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129 Cards in this Set
- Front
- Back
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What is the leading cause of death in children older than 1 year of age?
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Head trauma
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Why are young children susceptible to head trauma?
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Because they are top heavy and the muscle and ligaments in their neck are not as strong as older children
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What % of children will suffer head injuries serious enough for medical attention?
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25%
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How many children die each year as a result of brain injury?
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10 in 100,000
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What % of head injury survivors acquire significant disabilities?
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20%
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List some complications of head injury
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1. Developmental delays
2. Learning disabilities 3. Gross motor disabilities 4. ADD 5. seizures |
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What are the most common etiologies of head injuries?
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1. Falls 2. Motor vehicle accidents 3. bicycle injuries 4. abuse
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Why are intracranial contents damaged in head injuries?
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Because the force is too great to be absorbed by the skull and musculoligamentous support of the head
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What 2 injuries occur in acceleration-deceleration injuries?
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1. Bruising of the brain
2. shearing force |
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What are the 3 sites of injury in acceleration-deceleration injury?
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1. Coup
2. counter-coup 3. shearing of he vessels and nerves |
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What sport has been thought to cause head injuries in children?
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Soccer from heading
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List the types of primary head injuries.
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1. Concussion
2. contusion 3. skull fractures 3. intracranial hemorrhage or hematoma |
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What is the most common type of primary head injury?
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Concussion
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What is a contusion?
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Bruising of the brain
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List the complications/consquences of primary head injuries.
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1. Brain damage
2. ICP 3. Infections from fractures 4. Hypoxia 5. Cerebral edema |
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What must occur in the brain for a loss of consciousness to happen during a head injury>?
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The pressure inside the skull > arterial pressure
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What are the side effects of a concussion?
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Confusion and amnesia, but no LOC
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What are some common long term effects from concussions that may resolve after a year?
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Loss of memory, depression, development of phobias, personality changes
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What is a laceration?
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From a skull fracture
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What can result from a contusion or laceration?
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Epidural or subdural hemorrhage
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Skull fractures require a great deal of ____?
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FORCE
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If an infant presents with a scalp hematoma, what is this suggestive of?
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an underlying skull fracture
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What are the common complications for skull fractures?
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1. Hemorrhage
2. infection 3. Edema 4. herniation through the tentorium |
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What are epidural hematomas?
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Bleeding of the middle meningeal ARTERY! That occurs between the dura and the skull
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What are the symptoms of an epidural hemorrhage?
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Headache, vomiting, irritability, impaired consciouness, CONTRALATERAL WEAKNESS, INCREASE DEEP TENDON REFLEXES, and signs of ICP
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Which type of hematoma is more common in children?
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Subdural
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What is a subdural hematoma?
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bleeding of a vein in the brain and can happen over a long period of time. Occurs between the brain and the dura
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which type of hematoma is often seen in shaken baby syndrome?
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Subdural
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What is a sub-acute subdural hematoma?
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One that actually takes 2-10 days to occur after the initial injury
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List the symptoms of a subdural hematoma.
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1. Vomiting
2. Headache 3. drowsiness 4. seizures 5. irritability 6. personality changes 7. older children may complain of headache NO increase in DTR and no contra weakness |
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What is cerebral edema?
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Complication of the primary head injury and is swelling and changes the cerebral blood flow.
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What is the number one nursing concern when a child presents to the ER with possible head trauma?
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ABC's
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What are the 3 first steps to do when assessing a child with possible head trauma?
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1. ABCs
2. Stabalize the spine 3. Evaluate for shock |
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What aspect of the respiratory assessment is vital to pay attention to with head trauma?
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Rhythm!
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IF a child presents to the ER with possible head injury and displays periodic irregular breathing, what is this a possible sign of?
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Ominous sign of possible brain stem injury
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What is cushing triad?
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1. Increase in systolic BP
2. widened pulse pressure 3. bradycardia Late sign of increased ICP |
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What scale is used in the neurological evaluation of a child presenting with possible head trauma>?
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The Glasgow Coma scale
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What are the 3 aspects of the Glasgow coma scale?
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1. Eye opening 2. Verbal response 3. Motor response
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What pupillary symptoms would be seen in the nuerological surgical emergency for possible herneation of the brain stem?
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Bilateral fixed and dilated pupils
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What is the possible diagnosis if there is unilateral fixed pupils?
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May be a lesion on the same side of the fixed pupil
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What is a common sign of drug use that can be seen upon assessment?
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Pin point pupils
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If a recent seizure has occurred, how might the child's eyes appear?
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Widely dilated, but reactive pupils
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What is the technique used to assess extra occular eye movements in an unconscious child?
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Dolls head maneuver
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Explain the dolls head maneuver
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It assesses for cranial nerve 3
If no spinal chord injury: hold open their eyes and briskly turn their head side to side. If you turn their head to the left, the eyes should deviate right |
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What ist he method for assess occularvestibular response in comatose patients?
