What is the earliest indicator of change in neuro status? change in LOC
What is the term for forgetfulness confusion
What is the term for drowsy lethargy
What is the term for arousable by stimulation obtunded
What is the term for arousable by vigorous stimulation? stuporours
What is the term f...
NUR 425 Final Exam Questions and
Correct Answers
What is the earliest indicator of change in neuro status? ✅change in LOC
What is the term for forgetfulness ✅confusion
What is the term for drowsy ✅lethargy
What is the term for arousable by stimulation ✅obtunded
What is the term for arousable by vigorous stimulation? ✅stuporours
What is the term for cannot arouse? ✅coma
What to assess in a neuro assessment? ✅vitals:
-changes in HR and BP are more important than certain directions or limits they should
be in (trends!)
-HR and BP and temp variable
-respirations altered?
-hypotension: decreases cerebral blood flow (less pressure)
-hypertension: increases cerebral blood flow (more pressure)
Assess fontanels/sutures if less than 2 years old
-abnormal bulging
Assess head circumference
Assess pupils
-size and reactivity
-pinpoint: overdose
-bilateral fixed and dilated: brainstem herniation...could be caused by mydriatic drugs
What is cushing's reflex? ✅decreased HR, increased BP, altered respirations
This is a late sign and uncommon in children
The breathing is an ominous sign
What is Cheyne-Stokes breathing? ✅apnea of 10-60 sec followed by increasing depth
and frequency of breaths (occurs in DKA)
Why is MAP important? ✅it is a better indicator of perfusion
It is the average blood pressure during one cardiac cycle
Normal value for MAP in pediatrics? ✅should be above 50 (adults are 60-100)
What is cerebral perfusion pressure? ✅pressure needed to ensure adequate oxygen
and nutrients are delivered to the brain
It is the difference between pressure of blood going to the brain (MAP) and the back
pressure to this flow (ICP)
What is intracranial pressure? ✅it is the force exerted by the three contents of the
brain (csf, blood, tissue)
Why must cpp must be maintained within narrow limits? ✅because too little pressure
could cause ischemia and too much pressure could raise ICP
Net gradient that drives oxygen to tissue
What is the relationship between ICP and CPP? ✅they work against each other
-if icp increases, then cpp decreases
What is the normal value of CPP in children? ✅40-60
What is the normal value for ICP in children? ✅10-15
Epidural hematoma involves what bleeding issue? ✅arterial
Bleed between the skull and dura (above the dura)
Subdural hematoma involves what bleeding issue? ✅venous
Bleed between the dura mater and arachnoid mater (below the dura)
What would you assess for a patient with suspected IICP? ✅S/S of IICP for all peds
-drowsiness
, -increased sleeping
-high pitched cry
-increased frontooccipital circumference
-distended scalp veins
-poor feeding
-setting sun sign
-forceful vomiting
-seizures
-indifference, drowsiness
-diminished physical activity and motor performance
-inability to follow simple commands
-lethargy
-crying when disturbed
-irritable/restless
What would you assess for in an infant with suspected IICP? ✅-bulging fontanel
-separated cranial sutures
-macewen (cracked pot) sign
-sunset eyes (late and severe sign)
What would you assess for in an older child with suspected IICP? ✅-nausea
-diplopia, blurred vision
-decline in school performance
-c/o headache
Late signs of IICP in all ages ✅-bradycardia
-decreased motor and sensory response
-change in pupils
-extension and flexion posturing
-cheyne stokes respirations
-papilledema
-decreased LOC
-coma
Head Expansion with IICP ✅-head circumference measured until 36 months
-cranial bones ossify by age 8
-suture lines fuse by age 12
So with IICP in an older child, what happens? ✅brain contents herniate and end result
is herniation through foramen magnum
List the interventions for IICP ✅-recognition ASAP
-oxygenate: intubate and ventilate (if less than 8 on GCS)
-IVF to help with blood pressure and perfuse brain
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