Intracranial Pressure and Neuro Systems

Intracranial Pressure (ICP)

• Severe consequence: Untreated ICP can lead to brain herniation and death.
• Causes: Bleeding (e.g., low INR), tumors, or anything increasing pressure within the skull.
• Mechanism of brain herniation: Swelling pushes the medulla into the C1 and C2, collapsing it and stopping heartbeat and breathing.
• Symptoms: Headache, nausea, vomiting (body's attempt to decrease pressure), hypertension.
• Treatment: Elevate head of bed.
• Warning sign: Sudden headache and vomiting upon waking can indicate increased risk of ICP.

Child vs. Adult Neuro Systems

• Rapid brain development in children: Children need whole milk until age 2 for myelin sheath development.
• Fontanelles: Anterior fontanelles close by 18 months.
• Increased ICP risk after 18 months: Cranium is sealed, increasing risk of brain injury from falls.
• Long-term neurological deficits: Patients with unspecified neurological issues may experience bowel/bladder problems and inability to walk.

Craniosynostosis

• Suture closure: Early suture closure causes head deformation.

Deformational Plagiocephaly

• Flat head: Can result from prolonged laying in one position.

Microcephaly

• Cognitive impairments: Head circumference is 2 standard deviations below normal.

Hydrocephalus

• CSF buildup: Excess cerebrospinal fluid in the brain.
• No bulging or firmness: A sunken head in babies indicates dehydration.
• Treatment: Ventriculoperitoneal (VP) shunt.

Intracranial Arteriovenous Malformations (AVMs)

• Abnormal connections: Arteries and veins are abnormally connected.

Meningitis

• Viral or bacterial: Possible with or without sepsis.
• Viral Meningitis: Self-limiting; avoid light and noise, use Tylenol for headaches.
• Bacterial Meningitis: Can be fatal (septic); fever, headache, stiff neck (nuchal rigidity), photophobia, hemorrhagic rash, droplet precautions, antibiotics, isolation, more common in patients with shunts.
• Kernig sign and Brudzinski sign: (Note: need specific references about these signs)
• Important note: Droplet precautions are required.

Reye Syndrome

• Multi-organ failure: Very rare condition.
• Aspirin avoidance: Avoid aspirin in young children.

Encephalitis

• Meninges infection: Viral, bacterial, fungal, parasitic, or toxic.
• Seizure precautions: Side rails up, bed lowest position, oxygen and suction available.

Seizures

• Electrical brain disturbances: Focal or generalized.
• Precise documentation: Important for accurate diagnosis and treatment.
• Status Epilepticus: Seizure lasting > 5 minutes. Requires intervention.

Epilepsy

• Diagnosis: 2 unprovoked seizures ≥ 24 hours apart.
• Treatment: Vagal nerve stimulator if medications ineffective.

Seizure Precautions

• Protect patient: Do not put your hands in their mouth.
• Provide support: Intermittent suction, side rails up, common sense.

Status Epilepticus

• Serious condition: >5 minutes.
• Aggressive treatment: IV fluids, oxygen, IV meds (lorazepam, diazepam). Stop the seizure activity.

Febrile Seizures

• Common in children (<7 years): Body temperature > 101.2°F.
• Self-limiting: Anxiety-producing for parents.
• EEG: Diagnostic testing.

Antiepileptic Medications

• Example: Carbamazepine.

Head Trauma

• Glasgow Coma Scale (GCS): Objective tool for head injury severity. GCS 8 or lower is critical.
• GCS 8 or lower: Intubation required.
• Posturing: Decorticate vs. decerebrate assess for injury severity.
• Infant/toddler: High-risk due to larger heads.

Headaches

• Headache journal: To determine cause in children.
• Abortive medicines: Taken at headache onset.

Eye Disorders

• Nystagmus: Abnormal eye movement (up and down) during lateral gaze.
• Strabismus: "Cross-eye"; treated with occlusion therapy (covering stronger eye).

Nasolacrimal Duct Obstruction

• Unformed tear ducts: Fluid buildup, infection, redness, conjunctivitis.
• Self-limiting: Usually resolves on its own.

Periorbital Cellulitis

• Eyelid/tissue infection: Very serious; requires prompt treatment.
• Hospitalization: IV antibiotics and close monitoring.
• Blindness risk: Untreated. Facial infections increase risk.

Hearing Deficits

• Suspect loss: Absent startle reflex or no response to verbal stimuli at 6 months old.

Respiratory System (General)

• Pediatric respiratory failure: Rapid onset, often more critical than in adults.
• Assessment: Rate and rhythm, chest pain, contractions, cough (effort and timing), lung sounds (wheezes, stridor, crackles), odors (breath and mucus), mucus (color and consistency), positioning.

Croup Disorders

• Laryngotracheobronchitis: Most common, viral upper airway infection.
• Treatment: Steroids, fluids, racemic epinephrine.
• Spasmodic Laryngitis: (Usually <8yo); barking cough, afebrile, night-time; often self-limiting. Treatment: cool mist.

