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Five Levels of LOC - 🧠 ANSWER ✔✔1) Full consciousness [awake and alert,
orientated, normal feeding]
2) confusion [disorientated, alert but inappropriate responses]
3)obtunded [child has limited responses to environment and falls asleep unless
stimulation]
4) Stupor [child only responds to vigorous stimulation]
5) Coma [unable to arouse to any stimulus]
GCS - 🧠 ANSWER ✔✔-eye opening
-verbal response
-motor response
Posturing - 🧠 ANSWER ✔✔-Decorticate [flexion in arms and extension of legs,
seen with damage to cerebral cortex or brainstem]
,-Decerebrate [arms extend and pronated legs, seen in damage to midbrain &
brainstem]
-both include rigid muscle tone and lower limb extension
Patient teaching for Seizures - 🧠 ANSWER ✔✔-call 911 when: child stops
breathing, injury occurs, seizure lasts more than 5 minutes, 1st seizure OR
unresponsive to painful stimuli after.
-do not go swimming alone
-safety & precautions
-medications
Hydrocephalus - 🧠 ANSWER ✔✔-due to underlying brain disorder
-abnormality in circulation of CSF [imbalance production and absorption]
-early intervention to precent macroencephaly or injury
-shunt may be required
-2 types [non-obstructive/communicating and obstructive/non communicating]
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,-Assessment: fontanels [broadening of forehead and large head, bulging fontanel,
quick increase in head circumference, headaches, developmental decline &
changes in personality]
VP Shunt in Hydrocephalus - 🧠 ANSWER ✔✔-CSF accumulates in ventricular
system [ventricles enlarge]
-ventriculoperitoneal shunt catheter is placed in an enlarged ventricle
-the shunt diverts the flow of CSF within the ventricular system to the peritoneum
-CSF is then absorbed in peritoneal and into body's circulation
Non obstructive/communicating - 🧠 ANSWER ✔✔-a passage of CSF between the
ventricles and the subarachnoid space occurs but CSF reabsorption is impaired
-results from subarachnoid hemorrhage and meningeal infections
Obstructive/non-communicatins - 🧠 ANSWER ✔✔-CSF is unable to pass between
ventricles and subarachnoid space
-caused by neural tube defects, neonatal meningitis, trauma/tumours, chiari
malformations
Positional plagiocephaly - 🧠 ANSWER ✔✔-flattened head from lying on back/side
too long
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, perinatal head trauma - 🧠 ANSWER ✔✔-excessive forces before or during birth
process (forceps)
Teaching guideline for head trauma - 🧠 ANSWER ✔✔-stay with child for first 24
hours
-wake every 2 hours
-observe closely
-return to emerg if: worsening headache, slurred speech, reoccurring dizziness,
extreme irritability, vomiting, clumsiness, bleeding from ears, difficulty waking,
unequal pupils, seizures
Meningitis - 🧠 ANSWER ✔✔-inflammation and tissue damage to brain (lining that
surrounds brain and spinal cord, can lead to brain & nerve damage, deafness &
stroke)
-treatment: IV antibiotics, LP for blood cultures [including glucose level],
corticosteroids, treat the cause, isolate, reduce ICP
-brudzinski's sign: chin to chest and causes pain and hips & knees flex
-Assess: fever, stiff neck, headache/pain
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