NURS 307 (Pediatrics) Pediatric
Neurology & Renal WEEK 5
SUMMARIZED LECTURE NOTES BEST
FOR YOUR EXAM TO SCORE AN A+
WEST COAST UNIVERSITY.
, Renal and Cerebral Dysfunctions; Pediatric Nursing Interventions and Skills
Alterations in neurologic function
o Focused assessment
o Level of consciousness
o Cranial nerves
o Fontanels and sutures
o Cognitive function
o Pupils
▪ A. unilateral dilated and reactive pupil is associated with an
intracranial mass
▪ B. fixed and dilated pupil may be a sign of impending brainstem
herniation
▪ C. Bilateral fixed and dilated pupils are associated with brainstem
herniation from increased intracranial pressure
o Vital signs
o Posture and movement
o Neck stiffness
o Pain
o Family history
o LOCs
▪ Confusion
▪ Delirium
▪ Lethargy
▪ Stupor
▪ Coma
o Etiology
▪ Injury
▪ Infection
▪ Increased ICP
o Posturing
▪ Decorticate→ Lesions above brainstem
▪ Decerebrate→ Lesions of brainstem
o Glasgow coma
- Three-part assessment
o Eye opening
o Verbal response
o Motor response
- Scores
o highest score of 15→ unaltered LOC
o 8→ coma
o Lowest score of 3→ deep coma or death
o The lower the score the deeper the coma
▪ 8 or less → comatose
▪ 5 or less→ brain death
Care management
• Maintain airway
• Monitor for secretions
• Be alert for no-gag reflex
• Suction PRN
• Protect from seizures
• bed side rails
• Be ready to time
• Medication management
• Eye and oral care
• Nutrition NG, GT, TPN/IL
• Sensory stimulation
• Music therapy
• Talk to the child as if they are
responsive
• Psychosocial support
, Head injury
Concussion: traumatic brain injury, affects the way it functions *** hallmark sign (confusion & amnesia)
Contusion: bruising of cerebral tissue
Laceration: tearing of the cerebral tissue
- Expected findings
o Dizziness, headache, diplopia, vomiting
o Amnesia before or after injury
o Hx of alcohol or controlled substance use
o Manifestations
▪ Minor injury→Loss of consciousness, pallor, lethargy, drowsiness, irritability, vomiting
▪ Progression of injury→ marked changes, altered mental status, focal neurological deficits,
increase in agitation
▪ Severe injury→ ICP
• Infants (bulging fontanels, High pitch cry, poor feeding, increased sleeping)
• Children (seizures, unable to follow commands, blurred vision, vomit, HA)
- Labs
o CBC W differential
o ABGs
o Blood alcohol & toxicology screening
o Liver function
- Complications
▪ Epidural hematoma
▪ Subdural hemorrhage
▪ Cerebral edema
▪ Brain herniation (downward shift of brain tissues→ Cushing’s triad)
▪ sequelae of TBI
• hydrocephalus, posttraumatic HA & seizures, post-concussion syndrome
Health promotion
- Wear helmets to prevent injury
- Never shake a baby→ shaken syndrome
Intracranial pressure (ICP), pressure inside the skull increases (medical emergency), it is affected by CSF, brain blood &
tissue.
→ Pressure is measured in mmHg CPP= MAP-ICP
- Normal→ 1-10 mm Hg MAP= DBPx2 + SBP-3
o Anything > 15 mm Hg needs immediate Tx (Per ATI)
- The normal cerebral perfusion pressure (CPP)→ 60-100 mg
- An increase or decrease in ICP is accompanied by compensatory measures such as a decrease or increase in CSF
o Examples:
▪ Reduction in blood volume
▪ Increase in SBP and decrease in HR
▪ Decrease in production of CSF
▪ Increase in CSF
▪ Shrinkage of the brain mass by displacement of
extracellular and intracellular fluid
o Factors that influence ICP
▪ Body temp
▪ O2 status & CO2 levels
• Ex. hypoxia can increase ICP
▪ Body position
• Keep pt. at 30-35 degrees and midline, neutral
▪ Arterial & venous pressure such as elevating the legs
▪ Anything that increases abdominal pressure
→ Monroe-Kelli Hypothesis, states that as things compensate it eventually makes things worse→ leads to
Cushing’s triad (increased SBP, decreased DBP and HR, and RR (Cheyne’s stoke- increases CO2))
o Clinical manifestations
▪ Early s/s: headache, vomiting, irritability, fatigue, personality changes
o Treatment
▪ Pharmacological
• Mannitol→ osmotic diuretic, decreases intracranial pressure and cerebral edema
• Antiepileptics→ prevent or tx seizures that might occur
• Corticosteroids→ to decrease inflammation and edema
• Antibiotics→ if CSF leakage, lacerations, or penetrating injuries
• Analgesic→ Tylenol for HA, pain, & fever; morphine and midazolam are also ok
Neurology & Renal WEEK 5
SUMMARIZED LECTURE NOTES BEST
FOR YOUR EXAM TO SCORE AN A+
WEST COAST UNIVERSITY.
