Chapter 23

The Child with a Sensory or The Child with a Sensory or Neurological ConditionNeurological Condition

DISORDERS AND DYSFUNCTION OF THE EAR

• OTITIS EXTERNA- swimmers earProlonged exposure to moisturePain – pinna and or tragusErythema of the ear canal – tympanic

membrane is normalTopical antibiotics – antivirals

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EAR (cont’d)

• OTITIS MEDIA- inflammation of the middle ear• Organs of hearing and balance- guarded by tympanic

membrane/ eardrum • opens into sinuses and also connects to throat via eustachian

tube- linings are mucus membranes so infections can easily spread from throat-sinuses to middle ear

• Eustachian tube in the infant is shorter, straighter and wider which allows fluids to pool and harbor bacteria

• Manifestations: fever, headache, vomiting diarrhea, irritability, rubbing/pulling on ear

• Tympanic membrane will appear reddened and bulging

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TREATMENT

• ID CAUSITIVE ORGANISM IF POSSIBLE(CX)• BROAD SPECTRUM ANTIBIOTICS• ANALGESICS

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Cont’d

PERFORATED EARDRUM MAY OCCUR• Ruptures ear drum – Lie on affected side apply cool compress

• IF PRONE TO MEI”s: surgical intervention may be an option• Surgery

– Myringotomy with or without tubes (fall out)– Allows ventilation reduce pressure build up– Avoid water in ear– Follow up with hearing tests

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Dyslexia

• Reading disability– Involves a defect in the cortex of the brain that

processes graphic symbols

• Treatment involves remedial instruction

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Hyphema• Presence of blood in

the anterior chamber of the eye

• One of the most common ocular injuries

• Appears as a bright-red or dark-red spot in front of the lower portion of the iris

• Treatment– Bedrest with HOB

elevated 30 to 45 degrees

– Topical medications may also be prescribed

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Reye’s SyndromeReye’s Syndrome

• Acute noninflammatory encephalopathy (pathology of brain)and hepatopathy (liver) that follows a viral infection in children

• May be a relationship between the use of aspirin during a viral flu or illness

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Reye’s Syndrome Reye’s Syndrome (cont.)(cont.)

• Manifestations– Ammonia accumulates

in the blood– In children, sudden

onset -effortless vomiting and altered behavior, or ALOC after a viral illness, are characteristic of Reye’s syndrome

• Treatment– If early, can result in

complete recovery– Goals are

• Reducing ICP• Maintaining a patent airway• Cerebral oxygenation• Fluid and electrolyte balance

– Observe for signs of bleeding due to liver dysfunction

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Brain TumorsBrain Tumors

• Second most common type of neoplasm in children• Most occur in lower part of the brain(cerebellum and

brain stem) and commonly in school-age children• Diagnosis is made by clinical presentation, laboratory

tests, head CT or MRI, EEG• Surgical intervention in some cases, chemotherapy

and/or radiation therapy in others• Children c/o headaches in morning, vomiting,

drowsiness and seizures.

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Seizure DisordersSeizure Disorders

• Most commonly observed neurological dysfunction in children

• Sudden, intermittent episodes of ALOC that last seconds to minutes and may include involuntary tonic and clonic movements

• Abscence – staring into space for short period of time (pg 545)

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Causes of Seizures in ChildrenCauses of Seizures in Children

• Intracranial– Epilepsy

– Congenital anomaly

– Birth injury

– Infection

– Trauma

• Extracranial– Fever (Febrile)

– Heart disease

– Metabolic disorders

– Hypoglycemia

– Dehydration and malnutrition

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Safety Alert Safety Alert

• The nurse is responsible for maintaining seizure precautions– Keep side rails up– Pad all sharp or hard objects around the bed– Make sure child wears a medical ID bracelet– Avoid triggering factors– Teach the importance of compliance with the

medication regimen– Last longer than 5 mins in school setting- call

911

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Cerebral Palsy (CP)

• A group of motor disorders caused by dysfunction of various motor centers in the brain

• Contributing factors – could be related to prematurity, hypoglycemia, hyerbilirubinemia, encephalitis, meningitis, shaken baby syndrome, prenatal brain abnormality

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Cerebral Palsy (CP) Cerebral Palsy (CP) (cont.)(cont.)

• Manifestations– May range from mild to severe– Mental retardation sometimes seen

• Suspected during infancy if – There are feeding problems – Convulsions not associated with high fevers– Developmental milestones are not being

achieved at expected age level– Persistence of Moro and tonic neck reflexes

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TYPES OF CEREBRAL PALSY

• SPASTIC• ATHETOID• ATAXIC• MIXED

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Treatment of CPTreatment of CP

• Specific treatment is highly individualized– Good skin care is essential– All precautions taken to prevent contractures

• Braces are often used to treat these• Orthopedic surgery is sometimes indicated• Medications as ordered

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Definition of Mental Retardation Definition of Mental Retardation • The American

Association on Mental Retardation (AAMR): – Mild or severe – IQ below 75

• Numerous test to measure intelligence– Stanford-Binet– All tests have

limitations

• Limitations in at least 2 of the following– Communication– Self-care– Home living– Social skills– Self-direction

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Some Causes of Cognitive Impairment

• Neonatal period– PKU– Hypothyroidism– Fetal alcohol syndrome– Down syndrome– Malformations of the brain– Maternal infections

• Birth injuries or anoxia during or shortly after delivery

• Heredity

• During childhood– Meningitis– Lead poisoning– Neoplasms– Encephalitis– Living in a physically

or emotionally deprived environment

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Head Injuries

• Major cause of death in children older than 1 year of age

• A concussion is a temporary disturbance of the brain that is usually followed by a period of unconsciousness

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Complications of Head InjuriesComplications of Head Injuries

• Hypoxia, increased ICP, cerebral edema, and infection can occur within a few days of a head injury

• Infants – bulging fontanels and high pitch cry

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Neurological Monitoring of Infants Neurological Monitoring of Infants and Childrenand Children

• Pain stimuli response• LOC• Arousal awareness• Motor response

• Pupil response of the eyes

• Bulging fontanels• Scalp vein distention• Ataxia; spasticity of

lower extremities• Moro/tonic neck with

withdrawal reflexes

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Near-Drowning• Accidental or near-drowning is the fourth leading

cause of death in children under 19 years of age• Near-drowning is defined as survival beyond 24

hours after submersion• Priorities include immediate treatment of

– Hypoxia– Aspiration– Hypothermia

• CNS injury remains the major cause of death or long-term disability

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Near-Drowning Near-Drowning (cont.)(cont.)

• Submersion for more than 10 minutes with failure to regain consciousness at the scene

OR

• Within 24 hours is an ominous sign and indicates severe neurological deficits if the child survives

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