 30

Reye's Syndrome

Answer 30

*A disorder defined as toxic encephalopathy associated with other characteristic organ involvement

Question 31

Reye's Syndrome is characterized by

Answer 31

*fever, profoundly impaired consciousness, and disordered hepatic function

Question 32

most common cases of reyes syndrome follow

Answer 32

common viral illness (influeza and varicella)

Question 33

what medication is associated with reyes syndrome

Answer 33

*aspirin therapy for fever and development of Reye's syndrome

Question 34

what is the definitive diagnosis for reye's syndrome

Answer 34

liver biopsy

Question 35

a build up of ammonia in reyes syndrome will cause

Answer 35

sudden behavioral shift

Question 36

therapeutic management for reyes syndrome

Answer 36

*Early diagnosis and aggressive therapy

Question 37

seizure disorders

Answer 37

"transient occurrence of signs and/or symptoms due to abnormal excessive and synchronous neuronal activity in the brain".

Question 38

seizures are determined by

Answer 38

site of origin

Question 39

The manifestations of seizures

Answer 39

unconsciousness or altered consciousness, involuntary movements, and changes in perception, behaviors, sensations, and/or posture

Question 40

Epilepsy

Answer 40

chronic brain disorder characterized by Two or more unprovoked seizures

Question 41

partial seizure

Answer 41

a seizure that affects only one part or one side of the brain, local onset

Question 42

generalized seizure

Answer 42

a seizure that affects both sides/hemispheres of the brain without local onset

Question 43

goal for seizure disorders

Answer 43

*To control seizures or reduce the frequency and severity

Question 44

Therapeutic Management of Seizure Disorders

Answer 44

-discovery and correction of cause -medication (start at lowest dose possible) and gradually increase until seizures are controlled)

Question 45

febrile Seizures

Answer 45

Seizures that result from sudden high fevers, particularly in children between 6mo. and 3 years

Question 46

Hydrocephalus is caused by

Answer 46

*an imbalance in the production and absorption of CSF

Question 47

hydrocephalus

Answer 47

accumulation of fluid in the spaces of the brain

Question 48

myelomeningocele

Answer 48

hernia of the spinal cord and meninges

Question 49

hydrocephalus is commonly associates with

Answer 49

myelomeningocele

Question 50

Therapeutic Management of Hydrocephalus

Answer 50

*Ventriculoperitoneal shunt

Question 51

Ventriculoperitoneal shunt

Answer 51

a tube used to drain fluid from brain ventricles into the abdominal cavity

Question 52

when is a VP shunt at greatest risk for infection

Answer 52

1 to 2 months after shunt placement

Question 53

treatment for shunt infection

Answer 53

Massive-dose antibiotics or shunt removal

Question 54

what is the cardinal sign for shunt obstruction

Answer 54

headache