LOC
Name the level of consciousness!
Unconsciousness. Unarousable.
Coma
Discuss nursing care for a pt with hydrocephalus.
Pre-op goal is to maintain cerebral perfusion through;
-positioning
-nutrition
neuro checks
Post-op:
-positioning and neuro checks
-monitor for shunt malfunction and infection
-discharge education (assess for S&S of complications, kid can be active, healthy diet please, measure head circumference, check LOC)
What is Cerebral Palsy?
A group of non-specific clinical symptoms involving abnormal movement and posture.
Remember, this one is not genetic and non-progressive.
Whats the leading cause of death for infants, kids, and teens?
Traumatic brain injury.
What is the difference b/w a simple and status epilepticus seizure?
Simple seizures last for less than 15 minutes.
Name the level of consciousness!
All of confusion plus fear, irritability, agitation, mental/motor excitement.
Delirium.
List 3 nursing responsibilities for a pt w/meningitis
Raise HOB
Keep head midline
Assess for increased ICP
Administer meds (i.e. steroids to decrease swelling)
Reduce stimulation
Prevent or manage complications
Follow isolation procedure
List 7 clinical manifestations of CP
Abnormal muscle tone and lack of coordination
Failure to meet developmental milestones
Persistent primitive reflexes
Poor head control
Abnormal posturing
Seizures
Vision/hearing impairments
Impaired social relationships
75% have cognitive impairment
Other findings depend on type of CP
Whats 2 nursing responsibilities involving AED specifically(meaning don't say the 3 checks)?
Admin the IV AEDs slowly (like benzos, pheno, dilantin)
Assess for hypotension and respiratory depression
Ensure vit D and folic acid intake esp for long-term AED use
Promote frequent dental care for gingival hyperplasia (caused by AEDs, esp dilantin)
Give with food for better absorption and less GI upset
Name the one type of benign seizure.
Febrile seizures.
Name the level of consciousness!
Not oriented to person, place or time. Can answer simple but not difficult questions.
Confusion!
Name two goals of nursing care/treatment for a pt with meningitis.
Reduce ICP
Maintain cerebral perfusion
Decrease inflammation
Prevent long-term brain injury
What are 5 nursing care goals for a pt with CP?
Adequate nutrition (potentially blend foods, time to chew, watch for aspiration)
Skin integrity
Promote physical mobility (position to help tendon stretching, PT/OT, braces, ROM, etc)
Promote growth and development
Emotional support
Treat complications (like seizures, contractures, aspiration pneumonia, etc)
Support families (respite care, don't judge if not present in hospital)
Name 4 early signs of increased ICP.
Unequal pupils
N/V
Irritability
Shrill cry (infant)
Bulging fontanelle
Headache
Vision changes
Name the 3 phases of a generalized seizure.
Tonic
Clonic
Post-ictal
Name the level of consciousness!
Profound slumber. Can arouse child with light stimulation but they return to sleep when stimulation is stopped.
Lethargy.
Hydrocephalus can be congenital or acquired, and either communicating or non-communicating. Please explain the difference b/w communicating and non-communicating.
Communicating- CSF still flowing but doesn't get absorbed
Non-communicating- blockage in ventricular sections in the brain. This one is more common and this one can be treated with a VP shunt.
List 6 of the 8 elements Park includes in a neurologic assessment.
LOC
Cognitive function
Cranial nerves
Skull (intact? no?)
Pupils
VS
Posture and movement
Neck stiffness/pain
Name three late signs of increased ICP.
Decreased LOC
Fixed, dilated pupils
Cushing triad
Seizures
What are the three categories of TBI and what is the classification criteria?
Mild TBI has only brief or no loss of consciousness
Moderate TBI has 5-10 minute LOC
Severe TBI has coma or unconsciousness, increased ICP, posttraumatic seizures
Also, remember amnesia is an important sign of a more serious injury
Name the level of consciousness!
Deep sleep or unresponsiveness. Arouses with deep/painful stimulation then back to sleep.
Stupor.
What are the four clinical manifestations of hydrocephalus?
Rapid increase in head circumference
Signs of increased ICP
Sunsetting eyes
Loss of developmental milestones
What 4 medications/med types are often prescribed for pts with CP?
Baclofen; or centrally acting skeletal muscle relaxant (this is the one that has a pump)
Botulin toxin: or: botox, given for spasticity
Benzodiazepams: or antiseizure (also relieves muscle spasm)
Anti-cholinergics to decrease secretions
What are the three signs included in the Cushing's Triad.
Bradycardia, irregular respirations, increased bp.
This means someone is about to die.
What is the classic diagnostic sign of Shaken Baby Syndrome?
Retinal hemorrhage.
Also will do a cat scan to look for cerebral edema-the brain swelling is caused by bruising and tearing of tissues. If the swelling is severe you can see respiratory and cardiac arrest.