Nursing care of child with a neurological disorder MSN.KHETAM MOH’D

Assessment History,seizure, LOC, daily tasks,headache. Past medical history infection during pregnancy V/S ( H.C, low HR,RR, change in BP ) Bulging forehead closed forehead high body temperature projectile vomiting spasticity of muscle

CSF normal finding : Opening pressure mmH2O AppearanceClear & colorless Cell count0-8 mm3 Protein15-45mg /100ml Sugar ( glucose)60%-80% Albumin /globulin ( A/G)8:1

* IN PHYSICAL EXAM : 1. Cerebral 2. cranial nerve 3. cerebellar 4. motor 5. sensory 6. reflex function

* Assessment ( in general you can found decrease in LOC) *Orientation,performance, mood,and behaviour * Child aware ( in 4 y/d for the firat and last name) 5 y/d school age know address 8 y/d complete orientation to the days and week

language * sensory and motor function 1. stereognosis ( recognize object by touch ) 2. grophesthesia ( recognize shape that has been trace first on the skin ) 3. kinesthesia ( ability to distinguish movement )

* cranial nerve function : 1. cerebellar function (balance,coordination &walking ) 2. motor function ( muscle size,strength, tone, movement, & range of motion ) 3. sensory function ( distinguish light,pain,hot,cold,when closed eye) 4. reflex testing -neonatal reflex

Diagnostic Testing A. L.P ( L4-L5 ) TO obtain CSF used local anesthesia Emla cream 1. 3 tube obtain ( 2-3 ml ) 2. after 30 min order the child to drink fluid 3. supine position after L.P 4. Assess V/S, puncture site, headache & LOC B. X-ray ( CT.skull x-ray, & MRI ) C. Electroencephalography ( EEG ) D. Echoencephalography ( Ultrasound )

meningitis ** meningitis ( child under 24 month common in winter ) assessment : 1. irritable ( seizure ) with high temperature 2. Brudzinskis & Kernig's signs +ve 3. Bulging Fontanelles 4. weak cry or lethargy

management : * 1. anti-biotic IV ( Claforan & Rocefin ) 2. Dexamethasone 3. mannitol to decrease ICP 4. respiratory percution for 24 hr 5. seizures and cognitive challenges 6. daily measurement 7. sleep without pillow 8. measure intake and output.

meningitis * cause : 1. Neisseria 2. streptococcus pneumonia 3. G-B- Streptococcus 4. Pseudomonas 5. Hemophilus influenza * complication : 1. deafness 2. Blindnesss 3. Facial paralysis 4. Hydrocephulus

Encephalitis inflammation of brain tissue cause by bacterial, virus,& fungal. * assessment : 1. headache 2. high tem 3. Ataxia 4. muscle weakness 5. confusion 6. irritable * management : 1. Antipyretic 2. check V/S 3. Medication ( zovrax) 4. dexamethazon 5. manitol.

Cerebral Palsy ( motor dysfunction ) cause unknown but there is risk group : 1. LBW (low birth weight) 2. birth injury 3. intrauterine anorexia 4. placenta disorder 5. drug administration or nutrition disorder during pregnancy.

* type of C.P: 1. Spastic type ( hypertonic muscle, abnormal reflex,Arch their back,and scisors gait ) 2. Dyskinetic or Athetoid type ( abnormal involuntary movement,child limp flaccid,make every thing slow – difficult swallow and diet ) 3. Ataxic type ( wide based gait - fine coordination motion disorder- failed to perform finger- to - noise ) 4. Mixed type ( several degree of physical impairment )

assessment :- 75% cognitive disorder and 50% recurrent seizures sensory and motor disorder attention deficit disorder (ADD) * Management : 1. medication to decreased spasticity 2. passive & active muscle exercises 3. self -care daily ( dressing,bathing,toileting,& feeding ) 4. nutrition 5. communication device

* Recurrent seizure seizure- is an involuntary contraction of muscle by a abnormal electronic brain disorders 1.idiopathic 2. infection 3. truma 4. tumor growth. * epilepsy (Greek words ) mean(to take hold of ) two type : 1. partial seizure ( one area involve ) 2. generalized seizure ( more than one area )

* Seizure in Newborn ( flaccid, twitching head,arm, eyes, slight cyanosis, & respiratory difficulty ) cause : 1. trauma and anorexia 2. metabolic disorder ( sugar less than 40mg/100ml ) 3. Neonatal infection in treat child with recurrent seizure we have to give anti – convulsions drug in high dosage because they have rapidly metabolic mechanize ( 1.5mg/kg/day Phenobarbital )

seizure in infant and toddler common first 6 month of life,unknown cause ( may truma,metabolic disorder ) * response to treatment is poor common age group 6month - 3 years/old. * seizure in child more than 3 years /old 1. febrile seizure ( ) at night tonic -clonic pattern ( second ),EEG normal,usually occurs after immunization ( drug of choice is Phenobarbital 2-3 days).

* management : 1. cold compress to elevate the temp used tab water 2. give antipyretic 3. treat underling cause 4. L.P to exclude any other problem 5. this type of seizure will not lead to brain damage