neurological disorders in the pediatric patient presented by marlene meador rn. msn, cne
DESCRIPTION
Neurological Assessment: LOC & behavior Vital Signs and respiratory status Eyes Reflexes and motor function Cranial nerve function (p 842 table 33-4) page 1467 discuses Modified Glasgow Coma Scale for ages 3 and younger ( p 1469, table 52-1)TRANSCRIPT
Neurological Disorders in the Pediatric Patient
Presented by Marlene Meador RN. MSN,
CNE
Review of CNS of the Pediatric Patient Head to torso ratio Cranial bones- thin, pliable, suture lines not
fused Brain vascularity and small subarachnoid
space Excessive spinal mobility Wedge shaped cartilaginous vertebral
bodies
Neurological Assessment: LOC & behavior Vital Signs and respiratory status Eyes Reflexes and motor function Cranial nerve function (p 842 table 33-4)
page 1467 discuses Modified Glasgow Coma Scale for ages 3 and younger ( p 1469, table 52-1)
Increased Intracranial Pressure- IICP or ICP (p 1468, Box 52-1)Infants Irritability &
restlessness Fontanelles / FOC Poor
feeding/sucking Skull & scalp veins Nucal rigidity,
seizures (late signs)
Children Headache Vomiting Irritable, lethargic, mood
swings Ataxia, spasticity Nucal rigidity Deterioration in
cognitive ability Vital sign changes
Priority nursing diagnosis for a child with IICP? What assessment findings should
the nurse monitor?
What emergency equipment should the nurse have on hand at all times for a child with IICP?
Nursing interventions: What diagnostic procedures would
the nurse anticipate for this child? What priority interventions must
the nurse include with respect to these diagnostic procedures? What specific teaching is required? What additional lab/serum tests
would you anticipate?
Medications used to treat IICP:
Corticosteroids Anti-inflammatory Contraindications-
acute infections Monitor I&O Protect from infection Add K+ foods Discontinue gradually
Osmotic diuretic
Reduce fluid Contraindications-
intracranial bleeding Monitor I&O carefully Monitor electrolytes Teaching
Quick Review: Priority nursing interventions/ rationale What equipment is essential? Vital signs & neuro signs Additional assessment findings Activity level Hydration status Positioning Parent teaching
International Classification of Seizures ( p 1489 Box 52-5) Febrile- rapid temp rise above 39°C (102°F) Generalized- loss of consciousness,
involves both cerebral hemispheres onset at any age
Tonic/Clonic- impaired consciousness, abnormal motor activity, posturing, automatisms
Absence- may confuse with daydreaming or inattentiveness
Nursing Interventions: Assessment findings Priority interventions
Prevention During seizure Following seizure
p 1490 Nursing Care Plan
Medications used to control seizures in children
Phenobarbital- CNS depressant- monitor: sedation, VS, serum levels, Teach- S&S of toxicity, no ETOH, adhere to
regime Carbamazepine- sedative/anticonvulsant
hold med if lab values = Teach- S&S of toxicity
Phenytoin- anticonvulsant Safety measures- on-hand equipment Teach- oral care, sun exposure
Quick Review: What is most important nursing
intervention when a child is experiencing a seizure?
What is most important teaching regarding seizure medication?
Meningitis: Why does bacterial meningitis
present more of a risk than viral meningitis?
(p. 1494)
How do the manifestations of meningitis differ between infants and young children (p. 1494)
Meningitis: Infant
Fever (not always present) Poor feeding
Vomiting Irritability Seizures
High-pitched cry
Child/Adolescent Fever
Headache Photophobia
Nuchal rigidity Altered LOC
Anorexia/ vomiting Diarrhea
Drowsiness
Lumbar Puncture- nursing interventions
What findings differentiate between bacterial and viral meningitis?
What specific interventions does the nurse include for this procedure? Monitor VS & neuro VS LOC Teaching
Nursing Care & Medications for treatment of meningitis:
Ceftriaxone Sodium (Rocephin®)- who must receive this medication?
Cefatoxime Sodium (Claforan ®)- Dexamethasone- special nursing
care Antipyretics
Clinical Judgment:
What intervention must the nurse initiate to protect the patients and staff when a diagnosis of bacterial meningitis is suspected?
Hydrocephalus: What priority nursing assessment of
a newborn monitors for this condition?
What assessment findings occur in the older child?
What diagnostic measures confirm this diagnosis?
Diagnostic of Hydrocephaly:
LP-dangerous MRI; CT scan Skull X-ray Measure FOC Provide for safety, informed consent, support
for child and family, accurate H&P
(added 2010)
Correction of Hydrocephaly:
Shunt placement- surgical procedure to place a tube that drains CSF into the atrioventricular or peritoneal cavity.
Atrioventricular- drains into atrium (not used as frequently)
Ventricular peritoneal- drains into the peritoneal cavity
Nursing Care: Pre Operatively:
Baseline VS, monitor for IICP, What teaching/interventions for
parents? Post-op:
Monitor shunt function (how?) Positioning and activity VS, neuro VS & I&O Teaching
Long-term Nursing care for the child with hydrocephaly Home care needs S&S of IICP S&S of infection S&S of seizures Emergency numbers of
Pediatrician & neurosurgeon Refer to home care, social services
and support groups
Spina Bifida: (see p 1470) What common nutritional supplement is
encouraged for all women of childbearing age? Discuss the 6 types of neural tube defects:
AnecephalyEncephaloceleSpina bifida occultMeningoceleMeningomyelocele
Priority nursing diagnosis and interventions: At risk for infection-
Protect Position
At risk for injury- Protect Position
Pre/post-op nursing goals: what interventions should receive highest priority? Prevent infection- monitor VS, incision
care Monitor for IICP- Parent/child interaction- Prevent muscle wasting- Long-term care- latex allergies,
urinary cath,
Nursing care of the child with Cerebral palsy: (p.1477) Assessment (historical) data- Lab findings- Priority goal- (p 1480-early detection) Priority complication- “at risk for” Long-term complications Additional support to include in
care
Head Injuries in the Pediatric Client
Anatomy predisposes infant/young to injury
Pathophysiology of “Shaken Baby Syndrome”
Nursing care of child experiencing a closed head injury: (p 1483) Assessment findings- Immediate nursing interventions- Legal implications
Why is it not prudent for the nurse to discuss suspicions of abuse with the parents or primary caregiver?
Pervasive Developmental Disorders / Autism (p. 1549)
Home Setting Reduce environmental
stimuli Communicate via age-
appropriate touch & verbalization
Keep toys or other items out of reach if child uses them for harmful self-stimuli
Ritualistic ADLs Encourage therapists &
support groups
Acute Care Setting Keep at least 1 constant
caregiver. Encourage parents to stay with,keep room quiet & limit number of staff
Anxiety/aggression when touched by strangers
Constant monitoring by nurse or parents
Allow to maintain rituals of ADLs
Encourage therapists & support groups
Down’s Syndrome (chromosomal anomaly associated with Trisomy 21)(p 1543)
Nursing assessment findings: Facial (forehead, eyes, nose, tongue,) Ears Neck Hands & feet Abdomen
If the nurse visualizes any of the outward signs of Down’s syndrome, what is the next immediate priority nursing assessment?
Health Promotion How does the nurse promote health of the
child with Down’s syndrome? Initial assessment of newborn Parental perception (focus on the positive)
{why is blame-laying a concern? Across cultures…}
Initiate long-term assistance Speech Occupational Nutritional Financial assistance