Neuro alterations

  1. Brain hernia
    Portion of the brain is displaced because of increased pressure inside skull
  2. Normal ICP
  3. Which is better an open or closed head injury
    Open (releives pressure from brain swelling)
  4. Portion of brain in cranium total volume
  5. CSP percent of cranium total volume
  6. Blood is what % of cranium total volume?
  7. Early sign and symptoms of head injury in an infant
    • Bulging fontanel
    • High pitched cry
    • Distended scap vein
    • Change in feeding
    • Setting-sun sign (dowward deviation of the infant's eyes)
  8. Early sign and symptoms of head injury in children
    headache, nausea, vomiting, diplopia, seizures
  9. Behavioral signs if ICP
    • Irritability
    • restlessness
    • drwosiness
    • diminished physical activy
    • increased sleeping
    • memory loss
    • can't follow simple commands
    • lethargy
  10. Late signs of ICP
    • Bradycardia
    • Decreased LOC
    • Decreased motor response
    • Alterations in pupil size
    • Decerebate or decorticate (outward feet, hands flexed on chest) posturing
    • Papilledema (buling of the optic disc)
    • Coma
  11. Depressed cerebral function - in ability to resond to sensory stimuli and have subjective exeriences
  12. State of unconsciousness which teh patient cannot be around even with pain
  13. EARLIEST indicator of neurological status
  14. Permantly lost function of teh cerebral cortex
    PVS (persistant vegetative state)
  15. Eyes follow objects by reflex
  16. Limbs are spastic but withdraw from painful stimuli
  17. Face can grimace
  18. Child may cry or maol (NO WORDS)
  19. Eye opening GCS -
    1-4 (4 best)
  20. Verbal response GCS
    1-5 (5 best)
  21. Motor response GCS
    1-6 (6 best)
  22. below 6 on GCS
  23. Temp in coma
    often elevated
  24. If coma is toxic in origin, what happens to body temp?
  25. High temp could also be caused by
    • acute infection
    • Heat stroke
    • Salicylates
    • Alcohol
    • Barbituates,
    • ICP
    • subarachoid hemorrhage
  26. Hypothalmic involvement related to coma can cause
    increased or decreased temp
  27. Pulse during coma
    Variable, rapid, sow and bounding and feeble
  28. BP during coma
    normal, elevated or shock levels
  29. Actual changes in BP during coma
    are more important than the direction of the change
  30. Increase of BP in a comatose patient may indicate
  31. Respirations during coma
    slow deep irreglar
  32. Breathing pattern during coma
    irregular or periodic
  33. irregular breathing during coma may precede
    complete apnea
  34. Breath odor can provide clues to
    Ketosis, uremia (foul)
  35. Skin during coma
    important to assess for bites
  36. Eyes during coma
    Pinpoint in opiate or barbituate poisoning, also brainstem dysfunction
  37. Dilated and reactive eyes seen after
    seizures, and may only involve one side
  38. Widely dilated and fixed pupils
    Paralysis of cranial nerve III (100% morbidity)
  39. Pupils bilaterally fixed for > 5 minutes
    brainstem damage (neurologically devistated)
  40. Dolls head maneuver
    One side to other side, goal is to have eyes move opposite, absense my be brainstem damage or oculomotor damage III... odone byu physician
  41. Who does Dolls' head maneuver
    2 different specialty drs 24 hours apart.
