PEDS Final - Neurology

The Glasgow scale is a neurological scale used to assess the level of consciousness and neurological functioning in patients. It consists of three components: eye opening, verbal response, and motor response. Blanching, which refers to the temporary whitening or paleness of the skin due to reduced blood flow, is not a part of the Glasgow scale assessment.

The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in a patient. A GCS score of 3 indicates that the patient has no eye opening, verbal response, or motor response, suggesting a complete lack of response. Therefore, the patient with a GCS score of 3 would have no response.

The correct answer is BP 139/95, HR 55, RR 13, Temp 38.5°C. These findings indicate that the child's blood pressure is elevated, heart rate is low, respiratory rate is low, and temperature is high. These abnormalities in vital signs suggest that the child may be experiencing a medical emergency, such as sepsis or shock. Immediate medical intervention is necessary to address the underlying cause and stabilize the child's condition.

An increase in blood pressure of more than 15 points can be a sign of increased intracranial pressure (ICP) in individuals with meningitis. Meningitis is an inflammation of the meninges, which are the protective membranes surrounding the brain and spinal cord. Increased ICP occurs when there is an excessive build-up of pressure within the skull, which can be caused by various factors including inflammation. Monitoring blood pressure is crucial in assessing ICP, as an increase in blood pressure can indicate the body's attempt to compensate for the elevated pressure. Therefore, the statement "True" is an accurate explanation of the given answer.

A generalized seizure is characterized by abnormal electrical activity in both cerebral hemispheres of the brain, leading to a loss of consciousness (LOC). This means that the correct answer is "both cerebral hemispheres with a change in LOC." In this type of seizure, the entire brain is affected, resulting in a loss of awareness and often accompanied by convulsions or other physical symptoms.

EKG's are for cardiac assessments, not used for seizures

A low-grade fever is not a patient contraindication for a lumbar puncture. A lumbar puncture is a procedure used to collect cerebrospinal fluid (CSF) from the spinal canal for diagnostic purposes. It is commonly performed to diagnose meningitis. While a low-grade fever may be present in a patient with meningitis, it is not a contraindication for the procedure. Contraindications for a lumbar puncture include increased intracranial pressure (ICP), presence of MRSA/Staph infection on the skin, and an unstable patient.

The correct answer is that the hypothalamus, which regulates temperature, is now under pressure. This means that there may be some underlying issue or condition causing the sudden rise in temperature. The hypothalamus plays a crucial role in maintaining body temperature, so if it is under pressure, it may not be able to function properly, resulting in a rise in temperature. It is important for the nurse to further investigate and determine the cause of the pressure on the hypothalamus in order to provide appropriate treatment for the child.

When a patient experiences sudden arrest of activity with no memory of the event and brief loss of consciousness (LOC) that is mistaken for daydreaming, they are likely experiencing petit-mal seizures. Petit-mal seizures, also known as absence seizures, are characterized by brief episodes of altered consciousness where the person may appear to be staring blankly into space. These seizures typically last for a few seconds and are often mistaken for daydreaming or inattentiveness.

Ataxia, positive Babinski, increased ICP (intracranial pressure), and hemiparesis (weakness on one side of the body) are symptoms commonly associated with glioblastoma. Glioblastoma is a type of brain tumor that can cause these neurological symptoms due to its location and effect on the surrounding brain tissue. Seizure disorder and status epilepticus are conditions characterized by recurrent seizures, while meningitis refers to inflammation of the protective membranes covering the brain and spinal cord. Therefore, glioblastoma is the most likely cause of the mentioned symptoms.

Alkaline phosphatase is not used to diagnose seizure disorders because it is an enzyme that is primarily used to assess liver and bone health. Seizure disorders are diagnosed through various methods such as electroencephalogram (EEG) to measure brain activity, blood tests for electrolyte imbalances, and imaging tests like MRI or CT scans to identify any structural abnormalities in the brain. Alkaline phosphatase levels are not directly related to seizure disorders and therefore not used as a diagnostic tool for this condition.

When a nurse suspects increased intracranial pressure (ICP) in a child, one of the expected findings during the eye assessment is papilledema. Papilledema refers to the swelling of the optic disc due to increased pressure within the skull. This can occur as a result of various conditions affecting the brain, such as head trauma, brain tumors, or meningitis. The presence of papilledema indicates that there is increased pressure within the child's skull, which supports the nurse's suspicion of ICP in this case.

Psychomotor seizures that last 5-10 minutes with periods of altered behavior are classified as complex partial seizures. Complex partial seizures are a type of seizure that typically involves a loss of awareness and altered behavior. These seizures can cause a person to engage in repetitive movements or actions, have difficulty speaking or understanding language, and experience changes in emotions or sensations. The duration of 5-10 minutes aligns with the typical length of complex partial seizures.

