NURS 364 EXAM 3 QUESTIONS AND ANSWERS
Clinical manifestations of increased intracranial pressure - infants
- tense, bulging fontanel
- separated cranial sutures
- irritability, restlessness
- drowsiness
- increased sleeping
- high-pitched cry
- distended scalp veins
- poor feeding
- crying when disturbed
- setting-sun sign
setting sun sign
-eyes deviate downward with rim of sclera showing above iris
-may indicate hydrocephalus
Clinical manifestations of increased intracranial pressure - children
- HA
- Nausea
- Forceful vomiting
- diplopia, blurred vision
- seizures
- indifference, drowsiness
,decreased school performance
obese, decreased exercise and motor activity
sleep more
inability to follow simple directions
lethargic
loss of memory
cerebral spinal fluid (CSP) functions
protects, cushions-shock absorber
nourishes the brain
removes waste products
Major causes of increased intracranial pressure
meningitis-most common
bacterial, viral-aseptic
encephalitis
myelitis
Meningitis
infection/inflammation of the meninges
meninges
three layers of membranes that protect the brain and spinal cord
encephalitis
infection/inflammation of the brain
,myelitis
inflammation of the spinal cord
Bacterial Meningitis
inflammation of the meninges caused by bacteria - has potential to cause lasting
neurologic damage so it needs to be recognized and treated promptly
etiology of bacterial meningitis - neonates
- group B strep
- E coli
etiology of bacterial meningitis - children
- S. pneumoniae
- N. meningitides
- group B strep
- H-flue
pathophysiology of bacterial meningitis
transmitted by resp droplets → colonize in respiratory tract (nasopharynx) → invade
underlying blood vessels → cross BBB → multiply in CSF
Clinical manifestations of bacterial meningitis
- febrile appearance
- fever
- HA
- photophobia
- N/V
- confusion
, - nuchal rigidity (stiff neck)
- Positive Kernig's sign
- Positive Brudzinski's sign
- bulging fonanel (Young infant)
- high-pitched crya
- seizures (common early sign)
Kernig's sign
a diagnostic sign for meningitis characterized by the patient's inability to fully extend the
leg when the thigh is flexed upon the abdomen and the patient is seated or lying down
Brudzinski's sign
pain w/resistance and involuntary flex of hip/knee when neck is flexed to chest when
lying supine
Diagnosis of bacterial meningitis
- lumbar puncture/spinal tao (definitive test) w/C&S
- CMP
- CBC
- UA
lumbar puncture (spinal tap)
evaluation of spinal fluid removed by needle insertion; fluid pressure taken, culture,
gram stain, count of blood cells and determination of protein and glucose
CSF findings w/ bacterial meningitis
- Opening pressure increased
- CSF turbid w/ positive gram stain
Clinical manifestations of increased intracranial pressure - infants
- tense, bulging fontanel
- separated cranial sutures
- irritability, restlessness
- drowsiness
- increased sleeping
- high-pitched cry
- distended scalp veins
- poor feeding
- crying when disturbed
- setting-sun sign
setting sun sign
-eyes deviate downward with rim of sclera showing above iris
-may indicate hydrocephalus
Clinical manifestations of increased intracranial pressure - children
- HA
- Nausea
- Forceful vomiting
- diplopia, blurred vision
- seizures
- indifference, drowsiness
,decreased school performance
obese, decreased exercise and motor activity
sleep more
inability to follow simple directions
lethargic
loss of memory
cerebral spinal fluid (CSP) functions
protects, cushions-shock absorber
nourishes the brain
removes waste products
Major causes of increased intracranial pressure
meningitis-most common
bacterial, viral-aseptic
encephalitis
myelitis
Meningitis
infection/inflammation of the meninges
meninges
three layers of membranes that protect the brain and spinal cord
encephalitis
infection/inflammation of the brain
,myelitis
inflammation of the spinal cord
Bacterial Meningitis
inflammation of the meninges caused by bacteria - has potential to cause lasting
neurologic damage so it needs to be recognized and treated promptly
etiology of bacterial meningitis - neonates
- group B strep
- E coli
etiology of bacterial meningitis - children
- S. pneumoniae
- N. meningitides
- group B strep
- H-flue
pathophysiology of bacterial meningitis
transmitted by resp droplets → colonize in respiratory tract (nasopharynx) → invade
underlying blood vessels → cross BBB → multiply in CSF
Clinical manifestations of bacterial meningitis
- febrile appearance
- fever
- HA
- photophobia
- N/V
- confusion
, - nuchal rigidity (stiff neck)
- Positive Kernig's sign
- Positive Brudzinski's sign
- bulging fonanel (Young infant)
- high-pitched crya
- seizures (common early sign)
Kernig's sign
a diagnostic sign for meningitis characterized by the patient's inability to fully extend the
leg when the thigh is flexed upon the abdomen and the patient is seated or lying down
Brudzinski's sign
pain w/resistance and involuntary flex of hip/knee when neck is flexed to chest when
lying supine
Diagnosis of bacterial meningitis
- lumbar puncture/spinal tao (definitive test) w/C&S
- CMP
- CBC
- UA
lumbar puncture (spinal tap)
evaluation of spinal fluid removed by needle insertion; fluid pressure taken, culture,
gram stain, count of blood cells and determination of protein and glucose
CSF findings w/ bacterial meningitis
- Opening pressure increased
- CSF turbid w/ positive gram stain
