Copyright © 2012 Delmar Cengage Learning. All rights reserved. CHAPTER 32 Neurological Alterations

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Anatomy and Physiology  Head  Cerebral spinal fluid  Intracranial pressure  Spinal column and cord 32-2

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Differences Between Children and Adults  Clinical manifestations of altered neurological function o Alert, verbal stimulus, painful stimuli, unresponsiveness o Glasgow Coma Scale o Decorticate posturing o Decerebrate posturing 32-3 (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Differences Between Children and Adults (continued)  Diagnostics o CAT scan o MRI o Skull X-rays o Angiogram o EEG 32-4

Copyright © 2012 Delmar Cengage Learning. All rights reserved. General Nursing Issues  ABCs (airway, breathing, circulation)  Loss of consciousness  Motor response  Sensory  Reflexes  Physical abilities 32-5

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Seizures  Incidence and etiology o Febrile seizures o Unprovoked first seizure o Epileptic seizures  Pathophysiology o Status epilepticus o Refractory seizures o Epilepsy 32-6 (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Seizures (continued)  Clinical manifestations o Partial seizures Simple partial seizures Complex partial seizures 32-7 (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Seizures (continued) o Generalized seizures Tonic/clonic seizures Absence seizures Myoclonic seizures Atonic or astatic-akinetic seizures Akinetic seizures o Diagnosis and treatment o Nursing management and family treatment 32-8

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Hydrocephalus  Etiology and pathophysiology o Communicating hydrocephalus o Noncommunicating hydrocephalus o Clinical manifestations  Diagnosis  Treatment  Nursing management and family teaching 32-9

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Neural Tube Defects  Incidence and etiology  Pathophysiology 32-10

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Spina Bifida  Clinical manifestations o Anencephaly o Cranioschisis o Exancephaly o Encephalocele o Spina bifida occulta o Rachischisis o Spina bifida cystica Meningocele Meningomyelocele (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Spina Bifida (continued)  Diagnosis  Treatment  Nursing management and family teaching 32-12

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Craniosynostosis  Incidence and etiology  Pathophysiology  Clinical manifestations and diagnosis  Treatment  Nursing management 32-13

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Structural Abnormalities: Arteriovenous Malformation  Incidence  Etiology and pathophysiology  Clinical manifestations  Diagnosis  Treatment  Nursing management 32-14

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Bacterial Meningitis  Incidence and etiology  Pathophysiology  Risk factors  Clinical manifestations o Infants may have subtle symptoms o Child over 2 may have GI upset and cold-like prodromal signs o Hyper-reactive reflexes o Kernig’s sign o Brudzinski sign (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Bacterial Meningitis (continued)  Diagnosis  Treatment  Nursing management and family teaching 32-16

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Viral (Aseptic) Meningitis  Incidence and etiology  Pathophysiology  Clinical manifestations o Not as ill as with bacterial meningitis o Gradual or abrupt onset o General malaise and myalgia o Kernig’s sign and Brudzinski sign may be present (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Viral (Aseptic) Meningitis (continued)  Diagnosis  Treatment  Nursing management  Family teaching 32-18

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Reye’s Syndrome  Incidence and etiology  Pathophysiology  Clinical manifestations o Initially mild symptoms of viral infection o Signs of recovery may be present o 24–48 hours later child worsens o Neurological symptoms develop  Diagnosis and treatment  Nursing management and family teaching 32-19

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Infections: Encephalitis  Incidence and etiology  Pathophysiology  Clinical manifestations o Acute onset o Neurological symptoms  Diagnosis and treatment  Nursing management and family teaching 32-20

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Neurological Injury: Head Trauma  Incidence and etiology  Pathophysiology o Age-related risks o Cerebral edema o Malignant brain edema  Clinical manifestations: Vary with type of injury (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved.  Diagnosis o History of trauma o Past medical history o Observation o Assessment o Evaluation  Treatment  Nursing management and family teaching Neurological Injury: Head Trauma (continued)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Neurological Injury: Spinal Cord Injury  Incidence and etiology  Pathophysiology  Clinical manifestations o Depend on whether concurrent injuries are present o Depend on level of trauma o Depend on whether the lesion is complete or incomplete o Neurogenic and spinal shock (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Neurological Injury: Spinal Cord Injury (continued)  Diagnosis and treatment  Nursing management and family teaching 32-24

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Neurological Injury: Drowning  Incidence and etiology  Pathophysiology o Wet drowning o Dry drowning  Clinical manifestations  Diagnosis  Treatment  Nursing management  Family teaching 32-25

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Cerebral Palsy  Incidence and etiology  Pathophysiology  Clinical manifestations o Hypotonic o Hypertonic o Athetosis o Ataxia o Hemiplegia o Diplegia o Quadriplegia (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Cerebral Palsy (continued)  Diagnosis and treatment  Nursing management  Family teaching 32-27

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Headaches  Incidence and etiology  Pathophysiology  Clinical manifestations o Migraine headaches o Cluster headaches o Tension headaches (continues)

Copyright © 2012 Delmar Cengage Learning. All rights reserved. Headaches (continued)  Diagnosis  Treatment  Nursing management  Family teaching 32-29