NR 328 Exam 3 review Case studies
I I I I I I
Head Injury I
Tommy Iis Ia I6-year-old Iboy Iwho Ifell Ioff Ithe Iswing Iyesterday Iand Ihit Ithe Iback Iof Ihis Ihead
Ion Ithe Ipavement. IHe Iis Inow Iin Ithe Ihospital Iin Ithe Iintensive Icare Iunit, Iunresponsive. IHe
Ihas Isymptoms Iof Iincreased Iintracranial Ipressure I(ICP) Ifrom Ithe Ifall.
1. What Iare Ithe Iclinical Isymptoms Iof Iincreased IICP Iin Ia Ichild ITommy's Iage?
The Icorrect Ianswers Iare:
Headache, Inausea, Iforced Ivomiting, Idiplopia, Iblurred Ivision, Iand Iseizures
2. When Icerebral Iblood Iflow Iis Idecreased, Iwhat Isymptoms Ifrequently Ioccur?
ICorrect IAnswer
The Icorrect Ianswers Iare:
Nausea, Ifainting, Iand Idizziness
3. Identify Ithe Ivital Isign Ichanges Ilisted Ibelow Ithat Iare Iassociated Iwith Ibrainstem
Iinjury Ifollowing Iacute Ihead Itrauma. I(Select Iall Ithat Iapply.)
A. Rapid Ior Iintermittent Irespirations
B. Wide Ifluctuations Iin Ipulse
C. Widening Ipulse Ipressure
D. Extreme Ifluctuations Iin Iblood Ipressure
E. Elevated Itemperature
Correct IAnswer
I
The Icorrect Ianswers Iare IA, IB, IC, ID, Iand IE.
4. One Iof ITommy's Inursing Idiagnoses Iis IRisk Ifor IInjury Irelated Ito Iphysical
Iimmobility, Idepressed Isensorium, Iand Iintracranial Ipathologic Icondition. IList Ifour
Inursing Iinterventions Ifor Ithis Inursing Idiagnosis Ithat Ifocus Ion Imaintaining Ia Istable
IICP.
Correct IAnswer
The Icorrect Ianswer Iis:
A. Elevate Ithe Ihead Iof Ithe Ibed I15 Ito I30 Idegrees.
, B. Maintain Ithe Ihead Iin Ia Imidline Iposition.
C. Avoid Ipressure Ion Ineck Iveins.
D. Avoid Iflexion Ior Ihyperextension Iof Ithe Ineck.
E. Avoid Irespiratory Iprocedures Isuch Ias Isuctioning.
F. Prevent Iconstipation.
G. Minimize Iemotional Istress Iand Icrying.
H. Prevent Ior Irelieve Ipain.
I. Monitor IICP.
o I What Iis Ithe Iexpected Ioutcome Irelated Ito Ithe Inursing Idiagnosis Ipresented Iin
Iquestion I4?
Correct IAnswer
The Icorrect Ianswer Iis:
ICP Iwill Iremain Iwithin Isafe Ilimits. IThe Ichild Iwill Ishow Ino Ievidence Iof Iincreased
IICP.
o I Complete Ithe Ifollowing Itable Idescribing Ithe Idiagnostic Itests Iused Ito Iassess Ithe
Iextent Iof ITommy's Ihead Iinjury.
Diagnostic ITest Rationale Ifor ITest How ITest IIs IPerformed
Brain Icomputed Itomographic
I(CT) Iscan Iwithout Icontrast
Skull Iradiography
Cervical Ispine Iradiograph
Brain Iperfusion Itest
o Correct IAnswer
,o The Icorrect Ianswers Iare:
Diagnostic ITest Rationale Ifor ITest How ITest IIs IPerformed
Brain ICT Iscan Iwithout To Ievaluate Ifor Iblood Iin Ithe CT Iscan Iof Ibrain
Icontrast Icranium
Skull Iradiography To Ievaluate Ifor Ifractures Radiography Iof Iskull
Cervical Ispine Iradiograph To Ievaluate Ifor Ifractures Radiography Iof Ispine
Brain Iperfusion Itest To Idetermine Iwhether Ithe Inject Idye Iintravenously Ito
Ibrain Iis Ireceiving Iblood Iflow Itrace Iblood Iflow
o Describe Ithe Ipathology Iof Iacute Ihead Iinjury Iin Ia Ichild Iby Imatching Ithe Ifollowing
Iterms.
