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