  42. Optic disc swelling, hemorrhage develops in
    24-48 hours
  43. Retinal hemorrhages seen in
    acute trauma with intracranial bleeding
  44. Rigid flexion, associated with lesions ABOVE the brainstem
    Decorticate posturing
  45. Rigid extension associated with lesions of the brainstem seen in
    Decerebate posturing
  46. Bebinski reflex significant if seen in children what age?
    >18 mo
  47. Lab values to look at RT cerebral function
    • NA
    • K
    • PT
    • PTT
    • WBC
    • LFT
  48. Measures spinal fluid pressure
  49. Relieves ICP in an infnat w/out closuure of closed fontanels
    Subdural tap
  50. Detects electrical abnormalities/seqizures brain death
  51. Horizontal and vertical cross sections at any axis...does not show blood flow
  52. Tissue discrimination, morphologic features of target structures
  53. Tests for meningitis
  54. Chloral hydrate, what route?
    PO elixer
  55. Dose for chloral hydrate
    75 - 100 mg/kg (max dose is 1 gram for infants 2 grams for children)
  56. If child awake after 20 minutes of first dose of chloral hydrate, give
    100 mg/kg up to a total of 1 gram for infants, 2 grams for children
  57. Give at least 35 to 45 minutes before procedure
    Chloral hydrate
  58. Carry to room or sedate in tx room when using
    Chloral hydrate
  59. Are controversial in pain management of the comatose child
  60. Morphine, demerol, etc in comatose child not suggested due to
    further depression of the CNS
  61. Unrelieved pain can cause
  62. Used for mild to moderate pain
    Co-analgesics delivered via o/g
  63. Nonpharmacologic interventions for pain management in the comatose child
    dim lights, quiet environment, preventing jarring or sudden movmeent
  64. Stimulation in comatose patient causes
    Increase in ICP
  65. First priority in respiratory managment in comatose patient
    Establishment of airway
  66. No oxygen beyond how long causes brain damage
    4 min
  67. Used to decrease drisk of aspiration and cardiac arrest for respiratory management
  68. Chest PT aloong with position changes every q hrs
  69. Osmotic diuretics provide relieve up to
    6 hours
  70. Can be used in an emergency
    Osmotic diuretecs
  71. Mannitol usually given
    IV infusion slowly
  72. Can be given IV push in case of herniation
  73. Need catheter for use of mannitol why?
    extreme diuretic effect
  74. Frequently accompanies CNS disease - brain injury, meningitis, brain tumor, etc.
  75. Scant quantities of urine
  76. Clients have hypOnatremia, hypOsmolality, overhydrated
  77. Tsx of SIADH
    Restriction of fluids
  78. Typically it self corrects
  79. May follow intercranial trauma
  80. Can die from this
  81. Must replace fluids and monitor electoryte imbalance
  82. May have hypernatremia and hyperosmolality
  83. Give exogenous vasopressin (ADH) desmopresson for
  84. Meds for treatment of unconsious/comatose child with ICP
    • Morphine
    • Fentanyl
    • Versed (produces amnesia, short half life)
    • Paraytic agent
  85. Only use barbituates when meds in the unconsciou comatose chilod with ICP
  86. HR or BP can idicate the need for more
  87. Where does blood accmulate with epidural hemorrhage /hematoma
    b/w dura and skull
  88. Brain compressure in a head injury occurs
  89. Can be sx free with a head injury for how long?
    48 hours
  90. Subdural hemorrhage bleeding between
    dura and cerebrum
  91. More common in children than epidural hemorrhage
    subdural hemorrhage
  92. occurs most frequenct in infancy, peaks at 6 months
    subdural hemorrage
  93. what provides relief in infants when client has subdrual hemorrhage
    Subdural taps
  94. Most common malignant solid tumor in children
  95. higher incidence in males (tumor)
  96. known as the silent tumor
  97. Often diagnosed after metastasis
  98. Radiation of neuroblastoma usually for stage ____ or greater
  99. Radiation is used as emergency management of neuroblastoma when
    compressing on the spinal column.
  100. Infratentorial tumors are bad because
    they affect cerabellum (posterior third of brain) and brain stem
  101. Supratentorial tumors are located where?
    Cerebrum, with better outcomes
  102. Worst possible form of glimoa
    glioblastoma multiform (GBM)
  103. Vascular neoplasms with prominent areas of necrosis and hemorrhage
    Glioblastoma multiform
  104. What dx method to detect gliobastoma multiform
    MRI, which shows blood flow
  105. Glioblastoma typically 100%
  106. S&S of glioblastoma directly related to what?
    Anatomic location and size
  107. Most common symtoms of Glioblastoma are
    • 1.) HA upon awakening
    • 2.) Vomiting not related to feeding
    • Often vague and overlooked. Needs excellent hx
  108. Neuro changes with glioblastoma multiform
    Ataxia, poor fine motor control + babinski reflex
  109. Behavior manifestations of glioblastoma multiform
    Irritability, fatigue, lethargy, bizzare B
  110. Acute inflammation of the meninges and CNS
    Bacterial meningitis
  111. H influeinza Type B vaccine has decreased incidence of
    Bacterial menengitis
  112. Other bacteria causing bacterial meningtitis
    • Streptocoscus pneumoniae
    • Neisseria Meningitidis
    • Nenates: E coli and group B strep
  113. Majority of cases ofbacterial meningitis are between what age?
    1 month and 5 years
  114. Increased blood in the brain and edematous brain are problems seen with
    Bacterial meningitis
  115. Entire surface of brain covered with purulent exudate
    Bacterial meningitis
  116. Nucah rigidity and floppy presentation seen with
    Bacterial meningitis
  117. Purpuric or petechial rash are CLASSIC signs of
    Bacterial meningitis
  118. Nuchal rigidity is a CLASSIC sign of
    Bacterila meningitis
  119. Most definitive dx test off bacterial meningitis
  120. LP during bacterial meningitis will show elevated
    WBC and protein
  121. LP will show decreased ___________ with bacterial meningitis
  122. Clear LP fluid from meningitis
  123. Child must be isolated if they have
    Bacterial meningitis
  124. What do you give for H influenza during bacterial meningitis
    Dexamethasone for H. Influencza
  125. Learning disabilities and decreased IQ are residual effects of
    Bacterial memngitis
  126. What nerve should be evaluated, and when during bacterial meningitis
    VIII at 6 month follow up (ears, due to ototoxicity of gent and vanco)
  127. Test question?
    LP tap then immediately give antibiotics
  128. Viral meningtitis as also known as
    viral meningitis
  129. DX of viral meningtitis
    septic work-up, LP
  130. until viral mengitis confirmed, treat as
  131. Life threatening encephalopty with accompanyintg microvascular fatty deposits in the liver and kidneys
    Reye's syndrome
  132. Usually follws a viral illness, varicella and influenza
    Reye's syndrom
  133. link between ASA and what?
