Neurological Disorders in the Pediatric Patient

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Neurological Disorders in the Pediatric Patient

• Presented by
• Marlene Meador RN. MSN, CNE

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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

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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)

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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

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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?

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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?

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Medications used to treat IICP

• Corticosteroids
• Anti-inflammatory
• Contraindications-acute infections
• Monitor IO
• Protect from infection
• Add K foods
• Discontinue gradually

• Osmotic diuretic
• Reduce fluid
• Contraindications- intracranial bleeding
• Monitor IO carefully
• Monitor electrolytes
• Teaching

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Quick Review Priority nursing interventions/
rationale

• What equipment is essential?
• Vital signs neuro signs
• Additional assessment findings
• Activity level
• Hydration status
• Positioning
• Parent teaching

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International Classification of Seizures ( p
1489 Box 52-5)

• Febrile- rapid temp rise above 39C (102F)
• 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

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Nursing Interventions

• Assessment findings
• Priority interventions
• Prevention
• During seizure
• Following seizure
• p 1490 Nursing Care Plan

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Medications used to control seizures in children

• Phenobarbital- CNS depressant- monitor sedation,
  VS, serum levels,
• Teach- SS of toxicity, no ETOH, adhere to
  regime
• Carbamazepine- sedative/anticonvulsant
• hold med if lab values
• Teach- SS of toxicity
• Phenytoin- anticonvulsant
• Safety measures- on-hand equipment
• Teach- oral care, sun exposure

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Quick Review

• What is most important nursing intervention when
  a child is experiencing a seizure?
• What is most important teaching regarding seizure
  medication?

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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)

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Meningitis

• Infant

• Child/Adolescent

• Fever (not always present)
• Poor feeding
• Vomiting
• Irritability
• Seizures
• High-pitched cry

• Fever
• Headache
• Photophobia
• Nuchal rigidity
• Altered LOC
• Anorexia/ vomiting
• Diarrhea
• Drowsiness

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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

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Nursing Care Medications for treatment of
meningitis

• Ceftriaxone Sodium (Rocephin)- who must receive
  this medication?
• Cefatoxime Sodium (Claforan )-
• Dexamethasone- special nursing care
• Antipyretics

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Clinical Judgment

• What intervention must the nurse initiate to
  protect the patients and staff when a diagnosis
  of bacterial meningitis is suspected?

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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?

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Diagnostic of Hydrocephaly

• LP-dangerous
• MRI CT scan
• Skull X-ray
• Measure FOC
• Provide for safety, informed consent, support for
  child and family, accurate HP
• (added 2010)

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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

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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 IO
• Teaching

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Long-term Nursing care for the child with
hydrocephaly

• Home care needs
• SS of IICP
• SS of infection
• SS of seizures
• Emergency numbers of Pediatrician neurosurgeon
• Refer to home care, social services and support
  groups

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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
• Anecephaly
• Encephalocele
• Spina bifida occult
• Meningocele
• Meningomyelocele

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Priority nursing diagnosis and interventions

• At risk for infection-
• Protect
• Position
• At risk for injury-
• Protect
• Position

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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,

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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

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Head Injuries in the Pediatric Client

• Anatomy predisposes infant/young to injury
• Pathophysiology of Shaken Baby Syndrome

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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?

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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

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Downs 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 Downs syndrome, what is the next immediate
  priority nursing assessment?

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Health Promotion

• How does the nurse promote health of the child
  with Downs 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

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For questions or concerns

• Contact Marlene Meador RN, MSN, CNE
• Email mmeador_at_austincc.edu