Hypothermia and Encephalopathy
Ventricular Drains
IVH 1
Neonatal Seizures
IVH 2
100
What is the fancy term used for selective head cooling or systemic cooling for neonatal encephalopathy?
Therapeutic hypothermia
100
What do you call the external closed system that allows for the drainage of CSF?
EVD- External ventricular drain, exits from skull
ELD- External lumbar drain, exits from lumbar region
100
When do you order a head ultrasound for a prematurely born baby?
According to the video, if the baby is <32 weeks or <1500 grams.
100
What is the most common cause of seizures in the neonate?
Hypoxic ischemic encephalopathy (HIE)
100
Where do intraventricular hemorrhages start in the brain?
The germinal matrix 
200
In the article, what temperature range was effective in animals for cooling to improve neuropathic outcomes?
32-34 degrees C
200
How often should you monitor CSF output from an EVD?
At least every 1-2 hours
200
How does an infant with an IVH present on assessment?
Usually it is a silent presentation...
- with or without a full fontanelle
- with or without anemia
200
What do you call the type of seizure that is described as this: rhythmic jerking movement (one to three movements per second) that's localized to a particular body part or body parts simultaneously
Clonic Seizures
200
What diagnostic procedure is used to detect and monitor the progress of IVH's?
Head ultrasounds (and sometimes EEG's)
300
What is a common adverse effect of therapeutic hypothermia?
Bradycardia and prolongation of the QT interval
300
When should you change the drainage bag?
When it is 2/3 full
(the policy also says between the hours of 0900-1700)
300
On the IVH grading system, this grade is not actually an IVH, but only a hemorrhage in the germinal matrix region.
Grade I
300
What do you call the kind of seizure described like this: Abnormal behavior, such as staring episodes, nystagmus, deviation of the eyes, eyelid fluttering, blinking, chewing, drooling, repetitive sucking, mouth movements, tongue protrusion, apnea, bicycling or swimming movements, and autonomic and vasomotor changes, that doesn't result from the other seizure classifications
Subtle Seizures
300
Name two risk factors for IVH
Chorioamnionitis, inflammation of the amniotic sac, respiratory distress, acidosis, prolongued mechanical intubation.
400
One of the eligibility criteria for cooling includes a pH less than or equal to _____ in a sample of cord blood or blood obtained during the first hour of birth.
7
400
When should you clamp the drainage system?
- When repositioning/moving/transporting a patient
- If the child is crying heavily
400
What can we do on assessment to monitor and diagnose posthemorrhagic hydrocephalus?
Daily measurement of head circumference
400
Name 5 things (of many) that you should have at the bedside if a patient has a seizure or if you know your patient has seizures...
- oxygen
- suction
- seizure record
- Pulse oximeter
- Cardiorespiratory monitor
- Stethoscope
- Thermometer
- Blood glucose monitoring equipment
- IV catheter insertion equipment
- Syringes
- Gloves
- Urine specimen collection supplies
- Appropriate blood and cerebrospinal fluid specimen-collection tubes
- Lumbar puncture tray
- Emergency medication list and weight-appropriate dosages
- Prescribed emergency seizure drugs
- Clock or wristwatch
- Optional: resuscitation equipment and medications, additional personal protective equipment, IV fluids, prescribed antiepileptic medication,3 other prescribed medications
400
What is something (a protocol) we do in the NICU as nurses to help prevent IVHs?
Maintaining a midline head position for premature neonates.
500
One of the eligibility criteria for cooling includes a 10-minute apgar score of less than _____ .
5
500
When a patient has an EVD, we need to be continuously monitoring them for signs of increased ICP. What are some signs of increased ICP?
Change in LOC, bulging fontanels, seizures, high-pitched cry, vomiting, poor feeding, hypertension, bradycardia, clear drainage from nose or ears.
*Call the doctor if you notice any signs of increased ICP
500
Name two ways we can try and prevent IVHs
- prevent premature birth
- antenatal steroids
- optimal management of labor and delivery
- postnatal pharmacotherapy (indomethacin)
500
Name 5 interventions you may need to do as a nurse if your patient has a seizure
- Assess the neonate closely to determine whether seizure activity vs normal neonatal jitteriness is occurring
- Note the start time of the seizure using your watch or a clock in the room to help determine the length of the seizure
- Call the doctor
- Assess the neonate's circulation, airway, and breathing
- Perform a neurologic assessment
- Assess the neonate's anterior fontanel
- Assess vitals frequently
- Start an IV or assess current IV access
- Administer an antiepileptic drug, as prescribed, following safe medication administration practices
- Discontinue feedings and administer IV fluids, as ordered, because feeding can exacerbate seizures and encephalopathy
- Obtain blood specimens for glucose, calcium, magnesium, and electrolyte levels; complete blood cell and platelet counts; culture and sensitivity tests
- Administer glucose, as prescribed, following safe medication administration practices.522232425
- Increase FiO2 if you suspect hypoxia
- Inspect the neonate's skin for lesions or neurocutaneous markings that may indicate infection or neurologic impairment
- Assist the practitioner with lumbar puncture if needed
- Obtain a urine specimen for culture and sensitivity testing if needed
- Monitor the neonate closely for recurrent seizure activity, and respond appropriately if seizureactivity occurs
- Arrange for an EEG if needed
500
What is the name of the grading system we use to classify the type of IVH that a baby has and how many grades are there?
Papile Grading System of IVH and there is I, II, III, and IV.