Pathophysiology
Intaventricular hemorrhage (IVH) is bleeding in the fragile capillaries that develop in the early months of prenatal development and grow stronger the last ten months of a pregnancy. There are four different degrees based on the bleeding and the areas that are damaged. Preterm infants are at a greater risk for bleeding during events that may cause fluctuations in cerebral blood flow because their blood vessels are not yet fully developed. When IVH occurs, the blood may rupture through the ependymal lining of the ventricles and fill the ventricular system. If it is a severe case, the bleeding may extend into the cerebral parenchyma network.
Bleeding in this area may lead to cycstic lesions that are a significant risk factor
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for developing cerebral palsy. Once the bleeding has ceased, the baby is at risk for obstruction of the passages between the ventricles from clots and other debris. This can lead to the development of hydrocephalus. Some of the risk factors of IVH include: birth asphyxia, early gestational age, low birth weight, respiratory distress, asynchronous breathing on ventilator therapy, pneumothorax, low blood glucose, hypercarbia, coagulation and platelet disorders, and hypotension. Associated problems and the prognosis are determined by the amount of posthemorrhagic hydrocephalus and the damage to the periventricular white matter of the brain. Clinical Manifestations About 50% of all IVHs occur on the first postnatal day of life, 25% on the second, 15% on the third, and 10% on or after the fourth. The most common general symptoms are apnea, change in blood pressure, change in heart rate, decreased muscle tone, decreased reflexes, excessive sleep, lethargy, a weak suck, and seizures. There are three categories of manifestations for IVH. The first is catastrophic deterioration. This begins within minutes of the insult and the baby will be in a coma or deep stupor. They will have respiratory abnormalities such as apnea or hypoventilation, fixed pupils, decerabrate posturing, generalized tonic seizures, flaccid quadriparesis, and cardiac arrhythmias. The second category is salutatory deterioration.
This has more subtle representation and appears over several hours, may stop, and then reappear. They will have an altered level of consciousness, hypotonia, subtle abnormal eye position and movements, decreased spontaneous or abnormal movements and an abnormally tight popliteal angle, and in some cases respiratory abnormalities.
The third category is clinically silent deterioration. This is often overlooked clinically with sudden unexplained decrease in hematocrit being the only sign.
Diagnosing
If the infant is at risk for IVH, or it is suspected, intracranial structure studies are done using ultrasound, computed tomography, or magnetic resonance imaging. This will be performed at bedside within 4 to 7 days if there is a suspicion of IVH.
Treatment
Treatment of IVH is primarily aimed at prevention. Factors that predispose an infant to IVH should be prevented. These include: acidosis, electrolyte imbalances, rapid fluid shifts, administration of hyperosmolar solutions, and hypotension followed by rapid volume expansion. Vitamin E, maternal vitamin K, pancuronium, ibuprofen, phenobarbital, ethamylate, magnesium sulfate, indomethacin, surfactant, and antenatal betamethasone have had varying levels of success in the prevention of
IVH. Once IVH has begun, treatment becomes supportive as well as preventative. Prompt detection is vital. Serial lumbar punctures may be used to decrease the amount of cerebral spinal fluid present and prevent posthemorrhagic hydrocephalus. They may also attach a closed reservoir to help relieve the pressure on the ventricles. When caring for an infant with an IVH, the nurse should prevent and reduce intracranial pressure by avoiding interventions that may cause crying. The infant should be in a middling, right side-lying position. The nurse should also limit the amount that the infant is handled to avoid excessive stimulation and avoid fluctuations in the cerebral blood flow. Prognosis The long-term outcome of IVH is variable and is difficult to predict. The complications are determined by the size of the hemorrhage and the area that was damaged. The infants with the smaller lesions will have the best outcomes and a better prognosis than those with larger lesions.
We can organize information regarding this case study by using the Four Topics Method beginning with the Medical Indications. Maria, a 20-year-old female, has been involved in a motor vehicle accident. She has a history of Sickle Cell disease and is currently twenty-five weeks pregnant with her first child. Initially Maria presents with somewhat stable vital signs. She displays tachypnea, and complains of severe abdominal cramping as well as weakness, light-headedness and left shoulder pain. She is neurologically intact with lung sounds that are within defined parameters. Maria’s condition changes and she begins to display signs and symptoms of internal bleeding. This is a life threatening condition. The problem is critical and can be reversed with a transfusion and surgery. The goal of transfusion would be to replace blood loss and restore vascular volume and the goal of surgery would be to repair the bleed. If the bleed is corrected in a timely manner and without complication, the probabilities of success are somewhat high. There is no plan in place to account for therapeutic failure. Medical care in this instance could not only save the life of this patient but also that of her unborn child. Further harm to Maria and her baby could be avoided if she would agree to the treatment.
