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What are THREE causes of Increased Intracranial Pressure?
- Increased Brain Mass
- Increased Cerebral Blood Volume
- Obstruction of CSF (cerebral spinal fluid)
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What are S/S of increased intracranial pressure?
- HA
- vomiting
- widening pulse pressure
- change LOC
- high pitched cry
- bulging, non-pulsatile fontanele
- Cushing's triad
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What are the THREE signs of Cushing's triad?
- Increased BP
- bradycardia
- irregular respirations
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What are FIVE ways to manage ICP?
- Osmotic diuretics
- Sedatives
- Anitconvulsants
- Paralyzing agents
- Antibiotics
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Why do we use paralyzing agents to manage ICP?
It takes over respirations and conserves energy and decreases O2 demand.
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What does the "bolt" do during ICP?
Gives ICP reading. DOES NOT DRAIN FLUID
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What are general aspects of the neuro assessment?
- age
- developmental status
- observation
- hx
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What else is included in the neuro assessment?
- LOC/mentation
- AVPU
- Glasgow Coma Score (centered around altered mentation)
- Pupil Assessment
- Motor/Sensory Fx
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What does a UNILATERAL FIXED pupil signify
lesion on same side
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What does a DILATED/NON-REACTIVE pupil signify?
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What does a PINPOINT pupil signify?
poisoning
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What does a WIDELY DILATED pupil signify?
after seizure, eye trauma
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What does a WIDELY DILATED & FIXED pupil signify?
- paralysis of CNII
- pressure from herniation
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What do CONJUGATE pupils signify?
- paired working together
- movement of eyes in direction opposite head rotation
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What does HIPPUS of the pupil signify?
rapid dilation, contraction of the pupil
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What are the FIVE levels of consciousness?
- Full: awake, alert, oriented, appropriate for age
- Confusion: impaired decision making
- Disorientation: confusion regarding person, place, time, dec LOC
- Lethargy: limited spontaneous movement
- Obtundation: arousable with stimulation ONLY
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What are THREE forms of LOC?
- Stupor: deep sleep, responds to vigorous stimulation only
- Coma: no motor or verbal response
- PVS: permanently lost fx of cerebral cortex
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What is decorticate posturing?
Abrnomal flexion to the core?
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What is decerebrate posturing?
Abnormal extension
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What is the etiology of Pediatric Neurological Problems?
- Infexion (i.e. Meningitis)
- Trauma
- Metabolic (Hyperthyroidism)
- Prenatal (Neural tube deficit, Downs)
- Postnatal (brain tumor)
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What is spina bifida occulta?
Failure of posterior archest to close. Not symptomatic. Tufts of hair.
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What is spina bifida occulta
Defect in closure, exterior sacular protrusion, but not too bad.
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What is meningocele?
Sac like cyst containing meninges, symptomatic, spinal cord is in tact.
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What is meningomyelocele?
Spinal cord in sac with meninges. More serious.
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What is encephalocele?
No compatible with life, looks like born with 2 heads.
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What is anencephaly?
complete absence of brain. Can breath because brain stem is intact.
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What is Monroe Kelly Hypothesis?
If manipulate any component of CNS, will see changes in other compartments.
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What is hydrocephalous
Excessive accumulations of CSF within ventricles
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What are two types of hydrocephalous?
- Communication: Problem with CSF being reabsorbed
- Non-communicating: CSF flow is normal but becomes blocked->excessive accumulation of CSF.
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What are clinical manifestations of hydrocephalous?
- Abnormally enlarged head
- bulging fontanelle
- sunsetting eyes
- shrill, high-pitched cry
- visual disturbances
- seizures
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How is hydrocephalous treated?
VP Shunt
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What are NI for VP Shunt?
- Elevate HOB post-op
- observe for s/s of increased ICP
- observe for s/s of CSF infxn
- frequent turning
- try and keep off operative side
- *If shunt is not working, don't want to leave it in body->disconnect it and connect it to ext. drain.
- Follow specific orders on level and pressure, fluid replacement
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What are the THREE types of meningitis?
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What is the patho of meningitis?
- local infxn that spreads to systemic circulation
- Organisms invade underlying blood vessels and CSF
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What are s/s of meningitis?
