Neurologic D/O
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| Menigitis definition | Inflamm of meningnes, viral or bacterial. Bacterial more dangerous
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| Meningitis risk factors | Viral illnesses, URI (otitis media, tonsillitis), immunosuppression, injuries (penetrate head wound and skull fracture), overcrowded living sit
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| Meningitis s/sx (newborns) | Poor muscle tone, weak cry, poor feeding, fever/hypothermia, no illness at irth but progresses within few days
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| Meningitis s/sx (2mo-2yrs) | Seizures c. high-pitched cry, fever and irritabilty, bulging fontanels, nuchal rigidity, poor feeding, vomiting
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| Meningitis s/sx (2 yrs-teen) | Seizures (initial sign), nuchal rigidity, + Brudzinski sx (Flexion of ext c. deliberate flex of neck), Kernig's sx (resist extension of leg from flexed position), fever, chills, HA, petechia/rash, chronic ear drainage
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| Meningitis other sx | Photophobia, progressive drowsiness, delirium, stupor, coma (may initially be irritable and restless)
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| Meningitis lab tests | Blood C&S to ID broad-spec antibiotic. CBC, CSF collection (elevated WBC, protein, decreased glucose, increased CSF pressure, cloudy CSF -bac, clear if viral)
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| Meningitis Dx procedures | CF analysis: best test. Collect c. lumbar puncture.
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| Lumbar puncture considerations | Empty bladder first. Place in fetal position if young, older kids can be sitting. Admin sedatives as Px. Apply local anesthetic, monitor site for hematoma/infxn.
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| T or F: with Meningitis start antibiotics stat and later adjust for specific microbe | T
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| Dexamethasone can be used for _____ | Initial reduction if increased ICP and herniation
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| Meningitis pt. education | Encourage remain in bed for 4-8hr in flat position to prevent leakage and spinal HA. CT scan or MRI to detect increased ICP or abscess
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| The presence of petechia or purpuric rash for Meningitis pt. requires | Immediate medical attention
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| T or F: pt. c. Meningitis on standard precautions | F. On droplet
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| How long pt. on isolation for Meningitis/ | Continue for 24h after first antibiotic given
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| Other RN considerations for Meningitis | NPO status if pt. decreased LOC (advance to clear->diet pt. toelrates when improved LOC). Decrease environ stimuli, minimize exposure to bright light, keep room cool, position w/o pillow and slightly elevate HOB. Seizure precautions.
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| How to reduce incidence of Meningitis | Hop and pneumococcal vaccines
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| Meningitis complications | 10-15% bacterial fatal; encephalitis, meningoccemia, may have lifetime neuro deficit.
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| Head trauma: 3 major causes in order of importance | Falls, MV injuries, bicycle injuries
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| Majority of deaths from falls at what age? Majority of bike accidents? | Falls: 0-4 yrs. Bicycle: 5-19 yrs
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| Head trauma s/sx | Altered mental status w/ or w/o loss of consciousness. Skull fracture, shaering or tissue, and prolonged effects.
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| Head trauma signs of increased ICP | Severe HA, deteriorating LOC, restlessness, irritability, agitation; dilated/fixed or constrcited/fixed, slow to react, or nonreactive pupils, altered breathing (deep fast, intermittent gasping), abnormal posturing
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| Decorticate | Arms, wrists, fingers flexed and bent inward onto chest. Legs extended and abducted. Dysfunction of cerebral cortex
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| Decerebrate | Backward arching of head and arms c. legs rigidly extended and toes downward. Dysfunction c. midbrain
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| Cushing's reflex | Late sign of head trauma, s/sx: severe HTN c. widening pulse pressure, bradycardia, irregular resp
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| GCS of 0-8 | Severe head injury and coma
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| GCS of 9-12 | Moderate head injury
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| GCS of 13+ | Minor head trauma
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| Head trauma lab tests | ABGs, ETOH/drug screen, CBC c. differential
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| Head trauma Dx procedure | Cervical spine films (r/o spine injury), CT or MRI of head, ICP (expected 10-15 mmHg)
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| Head trauma complications: | Risk of epidural/subdural hematoma, herniation, infxn, edema, Cushing triad, coma
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| Head trauma care: | Stabilize spine, neuro Ax, mecha vent if needed, give O2 so sat >95%, hyperventilate to keep PaCO2 30-35 mmHg, HOB @ 30, minimize endotrach/PO suction, avoid cough/straining
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| Head trauma care environ: | Calm, restful environ, conserve energy, restrain ext to prevent pulling tubes, turn q2h
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| Concussion will have immediate or delayed | HA, fatigue, vomiting, seizures. All need to be reported
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| T or F: subtle behavioral changes noticable day of concussion | T
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| Hallmarks of concussion: | Confusion, amnesia (usu immediately after concussion)
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| WA state law re: concussion | If pt. return to play before brain heals original concussion, may get 2nd concussion syndrome. Need written approval from MD trained in concussion Tx/eval before returning to sports
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| Post concussion syndrome | Sequela to brain injury: HA, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration, memory impariment. Typically develop within days and resolve in 3 mo.
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| Clinical sx of post concussion syndrome | Loss of consciousness, posttraumatic amnesia, disorientation or other mental status change
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| Posttraumatic seizures occur in... | Children who survive head injury, more common in younger than ppl > 16yrs
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| Anoxic brain injury definition | Decreased neuro function r/t birth injury or submersion trauma
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| 40% of submersion injuries occur in children of what age/ | Younger than 5 years. Top-heavy toddlers esp.
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| Anoxic brain injury, primary problem is | Hypoxia d/t global cell damage. Others include aspiration and hypothermia
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| Anoxia of less than ___ has good prognosis | Less than 5 min
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| All children c. submersion injury should be hospitalized ____ for observation | 12-48h d/t respiratory compromise or cerebral edema showing later
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