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45 Cards in this Set
- Front
- Back
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The entire glasgow coma scale
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Eye Opening
Spontaneous 4 To Verbal Stimuli 3 To Pain Only 2 No response 1 Verbal Response Coos & babbles/Oriented 5 Irritable cries/Confused 4 Cries to pain/Inappropriate words 3 Moans to pain/Non specific words 2 No response 1 Motor Response Moves Purposely/Obeys commands 6 Withdraws to touch/localizes painful stimuli 5 Withdraws to pain 4 Decorticate posturing/Flexion 3 Decerebrate posturing/Extension 2 No response 1 |
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What are the 4 different etilogies of increased ICP
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Mass
Brain tumor, head trauma Generalized brain edema Hypoxia, encephalopathy ↑ Blood Volume IVH, obstruction of jugular veins ↑ CSF production- Meningitis |
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What are the S/S of increased ICP in an infant?
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Infant
Poor feeding or vomiting Irritability Lethargy Bulging Anterior Fontanel ↑ HC High pitched cry Sun setting sign- √ Eyes deviated downward |
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What are the S/S of increased ICP in a child?
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Child
HA Diplopia Mood swings Slurred speech Papilledema (48 hours of ↑ICP) Altered LOC N/V especially in AM ↑ pressure from lying flat |
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What is the therapy for Increased ICP?
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Maintain Patent Airway
Supine & ↑ HOB @ 30 Avoid Prone & head turned to side ↓ venous drainage and ICP Avoid CO2 retention CO2 = Cerebral vasodilatation blood flow and ICP Hyperventilation = ↓ CO2 Cerebral vasoconstriction ↓ blood flow & ↓ICP √ for cerebral hypoxia & ischemia If Pt mechanically ventilated only suction PRN! |
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Monitoring for increased ICP
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Catheter in ventricle
√ pressure in brain. Glasgow Coma scale <7 Manitol Osmotic diuretic |
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What are neoplasms?
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High incidence in 5-10 years old
Prognosis is best when tumor is completely removed >60% found in cerebellum and brain stem |
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What are the S/S od Neoplasms?
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First cardinal sign = ↑ ICP
HA Irritability Projectile vomiting Personality changes Location/size of tumor Focal Affects (Behavior, Speech) Cerebellar tumor = Ataxia |
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What is a Glioblastoma?
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Tumor of brain or spinal cord (astrocytes)
Most common brain tumor in children 75% survival rate |
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What are the S/S of a Glioblastoma?
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Depends on location of tumor
Headache Ataxia Eyes deviating (cover/uncover test) Hemiparesis + Babinski Staring spells ↑ ICP |
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What is used to diagnose a Glioblastoma?
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Complete Neuro exam & cranial nerves
CT scan, MRI, Pet Scan Treatment Chemotherapy Radiation Surgery Retain as much viable tissue as possible! |
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What are the preop and the postop nursing interventions for a glioblastoma?
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Pre-op: Prepare child and family
Assess developmental milestones Shave all/part of head Extensive dsg with multiple drains Post-Op √ LOC & Glasgow Coma Scale √ VS √ Infection Restrict fluids post-op √ I & O External shunts/drains/monitors (√ for ICP) Increase HOB slowly- No trendelenburg! No Narcotics = ↓ cerebral functioning |
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What is seizure disorders?
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Epilepsy is recurrent seizure activity
Does not occur with a known cause i.e. infection, tumor Seizure is excessive discharge of neurons. Status Epilepticus Prolonged or recurrent seizures Not regaining consciousness >30 minutes |
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What is the primary secondary and idiopathic etilogies of a seizure
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Primary
Linked to genetic predisposition Include febrile, absence and benign seizures Early infancy from birth trauma or congenital defects Secondary or symptomatic seizure A temporary or permanent structural or metabolic abnormality. Cerebral lesions, malformations, metabolic disorders and hypoxia. Late infancy and early childhood from acute infections – meningitis. Idiopathic Most common = >3 years 50% of seizures. |
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What tests are used to diagnose a seizure?