I Causes Imass Imovement Iof Ithe Ibrain
A. Acceleration I
Causes Ibruising Iat Ithe Ipoint Iof Ibrain
impact
B. Deceleration I
Caused Iby Iunequal Imovement Iof Ithe
brain Ion Iimpact
C. Subdural I
Bleeding Ibetween Ithe Idura Iand Icerebrum
Ihematoma
I
Causes Igreatest Icerebral Iinjury Iat Ithe
point Iof Iimpact
D. ShearingIforces
E. Deformation
o Correct IAnswer
o The Icorrect Ianswers Iare IA, IE, ID, IC, IB.
Chapter I32: IThe IChild Iwith ICerebral IDysfunction
, Meningitis
Marshall Iis Ia I9-month-old Ichild Iadmitted Ito Ithe Ipediatric Inursing Iunit Ifor
Haemophilus Iinfluenzae Imeningitis. IHe Ihas Ihad Ino Ichildhood Iimmunizations.
1. What Iclinical Ibehaviors Iare Iexpected Iin Ian Iinfant Iwith Imeningitis?
The Icorrect Ianswers Iare:
o Fever
o Poor Ifeeding
o Vomiting
o Irritability
o Seizures
o High-pitched Icry
o Bulging Ifontanel
o Nuchal Irigidity
Rationale:
The Iclassic Ipresentation Iof Imeningitis Iis Irarely Iseen Iin Iinfants Iand Ichildren
Ibetween I3 Imonths Iand I2 Iyears; Ithus, Ithe Isymptoms Iseen Iin Ian Iinfant Iinclude Ifever,
Ipoor Ifeeding, Ivomiting, Imarked Iirritability, Itoxic Iappearance, Iand Ifrequent
Iseizures Iaccompanied Iby Ia Ihigh-pitched Icry. IThe Imost Isignificant Ifindings Iinclude
Ia Ibulging Ifontanel Iand Inuchal Irigidity.
2. Definitive Idiagnosis Iof Imeningitis Iis Imade Ion Ithe Ibasis Iof Iwhat Itest?
ICorrect IAnswer
The Icorrect Ianswer Iis:
Examination Iof Icerebrospinal Ifluid Iby Imeans Iof Ilumbar Ipuncture.
Rationale:
Spinal Ifluid Iis Ianalyzed Ifor Iculture, IGram Istain, Iblood Icell Icount, Iand
Idetermination Iof Iglucose Iand Iprotein Icount. IThese Ifindings Iare Iusually Idiagnostic:
Ithe Iculture Iand IGram Istain Iidentify Ithe Icausative Iorganism, Ithe Iwhite Iblood Icell
Icount Iis Iusually Ielevated Iand Ithe Iglucose Ilevel Iis Ireduced, Iand Ithe Iprotein
Iconcentration Iis Iusually Iincreased.
3. Marshall Imay Ibe Ikept Ion Ilow-maintenance Ilevels Iof Ifluids Ito Iprevent Iwhat Itwo
Iconditions?
The Icorrect Ianswer Iis:
Cerebral Iedema Iand Iincreased Iintracranial Ipressure I(ICP)
Rationale:
Increased IICP Iis Iavoided Ibecause Iit Iresults Iin Ithe Ireduction Iof Icerebral Iperfusion
Ipressure, Iwhich Icauses Iharmful Ineurologic Iconsequences Iof Ithe Iillness.
4. Could Ithis Icase Iof Imeningitis Ihave Ibeen Iprevented?
The Icorrect Ianswer Iis:
Yes, Iby Iimmunization Iwith IHib Ivaccine.