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First ensure that there is no infection in the ear or a rupture of the membrane.
Then place an ice cube in the ear and open their eyes. The eyes should deviate to the ear with the ice. Assesses for cranial nerve 8 |
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What should the nurse look for when using the fundoscope on a child who has a possible head trauma?
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papilledema of the retina
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When does papilledema often occur in children?
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1-2 days after a head injury
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what are the symptoms of papilledema?
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Venous engorgement, hemorrhage over or adjacent to the optic disc, blurring of the margins of the optic disc and elevation of the optic disc
also see Paton's line: look like waves around the optic disc |
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What should the nurse monitor for when assessing motor function post head injury?
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1. Spontaneous activity
2. posture 3. Resopnse to painful stimuli 4. symmetry of movements |
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Describe Decorticate posturing.
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Arms flexed in and legs extended out
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Which part of the brain is thought to be affected when the patient has decorticate posturing?
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The cerebral cortex
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Describe DECERABRATE posturing.
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Extension of both the arms and the legs
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What portion of the brain is likely damaged if the patient has decerabrate posturing?
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The midbrain
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What is the name when one eye lid droops and appears not to open widely?
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ptosis
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What has been considered the universal sign that something is wrong in children?
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Poor feeding
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List the SxS of ICP in infants.
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1. poor feeding!
2. irritable or lethargic 3. bulging fontanelle 4. high pitched cry 5. inc head circumference 6. setting sun eyes |
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What are the common symptoms of ICP in "children"?
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1. headache
2. diplopia 3. mood swings 4. slurred speech 5. papilledema 6. altered LOC 7. nausea and vomiting |
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What is usually the first signs of papilledema?
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Venous engorgement
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What are Paton's lines?
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Symptom of Papilledema where radial retinal lines cascading from the optic disc
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List the nursing responsibilities for a patient with ICP.
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1. Elevate HOB 15-20 degrees
2. Avoid neck compression: allows for free flow of cerebral spinal fluid 3. eliminate noise 4. NO SUCTIONING or percussion 5. NO rectal temps 6. Asses vital signs for cushing triad 7. LOC!!!!! |
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If a child experiences a head trauma, but does not have LOC, what are the management options?
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1. Home care
2. child checked q2 hours for arousal 3. re-examined in 1-2 days by practitioner |
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Describe the diet that a child who has had a head trauma will be placed on in the hospital.
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NPO and no clear liquids
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List the management requirements for a child with Head trauma including Loss of consciousness.
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1. NPO or clears
2. fluid balance 3. medications |
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What is the standard medication for the treatment of cerebral edema?
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Mannitol: osmotic diuretic
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what is the preferred method to reduce inflammation in children in ICP?
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Steroids
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What is the most common steroid used in pediatrics?
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Dexamethasone
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What is included in seizure precautions?
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1. Nothing in their mouth
2. padded side rails with at least 3 up 3. O2 available 4. suction and call bell working |
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What should the nurse check the nose for in a child with head trauma?
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Cerebral spinal fluid nose drainage: check for glucose
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What symptoms are involved with post concussion syndrome?
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2. depression
3. change in behavior 4. nausea 5. seizures 6. dizziness 7. new phobias |
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What is a seizure?
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Brief malfunctions of brain's electrical system resulting from excessive abnormal discharge of neurons
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What % of childhood seizures are idiopathic?
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50%
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What age group is most commonly associated with febrile seizures?
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After 6 months old and before 3 years
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What aspects of a fever are practitioners uncertain cause febrile seizures?
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Not sure if it is the height of the fever or the rapidity of the fever that causes the seizure
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Describe febrile seizures in terms of location and duration.
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Generalized and last under 5 mins
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What % of children who experience a febrile seizure will have only 1 occurance?
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30-40%
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What types of infections have been thought to percipitate febrile seizures?
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URI and GI infections
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How are febrile seizures treated?
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NOT WITH ANTICONVULSANTS!
Treat the underlying cause of the fever! |
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Descirbe the movements of a febrile seizure.
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Tonic-clonic movements on both sides of the body
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What is epilepsy?
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Chronic seizure disorder with recuurent & unprovoked seuizres
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What are some possible causes of epilepsy?>
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1. head injuries
2. tumors 3. drugs 4. electrolyte imbalances 5. infections (meningitis) 6. birth trauma or maternal infection during pregnancy |
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Can a fetus have seizure activity in utero?
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YES!!
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What is the most common etiology of epilepsy?
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IDIOPATHIC!
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The risk of reoccurance of seizures increases greatly after __ (#) seizures.
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2
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What are the two classes of seizures?
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Partial and generalized
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A simple partial seizure has 2 components; what are they?
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1. Motor signs: tonic clonic movement
2. sensory signs: |
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Explain the sensory signs associated with simple partial seizures.