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Family Hx & Hx of symptoms
Behavior before, during and after seizure Any predisposing illnesses/fever LP √ Infection or metabolic causes CT scan, MRI √ trauma, tumor, malformation √ Labs Serum Calcium, Glucose, & Magnesium Electroencephalogram (EEG) Measures voltage in brain Sharp waves on EEG = Epilepsy ↓sensory stimulation during exam |
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Classification of Seizures?
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Generalized
Both cerebral hemispheres and ∆ in LOC Tonic-Clonic Absence Myoclonic Atonic Partial One hemisphere affected & ∆ in LOC Symptoms occur on one side of body Partial Simple partial Complex partial |
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About Generalized Seizures tonic clonic?
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Aura
LOC Tonic phase (10-20 secs) Clonic phase (>30 sec) Post-ictal State |
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About generalized seizues absent siezure petite mal?
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↑ Incidence btwn 4-12 years
RT brain immaturity Usually cease at puberty Brief LOC may be mistaken for daydreaming Minimal or no alteration in muscle tone Sudden arrest of activity with no memory of event Lasts 5-20 seconds up to 20 times/day |
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About partial seizures (simple partial)?
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Localized motor symptoms
Somatosensory and autonomic symptoms Unilateral hand or 1 side of body No LOC! Eyes deviate toward opposite side Jacksonian Sylvian/Rolandic |
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About partial seizures (complex)?
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Psychomotor seizures-most common
Age 3-adolescence Period of altered behavior & repeated purposeless activities Last 5-10 minutes Aura Lip, smacking, chewing, drooling May yell out, inappropriate behavior |
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facts about Status Epilepticus?
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Medical emergency
Prolonged or recurrent seizures Not regaining consciousness >30 minutes Most common cause Sudden withdrawal of anticonvulsant meds LOC can last hours or days Maintain airway Will most likely be intubated Ativan (lorazipam) Quicker onset & longer acting Less respiratory depression than valium |
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What is medication therapy for Status Epilepticus?
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Controls symptoms
Prevent seizures or decrease # & activity Raise the seizure threshold Decrease responsiveness to neurons Loading & maintenance doses Phenobarbital (luminal) Therapeutic level 10-40 mcg/ml √ respirations can cause respiratory arrest! Dilantin (phenytoin) Therapeutic level 10-20mcg/ml. SE hyperplasia of gums! |
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What is medication therapy for Status Epilepticus (tegretol & Valproic Acid?
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Tegretol (carbamazepine)
Therapeutic level 4-12 mcg/ml- Monitor LFT’s! Hepatotoxic. SE neutropenia √ WBC’s! Valproic Acid (depakene) Therapeutic level 50-110 mcg/ml- Monitor LFT’s! |
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What are nursing interventions for Status Epilepticus?
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Monitor serum drug levels
Seizure precautions Padded bed rails O2 & Suction Teaching plan Parents, Pt, School, Sports, Community etc. Type of seizure Medications & SEs Med alert bracelet Protocol for discontinuing seizure meds: Pt should be seizure free for 2 years Normal EEG Slowly taper doses EEG’s Q 6 months |
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What is Meningitis?
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Bacterial meningitis 10-15% mortality rate
Acute inflammation of the meninges Infection: URI, OM or sinusitis Bacteria enters CNS/brain via nasal cavity, sinuses. HIB, Group B strep, S.pneumoniae and Neisseria meningitides N. Meningitides is most invasive disease. 13 serogroups Vaccine only covers A,B,C,Y and W-135 |
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What is the incidence of Meningitis?
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↑ Risk <1 year of age and >15 yrs
Deficiencies in terminal complement URI HIV Asplenia Crowding Smoking or passive exposure |
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What are the clinical signs of Meningitis?
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Depend on age and organism
Nucchal Rigidity “stiff neck” Brudzinski’s sign Kernig’s sign Abrupt onset fever and chills Vomiting & No Nausea HA Seizures Irritability Anorexia Petechiae and pupura = Sepsis disseminated disease |
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What tests do you so to get a diagnosis of Meningitis?
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CBC with Diff
BC NP/Pharyngeal cultures Lumbar Puncture LP √ CSF color, consistency, pressure of fluid. Sterile procedure √ Complications; Infection, bleeding, spinal fluid leak, Hematoma, Spinal HA |
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What are some facts about CSF fluid analysis?