When a patient is on seizure precautions, it is important for the nurse to pad the bed rails to prevent injury during a seizure. Additionally, having O2 and suction equipment readily available is necessary to manage any respiratory or airway complications that may arise during a seizure. However, using bed restraints is not recommended as it can increase the risk of injury during a seizure. Allowing the patient to be out of bed as tolerated and moving freely (OOB ADLIB) is also important to promote mobility and prevent complications associated with immobility.

Hyperventilation is used to induce cerebral vasoconstriction in a pediatric patient with ICP. By increasing the rate and depth of breathing, hyperventilation decreases the amount of carbon dioxide in the blood, leading to vasoconstriction of the cerebral blood vessels. This helps to reduce intracranial pressure and improve cerebral perfusion.

CSF analysis is a diagnostic test used to evaluate the cerebrospinal fluid for various conditions, including meningitis. In meningitis, there is inflammation of the meninges, which leads to certain changes in the CSF. Increased protein levels in the CSF are commonly seen in meningitis due to the breakdown of the blood-brain barrier. Decreased glucose levels occur because the bacteria or viruses causing meningitis consume glucose as a source of energy. Increased white blood cell (WBC) count is also observed in meningitis as the immune system responds to the infection. However, an increase in red blood cells (RBCs) is not typically seen in meningitis.

Assessing developmental milestones is not a post-op intervention for Glioblastoma. Glioblastoma is a type of brain tumor, and post-operative interventions for this condition typically involve monitoring the patient's neurological status, managing pain and swelling, maintaining fluid balance, and preventing complications. Assessing developmental milestones is more relevant in pediatric patients to monitor their growth and development, but it is not directly related to post-operative care for Glioblastoma.

The nurse should ask for Manitol because it is a medication commonly used to reduce intracranial pressure (ICP). Lasix, on the other hand, is a diuretic that helps remove excess fluid from the body but does not specifically target ICP. Therefore, it is important for the nurse to clarify the order and request the appropriate medication to effectively manage the patient's condition.

Ativan has less respiratory depression than valium, an extra consideration since patient is hypoxic

The nursing interventions for an unconscious patient include seizure precautions, cooling blanket, and turning and positioning every 2 hours. Seizure precautions are necessary to ensure the safety of the patient in case they experience a seizure. A cooling blanket is used to help regulate the body temperature of an unconscious patient, as they may be unable to control their body temperature effectively. Turning and positioning every 2 hours helps to prevent pressure ulcers and maintain the patient's comfort and circulation.

Partial seizures are characterized by localized motor symptoms and eyes deviating towards opposite sides. These symptoms suggest that the seizure activity is occurring in a specific area of the brain rather than affecting the entire brain. Repeated purposeless activities and lip smacking, chewing, and drooling are not specific to partial seizures and can occur in other types of seizures as well.

Infants with increased intracranial pressure (ICP) may experience poor feeding, irritability, lethargy, a bulging anterior fontanel, and the sun setting sign. Poor feeding can occur because increased pressure in the brain can affect the baby's ability to suck and swallow properly. Irritability and lethargy can be signs of discomfort and neurological changes due to increased pressure. A bulging anterior fontanel, the soft spot on a baby's head, can be a visible sign of increased pressure. The sun setting sign refers to the downward deviation of the eyes, which can be a neurological sign of increased pressure. Headache and mood swings are less likely to be seen in infants with ICP, as they may not be able to communicate these symptoms effectively.

The nurse should use sterile eye pads or sterile eyepads to prevent corneal abrasions in an unconscious patient with eyelids that don't close. These pads provide a protective barrier for the eyes and help to keep them moist. By using sterile pads, the nurse ensures that there is no risk of introducing any contaminants that could potentially cause an infection.

The primary etiology factors for seizure disorder include genetic predisposition and birth to early infancy trauma. Genetic predisposition refers to the presence of certain genes that increase the likelihood of developing a seizure disorder. Birth to early infancy trauma refers to any injury or trauma that occurs during the birthing process or in the early stages of infancy, which can lead to the development of seizure disorder. Other factors such as structural or metabolic abnormality and meningitis may also contribute to the development of seizure disorder, but they are not mentioned as primary factors in this question.

Seizure disorder can have various secondary etiology factors. Cerebral lesions refer to any abnormalities or damage in the brain, which can contribute to the development of seizures. Metabolic disorders involve disruptions in the body's chemical processes, which can also lead to seizures. Febrile seizures occur as a result of high fever, but they are considered a primary rather than a secondary cause. Trauma or congenital defects are also potential factors, but they are not mentioned in the given answer.

ICP stands for intracranial pressure, which refers to the pressure inside the skull. Increased ICP can cause various symptoms. Mood swings can occur due to the pressure affecting the brain's emotional centers. Headache is a common symptom of increased ICP. Diplopia, or double vision, can occur when the pressure affects the nerves controlling eye movements. AM (morning) nausea and vomiting can be a result of increased pressure on the brainstem. Altered LOC (level of consciousness) can occur as the brain's function is affected. However, eyes deviated downward and increased head circumference are not typical symptoms of increased ICP.