Neuro general/Increased intracranial pressure (ICP)/Glasgow Coma Scale/Levels of Consciousness?

• What are the nursing interventions for neurological disorders?

• Maintain hydration and nutrition

• Promote safety

• Promote skin integrity

• Maintain neurological function

• Prevent or manage infection

• Promote pain relief and comfort

• Administer and manage medications

• What is increased intracranial pressure?

• Buildup of pressure within the skull often due to increase in brain tissue, blood, or cerebrospinal fluid (CSF)

• Why does increased intracranial pressure occur?

• Since the skull limits the amount of space for brain and CSF and as soon as there is swelling there is no room

• What are the manifestations of increased intracranial pressure in infants?

• Irritability

• Poor feeding

• High pitched cry

• Fontanels are tense and bulging

• Cranial sutures are separated

• Eyes have the setting sun sign

• Scalp veins are distended

• Macewan sign

• Increased occipitofrontal circumference

• What is the first sign of increased intracranial pressure?

• CHANGE IN LEVEL OF CONSCIOUSNESS

• What are the manifestations of increased ICP in children?

• Headache

• Vomiting

• Motor weakness

• Seizures

• Blurred vision

• Irritability

• Restlessness

• Sleep alterations

• Personality changes

• What is a cushing triad?

• The clinical signs of ICP

• Bradycardia

• Hypertension

• Irregular respirations

• How to reduce ICP?

•  head elevation

• CSF drainage

• Medications like mannitol or hypertonic saline

• Surgery like decompressive craniectomy.

• What is the nursing care for a child with increased ICP?

• Patient position

• Avoid activities that may increase ICP

• eliminate/minimize environmental noise

• suction

• What is the Glasgow coma scale?

• Neurological assessment to gauge a person's level of consciousness after a brain injury

• What are the parts of a glasgow coma scale?

• Eyes

• Verbal response

• Motor response

• What is a good vs bad score for glasgow coma scale?

• Unaltered LOC

  • Score of 15

• Decreased LOC

  • Score of 3

    • Worst possible score

• What is the order of consciousness (in descending order)?

• Full consciousness

• Confusion

• Disorientation

• Lethargy

• Obtundation

• Stupor

• Coma

• Persistent vegetative state

• What is confusion?

• Impaired decision making

• What is lethargy?

• Sluggish speech

What is stupor?

• Response to only vigorous and repeated stimulation

• What is Coma?

• No motor or verbal response to noxious stimuli

• What is a persistent vegetative state?

• Permanently lost function of cerebral cortex

What is the nursing care of the unconscious child?

• Airway

• Reduction of ICP

• Administration of Mannitol

• Treatment of shock

What is the pain management for the comatose child?

• Watch for signs and symptoms

• Increased agitation

• Watch pain because it increases ICP

• Watch alterations in vital signs

• What are concussions?

• Short term and reversible

• Instant loss of awareness and responsiveness

• Generally followed by amnesia and confusion

• 24-48 hours rest from schoolwork tv video games

• Need clearance to return to sports

• What to watch for in concussions?

• Assess level of consciousness/amnesia

• Wake child during the night times 2 to assess

• Be alert for vomit 3 times or more

• Watch for fluid leak from ear or nose

• Watch for unsteady gait

• Watch if difficulty speaking

• Watch for bruising below eyes

• Difficult to arouse

• Excessive crying