Epiglottitis

• Bacterial infection: Airway obstruction; medical emergency.
• Clinical signs: Tripod positioning, drooling, "croaking" noise, steeple sign on x-ray.
• Treatment: Immediate endotracheal tube, antibiotics.

Pertussis

• Whooping cough: Long duration; begins with cold symptoms, progressing to severe coughing episodes (2-6 weeks).

Pneumonia

• Lower airway infection/inflammation: Bacterial or viral (community or hospital-acquired).
• Symptoms: Fever, tachypnea, cough, nausea/vomiting, irritability/restlessness, lethargy.
• Treatment: Antibiotics if bacterial; monitor for distress.

RSV Bronchiolitis

• Degenerative condition: Symptoms worsen over 2 days; severe congestion, thick mucus.

Asthma

• Airway inflammation: Priorities: medications, trigger control, education, peak flow meter use.

Cystic Fibrosis

• Genetic condition: Thick, sticky mucus builds up in lungs.
• Can be asymptomatic.

Acid-Base Balance

• Blood pH Range: 7.35-7.45
• Acidosis/Alkalosis: Respiratory and Metabolic.
• Compensation: Lungs and kidneys compensate for imbalances.

Foreign Body Aspirations

• Inhalation: (small foods/toys) blocks airway.
• Symptoms: Silence, couch, dyspnea, stridor, hoarseness.

Cardiac System (Newborn to 3 months)

• Normal BP/HR: 65-85/45-55 mmHg and 110-160 beats/minute.
• Prostaglandin E (PGE): Relaxes smooth muscle (e.g., patent ductus arteriosus -PDA).
• Indomethacin: Used to close PDA.
• Inotropes: Alters force/speed of contractions to improve cardiac output.

Congenital Heart Defects

• Increased pulmonary blood flow: Atrial septal defect (ASD), ventricular septal defect (VSD).
• Decreased pulmonary blood flow: Pulmonary stenosis, Tetralogy of Fallot.
• Obstruction to systemic blood flow: Coarctation of the aorta.
• Mixed flow: Transposition of the great arteries.
  • Tet Spell Symptoms: Cyanotic, syncope (in toddlers). Treatment varies by age.
    • Infant (below 12 months): Knee-to-chest position.
    • Toddler (2-3 yo): Squat position.
  • Antibiotics preemptively for dental procedures.

Heart Failure Interventions

• Maintain oxygenation and cardiac output.
• Cardiac Glycosides: Digoxin; monitor apical pulse > 90 bpm before admin.

Rheumatic Fever

• Autoimmune response: Untreated streptococcal infection causes inflammation in joints, skin, and heart.
• Valve replacement (e.g., mitral) may be required.

Kawasaki Disease

• Autoimmune inflammation of blood vessels: Risk of aneurysms and heart attacks. -IV immunoglobulin G (IVIG) and aspirin are treatments.

Pediatric Fluid Calculations

• Formula: First 10 kg: 100 mL/kg/day; Second 10 kg: 50 mL/kg/day; Each kg thereafter: 20 mL/kg/day

Skin Lecture

• Infant skin characteristics: Thicker, greater body surface area.
• Important nursing considerations: Promote skin integrity, prevent infection, promote comfort.

Impetigo

• Bacterial skin infection: Staph aureus; bullous or non-bullous (honey-crusted); topical antibiotics (10-14 days), Mupirocin.

Folliculitis

• Bacterial skin infection: Staph aureus; topical antibiotics; avoid sharing.

Cellulitis

• Bacterial skin infection: Mark the erythematous area. Oral antibiotics (cephalexin), IV cephalosporin for severe cases.

Measles (Rubeola)

• Viral infection: Highly contagious; MMR vaccine. Droplet precautions. Koplik spots (characteristic oral lesions).

Mumps

• Viral infection: Self-limiting; MMR vaccine; parotid gland swelling (near airway).

Rubella

• Viral infection: MMR vaccine; avoid pregnant women (congenital rubella syndrome risk).

Varicella (Chickenpox)

• Viral (Herpes) infection: Highly contagious; MMR vaccine; contagious until all lesions crusted.

Contact Dermatitis

• Irritant or allergic reaction to environmental triggers: Avoid exposure, Topical or oral corticosteroids, and antihistamines.

Erythema Multiforme

• Hypersensitivity reaction (note: no specifics given).

Urticaria (Hives)

• Self-limiting skin condition. Oral antihistamines for itching relief.

Infestations

• Lice: Eggs near scalp; permethrin, 2 rounds; shared articles, not species jumping.
• Scabies: Burrow under skin; permethrin 5%, antihistamines, corticosteroids; entire family treatment and house cleaning.

Burns

• Classification: Superficial to full thickness.
• Body Surface Area (BSA) Estimation: (9% head, 9% arm, 18% front chest, 18% back, 18% leg, 1%)
• Nursing interventions: Wound healing promotion, infection prevention, psychosocial support, urine output monitoring.

This quiz covers the critical aspects of intracranial pressure (ICP), including its severe consequences, causes, symptoms, and treatment options. Additionally, it explores the differences in neuro systems between children and adults, focusing on brain development and risks associated with increased ICP. Test your knowledge on these important medical topics!