T3-Blueprint: Head Injuries Flashcards Preview

Pediatrics-MJ > T3-Blueprint: Head Injuries > Flashcards

Flashcards in T3-Blueprint: Head Injuries Deck (57):
1

What are the normal percentages of head? What happens if one of these percentages changes?

Brain: 80%
CSF: 10%
Blood: 10%

Body has to adjust

2

What concerns might the nurse have about sedation in the acute head injury patient?

Interferes with the need to perform periodic neurological exams to assess for LOC and extent of injury

3

Why do infants handle ICP better?

Fontanels are not closed yet--more room for growth

4

What are signs of ICP?

-Headache (on awakening, in absence of eating)
-Vomiting
-Personality changes
-Irritability, fatigue
-Gait changes
-Double/blurred vision
-Pupils react more slowly, then dilate and become fixed
-Increased head circumference
-Bulging fontanels
-LOC: sleepy to coma (decreased recognition of parents)

5

What are late signs of ICP?

-Cushings triad
-Bradycardia
-Increased BP
-Irregular breathing

6

What is cushings triad (late sign of ICP)?

Bradycardia
High BP
Slow breathing

7

What does ICP monitoring tell?

Amount of pressure build up in head

8

What does a ventricular catheter do?

Surgical insertion that burrs a hole (external ventricular drain)...it drains excess CSP

9

What is the name of the catheter the surgeon can manipulate?

Bolt catheter

10

What are some treatments for ICP?

-Mannitol
-Steroids
-Versed
-Antibiotics
-Anti-epleptics
-Barbituates
-Phenobarbital

11

Should we do neck compression for ICP? Explain

Avoid; keep the head midline and elevate HOB

12

How should environment be for child with ICP?

Calm environment

13

How should child eat if they have ICP?

NG feedings

14

How do we hydrate child with ICP?

2/3 maintenance--dont want to increase ICP even more by adding lots of extra fluids

15

Signs of ICP?

-Headaches
-Irritability
-High pitched cry
-Vomiting
-Visual changes
-Ataxia
-Seizures

16

What is a neurological sign of ICP?

"Cat cry"

17

What are the 5 LOC states?

1. Lethargy
2. Obtunded
3. Stupor
4. Coma
5. Persistent vegetative state

18

Falls asleep quickly

Lethargy

19

What is obtunded?

Arousable with stimulation

20

Deep sleep, responds to vigorous, repeated stimulation

Stupor

21

What is coma?

No response to decerebrate posturing to pain

22

Eyes open, limbs spastic, no words, some swallow

Persistent vegetative state

23

What are 3 parts to glasgow coma?

1. Eye opening (up to 4 pts)
2. Verbal response (up to 5 pts)
3. Motor resposne (up to 6 pts)

24

How is glasgow coma scored?

3-15

25

What is a good glasgow coma score?

15

26

What is a poor score for glasgow coma?

8 or less (3=worst)

27

What is the last sense to be lost with coma?

Hearing

28

What are nursing interventions for a child with an acute head injury?

Anti-inflammatory meds and pain management

29

What are nursing interventions for the unconscious child?

-ABC (only suction if needed)
-Pain control
-ICP monitoring
-Bowel functioning
-Skin care

30

What are long term issues of a child with an acute head injury?

Physical problems
Cognitive impairments

31

Premature closures of the sutures/absence of sutures

Craniostenosis

32

Craniostenosis is the result for premature closure of the sutures/absence of sutures. What does that cause?

Increased ICP--> seizures, coma, death

33

What are manifestations of craniostenosis? What age?

Early CORONAL sutures will show depression of the ORBITAL roof leading to visual changes like exophthalmia, strabismus, and other eye findings

18 months

34

What is the mangement for craniostenosis?

Frequent positional changes in newborns and infants

35

What is the treatment for craniostenosis?

Need surgical correction to realign cranial bones which relieves ICP pressure and helps cosmetic issues

36

If craniostenosis is not treated, what happens?

Brain damage and mental retardation can occur

37

What is the post-op for craniostenosis?

-Emotional support
-PRESSURE DRESSINGS
-Careful monitor of Hct and Hgb!

38

Small skull due to lack of brain growth

Microcephaly

39

What are 5 etiologies for microcephaly?

1. Cromosomal abnormality
2. Radiation exposure in preg.
3. Maternal infections like rubella or toxoplasmosis
4. Maternal alcoholism
5. 3rd trimester trauma, metabolic disorders, anoxia

40

Hypoxic-ischemic brain injury: What are near drownings for infants and toddlers?

Infants: bath tub
Toddlers: toilet bowel

41

What happens in hypoxic-ischemic brain injuries?

-Laryngospasm
-Swallow water
-Vomit, gasp, aspirate
-Blood shunts to the brain and heart
-Hypoxia leads to brain damage!!!

42

What happens in shaken baby syndrome?

Retinal hemorrhages

Torn subdural vessels

43

What is the most common head injury?

Concussion

44

What is the hallmark signs of concussion?

Amnesia
Confusion

45

Cranial injury: What kind of fracture? Treatment?

Skin laceration and fracture

Compound--antibiotics and surgery

46

Cranial injury: What type of fracture?

Result in dural year, hemorrhage into nose and middle ear

Basilar

47

Cranial injury: What are 2 key signs of basilar fractures?

1. Raccoon eyes
2. Battle sign

48

Cranial injury--basilar fracture

What is raccoon eyes?

Anterior basal fractures!

Bilateral periorbital ecchymosis--associated with orbital fractures

49

Cranial injury--basilar fracture

What is the battle sign?

Effusion of blood under ear

Retroauricular ecchymosis

Fracture of auditory canal/lower areas of the skull!

50

Cranial injuries: What type of fracture?

Traumatic separations of cranial sutures

Diastatic

51

Why do kids get cranial injury easier?

-Insufficient musculoskeletal support of head

-Thinner, softer brain

-Thinner and compliant skull of younger children

52

If a child has unilateral dilated pupils, what does this mean?

Intracranial mass

53

If a child has a brainstem herniation what will their pupils be like?

Fixed and dilated

54

What does it mean if a child has bilateral fixed and dilated pupils?

Brainstem herniation from increased ICP

55

What kind of pupils for inter cranial mass?

Unilateral dilated

56

What kind of injury if child has fixed and dilated pupils?

Brainstem herniation

57

What kind of pupils will child have if they have a brainstem herniation from increased ICP?

Bilateral fixed and dialted

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