Neurologic Exam 4 Pediatric.
What is the emergency care of a unconscious child?
-Airway -Reduction of ICP -Treatment of Shock.
What are the possible LOC? & Changes in Descending order.
-Full Consciousness -Confusion: impaired decision making -Disorientation: to time & place. -Lethargy: sluggish speech. -Obtundation: Arouses w/ stimulation -Stupor: responds only to vigorous & repeated stimulation. -Coma: no motor or verbal response to noxious stimuli. -Persistent vegetative state: permanently lost function of cerebral cortex.
Increased Intracranial Pressure (ICP) Signs & Symptoms in Infants?
-Irritability, poor feeding. -High-pitched cry, Difficult to soothe. -Fontanels, tense, bulging. -Cranial sutures: separated. -Eyes: Setting-sun sign. -Scalp Veins: distended.
Behavioral signs of increased ICP? Powerpoint.
-Irritability, restlessness. -Drowsiness, indifference, decrease in physical activity & motor skills. -Complaints of fatigue, somnolence. inability to follow commands, memory loss -Weight loss.
Assessment parameters:
-LOC - Pupillary reaction -Vital signs -frequency of assessment depends on condition: range from every 15 minutes to 2 hours.
What is the pain management?
-Opioids -Fentanyl + midazolam + vecuronium. -Acetaminophen & codeine. -Quiet dimly lit environment.
Nursing Care of Unconscious Child.
-Outcome & recovery of unconscious child may depend on level of nursing care & observational skills.
Nursing Assessment: Early Signs: (ICP), Saunders Book, Infants.
-Slight Change in Vitals -Slight Change in Level of Consciousness. -Infant: Irritability, High-pitched cry, Bulging fontanel, Increased head circumference, dilated scalp veins, Macewen's sign (Cracked-pot sound on percussion of the head), Setting sun sign (Sclera visible above the iris).
How do you perform a Neurologic Examination?
-Vital Signs -Skin -Eyes -Motor Function -Posturing -Reflexes.
Nursing Interventions: ICP
1. Monitor the Airway, Admin. Oxygen as prescribed. 2. Assess injury, if present. 3. Position client so that the head is maintained midline to avoid jugular vein compression which can increase ICP. 4. Assess Vitals & neurological function, monitor LOC Carefully. 5. Notify HCP if signs of increased ICP. 6. Keep stimuli to a minimum, attempt to minimize crying in an infant. 7. initiate seizure precautions.
What is the Respiratory management?
Airway management is primary concern.
What are Imaging tests for ICP?
CT Scan, MRI, Echoencephalography, Ultrasound, Nuclear brain scan, positron emission tomography. -Electroencephalogram (EEG) -X-ray (rule-out skull fractures, dislocations; evaluate degenerative changes, suture lines). -Lumbar puncture.
What is Deceberate (Extension) posturing?
Deceberate (Extension) posturing: Rigid extension and pronation of the arms and the legs; sign of dysfunction at the level of the midbrain.
What is Decorticate (Flexion) posturing?
Decorticate posturing, Adduction of the arms at the shoulders; arms are flexed on the chest with the wrists flexed and the hands fisted, and the lower extremities are extended and adducted; seen with severe dysfunction of cerebral cortex.
Increased Intracranial Pressure (ICP) Pathophysiology
Early signs & symptoms may be subtle. -As pressure increases, signs & symptoms become more pronounced, and level of conciousness (LOC) deteriorates.
What are some lab tests to help diagnose ICP?
Glucose, CBC, Electrolytes, Blood culture if fever, evaluate for toxic substances, liver function.
Nursing Assessment Signs & Symptoms (ICP), Children, Saunder's Book?
Headache Nausea Vomiting Diplopia (Visual Disturbances) Seizures.
What are the Late signs of ICP?
Significant decrease in level of consciousness. -Bradycardia -Decreased motor and sensory responses. -Alteration in pupil size & reactivity. -Papilledema: optic disc swelling. -Decorticate posturing. -Deceberate (Extension) posturing. -Cheyne-Stokes respirations -Coma.
Pain assessment in the comatose child?
Signs of pain: -Increased rigidity & agitation. Pain increases ICP. Alterations in vital signs: -Usually increase in HR, RR, BP & Decrease in oxygen saturation.
What is the Glasgow Coma Scale? Pediatric.
Three-part assessment: -Eyes -Verbal Response -Motor Response A score of 15 = Unaltered LOC. A score of 3 = Extremely decreased LOC. (Worst possible score).