Rationale:
Routine Ivaccinations Ifor IH. Iinfluenzae Itype Ib Iare Irecommended Ifor Iall Ichildren
I I I I I I
Head Injury I
Tommy Iis Ia I6-year-old Iboy Iwho Ifell Ioff Ithe Iswing Iyesterday Iand Ihit Ithe Iback Iof Ihis Ihead
Ion Ithe Ipavement. IHe Iis Inow Iin Ithe Ihospital Iin Ithe Iintensive Icare Iunit, Iunresponsive. IHe
Ihas Isymptoms Iof Iincreased Iintracranial Ipressure I(ICP) Ifrom Ithe Ifall.
1. What Iare Ithe Iclinical Isymptoms Iof Iincreased IICP Iin Ia Ichild ITommy's Iage?
The Icorrect Ianswers Iare:
Headache, Inausea, Iforced Ivomiting, Idiplopia, Iblurred Ivision, Iand Iseizures
2. When Icerebral Iblood Iflow Iis Idecreased, Iwhat Isymptoms Ifrequently Ioccur?
ICorrect IAnswer
The Icorrect Ianswers Iare:
Nausea, Ifainting, Iand Idizziness
3. Identify Ithe Ivital Isign Ichanges Ilisted Ibelow Ithat Iare Iassociated Iwith Ibrainstem
Iinjury Ifollowing Iacute Ihead Itrauma. I(Select Iall Ithat Iapply.)
A. Rapid Ior Iintermittent Irespirations
B. Wide Ifluctuations Iin Ipulse
C. Widening Ipulse Ipressure
D. Extreme Ifluctuations Iin Iblood Ipressure
E. Elevated Itemperature
Correct IAnswer
I
The Icorrect Ianswers Iare IA, IB, IC, ID, Iand IE.
4. One Iof ITommy's Inursing Idiagnoses Iis IRisk Ifor IInjury Irelated Ito Iphysical
Iimmobility, Idepressed Isensorium, Iand Iintracranial Ipathologic Icondition. IList Ifour
Inursing Iinterventions Ifor Ithis Inursing Idiagnosis Ithat Ifocus Ion Imaintaining Ia Istable
IICP.
Correct IAnswer
The Icorrect Ianswer Iis:
A. Elevate Ithe Ihead Iof Ithe Ibed I15 Ito I30 Idegrees.
, B. Maintain Ithe Ihead Iin Ia Imidline Iposition.
C. Avoid Ipressure Ion Ineck Iveins.
D. Avoid Iflexion Ior Ihyperextension Iof Ithe Ineck.
E. Avoid Irespiratory Iprocedures Isuch Ias Isuctioning.
F. Prevent Iconstipation.
G. Minimize Iemotional Istress Iand Icrying.
H. Prevent Ior Irelieve Ipain.
I. Monitor IICP.
o I What Iis Ithe Iexpected Ioutcome Irelated Ito Ithe Inursing Idiagnosis Ipresented Iin
Iquestion I4?
Correct IAnswer
The Icorrect Ianswer Iis:
ICP Iwill Iremain Iwithin Isafe Ilimits. IThe Ichild Iwill Ishow Ino Ievidence Iof Iincreased
IICP.
o I Complete Ithe Ifollowing Itable Idescribing Ithe Idiagnostic Itests Iused Ito Iassess Ithe
Iextent Iof ITommy's Ihead Iinjury.
Diagnostic ITest Rationale Ifor ITest How ITest IIs IPerformed
Brain Icomputed Itomographic
I(CT) Iscan Iwithout Icontrast
Skull Iradiography
Cervical Ispine Iradiograph
Brain Iperfusion Itest
o Correct IAnswer
,o The Icorrect Ianswers Iare:
Diagnostic ITest Rationale Ifor ITest How ITest IIs IPerformed
Brain ICT Iscan Iwithout To Ievaluate Ifor Iblood Iin Ithe CT Iscan Iof Ibrain
Icontrast Icranium
Skull Iradiography To Ievaluate Ifor Ifractures Radiography Iof Iskull
Cervical Ispine Iradiograph To Ievaluate Ifor Ifractures Radiography Iof Ispine
Brain Iperfusion Itest To Idetermine Iwhether Ithe Inject Idye Iintravenously Ito
Ibrain Iis Ireceiving Iblood Iflow Itrace Iblood Iflow
o Describe Ithe Ipathology Iof Iacute Ihead Iinjury Iin Ia Ichild Iby Imatching Ithe Ifollowing
Iterms.
