NURS NEURO FINAL EXAM:PEDIATRICS GUIDE 2022/2023
NEURO (A lot of neuro questions on test)
- LOC (#1 Assessment)
o 1.) Fully Conscious
o 2.) Confusion
▪ Impaired decisions
o 3.) Disorientation
▪ To time and place
o 4.) Lethargy
▪ Sluggish speech and movement
o 5.) Obtundation
▪ Arouse with stimulation
o 6.) Stupor
▪ Responds to vigorous and repeated stimulation (sternal rub)
• Worse than obtundation
o 7.) Coma
▪ No motor or verbal response to stimuli
o 8.) Veggie
- S/S = Non-stop headache, n/v, seizure activity
- Make sure to not overload sensory
- Glascow Coma Scale =
o 15 = Unaltered LOC (perfect)
o 3 = Extreme decreased LOC (dead)
o 7-8 = CALL MD
▪ Be able to identify patient based on their number!
- Can you give Codeine to a neuro patient?
o NO
- Care for a patient with increased cranial pressure
o Positioning – use pillows (30 degrees)
o Avoid activity
o No noise
o NO deep suction – can increase ICP
o Do you give fluids?
o Do you give supplemental oxygen?
- Decorticate (IN) & Decerebrate (OUT) – ATIVAN DRUG OF CHOICE!!
o Know posture differences: decerebrate and
decorticate Increased Intracranial Pressure (ICP)
- Early signs and symptoms may be subtle
, NURS NEURO FINAL EXAM:PEDIATRICS GUIDE 2022/2023
- As pressure increases, signs and symptoms become more pronounced
- Loss of Consciousness is first sign of cerebral edema
o When you do neuro assessment, first thing you assess is LOC
- Signs and symptoms in infants:
o Irritability
o Poor feeding
o High-pitched cry, difficult to soothe
o Fontanels – BULGING
▪ May feel it pulsing to heart beat
o Cranial sutures separated
o Eyes- setting sun signed
▪ If they turn their head one way, their eyes go the other way
o Scalp veins distended
o Headache & Vomiting –FIRST TWO SIGNS OF SHUNT FAILURE
o Seizures
o Diplopia, blurred vision
o Drowsiness, decrease in physical activity and motor skills
o Diminished physical activity
o Inability to follow commands
o Memory loss lethargy
- LATE signs of Increasing ICP
o Decreased LOC
o Decreased motor responses to commands
o Decreased sensory response to painful stimuli
o Alteration in pupil size and reactivity – Pupils go up
o Decerebrate or Decorticate posturing
o Eyes swelling (papilledema)
Unconscious Child
- Airway
- Reduction of ICP
- Treatment of shock
(Monitol) Nutrition
- Watch for fluid overload
- G-tube
Cerebral Trauma:
- #1 = Stabilize neck and spine if any trauma
- CT scan
first! Near
Drowning:
NEURO (A lot of neuro questions on test)
- LOC (#1 Assessment)
o 1.) Fully Conscious
o 2.) Confusion
▪ Impaired decisions
o 3.) Disorientation
▪ To time and place
o 4.) Lethargy
▪ Sluggish speech and movement
o 5.) Obtundation
▪ Arouse with stimulation
o 6.) Stupor
▪ Responds to vigorous and repeated stimulation (sternal rub)
• Worse than obtundation
o 7.) Coma
▪ No motor or verbal response to stimuli
o 8.) Veggie
- S/S = Non-stop headache, n/v, seizure activity
- Make sure to not overload sensory
- Glascow Coma Scale =
o 15 = Unaltered LOC (perfect)
o 3 = Extreme decreased LOC (dead)
o 7-8 = CALL MD
▪ Be able to identify patient based on their number!
- Can you give Codeine to a neuro patient?
o NO
- Care for a patient with increased cranial pressure
o Positioning – use pillows (30 degrees)
o Avoid activity
o No noise
o NO deep suction – can increase ICP
o Do you give fluids?
o Do you give supplemental oxygen?
- Decorticate (IN) & Decerebrate (OUT) – ATIVAN DRUG OF CHOICE!!
o Know posture differences: decerebrate and
decorticate Increased Intracranial Pressure (ICP)
- Early signs and symptoms may be subtle
, NURS NEURO FINAL EXAM:PEDIATRICS GUIDE 2022/2023
- As pressure increases, signs and symptoms become more pronounced
- Loss of Consciousness is first sign of cerebral edema
o When you do neuro assessment, first thing you assess is LOC
- Signs and symptoms in infants:
o Irritability
o Poor feeding
o High-pitched cry, difficult to soothe
o Fontanels – BULGING
▪ May feel it pulsing to heart beat
o Cranial sutures separated
o Eyes- setting sun signed
▪ If they turn their head one way, their eyes go the other way
o Scalp veins distended
o Headache & Vomiting –FIRST TWO SIGNS OF SHUNT FAILURE
o Seizures
o Diplopia, blurred vision
o Drowsiness, decrease in physical activity and motor skills
o Diminished physical activity
o Inability to follow commands
o Memory loss lethargy
- LATE signs of Increasing ICP
o Decreased LOC
o Decreased motor responses to commands
o Decreased sensory response to painful stimuli
o Alteration in pupil size and reactivity – Pupils go up
o Decerebrate or Decorticate posturing
o Eyes swelling (papilledema)
Unconscious Child
- Airway
- Reduction of ICP
- Treatment of shock
(Monitol) Nutrition
- Watch for fluid overload
- G-tube
Cerebral Trauma:
- #1 = Stabilize neck and spine if any trauma
- CT scan
first! Near
Drowning:
