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