- non-specific in younger children
- fever
- dehydration (can be because haven't been feeling well for a while)
- bulging fontanelle
- seize, irritable
- Respiratory distress
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What are s/s of meningitis in older children?
- may have classical symptoms as well as additional findings
- nuccal rigidity
- +kernig's sign (flex hip and knee and extend leg)
- +brudzinski sign (flexion at hips and knee)
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How is meningitis diagnosed?
- LP
- Blood culture
- CBC
- electrolytes/glucose
- If 1 or 2 WBC in CSF->aggressive TX!
- decreased glucose, increased protein
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What is a NI for LP?
- Respiratory concern.
- Pulse Ox
- Resuscitation at fingertips
- Position: babies and children at extreme knee chest position
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How is meningitis treated?
- IV antibiotics
- Hydrate (though on fluid restriction)
- Ventilation support)
- Dexamethasone (steroid)
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What is meningococcemia?
- Potentially life threatening->usually fatal.
- Death can occur within hours
- Incubation pd 2-10 days, spread via oral or nasal droplet
- Watch for petachiae or rash
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What is the etiology of seizures?
- head trauma
- tumors
- metabolic disturbances
- infxn
- toxins
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What are the classifications of seizures?
Generalized: simple partial, complex partial, tonic-clonic
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What are febrile seizures?
Generalized seizures in children with febrile illness: the PEAK temp, rather than the rapidity of the fever
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What are s/s of the febrile seizure?
- generalized tonic-clonic seizure lasting a few minutes and self-limited
- POST-ICAL (Confused for an hour)
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What is tx for seizures?
- airway: o2, sx, bvm
- LP with 1st seizure
- anticonvulsants
- aggressive antipyretic therapy
- parental reassurance, education
- seizure precautions
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What are the qualifications for epilepsy surgery?
- Scalp Recordings: 3-5 hospital stay weaned off meds (camera and EEG)
- SPEC Scan: single photon emission computed tomography. Localization of epilepsy to region of brain, measures blood flow to various regions.
- Grid placement: Helps to further localize sz focus with subdural electrodes placed, mapping by neurologist
- Craniotomy: removes areas of sz foci (focal resection of total hemispherectomy)
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What is craniosynotosis?
- Premature closure of the cranial sutures?
- Elongation of the skull (anterioposterior)
- Etiology is unknown-not the result of impaired brain growth
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What are s/s of craniosynotosis?
- increased ICP
- abnormal head shape
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How is craniosynotosis diagnosed?
- Inspect for symmetry
- Palpate sutures, fontanelle, OFC (falls off chart)
- May see papiledema
- optic atrophy
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What is CP and what are risk factors?
- Leading cause of childhood disability
- weight <2500gm
- Born at less than 32 weeks
- Maternal HX
- during gestation
- Fetal factors
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What does prematurity have to do with CP?
- Fragile brain vasculature
- physical stresses of prematurity can compromise blood flow
- Hemorrhage in germinal matrix
- Parenchymal hemorrhage leads to periventricular leukolmalacia (PVL)->strong indicator of CP
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What are some early ID of CP?
- alteration in muscle tone, deep tendon reflexes
- delay in acquistion of motor milestones
- persistence of primitive reflexes
- abnormal postural reactions
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How can you predict CP in the NICU?
- coarse jitters
- dominant asymmetrical tonic neck reflex
- decreased movements
- contradictory development
- hypotonia
- hypertonia
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What is spastic CP?
tense, contracted muscles (most common type of CP)
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What is athetoid CP?
constant uncontrolled motion of limbs, head, and eyes
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What is rigidity CP?
tight muscles that resist the effort to make them move
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What is ataxic CP?
poor sense of balance, often causes falls and stumbles
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What is tremor CP?
uncontrollable shaking, interfering with coordination
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What are clinical manifestations of CP?
- delayed gross motor development
- alterations of muscle tone
- abnormal posture
- reflex abnormalities
- sensory impairment
- gait abnormalities
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What are interventions for CP?
- mobilizing devices
- surgery
- medications
- technical aids
- visual & auditory therapy
- occupational therapy
- family support/education/resources
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