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Exam #4 - Neurological Injury

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