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Flashcards in T3 - Neuro PPT (Josh) Deck (90):
1

On the Glasgow Coma Scale, what score is poor?

8 or less

2

Glasgow Coma Scale measures for what?

- Eye opening
- Verbal response
- Motor response

3

-- is very tough and covers the entire brain.

Dura mater

4

--- is under the dura mater, thin, arteries and veins are suspended here

Pia arachnoid

5

-- is very thin, lies under the arachnoid, and adheres to the surface of the brain.

Pia mater

6

CSF is found beneath the --- and ---

arachnoid

pia mater

7

Brain comprises --- of body mass in infancy and --- in adults.

15% in infants

3% in adults

8

In infants, a large proportion of blood volume is in --

the head

9

Why can brain tumors be missed in infants?

intercranial pressure can be less likely to be seen due to anterior fontanel

10

Reasons infants and young children are more susceptable to head injury

- top heavy
- large head in proportion to body
- excessive spinal mobility and immature muscles

11

Startle reflex

MORO

12

Stroke foot and toes curl

Plantar Reflex

13

Infant swings to the side that is stroked

Galant Reflex

14

--- can reveal a spinal fluid leak.

Glucose test

15

Why do infants handle increased ICP better than adults?

fontanels

16

Space in scull is filled how?

Brain (80%)

CSF (10%)

Blood (10%)

17

Early signs of ICP

- Headache on awakening (w/out eating)
- Vomiting, personality changes, irritabilty, fatigue, gait change
- Double/Blurred vision. slow pupil reaction
- Seizures
- Increased head circumference, bulging fontanels
- LOC change

18

Late Signs of ICP:

Cushing's Triad

Bradycardia

High BP

Slow breathing (bradynea)

19

Late Signs of CP:

Bradycardia

Widening pulse pressure

slow HR

20

LOC levels:

Falls asleep quickly

Lethargy

21

LOC levels:

Arousable w/ stimulation

Obtunded

22

LOC levels:

Deep sleep, responds to vigorous, repeated stimulation

Stupor

23

LOC levels:

No response to decerebrate posturing to pain

Coma

24

LOC levels:

eyes open, limbs spastic, no words, some swallow

Persistent Vegetative State (PVS)

25

How is brain death confirmed?

2 EEGs and 2 exams 24 hrs apart

26

What is the most important aspect of the physical exam for neuro probs?

Vital sign changes

27

Pinpoint pupils indicated...

MSO4 or poisoning

28

Fixed, dilated pupils mean...

brain herniation (med emergency)

29

Unilateral and dilated pupil means...

lesion on that side

impending herniation

30

Pupil's in an unconscious child look like...

Doll's Eyes (glassy)

31

--- is always checked w/ neuro probs.

Glucose

32

Nursing intervention for unconscious child:

ABCs (suctioning ONLY as needed, if intubated)

Assessment

Pain control

ICP monitoring

Bowel functioning

Skin Care

33

To monitor ICP, what is used?

Ventricular Catheter

34

What is ICP treated w/ ?

mannitol

steroids

35

Signs of ICP:

- LOC change
- Headache
- Papilledema
- Doll's eyes
- Pupillary changes
- V/S changes
- High pitched cry (infants)

36

Nursing Care for ICP

Avoid neck compression – keep head midline HOB elevated

Environment calm

Monitor ICP and treat as needed

Naso Gastric feedings

Hydration – 2/3 maintenance

Meds: Versed, antibiotics, anti-epileptics, barbiturates reduce brain oxygen need –

Pavulon, phenobarbital

Thermoregulation – NTE

Elimination – foley, stool softeners

Skin care – mouth care - artificial tears

37

What is the last sense to be lost in a coma?

hearing

38

--- injuries account for the highest mortality.

--- are twice as likely to be affected as ---

Neurological

Boys

Girls

39

Head injuries can cause large blood loss why?

head is more vascular than adults

40

Coup is ---

Contre-coup is ---

Acceleration (bruising at point of impact)

Rebound brusing

41

Assessment for Head Injury

ABCs

Stabilize spinal cord

Evaluate for shock

Neuro exam

42

Neuro exam for Head injury includes:

LOC

Pupillary symmetry

Seizures

Test nasal discharge for GLUCOSE

43

Near drowning is more common in --

males less than 4 yrs

44

What is Hypoxic-Ischemic brain injury caused by near drowning?

survival 24 hours after incident

45

What happens in Hypoxic-Ischemic brain injury caused by near drowning?

Laryngospasm, swallow water, vomit, gasp, aspirate

Blood shunts to brain and heart

Hypoxia leads to brain damage

46

A characteristic sign of Shaken Baby Syndrome is ---

Retinal Hemorrhage

47

-- --- results from initial impact in shaken baby syndrome

-- --- results from secondary impact as brain move backward in skull

Coup injury

Contrecoup injury

48

Most common head injury is ---

Hallmark signs?

