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NUR 425 PEDS EXAM 3 BLUEPRINT.
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NUR 425 PEDS EXAM 3 BLUEPRINT.
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NUR 425 PEDS EXAM 3 BLUEPRINTMedications:
● Nystatin: antifungal
● Mannitol: Give osmotic diuretic like mannitol to help balance the fluids levels in increased
ICP, Mannitol is the preferred diuretic as it acts quicker and lasts longer. It also does not
affect the sodium level.
● N-acetylcysteine: acetaminophen antidote
● Deferoxamine: treats iron toxicity
● Epi-pen: epinephrine for severe allergic reaction
● Mupirocin (Bactroban): antibiotic for boils
● Loratadine (Claritin): non sedating antihistamines for atopic dermatitis
● Naloxone (Narcan): reversal for opioids
Vaccinations:
● Hib vaccine: protect against bacterial meningitis; 2,4,6 and 12 months
● DTap vaccine: 2, 4, 6, 18 months
● Pneumococcal conjugate vaccine-PCV13: 2, 4, 6, 12 months for bacterial meningitis
● Meningococcal polysaccharide vaccine-Menactra: 11-12 and 16 years for bacterial
meningitis
NEW CONTENT
Neuro lecture - 19 questions
1. Describe the methods of assessing the neurologic function of a pediatric patient,
including use of the Glascow Coma Scale 3 questions
● Earliest indicator of change in neuro status
○ Earliest indicator: change in LOC
○ Changes in HR and BP more important than the directions
○ Heart rate and BP and temperature: variable
■ Hypotension decreases cerebral blood flow (less pressure)
■ Hypertension increases cerebral blood flow. (more pressure)
○ Respirations: altered
○ Cushing Triad - VERY late sign in peds → high BP, low HR/RR
○ Pupils
■ Beware of fixed and dilated pupils as this can occur with use of drugs that
dilate the pupil, called mydriatic drugs. For example, it can be used in
bradycardia or exposure to nerve agents. So don’t just assume!
○ Fontanels
■ What happens to the fontanels? They bulge
■ But when else would they bulge? When the infant is crying!
■ Pushed out fontanel→ increased ICP (pushed in would be dehydration)
● Terms used in assessment of neuro status
, ○ Forgetful = Confusion
○ Drowsy = Lethargy
○ Arousable by stimulation = Obtunded, extreme drowsiness
○ Arousable by vigorous stimulation = Stuporous, moans & groans
○ Cannot arouse = Coma
○ Ways to remember the difference between obtunded and stuporous
■ O comes before S
■ Or S is for severe
● How to use the Glasgow Coma Scale
○ Will be provided on exam, intubate if score 8 or less, even dead score is 3
● Indicators for Cushing’s reflex
○ VERY late sign in pediatrics: Increased BP, Decreased HR, irregular breathing
2. Illustrate the effects and management of increased intracranial pressure in the
pediatric patient 5 questions
● What would you assess for in a patient with suspected increased ICP
○ CPP = MAP - ICP
○ CPP (Cerebral perfusion pressure) is the pressure needed to ensure that
adequate oxygen and nutrients are delivered to the brain. It is the difference
between the pressure of blood going to the brain (MAP) and the back pressure to
this flow or the ICP.
○ MAP (Mean arterial pressure) is the average blood pressure during one cardiac
cycle.
○ ICP (Intracranial pressure) is the force exerted by the three contents (CSF, blood
and tissue) on the brain.
○ Increased ICP will increase MAP
■ 50=60 (-10, normal)
■ 35=60 (-25, increased ICP)
■ 40=40 (due to decreased BP, -10)
■ 80=90 (due to increased BP, -10)
■ So as ICP increases, CPP decreases or as BP decreases, CPP
decreases. This will causes decreased blood flow in the brain.
○ Adults ICP < 20 and MAP > 60 to 80
○ Children CPP is 40 to 60
○ Normal ICP for Peds is 10 to 15
○ Peds MAP should be >50
○ Subdural hematoma: venous
○ Epidural hematoma: arterial (worst kind)
○ Symptoms of ICP
■ Drowsiness
■ increased sleeping
■ High-pitched cry
■ Increased fronto occipital circumference (up to school age, see slide re
head 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
○ S/S In Infants
■ Tense, bulging fontanel
■ Separated cranial sutures
■ MacEwen (cracked-pot) sign
● The sutures have separated, causing the cracked pot sound when
the skull is tapped- sutures are very soft and will stay open
■ Sunset eyes
● eyes appearing driven downward. The lower portion of the pupil
may be covered by the lower eyelid, and sclera may be seen
between the upper eyelid and the iris. Our textbook says this is a
late and severe sign
○ Older children
■ Nausea
■ Diplopia, blurred vision
■ Decline in school performance
■ Headache
■ Herniation through foramen magnum >12 years
○ Late signs in all ages
■ Bradycardia, decreased motor and sensory response, change in pupils,
extension and flexion posturing, cheyne-stokes respirations, papilledema,
decreased LOC, coma
● What interventions would be done for a patient with increased ICP consider the
age of the patient
○ Recognize it ASAP
○ We need to stabilize cardiopulmonary status by maintaining adequate ventilation
and blood pressure. What is this? ABCs! If we can, resolve the cause
○ Oxygenate: Intubate and ventilate
■ Intubate if GCS less than 8
○ IV fluids-it is a balance, To help with blood pressure
■ Use isotonic fluids
● Hypotonic fluids causes cerebral edema
○ Drugs (listed in next bullet point)
○ Extra Extraventricular drain
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