Pediatrics Final Exam Review
ICP
Brain is enclosed in the solid bony cranium and is well protected but highly vulnerable to
pressure that may accumulate within the enclosure
The volume 80% brain, 10% CSF, blood 10% must remain approximately the same at all
times. A change in one leads to compensation from another but the capacity for spatial
compensation is limited, once compensation is exhausted, increase in volume will result in a
rapid rise in ICP.
ICP
INFANTS sign and symptoms
• Irritability/ poor feeding
• High pitched cry/ difficult to soothe
• Fontanels: Tense & Bulging
• Cranial Sutures Separated
• Eyes: Sun Setting Eyes signs
• Scalp Veins Distended
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ICP
CHILDREN signs and symptoms
• Headache
• Vomiting (usually projectile)
• Seizures
,• Diplopia (Dbl vision), blurred vision
ICP
Pain Management in Comatose Child
• Opioids
• Fentanyl, Midazolam, Vecuronium
• Acetaminophen Codeine
• Quiet, Dim lit environment
PAIN INCREASES ICP
ICP
Personality and Behavioral Signs of Increasing Pressure
• Irritability, restlessness
• Drowsiness, indifference, decrease in physical activity and motor skills
• Diminished physical activity
• Inability to follow commands, memory loss
• Lethargy and drowsiness
ICP
Late Signs of Increasing Pressure
Decreased LOC
Decreased motor response to command
Decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Papilledema-(optic disc pressure)
Decerebrate or decorticate posturing
Cheyne-Stokes respirations
ICP
Management
Airway management is primary concern
Cerebral hypoxia LASTING >4 MINUTES MAY CAUSE IRREVERSIBLE BRAIN DAMAGE-
RECOGNIZE EARLY!!
CO2 causes vasodilation, increased cerebral blood flow, and increased ICP
May have minimal gag and cough reflexes
Risk of aspiration of secretions
,ICP
Medications
• Osmotic Diuretics
• Sedatives / Antiepileptic's
• Paralytic agents
• Anti-Pyretics
• Barbiturates (last resort)
ICP management
Coma Assessment
Pediatric Glasgow Coma Scale
THREE PART ASSESSMENT Includes:
• Eyes
• Verbal response
• Motor response
Score of 15: unaltered LOC
Score of 8: Generally accepted as definition of a coma
Score of 3: extremely decreased LOC (worst possible score on the scale)
ICP
Nursing Care in Child
• Frequent repositioning
• Avoid Activities that Increase ICP
• Eliminate / limit environmental noise
• Suctioning -Contraindicated causes Hypoxia + Cough = ↑ICP
ICP
Nutrition
• IV admin of fluids- parenteral nutrition
• Caution w/over hydration
• Later: gastric feedings w/NG Tube or GI Tube
• Pt may have risk of Aspiration
VP SHUNT CARE
Postoperative interventions:
• Position on nonoperative side to prevent pressure on shunt valve
, • Keep flat as prescribed
• Observe for increased ICP; if present, elevate head of bed 15 to 30 degrees
VP SHUNT CARE
Signs and Symptoms
of Shunt Infection
Period of greatest risk is 1 to 2 months after placement
Infections include:
• Septicemia
• Bacterial endocarditis
• Wound infection
• Shunt nephritis
• Meningitis
• Massive dose antibiotics or shunt removal
SEIZURE TYPES
• Absence seizure (previously referred to petit mal)
• Tonic-clonic seizure (previously referred to as grand mal)
• Myoclonic seizure
(Variety of seizure episodes, Symmetric or asymmetric involvement)
• Atonic or akinetic seizure (Muscle tone is lost for a few) seconds.
SEIZURE TYPES
Absence Seizures
• Formerly called petit mal or lapses
• Brief loss of consciousness
• Minimal or no change in muscle tone
• Almost always appear in childhood (4 to 12 years old)
PT LOOKS AS IF THEY ARE DAYDREAMING
SEIZURE TYPES
Atonic Seizures
• Sudden momentary loss of muscle tone
ICP
Brain is enclosed in the solid bony cranium and is well protected but highly vulnerable to
pressure that may accumulate within the enclosure
The volume 80% brain, 10% CSF, blood 10% must remain approximately the same at all
times. A change in one leads to compensation from another but the capacity for spatial
compensation is limited, once compensation is exhausted, increase in volume will result in a
rapid rise in ICP.