Concussion

Hallmarks signs:
- Amnesia
- Confusion

49

Which fracture has skin laceration and fracture?

Compound

50

Racoon eyes =

anterior basal fractures

sign of Basilar Skull fracture

51

Battle sign =

effusion of blood under ear

sign of Basilar Skull fracture

52

Signs of Basilar Skull fracture?

Racoon eyes

Battle Sign

53

Which fracture is traumatic separations of cranial sutures?

Diastatic

54

Children's brains are -- and -- which leads to greater long term damage in brain injury.

thinner

softer

55

A unilateral dilated and reactive pupil is a sign of --

A fixed and dilated pupil is a sign of ---

Bilateral fixed and dilated pupils are a sign of --

an intracranial mass.

impending brainstem herniation

brainstem herniation from increased ICP

56

Which posturing has arms curled up on chest?

Decorticate

- flexor posturing

57

Which posturing has arms to the side?

Decerebrate

- extensor posturing

58

Lesions ABOVE the brainstem are associated w/ --- posturing.

Lesions of the brainstem are associated w/ -- posturing

Decorticate

Decerebrate

59

What is Craniosynostosis?

premature closure of the sutures of the skull

- 18 mths
- surgical correction
- more common in males

60

Head shape abnormality that looks like a 'cone-head'?

Craniosynostosis (aka craniostenosis)

61

Primary Craniosynostosis is ---

Compound Craniosynostosis is --

one suture line is closed/absent

two or more suture lines are closed/absent

62

What is Positional Plagiocephaly?

flat occipatal part of skull due to child laying on back

63

What autosomal syndromes are related to Craniosynostosis?

Alpert Syndrome

Crouzon Syndrome

64

Patho of Craniosynostosis:

Premature closure or absence of sutures of the skull with normal brain growth can lead to displacement of cranial contents >>>

increased ICP >>>

decompensation >>>

seizures >>>

coma >>> death

65

Clinical manifestations of Craniosynostosis:

- no cranial symmetry

- exopthalmia

- strabismus

- increased ICP (headaches, irritability, high pitched cry, etc)

66

What treatment for Craniostenosis?

reconstructive surgery of the skull

67

In Craniostenosis, what is head shape dependent upon?

which sutures are involved

68

Pre-operative care for craniotomy?

- informed consent

- NPO

- Prophylactic meds (antibiotics, steroids for inflammation)

69

Post-op Nursing Responsibilities for Craniotomy?

Observe for signs (of periorbital edema; Changes in vision)

neuro assessment

Observe for signs of ICP

Cerebral edema

Surgical site care

Pain control

parent education

70

Why monitor HCT and Hgb following craniotomy?

head is very vascular

71

What is Microcephaly?

small skull size due to lack of brain growth

- 33 cm or less by 6 mths of age

72

Etiology of Microcephaly

Chromosomal Abnormality

Maternal infection (rubella)

Maternal alcholism

3rd trimester trauma

73

--- is abnormal accumulation of fluid within ventricles.

Hydrocephalus

74

S/S of Hydrocephalus:

- Sunset Sign

- ^ head circumference

- high-pitched cry

- poor feeding if ICP too high

75

What is the biggest complication of shunt placement surgery?

infection

76

What is sunset sign?

eyes that look like sun late on the horizon (depressed)

it is a sign of Hydrocephalus

77

Causes of Hydrocephalus:

Obstruction caused by:

- hemorrhage
- meningitis
- tumors
- infection

78

S/S of Hydrocephalus

- bulging fontanels
- thinning of skull bones
- dilation of scalp veins
- frontal enlargement (bossing)
- depressed eyes (setting sun)
- irritability
- Shrill, high pitched cry

79

Cat scan reveals -- ventricles.

enlarged

80

Which drugs can decrease the production of CSF until surgery for hydrocephalus?

Furosemide

Acetazolamide

81

The best and most effective treatment for Hydrocephalus is ---

shunts

82

Most common type of Shunt is --

VP (Ventricular Peritoneal)

drains into peritoneum

83

When would a VA Shunt be used?

if patient's had abdominal surgery

84

Types of Neural Tube defects:

Occulta (not visible)

Cystica (visible w/ sac-like protrusion)

85

Which type of Neural Tube defect has spinal fluid and nerves:

Meningocele

Myelomeningocele

Myelomeningocele

86

--- is frequenly associated w/ hydrocephalus.

Spina Bifida

87

What is the biggest problem w/ myelomeningocele?

infection if it bursts

88

-- encases meninges and spinal fluid with no neural elements

-- contains meninges, spinal fluid and neural tissue (nerves)

Meningocele

Mylomeningocele

89

-- is revealed w/ positive translumination (ie: the light shines through).

Meningocele

- b/c there are no nerves or neural elements

90

During pregnancy, eat foods rich in --- and ---

Folic Acid

Vit C (to absorb the FA)

- leafy greens
- citrus fruits