Question

In: Nursing

The nurse is assigned to care for a child with a brain injury who has a...

The nurse is assigned to care for a child with a brain injury who has a temporal lobe herniation and increasing intracranial pressure. Which signs should the nurse identify as indicative of this type of injury? Select all that apply.

1. Flaccid paralysis

2. Pupil response to light

3. Ipsilateral pupil dilation

4. Compression of the sixth cranial nerve

5. Shifting of the temporal lobe laterally across the tentorial notch

Expert Solution

The nurse assigned to care for the child with a brain injury who has a temporal lobe herniation and increasing intracranial pressure should identify the following signs as indicative of this type of injury.

2. PUPIL RESPONSE TO LIGHT:

In normal conditions the pupils dilate when the light is dim and constrict when there is enough light rays that enter the eye which is contolled by the occulomotor nerve. Here the child have a brain injury with increased intracranial pressure and temporal lobe herniation which puts pressure on the brain stem. This eventually compresses the occulomotor nerve ( IIIrd cranial nerve ) resulting in dilatation of the pupil most commonly in the affected side.

3. IPSILATERAL PUPIL DILATION :

Ipsilateral pupil means, pupil of the affecyed side. This is one of the hallmark signs. Because of the compression of the occulomotor nerve the ipsilateral pupil fails to constrict and hence remain ditated . This can be assessed by checking the pupillary light reflex or reaction (pupil remains dilated here.)

5. SHIFTING OF THE TEMPORAL LOBE LATERALLY ACROSS THE TENTORIAL NOTCH:

This can be evident by the ipsilateral pupillary dilatation due to the compression of the occulomotor nerve which happens only when the temporal lobe shifts tentorial notch thus putting pressure over the brain stem.

Why others are not a sign of the injury:

1.FLACCID PARALYSIS:

Paralysis means weakness or loss of control over the mucles in any part of the body which is not common in this condition. However if there is compression of the ipsilateral cerebral peduncle can result in contralateral hemiparesis ( weakness on one entire side of the body).

4. COMPRESSION OF THE SIXTH CRANIAL NERVE :

The function of the sixth cranial nerve- ABDUCENS NERVE is to send signal to the lateral rectus muscle of the eye which the helps in movement of eyes away from the nose (outward). However in the child's case the pressure exerted on the brain stem compresses only the occulomotor nerve(IIIrd cranial nerve) while the other two nerves namely - trochlear (IVth cranial nerve) and abducens ( VIth cranial nerve ) remains intact

Nightingale answered 2 years ago

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