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Nur-425
Exam #4 - Neurological Injury
| Term | Definition |
|---|---|
| What comprises the skull compartment? | Brain 80%, CSF 10%, blood 10% |
| Edema, blood and fluid do what to brain tissue? | Apply pressure |
| At what age does the anterior fontanel close? | 18 months |
| At what age does the posterior fontanel close? | 2 months |
| In regards to the signs/symptoms of increased cranial pressure, which changes happen first: physical or behavioral? | Physical changes happen first |
| Name three physical changes that can occur with increased cranial pressure | Widening head circumference, bulging fontanels, widening sutures |
| This is an earlier sign of increased cranial pressure | Setting sun sign |
| High-pitched cry, irritability, drowsiness and poor feeding are behavioral signs/symptoms of what? | Increased intracranial pressure |
| In the presence of fluid in the head, you will hear a resonant sound on percussion instead of a dull flat sound. What is this sign called? | Macewen's sign |
| This sign uses light to penetrate the skull that scatters to produce a distinct pattern that is consistent with hydrocephalus | Positive transillumination |
| Children experience many of the same signs/symptoms of increased ICP as infants do with these three additional ones | Headache, N/V, and lethargy |
| Papilledema, decerebrate or decorticate posturing, alterations in pupil size or response, periodic or irregular respirations and decreased consciousness/coma are late signs for what condition? | Increased ICP |
| This is defined as swelling in the fundus of the eyes | Papilledema; seen with an ophthalmoscope |
| Cheyene-stokes, agonal, ataxic and cluster are ways to describe what in regards to increased ICP? | Irregular respiratory patterns |
| This assessment is the most important to assess neurological functioning | Level of consciousness |
| The LOC is the mildest form that exhibits impairment in decision-making | Confusion |
| This LOC exhibits impairment about time, place or person | Disorientation |
| This LOC exhibits a decrease in movement or speech; synonymous with drowsy | Lethargy |
| This LOC exhibits a person who can be aroused with a stimulus; otherwise, they're drowsy | Obtundation |
| This LOC exhibits a person who is slow to respond to painful stimuli such as a sternal rub | Stupor |
| This LOC exhibits a person with no motor or verbal response to painful stimuli | Coma |
| What age of children can the Glasgow Coma Scale be used for? | Greater than 6 months |
| What is the possible score range of the Glasgow Coma Scale? | 3-15; even dead gets a score of 3 |
| What assessments can provide clues about underlying reasons for a decrease in LOC? | Vital signs |
| Systemic hypertension, bradycardia, and respiratory depression are collectively known as what? | Cushing triad |
| What three assessments are made using the Glasgow Coma Scale? | Eye opening response, verbal response, and motor response |
| These two cranial nerves are assessed when testing for pupil reactivity | CN II (Optic) and CN III (oculomotor) |
| When CN III is paralyzed, what would you expect to see in regards to the pupils? | Sudden fixed/dilated eyes; this is an EMERGENCY |
| What does it mean to say that the pupils are in a postictal state? | Dilated but reacting |
| What is possibly indicated when pupils are pinpoint with unilateral dilation? | Poisoning, lesion on same side, narcotics |
| What cranial nerve is tested with the corneal light reflex? | CN V (trigeminal) |
| How is the corneal light reflex test conducted? | Have client close their eyes and brush a wisp of cotton across their cheek; if they feel it, cranial nerve V (trigeminal) is intact |
| What is a normal response in the Doll's head maneuver? | When the child's head is moved from side to side, you should see the eyes move to the opposite side of the movement |
| What is a normal response in the Caloric test? | Irrigating the external canal with ice water should cause movement of the eyes toward the side of the stimulation |
| This is a late sign for increased ICP | Papilledema as indicated by a fundoscopic exam |
| This positioning is also called flexure positioning | Decorticate |
| In this positioning, the arms are adducted and flexed on the chest and hands are fisted | Decorticate |
| This posturing can indicate severe dysfunction of the cerebral cortex | Decorticate |
| This posturing is also called extension posturing | Decerebrate |
| In this positioning, there is rigid pronation of the arms and legs with inward rotation | Decerebrate |
| This posturing can indicate midbrain dysfunction | Decerebrate |
| If these three reflexes persist beyond 3 months of age, it can indicate cerebral palsy or some other lesion | Moro, tonic neck, and withdrawal |
| If this reflex persists after 12 months, it could indicate cerebral palsy | Babinski |
| An absence of brainstem function along with flaccid muscle tone/absence of spontaneous movement on two separate exams can be described as what? | Brain death |
| In regards to diagnostic testing for neurological deficits, why are lab tests performed? | To rule-out something else |
| What information is provided by a lumbar puncture? | Pressure reading to test for presence of an infection |
| What information is provided by an EEG? | Electrical activity of the brain; used to diagnose seizures and determine brain death |
| What information is provided by a CT scan? | Can distinguish hemorrhage, tumor, inflammation |
| What information is provided by an MRI? | Visualize specific structures |
| If sedation is needed on a child prior to performing selected diagnostic tests, what medication might be used? | Versed (Midazolam) |
| These are the #1 health risk for children | Injuries |