“… There is a feeling of strange intoxication and shifting consciousness with minor perceptual changes. There may also be strong physical effects, including respiratory pressure, muscle tension (especially face and neck muscles), and queasiness or possible nausea… After this the state of altered consciousness begins to manifest itself…..among the possible occurences are feelings of inner tranquility, oneness with life, heightened awareness, and rapid thought flow…these effects will deepen and become more visual. Colors may become more intense. Halos and auras may appear about things. Objects
Over some period of time, affected children (patients) experience mental impairment, worsening seizures, and progressive loss of sight and motor skills. Affected patients become totally disabled and eventually die.
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
The characteristic symptoms start between the age of 18 and 30. Symptoms include hallucinations and/or delusions. Hallucinations can have various modes. Auditory hallucinations are the most common. These may involve hearing a voice or voices talking to each other and/or to the patient. Visual hallucinations are less common and involve the patient believing they see an object that is not present. Tactile hallucinations are the least common and involve the patient thinking that someone or something is touching them (Nienhuis).
Visual Hallucinations: Differential Diagnosis and Treatment. N. p. : Physicians Postgraduate Press, Inc., 2009. PDF. The. Patrick, Christopher J., Don C. Fowles, and Robert F. Krueger. "
Being such, this disease can show small signs such as tingling in the fingertips, arms, and legs, temporary vision loss or red/ green discoloration, double vision, dizziness, and clumsiness. Sometimes the disease can skip the small beginner signs and show larger symptoms that are harder to dismiss such as, onset depression, inability to multitask, incapability to regulate bladder, fatigue mentally or physically, muscle spasms, and the inability to control one’s bladder. Signs and symptoms can occur over the course of one to ten days, and then disappear; this is known as an attack or
The diagnosis of epilepsy is usually made after the patient experiences a second unprovoked seizure (Leppik, 2002). Diagnosis is often difficult, however, since it is unlikely that the physician will actually see the patient experience and epileptic seizure, and therefore must rely heavily on patient’s history. An electroencephalography (EEG) is often used to examine the patient’s brain waves, and some forms of epilepsy can be revealed by a characteristic disturbance in electrical frequency (Bassick, 1993). The variations in frequency can take form as spikes or sharp waves (Fisher, 1995). The variations are divided into two groups, ictal electrograph abnormalities, which are disturbances resulting from seizure activity, and interictal electrograph abnormalities, or disturbances between seizures. The EEG can also give clues as to which region of the brain the disturbances arise from. Interictal temporal spikes will predict the side of seizure origin in 95% of patients if three times as ...
Further, the sufferer experiences frequent hallucinations, becomes paranoid, and suspicious. In other cases, the individual becomes unable to sleep and has difficulties communicating coupled with rapid mood swings.
... (1) sleep attacks; (2) cataplexy-sudden loss of muscle tone; (3) sleep paralysis; & (4) auditory, visual, or tactile hallucinations.
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
“Ibuprofen lysine is contraindicated in neonates with congenital heart disease when patency of the ductus arteriosus is necessary for adequate pulmonary or systemic blood flow (e.g., neonates with pulmonary atresia, severe tetralogy of Fallot, or severe coarctation of the aorta).”
Characterization of the syndrome often includes staring spells, and unawareness from the young person diagnosed. The eyes tend to roll up briefly or flutter, some experience unintended automatisms, although these spells last from 10 to 45 seconds each, the person usually resumes their normal activity and often has no recollection of the episode. Episodes can occur from 1 to 100 times a day, which makes people with JAE at a greater risk of developing nonconclusive status epilepticus. The differences with this development are significant, and can leave the person with seizures that can last from minutes to hours, along with confusion, irregular responses, and potentially difficulty walking. About ¾ of people with JAE also have generalized tonic-clonic seizures with body jerking and stiffening, which can occur before absence seizures or upon waking, lasting from seconds to minutes. Despite the many episodes and difficulties that come with them, including learning difficulties for children with frequent episodes, people with JAE usually develop normally. 1/3 of children have attention, memory, and concentration problems, although, learning problems often improve after treatment
#1 If you haven’t yet been diagnosed you may experience any of the following :