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Not an aura! Can have visual hallucinations, complaints of flashing light; unusal taste, smell or hear unusual sounds; can complain of numbness; tingling or pain in certain areas of the body;
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What type of seizure can have strange sensations that occur while the child is AWAKE and possibly talking?
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Simple partial seizure
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What is an aura?
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A feeling the patient has BEFORE the seizure. May be a feeling, taste in their mouth or infants can giggle
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What are the 5 aspects of complex partial seizures?
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1. Aura
2. impaired consciousness 3. automatisms 4. can develop into generalized 5. postictal |
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What are automatisms?
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Symptom of complex partial seizure where the pt has repeated activities without purpose.
Ex. Repeat the same word, lip smacking, taking clothes off in public, have antisocial characterstics |
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What is a postictal state?
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Time after the seizure where the pt has no idea what happened. (tired, confused and want to sleep)
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where do generalized seizures arise?
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Reticular formation
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Which hemispheres are affected in a generalized seizure
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BOTH
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What is the most frequent initial symptom of a generalized seizure?
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Loss of consciousness
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Are auras common in generalized seizures?
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Not usually, but it can happen
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Why must the nursing staff be prepared with O2 and glucose for patients with generalized seizures?
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Because they have INCREASED BMR during the seizure and can become hypoglycemic
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What often occurs after a generalized seizure?
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postictal state
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List the characteristics of the TONIC phase of a grand mal.
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1. rolling of eyes upward and LOC
2. generalized and symmetric CONTRACTION of body 3. apneic, may be cyanotic 4. may have increased salivation 5. last about 10-20 seconds |
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What is the name of the phase of grand mal seizures that involves jerking movements?
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Clonic phase
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What bodily functions are lost during the clonic phase of grand mal seizures?
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Oral secretion control; urine and bowel movement control
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What is the duration of grand mal seizures?
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From few minutes to 1/2 hour or longer
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What is the best position for a pt to be in that is having a grand mal seizure?
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On their side
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Describe the postictal state.
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* remain semiconscious & difficult
to rouse * may remain confused for several hours * mild impairment of fine motor movements * may have vision & speech difficulties * may vomit or complain of headache * usually sleeps for several hours * complain of sore muscles * does not remember event |
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What is the other name for a petit mal seizure?
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Absence seizure
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Describe a child who has atonic seizures.
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Often wear soft helmets because they fall to the ground. May have brief LOC and then get up and not remember.
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At what age is remission common for children with atonic seizures?
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6
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What type of seizure is often mistaken for daydreaming?
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Absence/petit mal
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How many absence seizures can occur in one day?
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20 or more a day
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What are myoclonic seizures?
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Occur when falling asleep or waking up; like a twitch
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How can a nurse tell if a contraction before falling asleep is a myoclonic seizure or just a twitch?
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Go and try to push their head forward and there is resistance then it is probably a seizure
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Absence seizures are known to go into remission around age ___?
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4
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What are the typical movements associated with infantile seizures?
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Jack-knife seizures: arms and legs come up and head goes down.
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How many jack-knife seizures can occur in one day?
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100 or MORE!!!!
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When do jack-knife seizures often occur?
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When falling sleep and waking up
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What is the medication often used to treat infantile seizures?
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Vegabatrim: must get it in canada
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What hormone can be given to help treat infantile seizures?
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ACTH
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If a child also has underlying ___ ____ then the prognosis for infantile seizures is much worse and tends not to resolve by age 2
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mental retardation
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The children with underlying mental retardation issues that have infantile seizures often go on to develop ____-____ seizures.
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Lenox-Gustant
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Why is a lumbar puncture often done on a child who has experienced a seizure?
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To check for meningitis which can cause seizures
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What are the 4 goals of the management of seizures in children?
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1. control seizure or decrease frequency
2. discover & correct cause when possible 3. as normal life as possible 4. medications – goal is desired effect w/o undesirable SE or toxicity |
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The 2 requirements that must be present to be taken of anti-seizure medication are?
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1. Seizure free for 3 years
2. Normal EEG for 3 years |
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When should a child not be tapered of anti-seizure medication?
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During a stressful time: ie adolescence or beginning work
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Why do breakthrough seizures often happen on children who are taking anti-seizure medication?
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Because the dose was not increased as the child grew
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What are the 2 common anti-seizure drugs used in children?
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Phenobarb and Phenytoin
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What should never be taken with phenobarb and phenytoin?
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Milk products: they decrease the absorption of folic acid and vitamin D
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What diet has been found to be benefitial for children with seizures?
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ketogenic diet
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describe the ketogenic diet
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high fat, low protein, low carb to put into ketoacidosis to slow down electrical impulses. Want to keep having ketones in the urine
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What is status epilepticus?
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seizure lasting more than 10 mins or never returning to their baseline. Can go into respiratory arrest then cardiac arrest
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What must be known before doing a surgery for seizures?
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The focal area; if it is on the brainstem then surgery is NOT and option
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