Pediatrics Final Exam Review Questions With Complete Solutions

*ICP* correct answer: 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 correct answer: • Irritability/ poor feeding • *High pitched cry/ difficult to soothe* • Fontanels: Tense & Bulging • Cranial Sutures Separated • Eyes: Sun Setting Eyes signs • Scalp Veins Distended *ICP* *CHILDREN* signs and symptoms correct answer: • Headache • Vomiting (usually projectile) • Seizures • Diplopia (Dbl vision), blurred vision *ICP* Pain Management in Comatose Child correct answer: • Opioids • Fentanyl, Midazolam, Vecuronium • Acetaminophen Codeine • Quiet, Dim lit environment *PAIN INCREASES ICP* *ICP* Personality and Behavioral Signs of Increasing Pressure correct answer: • 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 correct answer: 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 correct answer: 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 correct answer: • Osmotic Diuretics • Sedatives / Antiepileptic's • Paralytic agents • Anti-Pyretics • Barbiturates (last resort) *ICP* management Coma Assessment Pediatric Glasgow Coma Scale correct answer: 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 correct answer: • Frequent repositioning • Avoid Activities that Increase ICP • Eliminate / limit environmental noise • Suctioning -*Contraindicated causes Hypoxia + Cough = ↑ICP*