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

For questions or concernsContact Marlene Meador RN, MSN,

CNE

Email: mmeador@austincc.edu