Card Set Information

2012-12-01 13:35:27
neurological respiratory

Respiratory, neurological ped
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  1. CT scan
    • produces computer image of horizontal and vertical cross sections of brain at any axis. 
    • Purpose

    • identifies abnormal tissue and structures, such as in brain tumor, bleeding or hydrocephalus
    • Nursing priorities:
    • An IV line may need to be inserted if contrast medium is used.  Notify the radiologist if the child is allergic to iodine.  The child may be sedated if necessary.
  2.  Angiography
    • After IV contrast dye is injected, a clear image of the vessels is obtained b/c the computer eliminates all tissue that has not been infused by the contrast dye.
    • Purpose:
    • Shows vascular abnormalities
    • Nursing priorities:
    • May have nothing by mouth order.  Notify radiologist if the child is allergic to iodine.  Obtain signed permission form.  Some restrictions on activity necessary after the test.
  3.  Echoencephalography
    • Echoes from ultrasonic waves are recorded as they reflect off various surfaces of the skull. 
    • Purpose:
    • identifies abnormal structure, position, and function.
    • Nursing priorites:
    • Painless procedure, no preparation
  4. EEG
    • Electrodes placed on the scalp conduct and amplify electrical activity; electrical potential of the brain is measured and recorded. 
    • Purpose:
    • Identifies abnormal electrical brain discharges, such as in seizures
    • Nursing priorities:
    • Child may have regular diet or fluid but no caffeine or stimulants.  hair should be clean.  May include sleep EEG; in this case, child should be sleep deprived the night before test.  Tell the child the procedure is painless. 
  5. Long term video EEG
    • Electrodes placed on the scalp conduct and amplify electrical activity; electrical potential of the brain is measured and recorded. 
    • Purpose:
    • clinical events can be recorded and played back for in-depth review, as well as correlated with the presence of abnormal electrical activity.
    • Nursing priorities:
    • Electrodes are secured with a skin glue.  Electrode sites should be evaluated and documented every shift.  Child will have to stay in a small area during testing.  Age appropriate toys and activities should be available for child.
  6.  Lumbar puncture-
    • CSF pressure is measured and a specimen obtained as a neele is inserted into the subarachnoid space between L3 and L4.  
    • Purpose:
    • measures pressure and analysis of CSF, identifies infections.  Procedure may be used to administer medications.  
    • Nursing priorities:
    • Obtain signed consent.  Instruct the child to lie on side w/ knees up to chest.  After procedure child lies flat.  If not fluid restricted, encourage fluids after procedure.  
  7.  MRI
    • Produces computer images of the brain by radio frequency emissions from certain elements. 
    • Purpose:
    • demonstrate morphologic features of tissue and structures w/ degree of detail not achievable by other methods.  
    • Nursing priorities:
    • The procedure is painless, but the child may be sedated if necessary.  Inform child that loud clicking noises will be heard.  The child's head will be restrained. 
  8.  Nuclear brain scan (single photon emission computed tomography)(SPECT)
    • A radioactive substance is injected IV (the amount of the substance is measured and recorded) abnormal uptake indicates abnormal tissue or structure.
    • Purpose:
    • Identifies focal brain lesions and demonstrates CSF pathways.
    • Nursing priorities:
    • The child needs to remain still during the test. An IV line is needed.
  9. Glasgow Coma Scale
    •  A standardized scale that, in a modified form, is frequently used to assess level of consciousness in infants and children. Consists of three part assessment: eye opening, verbal response, and motor response.  Each level of response is given a number value.  
    • Level of consciousness- When assessment of each response is complete, the scores are totaled, providing an objective measure of the child's level of consciousness.  Total number scores range from 15- no change in level of consciousness to 3- deep coma and poor prognosis.  
    • Eyes- 4 open eyes spontaneously

    • 3 open eyes to speech
    • 2 open eyes to pain
    • 1 no response
    •             -    Motor 6 Obeys commands/ spontaneous movements
    • -  5 localizes/ withdraws from touch
    • - 4 Withdraws/ Withdraws from pain
    • - 3 Flexion 
    • - 2 Extension
    • - 1 no response
    •            - Verbal
    • - 5 Oriented/ coos and babbles
    • - 4 confused/ irritable cry
    • - 3 Inappropriate words/ moans to pain
    • - 2 incomprehensible words/ moans to pain
    • - 1 no response
    •            - Full consciousness- awake, alert, oriented, interacts w/ environment
    •            - Confused - lacks ability to think clearly and rapidly
    •           - Disoriented-  Lacks ability to recognize place or person
    •           - Lethargic- awakens easily but exhibits limited responsiveness
    •           - Obtuned- sleeps unless aroused; once aroused has limited interaction w/ the environment
    •           - Stupor- requires considerable stimulation to arouse
    •           - Coma- vigorous stimulation produces no motor or verbal response
  10. Encephalitis
    Requires critical care.  Inflammation caused by infection of toxin and resulting in cerebral edema and neurologic dysfunction.  Numerous agents are causative, such as St. louis encephalitis and west nile virus.  Peak incidence is in middle to late childhood.
  11. Headaches
    common disorder with children of all ages.  Up to 75% of children will complain of a significant headache at least once by age 15.  Three primary sources of headaches are: vascular, tension (stress), and increased ICP.  
  12.      Hydrocephalus-
     An imbalance of CSF absorption or production caused by malformations, tumor, hemorrhage, infections or trauma.  Results in head enlargement and increased ICP.
  13. Bacterial and viral meningitis
    Bacterial meningitis is made by testing CSF obtained by lumbar puncture; fluid cloudy w/ increased pressure, increased wbc, elevated protein, and decreased glucose levels.  Can be cause by various organisms, most commonly haemophilus influenzae type B, streptococcus pneumoniae, or neisseria meningitidis; meningococcal meningitis occurs in epidemic form and can be trasmitted by droplets from nasopharyngeal secretions. 
  14.  Neural tube defects
    Birth defects of the brain or spinal cord.  Group of disorders is characterized by an opening in the brain or spinal cord occurring at an early stage of human development.
  15. Cerebral palsy
    Disorder characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system.  The most common clinical type is spastic cerebral palsy, which represents an upper motor neuron type of muscle weakness.