Percussing the head by the nurse to hear crackpot sound is to detect the

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2022

Explanation

Macewen sign is also known as the 'cracked-pot' sign.
It is elicited by percussing the skull, which produces a resonant sound if the sign is positive.
The sound indicates separation of the cranial sutures, which is a finding associated with increased intracranial pressure (ICP).
This sign is most commonly observed in infants with hydrocephalus, as their cranial sutures have not yet fused.

Option A: Kernig sign is a test for meningeal irritation, not increased intracranial pressure detected by percussion. It involves pain on knee extension when the hip is flexed.
Option B: Brudzinski sign is also a test for meningeal irritation. It involves involuntary hip and knee flexion when the neck is passively flexed.
Option C: Scarf sign is part of a neonatal assessment to determine neuromuscular maturity and muscle tone. It does not assess for intracranial pathology.

Clinical Relevance

Nursing practice connection: Knowing Clinical signs for pediatric neurological assessment helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Early recognition of signs of increased intracranial pressure (ICP) in infants, such as the Macewen sign, is critical for timely intervention to prevent brain injury and long-term neurological deficits.
Nurses play a vital role in monitoring head circumference, fontanelle tension, and performing neurological checks in at-risk infants.
What if? If the patient were an adult with a closed skull, the Macewen sign would not be present because the sutures are fused. In an adult, other signs of increased ICP, such as severe headache, papilledema, Cushing's triad (hypertension, bradycardia, irregular respirations), and changes in consciousness, would be the primary indicators.

How to Approach the Question

First, identify the key actions and findings described in the question stem: the action is 'percussing the head,' and the finding is a 'crackpot sound.'
Next, consider the context. Percussing a head to check for separated sutures is a procedure typically done on an infant whose skull bones have not yet fused.
Review the definitions of the four signs provided as options.
Match the specific action (percussion) and finding ('cracked-pot' sound) to the correct clinical sign. Macewen sign is the only option that involves skull percussion to detect increased pressure.
Differentiate this from the other options by recalling that Kernig and Brudzinski signs test for meningeal irritation (meningitis) through limb and neck manipulation, and the Scarf sign assesses neonatal muscle tone.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1386-1388, 1568-1570

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