| Name the three major causes of brain damage in childhood | Falls, motor vehicle accidents, and bicycle injuries |
| Most common symptoms are confusion, headache, amnesia and fatigue | Concussion |
| These head injuries are traumatically induced and the head injury is caused by sheering forces in the brain; they cause actual bruising and tearing of cerebral tissue | Contusion and laceration |
| This head injury results in a decrease in strength, sensation and visual awareness | Contusion |
| How does a laceration compare with a contusion? | A laceration has the same side effects (decrease in strength, sensation and visual awareness) but more severe |
| This fracture type is of lower type velocity and less severe | Linear |
| This fracture type requires a faster blow and actually pushes brain tissue inward | Depressed |
| This fracture type is close to the brainstem; may actually see CSF or blood leakage from nose or middle ear | Basilar |
| This fracture type can produce raccoon eyes or a battle sign | Skull fracture |
| This is characterized by ecchymosis behind the ear | Battle sign |
| This is a type of hematoma that is arterial in nature where bleeding accumulates between the dura and the skull | Epidural hematoma |
| This is a type of hematoma that is venous in nature where bleeding occurs between the dura and the arachnoid membrane | Subdural hematoma |
| Some degree of this occurs with a head injury and peaks at 24 to 72 hours after impact | Cerebral edema |
| Describes a patient who continues to complain of headache, dizziness, and tiredness within a few days of the injury and it persists for months afterwards | Postconcussion syndrome |
| These occur within a few days of a head injury in the very young | Posttraumatic seizures |
| This occurs in 25-75% of people who suffer a head injury | Posttraumatic headache |
| Why would a child with a head injury be kept to a PaCO2 around 30 mm Hg instead of the normal range of 35-45 mm Hg? | The slight vasoconstriction helps the cerebral edema |
| To what level is the head of bed raised for a child with a head injury? | 15-30 degrees; raising it more than this can increase ICP |
| Loud noises, alarms, suctioning, sneezing, coughing and pain can do what to intracranial pressure? | Increase it |
| Why is the goal to keep a child with a head injury a bit on the dry side? | Don't want to add fluid to cerebral edema |
| This medication is a paralytic agent | Pancuronium (Pavalon) |
| This analgesic may be administered to a child with a head injury | Morphine sulfate |
| This sedative may be administered to a child with a head injury | Versed (Midazolam) |
| What do mannitol or hypertonic fluids do for the child with a head injury? | They are osmotic diuretics that pull fluid from the tissues into the vascular space where it can be excreted in the urine |
| This type of care is essential for someone on a ventilator | Oral care; the mucous membranes dry out |
| This is the 2nd leading cause of accidental death in children | Submersion injury |
| Described by the process of laryngospasm --> vomiting possible --> gasping and aspiration --> cardiopulmonary arrest secondary to asphyxia | Submersion injury |
| 50% of the children who die in these types of accidents are less than 4 years old | Submersion injury |
| 90% of these accidents occur in private pools | Submersion injury |
| What three major problems are caused by submersion injury? | Hypoxia and asphyxiation, aspiration, and hypothermia |
| In regards to a submersion injury, how long does it take before there is irreversible damage to cerebral cells? | 4-6 minutes |
| In the process of hypoxia and asphyxiation related to submersion injuries, what happens to the body's chemistry? | Metabolic acidosis |
| In regards to submersion injuries, this causes pulmonary edema, atelectasis, airway spasm and pneumonitis | Aspiration |
| Described as acute inflammation of the meninges and CSF | Meningitis |
| This is the hallmark sign of meningitis | Purpura on the skin |
| Bacterial meningitis usually involves this type of bacteria | Gram-negative; Group B streptococci |
| These three signs/symptoms are classic for meningitis | Nuchal rigidity and positive Kernig and Brudzinski signs |
| What does a positive Kernig and Brudzinski sign indicate? | Irritability of the spinal column |
| This is the definitive diagnostic test for bacterial meningitis | Lumbar puncture |
| A disorder defined as a metabolic encephalopathy associated with other characteristic organ involvement | Reye's syndrome |
| This disorder primarily affects the brain and liver | Reye's syndrome |
| While the pathophysiology of this disease is not fully known, it usually follows a common viral illness in which a fever was treated with aspirin | Reye's syndrome |
| These are the two common viral illnesses associated with Reye's syndrome | Varicella and influenza |
| Personality changes and deterioration in consciousness are signs of this disease | Reye's syndrome |
| Elevated serum ammonia levels tend to correlate with the clinical manifestations of this disease | Reye's syndrome |
| A liver biopsy provides a definitive diagnosis for this disease | Reye's syndrome |
| Cerebral edema with increased ICP is the most immediate threat to life in this disease | Reye's syndrome |
| Impaired coagulation and prolonged bleeding time are typical lab results for this disease | Reye's syndrome |
| This is a medical emergency that requires early recognition and immediate therapy to prevent death and avoid residual disabilities | Bacterial meningitis |
| Isolation precautions are necessary with this disease | Bacterial meningitis |
| Quick initiation of antimicrobial therapy is a must with this deadly disease | Bacterial meningitis |
Created by:
ssbourbon
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