, Renal and Cerebral Dysfunctions; Pediatric Nursing Interventions and Skills
Alterations in neurologic function
o Focused assessment
o Level of consciousness
o Cranial nerves
o Fontanels and sutures
o Cognitive function
o Pupils
▪ A. unilateral dilated and reactive pupil is associated with an
intracranial mass
▪ B. fixed and dilated pupil may be a sign of impending brainstem
herniation
▪ C. Bilateral fixed and dilated pupils are associated with brainstem
herniation from increased intracranial pressure
o Vital signs
o Posture and movement
o Neck stiffness
o Pain
o Family history
o LOCs
▪ Confusion
▪ Delirium
▪ Lethargy
▪ Stupor
▪ Coma
o Etiology
▪ Injury
▪ Infection
▪ Increased ICP
o Posturing
▪ Decorticate→ Lesions above brainstem
▪ Decerebrate→ Lesions of brainstem
o Glasgow coma
- Three-part assessment
o Eye opening
o Verbal response
o Motor response
- Scores
o highest score of 15→ unaltered LOC
o 8→ coma
o Lowest score of 3→ deep coma or death
o The lower the score the deeper the coma
▪ 8 or less → comatose
▪ 5 or less→ brain death
Care management
• Maintain airway
• Monitor for secretions
• Be alert for no-gag reflex
• Suction PRN
• Protect from seizures
• bed side rails
• Be ready to time
• Medication management
• Eye and oral care
• Nutrition NG, GT, TPN/IL
• Sensory stimulation
• Music therapy
• Talk to the child as if they are
responsive
• Psychosocial support
, Head injury
Concussion: traumatic brain injury, affects the way it functions *** hallmark sign (confusion & amnesia)
Contusion: bruising of cerebral tissue
Laceration: tearing of the cerebral tissue
- Expected findings
o Dizziness, headache, diplopia, vomiting
o Amnesia before or after injury
o Hx of alcohol or controlled substance use
o Manifestations
▪ Minor injury→Loss of consciousness, pallor, lethargy, drowsiness, irritability, vomiting
▪ Progression of injury→ marked changes, altered mental status, focal neurological deficits,
increase in agitation
▪ Severe injury→ ICP
• Infants (bulging fontanels, High pitch cry, poor feeding, increased sleeping)
• Children (seizures, unable to follow commands, blurred vision, vomit, HA)
- Labs
o CBC W differential
o ABGs
o Blood alcohol & toxicology screening
o Liver function
- Complications
▪ Epidural hematoma
▪ Subdural hemorrhage
▪ Cerebral edema
▪ Brain herniation (downward shift of brain tissues→ Cushing’s triad)
▪ sequelae of TBI
• hydrocephalus, posttraumatic HA & seizures, post-concussion syndrome
Health promotion
- Wear helmets to prevent injury
- Never shake a baby→ shaken syndrome
Intracranial pressure (ICP), pressure inside the skull increases (medical emergency), it is affected by CSF, brain blood &
tissue.
→ Pressure is measured in mmHg CPP= MAP-ICP
- Normal→ 1-10 mm Hg MAP= DBPx2 + SBP-3
o Anything > 15 mm Hg needs immediate Tx (Per ATI)
- The normal cerebral perfusion pressure (CPP)→ 60-100 mg
- An increase or decrease in ICP is accompanied by compensatory measures such as a decrease or increase in CSF
o Examples:
▪ Reduction in blood volume
▪ Increase in SBP and decrease in HR
▪ Decrease in production of CSF
▪ Increase in CSF
▪ Shrinkage of the brain mass by displacement of
extracellular and intracellular fluid
o Factors that influence ICP
▪ Body temp
▪ O2 status & CO2 levels
• Ex. hypoxia can increase ICP
▪ Body position
• Keep pt. at 30-35 degrees and midline, neutral
▪ Arterial & venous pressure such as elevating the legs
▪ Anything that increases abdominal pressure
→ Monroe-Kelli Hypothesis, states that as things compensate it eventually makes things worse→ leads to
Cushing’s triad (increased SBP, decreased DBP and HR, and RR (Cheyne’s stoke- increases CO2))
o Clinical manifestations
▪ Early s/s: headache, vomiting, irritability, fatigue, personality changes
o Treatment
▪ Pharmacological
• Mannitol→ osmotic diuretic, decreases intracranial pressure and cerebral edema
• Antiepileptics→ prevent or tx seizures that might occur
• Corticosteroids→ to decrease inflammation and edema
• Antibiotics→ if CSF leakage, lacerations, or penetrating injuries
• Analgesic→ Tylenol for HA, pain, & fever; morphine and midazolam are also ok
