Intracranial Disease Processes

hydrocephalus

imbalance in production and absorption of CSF in the ventricular system, irregular production CSF and not flowing properly

what occurs the in head with hydrophalus

too much fluid that the brain cannot grow to normal size, intensity depends on how much brain tissue is present

internal shunt for hydrocephalus

drains the fluid in the head into the GI tract

s/s of hydrocephalus

bulging fontanels, dilated scalp veins, separated sutures, frontal protrusion, crack pot (macewen sign), eyes rotate downward (setting sun), irritable, lethargy, poor feeding, change in LOC, opisthotonos, spasticity in lower extremities 

hydrocephalus interventions

watch vital trends, assess LOC, measure head circumference daily, monitor for infection within first 6 months of shunt placement 

what happens if infection does occur after shunt replacement 

remove internal and repalce with external shunt during antibiotic treatment, replace by another internal shunt when infection is gone 

bacterial meningitis

medical emergency, symptoms occur quickly

casative agent of meningitis for neonates 

GBS

casative agent of meningitis for 3 months ot 11 years 

s. pneumoniae

casative agent of meningitis for 11 years to 17 years

n. meningitides

meningitis diagnostics

lumbar puncture, culture and sensitivity, elevated WBC and glucose

meningitis s/s

fever, chills, headache, vomiting, alterations in sensorium, seizures, irritability, agitation, photophobia, deliruim, halluncinations, aggressive behavior, drowsiness, stupor, coma, nucheal rigidity, positive kernig and brudzinski

meningitis infant specific s/s

poor feeding, bulging fontanels 

meningitis complicaitons 

infection, aspiration, seizure 

meningitis nursing interventions

antibiotics, seizure precautions, monitor i/o, reduce ICP, keep temperature even, maintain IV infusion, hydration 

how to reduce ICP with meningitis

elevate head of bed to 30 degrees, keep head in neutral position by log rolling, keep room quiet, dim lights, limit visitors, avoid painful stimuli 

myelomeningocele

known as spina bifida, part of spinal cord is poking throught the back, indicated by dimple, make sure spinal cord is intact 

fetal surgery/infancy nursing care for spina bifida

keep sterile, prone position, covered in plastic, defect covered by a moist sterile dressing, remains prone post op

orthopedic management goals for spinal bifida

prevent joint contracture, correct existing deformities, prevent or minimize effects of motor and sensory deficit, prevent skin breakdown, obtain best possible function of affected lower extremties 

assistive device nursing care for spina bifida

brace, wheelchair

early infancy nursing care for spina bifida

passive ROM and stretching exercise, positioning, PT

GI function nursing care for spina bifida

in and out cath

bowel control nursing care for spina bifida

high fiber diet, laxative, suppositiory, enema

prevention of spina bifida

increase folate and fortified food consumption

folate riched food 

leafy green vegetables, citrus fruit 

fortified rich food

cereal, bread, rice, grits, pasta

seizure disorder

transient occurence of s/s due to abnormal, excessive, and synchronous neuronal activity in the brain

types of seizures

tonic clonus, absent, atonic, myoclonic, febrile, partial

tonic clonus seizures

increased tone and twitching

absent seizure s/s

brief loss of consciousness, no warning or aura, slight loss of muscletone, minor movements, amnesia, reorient self to previous activity 

atonic seizure s/s

no tone, stuck in place, loss of tone causing a violent fall

myoclonic seizure s/s

brief contractures of muscle, no postictal state, loss of consciousness

febrile seizures

due to high temp, resolves when temp resolves, does not usually happen again, call ambulance don’t transfer to ED 

postictal state (recovery) s/s for seizures 

relax, semiconscious, awake, confused, poor coordination, no recollection of event, milk fine motor impairment, visual and speech difficulty, severe headache, sleep, tired with sore muscles 

assessment for seizure

only diangosed if seen on EEG, activity, presence of aura, change in perception 

risk factors of seizures

stress, lack of sleep, infection, injury

complication of seizure disorder

more seizures, injury 

how to determine seizure medication therapeutic dose

goals is least amoutn in monotherapy, increase dose if seizures are still present, start to slowly pull back wehn seizures stop, after 2 years of no seizures slowly taper off 

seizure disorder pharmacology

levetiracetam, phenytoin, phenobarbital

post seizure assessment

child getting back to baseline

nursing interventiosn during seizure

side position, suction, tiem the seizure, blow by O2, characteristics

status epilepticus 

series of seizures at intervals too brief to allow child to regain consciousness 

what does status epilepticus lead to

exhaustion, respiratory failure, death

status epileticus first line treatment

ativan

status epileticus last line treatment

paralyze and intubate