I Causes Imass Imovement Iof Ithe Ibrain
A. Acceleration I
Causes Ibruising Iat Ithe Ipoint Iof Ibrain
impact
B. Deceleration I
Caused Iby Iunequal Imovement Iof Ithe
brain Ion Iimpact
C. Subdural I
Bleeding Ibetween Ithe Idura Iand Icerebrum
Ihematoma
I
Causes Igreatest Icerebral Iinjury Iat Ithe
point Iof Iimpact
D. ShearingIforces
E. Deformation
o Correct IAnswer
o The Icorrect Ianswers Iare IA, IE, ID, IC, IB.
Chapter I32: IThe IChild Iwith ICerebral IDysfunction
, Meningitis
Marshall Iis Ia I9-month-old Ichild Iadmitted Ito Ithe Ipediatric Inursing Iunit Ifor
Haemophilus Iinfluenzae Imeningitis. IHe Ihas Ihad Ino Ichildhood Iimmunizations.
1. What Iclinical Ibehaviors Iare Iexpected Iin Ian Iinfant Iwith Imeningitis?
The Icorrect Ianswers Iare:
o Fever
o Poor Ifeeding
o Vomiting
o Irritability
o Seizures
o High-pitched Icry
o Bulging Ifontanel
o Nuchal Irigidity
Rationale:
The Iclassic Ipresentation Iof Imeningitis Iis Irarely Iseen Iin Iinfants Iand Ichildren
Ibetween I3 Imonths Iand I2 Iyears; Ithus, Ithe Isymptoms Iseen Iin Ian Iinfant Iinclude Ifever,
Ipoor Ifeeding, Ivomiting, Imarked Iirritability, Itoxic Iappearance, Iand Ifrequent
Iseizures Iaccompanied Iby Ia Ihigh-pitched Icry. IThe Imost Isignificant Ifindings Iinclude
Ia Ibulging Ifontanel Iand Inuchal Irigidity.
2. Definitive Idiagnosis Iof Imeningitis Iis Imade Ion Ithe Ibasis Iof Iwhat Itest?
ICorrect IAnswer
The Icorrect Ianswer Iis:
Examination Iof Icerebrospinal Ifluid Iby Imeans Iof Ilumbar Ipuncture.
Rationale:
Spinal Ifluid Iis Ianalyzed Ifor Iculture, IGram Istain, Iblood Icell Icount, Iand
Idetermination Iof Iglucose Iand Iprotein Icount. IThese Ifindings Iare Iusually Idiagnostic:
Ithe Iculture Iand IGram Istain Iidentify Ithe Icausative Iorganism, Ithe Iwhite Iblood Icell
Icount Iis Iusually Ielevated Iand Ithe Iglucose Ilevel Iis Ireduced, Iand Ithe Iprotein
Iconcentration Iis Iusually Iincreased.
3. Marshall Imay Ibe Ikept Ion Ilow-maintenance Ilevels Iof Ifluids Ito Iprevent Iwhat Itwo
Iconditions?
The Icorrect Ianswer Iis:
Cerebral Iedema Iand Iincreased Iintracranial Ipressure I(ICP)
Rationale:
Increased IICP Iis Iavoided Ibecause Iit Iresults Iin Ithe Ireduction Iof Icerebral Iperfusion
Ipressure, Iwhich Icauses Iharmful Ineurologic Iconsequences Iof Ithe Iillness.
4. Could Ithis Icase Iof Imeningitis Ihave Ibeen Iprevented?
The Icorrect Ianswer Iis:
Yes, Iby Iimmunization Iwith IHib Ivaccine.
Rationale:
Routine Ivaccinations Ifor IH. Iinfluenzae Itype Ib Iare Irecommended Ifor Iall Ichildren