  134. Mild viral infection, signs of recovery noted 24 to 48 hours, but after initial improvement condition may worsen
  135. After vomiting, changes in LOC
  136. How fast to death after onset of Reyes?
    2-3 days, however downward progression can stop fast
  137. Inflammatory process of CNS; produces altered function of portions of the brain and spinal cord
  138. Cuased usually by viral, and herpes accounts for 30% of cases
  139. DX can be mabde by appreanace of IgM antibody to HSV type I in CSF and serum
  140. Early use of what IV antibiotic reduced mortality and morbidity in encephalitis?
  141. Complicatition of AIDS
    HIV encephalopathy
  142. Symptom of an underlying disease
  143. Is every seizure a sign of epilepsy?
  144. What is epilepsy?
    Chronic seizure disorders, recurrent and unprovoked
  145. Focal sezure
    Paritalo, frontal temp, pariet, does not cross corpus collosum
  146. May have auro
    Focal/partial seizure
  147. Generalized siezure
    No focal onset, no auro, both hemispheres, lose consciousness!!
  148. Tonic/clonic movmeents
    Generalized seizures
  149. Tonic is
    unconsciousness, stiffness, muscles contract
  150. Clonic
    Alternates b/w contractions and sustained stiffness
  151. Preictal
    During aura
  152. ictal
    during seizure
  153. DX for siaures
    EEG, complte physical and neuro exam, lab, CT and PREFER MRI
  154. Refractory seizures
    don't go away
  155. Goa of AED
    Raise threshold and prevents seizures
  156. AED can be used as monotherapy or?
  157. Depakote
  158. Primary AEDs, first generation (affect the liver) can be used as mood stabilizers
    • Carbamazepine
    • Dilantin
    • Cerebyx
    • Valproic acid
  159. Can gradually decrease dose of AED's if
    2 years seizure free/normal EEG
  160. Which seizure type not well controlled?
  161. seizure lasting longer than 30 minutes
    Status epilepticus
  162. TX of status epilepticus
    Diazepam or larazeman (benzos), IV, if theycontinue cerebex and dilantin or distate rectally
  163. Absence seizures
    interpreted as inattention/daydreaming/onfused with ADHD
  164. Tegretol/Carbamazepine therapuetic level
  165. Phentoin/Dilantin terhapeutic level
  166. Phenobarbital therapeutic level
  167. Depakote therapeutic level
  168. Side effects of AED depakote
    • alopecia and loose hair
    • Increase appetite
  169. SE of Dilantin
    Gingival hyperplasia
  170. SE Lamictal
    Steven's Johnsons
  171. SE of many first generation AEDs
  172. Triggers of epilepsy
    • Illenss (strepP
    • dehydration
    • fatigue
    • hyperventilation
    • hypoglycemia
    • changes in temp
    • viral/bact epilep
  173. Age for febrile siezures
    6 mo to 3 years
  174. minutes for febrile sez
    5 minutes
  175. During the rise of a fever, may cause
  176. TX of febrile seizures
    • Valium (anticonvulsant)
    • Antipyretic
  177. Do not institute prohylactic AED therapy
  178. Tepid baths for febrile
    Not effective...makes things worse
  179. Caused by increase production, impaired absorption or block of flow of CSF
  180. Results in massive amount of CSF within cerebral ventricles
  181. Congenital or aquired
    Hydrocephaly (head trauma, shaken baby)
  182. Early sign of Hydrocephaly
    Head circumphrance...rapid increase
  183. Tense full bulging fontenael
  184. Late sign of hydroceph
    • Apnea
    • High pitched cry,
  185. Daily mresuremtn of head
    Therapuetic for hydroceph
  186. VP shunt used for
  187. Problems with shunt
  188. Shunt obstruction
    leads to increased ICP
  189. TX infections of shunts with
    massive doses of IV antibiotic therapy
  190. Keep child fat after
    shunt placement so ICP not rapidly reduced
  191. Monitor for abdominal distention , which can lead to peritonitis or postop ileus
    After shunt placement
  192. Guillian Barre caused by
    Virus, usually pertussis
  193. Guillian Barre usually caused brom a GI or respiratlory illness abou thow many days prior to onset
  194. How long for recovery of GB?
    2 years
  195. GB weakness, asymm or symmetrical
  196. Labs in GB
    Not useful in dx
  197. Protein levels in CSF in GB
    Not definative
  198. Is GB an emergency?
  199. May need anticoagulants and SCD's, plasmaphoresis and/or IVG
  200. TX for headaches
    Topomax if severe, otherwise NSAIDS
  201. Pigmentented patches called cafe au lait maules
    neurofibromatosis (6 or more, that increase with age)
  202. Bening tumors that grow around nerves under the skin
    Dermal neurofibromas
Card Set
Neuro alterations
Neuro alterations