A nurse is caring for four patients in the pediatric intensive ...

[Lisaclaire]

A nurse is caring for four patients in the pediatric intensive care unit with head injuries or brain infections. Which child should the nurse see first?
 
  A.
  Blood pressure change from 110/58 to 134/40 mm Hg in a child with brain injury
  B.
  Child with brain injury who has vomited twice in 12 hours, now sleeping
  C.
  Child with meningitis who is irritable, complaining of a bad headache
  D.
  Oral temperature of 100.4 F (38 C) in a child with meningitis

Question 2

A student nurse is confused about the Monroe-Kelly doctrine. How does the registered nurse explain it to the student?
 
  A.
  Compensation for an increase in one of the skull's components
  B.
  Hypothesis about the length of a coma determining the outcome
  C.
  Immunomodulatory theory of an inborn resistance to rabies
  D.
  Theory that seizures change the neurons and provoke more seizures

[Chou]

Answer to Question 1

ANS: A
Hypertension (with widening pulse pressure), bradycardia, and changes in respiratory pattern are components of Cushing's triad, a late sign of increased intracranial pressure, indicative of impending herniation. The change in the child's blood pressure, including the widened pulse pressure (difference between systolic and diastolic pressures), is worrisome. A child with a head injury and minimal vomiting is not alarming. A child with a brain infection who is irritable with a headache needs attention, but not over the child with possible herniation. An oral temperature of 100 F would be expected in a child with a brain infection.

Answer to Question 2

ANS: A
The brain consists of three components: brain matter, cerebral spinal fluid (CSF), and blood. Because the skull is a hard vault (after fontanels have closed), an increase in one of the components is not tolerated. The Monroe-Kelly doctrine states that in order to compensate for an increase in one of the components, there must be an equitable decrease in the other two components in order to prevent brain injury.

[Lisaclaire]

Thanks for the timely response, appreciate it

[amcvicar]

YES! Correct, THANKS for helping me on my review