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Clear, cloudy or bloody
Bacterial or viral meningitis ↑ Protein ↓ Glucose WBC (PMN cells) Gram stain- +/- Culture-identifies organism √ pressure >15 = ↑ ICP ↑ Blood = ↓ skill or traumatic tap |
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What are some contraindications to a lumbar puncture?
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↑ ICP-
Need CT scan. If LP done fatal herniation can occur Bleeding disorders Overlying skin infection (Staph/MRSA) Unstable patient |
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What is therapy for Meningitis?
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Respiratory isolation right away!
Antibiotics 2-3 immediately!!!! Meningitic dose (2x usual dose) Cephalosporins and Ampicillin Dexamethasone ↓ inflammation Phenobarbital ↓ seizure activity Mannitol ↓ brain edema |
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What are some nursing interventions for Meningitis?
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Keep HOB >30%
Quiet environment Frequent neurochecks & VS Maintain Isolation Prophylaxis medication = Rifampin Persons in close contact Urine turns orange and stains contact lenses |
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What is Reyes Syndrome?
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Acute Toxic Encephalopathy
↑ Incidence with 6-11 years & virus infection (flu/varicella) + Relationship when treating fever with ASA NH4 accumulates and builds up urea → Brain edema, necrosis of neurons and cell death Fatty infiltration of liver cells, kidney and myocardium Impaired hepatic, renal and cardiac function |
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What are S/S of Reyes syndrome?
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A history of preceding URI or chickenpox
Nausea and vomiting x 24 hours/intractable Mental status changes Lethargy Confusion Combative behavior Loss of consciousness or coma may develop Seizures Hepatomegaly |
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How to diagnose Reyes Syndrome?
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↑↑ LFT’s 2x normal
Prolonged pt/ptt ↑↑ NH4 4x normal Palliative Support ↑↑ Mortality if pt is in coma = 40% |
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What is Cerebral Palsy?
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Impaired neuromuscular control
Abnormality in cortex, basal ganglia and cerebellum Brain injured area determines type of neuromuscular disability Non-progressive |
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What is the etiology of Cerebral Palsy?
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Developmental anomalies
Infections Toxins Cerebral trauma Hypoxia Vascular occlusion RT IVH |
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What are the clinical signs of Cerebral Palsy?
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Abnormal muscle tone: hyper or hypotonicity
Impaired coordination and motor function Delayed gross motor development Abnormal postures Persistent primitive reflexes Spasticity or uncontrolled movements Seizures Sensory impairments |
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Classifications of Cerebral Palsy (Spasic)?
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Most common with cortex involvement.
Muscles very tense with any stimulus Sudden jerking movements |
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Classifications of Cerebral Palsy (Diskinetic)?
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Injury at basal ganglia.
Slow, writhing, uncontrolled, involuntary movements involving all extremities |
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Classifications of cerebral Palsy (Ataxic)?
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Cerebellum affected.
“Clumsy” characterized by loss of coordination, equilibrium and kinesthetic sense |
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Classifications of cerebral Palsy (Rigid)?
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Rare form with poor prognosis.
Rigidity of flexor and extensor muscles. Tremors at rest and with movement Mixed |
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What is the therapy for Cerebral Palsy?
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Early recognition and intervention is goal
Maximize child physical abilities (Child intellectually intact) Multidisciplinary team approach- PT, OT, Neurologist, Orthopedic surgeon, RN, social worker Family support & community via UCP Treat symptoms Baclofen pump- skeletal muscle relaxant Increase locomotion, communication and self-help Correct defects Contractures or spastic deformities Braces |
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What is retinoblastoma?
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Most common congenital intraocular tumor
60% non-hereditary and unilateral 25% genetic & bilateral 15% genetic & unilateral Red inflamed eye. Persistent redness, irritation & itchy Leukokoria Loss of red reflex Strabismus-25% present Glaucoma |
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What is the therapy for Retinoblastoma?
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Genetic counseling
Early stage Radiation or cyrosurgery Late stage Radiation, Chemo Enucleation Fit with prosthesis in 3 weeks 90% survival rate Unaffected eye is fine! |
