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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)
What are S/S of increased intracranial pressure?
- widening pulse pressure
- change LOC
- high pitched cry
- bulging, non-pulsatile fontanele
- Cushing's triad
What are the THREE signs of Cushing's triad?
- Increased BP
- irregular respirations
What are FIVE ways to manage ICP?
- Osmotic diuretics
- Paralyzing agents
Why do we use paralyzing agents to manage ICP?
It takes over respirations and conserves energy and decreases O2 demand.
What does the "bolt" do during ICP?
Gives ICP reading. DOES NOT DRAIN FLUID
What are general aspects of the neuro assessment?
- developmental status
What else is included in the neuro assessment?
- Glasgow Coma Score (centered around altered mentation)
- Pupil Assessment
- Motor/Sensory Fx
What does a UNILATERAL FIXED pupil signify
lesion on same side
What does a DILATED/NON-REACTIVE pupil signify?
What does a PINPOINT pupil signify?
What does a WIDELY DILATED pupil signify?
after seizure, eye trauma
What does a WIDELY DILATED & FIXED pupil signify?
- paralysis of CNII
- pressure from herniation
What do CONJUGATE pupils signify?
- paired working together
- movement of eyes in direction opposite head rotation
What does HIPPUS of the pupil signify?
rapid dilation, contraction of the pupil
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
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
What is decorticate posturing?
Abrnomal flexion to the core?
What is decerebrate posturing?
What is the etiology of Pediatric Neurological Problems?
- Infexion (i.e. Meningitis)
- Metabolic (Hyperthyroidism)
- Prenatal (Neural tube deficit, Downs)
- Postnatal (brain tumor)
What is spina bifida occulta?
Failure of posterior archest to close. Not symptomatic. Tufts of hair.
What is spina bifida occulta
Defect in closure, exterior sacular protrusion, but not too bad.
What is meningocele?
Sac like cyst containing meninges, symptomatic, spinal cord is in tact.
What is meningomyelocele?
Spinal cord in sac with meninges. More serious.
What is encephalocele?
No compatible with life, looks like born with 2 heads.
What is anencephaly?
complete absence of brain. Can breath because brain stem is intact.
What is Monroe Kelly Hypothesis?
If manipulate any component of CNS, will see changes in other compartments.
What is hydrocephalous
Excessive accumulations of CSF within ventricles
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.
What are clinical manifestations of hydrocephalous?
- Abnormally enlarged head
- bulging fontanelle
- sunsetting eyes
- shrill, high-pitched cry
- visual disturbances
How is hydrocephalous treated?
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
What are the THREE types of meningitis?
What is the patho of meningitis?
- local infxn that spreads to systemic circulation
- Organisms invade underlying blood vessels and CSF
What are s/s of meningitis?
- non-specific in younger children
- dehydration (can be because haven't been feeling well for a while)
- bulging fontanelle
- seize, irritable
- Respiratory distress
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)
How is meningitis diagnosed?
- Blood culture
- If 1 or 2 WBC in CSF->aggressive TX!
- decreased glucose, increased protein
What is a NI for LP?
- Respiratory concern.
- Pulse Ox
- Resuscitation at fingertips
- Position: babies and children at extreme knee chest position
How is meningitis treated?
- IV antibiotics
- Hydrate (though on fluid restriction)
- Ventilation support)
- Dexamethasone (steroid)
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
What is the etiology of seizures?
- head trauma
- metabolic disturbances
What are the classifications of seizures?
Generalized: simple partial, complex partial, tonic-clonic
What are febrile seizures?
Generalized seizures in children with febrile illness: the PEAK temp, rather than the rapidity of the fever
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)
What is tx for seizures?
- airway: o2, sx, bvm
- LP with 1st seizure
- aggressive antipyretic therapy
- parental reassurance, education
- seizure precautions
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)
What is craniosynotosis?
- Premature closure of the cranial sutures?
- Elongation of the skull (anterioposterior)
- Etiology is unknown-not the result of impaired brain growth
What are s/s of craniosynotosis?
- increased ICP
- abnormal head shape
How is craniosynotosis diagnosed?
- Inspect for symmetry
- Palpate sutures, fontanelle, OFC (falls off chart)
- May see papiledema
- optic atrophy
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
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
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
How can you predict CP in the NICU?
- coarse jitters
- dominant asymmetrical tonic neck reflex
- decreased movements
- contradictory development
What is spastic CP?
tense, contracted muscles (most common type of CP)
What is athetoid CP?
constant uncontrolled motion of limbs, head, and eyes
What is rigidity CP?
tight muscles that resist the effort to make them move
What is ataxic CP?
poor sense of balance, often causes falls and stumbles
What is tremor CP?
uncontrollable shaking, interfering with coordination
What are clinical manifestations of CP?
- delayed gross motor development
- alterations of muscle tone
- abnormal posture
- reflex abnormalities
- sensory impairment
- gait abnormalities
What are interventions for CP?
- mobilizing devices
- technical aids
- visual & auditory therapy
- occupational therapy
- family support/education/resources