Neurological Disorders in the Pediatric Patient Presented by Marlene Meador RN. MSN, CNE

Neurological Assessment: LOC & behavior Vital Signs and respiratory status Eyes Reflexes and motor function Cranial nerve function (p. 1673) Page 1672 discuses Modified Glasgow Coma Scale for ages 3 and younger

Increased Intracranial Pressure- IICP or ICP 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

Seizures ( p ) Febrile- rapid temp rise above 39°C (102°F) Focal- impaired consciousness, abnormal motor activity, posturing, automatisms Generalized- loss of consciousness, muscles rigid, rhythmic jerking Absence- may confuse with daydreaming or inattentiveness

Nursing Interventions: Assessment findings Priority interventions Prevention During seizure Following seizure

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 _____ 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. 1682) How do the manifestations of meningitis differ between infants and young children (p. 1682)

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

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?

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. 1697) 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 Spina bifidacystica Meningocele Meningomyelocele

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

Nursing care of the child with Cerebral palsy: (p.1702) Assessment (historical) data- Lab findings- Priority goal 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 ) 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. 1732) 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) 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 concerns Contact Marlene Meador RN, MSN, CNE