ICP
INFANTS sign and symptoms
• Irritability/ poor feeding
• High pitched cry/ difficult to soothe
• Fontanels: Tense & Bulging
• Cranial Sutures Separated
• Eyes: Sun Setting Eyes signs
• Scalp Veins Distended
Previous
Play
Next
Rewind 10 seconds
Move forward 10 seconds
Unmute
0:01
/
0:15
Full screen
Brainpower
Read More
ICP
CHILDREN signs and symptoms
• Headache
• Vomiting (usually projectile)
• Seizures
,• Diplopia (Dbl vision), blurred vision
ICP
Pain Management in Comatose Child
• Opioids
• Fentanyl, Midazolam, Vecuronium
• Acetaminophen Codeine
• Quiet, Dim lit environment
PAIN INCREASES ICP
ICP
Personality and Behavioral Signs of Increasing Pressure
• Irritability, restlessness
• Drowsiness, indifference, decrease in physical activity and motor skills
• Diminished physical activity
• Inability to follow commands, memory loss
• Lethargy and drowsiness
ICP
Late Signs of Increasing Pressure
Decreased LOC
Decreased motor response to command
Decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Papilledema-(optic disc pressure)
Decerebrate or decorticate posturing
Cheyne-Stokes respirations
ICP
Management
Airway management is primary concern
Cerebral hypoxia LASTING >4 MINUTES MAY CAUSE IRREVERSIBLE BRAIN DAMAGE-
RECOGNIZE EARLY!!
CO2 causes vasodilation, increased cerebral blood flow, and increased ICP
May have minimal gag and cough reflexes
Risk of aspiration of secretions
,ICP
Medications
• Osmotic Diuretics
• Sedatives / Antiepileptic's
• Paralytic agents
• Anti-Pyretics
• Barbiturates (last resort)
ICP management
Coma Assessment
Pediatric Glasgow Coma Scale
THREE PART ASSESSMENT Includes:
• Eyes
• Verbal response
• Motor response
Score of 15: unaltered LOC
Score of 8: Generally accepted as definition of a coma
Score of 3: extremely decreased LOC (worst possible score on the scale)
ICP
Nursing Care in Child
• Frequent repositioning
• Avoid Activities that Increase ICP
• Eliminate / limit environmental noise
• Suctioning -Contraindicated causes Hypoxia + Cough = ↑ICP
ICP
Nutrition
• IV admin of fluids- parenteral nutrition
• Caution w/over hydration
• Later: gastric feedings w/NG Tube or GI Tube
• Pt may have risk of Aspiration
VP SHUNT CARE
Postoperative interventions:
• Position on nonoperative side to prevent pressure on shunt valve
, • Keep flat as prescribed
• Observe for increased ICP; if present, elevate head of bed 15 to 30 degrees
VP SHUNT CARE
Signs and Symptoms
of Shunt Infection
Period of greatest risk is 1 to 2 months after placement
Infections include:
• Septicemia
• Bacterial endocarditis
• Wound infection
• Shunt nephritis
• Meningitis
• Massive dose antibiotics or shunt removal
SEIZURE TYPES
• Absence seizure (previously referred to petit mal)
• Tonic-clonic seizure (previously referred to as grand mal)
• Myoclonic seizure
(Variety of seizure episodes, Symmetric or asymmetric involvement)
• Atonic or akinetic seizure (Muscle tone is lost for a few) seconds.
SEIZURE TYPES
Absence Seizures
• Formerly called petit mal or lapses
• Brief loss of consciousness
• Minimal or no change in muscle tone
• Almost always appear in childhood (4 to 12 years old)
PT LOOKS AS IF THEY ARE DAYDREAMING
SEIZURE TYPES
Atonic Seizures
• Sudden momentary loss of muscle tone
