1. Copyright © 2005 by Elsevier, Inc. All rights reserved. The Child with a Neurologic Alteration Chapter 52

2. Copyright © 2005 by Elsevier, Inc. All rights reserved. Developmental Manifestations in an Infant with Increased Intracranial Pressure Poor feeding or vomiting Irritability or restlessness Lethargy Bulging fontanel High-pitched cry Increased head circumference Separation of cranial sutures Distended scalp veins Eyes deviated downward (“setting sun” sign) Increased or decreased response to pain Poor feeding or vomiting Irritability or restlessness Lethargy Bulging fontanel High-pitched cry Increased head circumference Separation of cranial sutures Distended scalp veins Eyes deviated downward (“setting sun” sign) Increased or decreased response to pain Child Headache Diplopia Mood swings Slurred speech Papilledema (after 48 hours) Altered level of consciousness Nausea and vomiting, especially in the morning Child Headache Diplopia Mood swings Slurred speech Papilledema (after 48 hours) Altered level of consciousness Nausea and vomiting, especially in the morning

3. Copyright © 2005 by Elsevier, Inc. All rights reserved. Standard Terms for Level of Consciousness Full consciousness – Awake, alert, oriented, interacts with environment Confused – Lacks ability to think clearly and rapidly Disoriented – Lacks ability to recognize place or person Lethargic – awakens easily but exhibits limited responsiveness Obtunded – Sleeps and, once aroused, has limited interaction with environment Stupor – Requires stimulation to arouse Coma – Vigorous stimulation produces no response Full consciousness – Awake, alert, oriented, interacts with environment Confused – Lacks ability to think clearly and rapidly Disoriented – Lacks ability to recognize place or person Lethargic – awakens easily but exhibits limited responsiveness Obtunded – Sleeps and, once aroused, has limited interaction with environment Stupor – Requires stimulation to arouse Coma – Vigorous stimulation produces no response

4. Copyright © 2005 by Elsevier, Inc. All rights reserved. Factors Associated with Cerebral Palsy Prenatal Maternal diabetes Rh or ABO incompatibility Rubella in the first trimester Genetics Intrauterine ischemic event Toxoplasmosis Cytomegalovirus Congenital brain abnormality Prenatal Maternal diabetes Rh or ABO incompatibility Rubella in the first trimester Genetics Intrauterine ischemic event Toxoplasmosis Cytomegalovirus Congenital brain abnormality

5. Copyright © 2005 by Elsevier, Inc. All rights reserved. Factors Associated with Cerebral Palsy (cont’d) Perinatal Asphyxia Low birth weight Prematurity Precipitous delivery Pregnancy-induced hypertension Birth trauma Anoxia Prolonged labor Perinatal metabolic condition (diabetes) Intracranial hemorrhage Perinatal Asphyxia Low birth weight Prematurity Precipitous delivery Pregnancy-induced hypertension Birth trauma Anoxia Prolonged labor Perinatal metabolic condition (diabetes) Intracranial hemorrhage

6. Copyright © 2005 by Elsevier, Inc. All rights reserved. Factors Associated with Cerebral Palsy (cont’d) Postnatal Infections Trauma Stroke Poisoning Postnatal Infections Trauma Stroke Poisoning

7. Copyright © 2005 by Elsevier, Inc. All rights reserved. Severity of Head Injuries Based on Glasgow Coma Scale Mild (Score of 13-15) -- Possible headache and cognitive deficits (especially affecting memory -- Possible stress intolerence Moderate (Score of 9-12) -- Headache, memory deficits, cognitive deficits -- Difficulty with activities of daily living -- Occasionally results in death Mild (Score of 13-15) -- Possible headache and cognitive deficits (especially affecting memory -- Possible stress intolerence Moderate (Score of 9-12) -- Headache, memory deficits, cognitive deficits -- Difficulty with activities of daily living -- Occasionally results in death

8. Copyright © 2005 by Elsevier, Inc. All rights reserved. Severity of Head Injuries Based on Glasgow Coma Scale, (cont’d) Severe (Score of 3-8) -- Posttrauma syndromes and cognitive, emotional, motor, and sensory deficits caused by irreversible brain injury -- Long-term care or support in the community usually needed -- Occasionally results in death Severe (Score of 3-8) -- Posttrauma syndromes and cognitive, emotional, motor, and sensory deficits caused by irreversible brain injury -- Long-term care or support in the community usually needed -- Occasionally results in death

9. Copyright © 2005 by Elsevier, Inc. All rights reserved. Observations and Nursing Care During a Seizure As the seizure begins, note the time and begin to time the seizure Protect the child from injury by loosening clothing at the neck Turn the child gently onto the side Do not restrain the child or insert any object into the mouth Observe where the seizure begins; note its progression and ending Note any preceding or accompanying sensory or motor manifestations When the seizure ends, allow the child to rest Record the child’s behavior before, during, and after the seizure As the seizure begins, note the time and begin to time the seizure Protect the child from injury by loosening clothing at the neck Turn the child gently onto the side Do not restrain the child or insert any object into the mouth Observe where the seizure begins; note its progression and ending Note any preceding or accompanying sensory or motor manifestations When the seizure ends, allow the child to rest Record the child’s behavior before, during, and after the seizure

10. Copyright © 2005 by Elsevier, Inc. All rights reserved. Drug Therapy for Generalized Tonic-Clonic Status Epilepticus Diazepam (Valium) or lorazepam (Ativan) are given intravenously IV diazepam must be given directly into the vein at a rate no greater than 1 mg/min Drugs must not be mixed and can be diluted only with normal saline Keep resuscitation equipment at the bedside Monitor the child’s respirations during IV administration Diazepam (Valium) or lorazepam (Ativan) are given intravenously IV diazepam must be given directly into the vein at a rate no greater than 1 mg/min Drugs must not be mixed and can be diluted only with normal saline Keep resuscitation equipment at the bedside Monitor the child’s respirations during IV administration

11. Copyright © 2005 by Elsevier, Inc. All rights reserved. Guidelines for the Child with Meningitis For the child with Hemophilus influenzae –The child's close contacts need prophylactic treatment –Anyone who has spent at least 4 hours with the child in the 5-7 days before hospitalization needs prophylactic treatment For the child with Neisseria meningitidis, all close contacts need prophylactic treatment Rifampin colors the urine and sweat a red- orange and will stain contact lenses For the child with Hemophilus influenzae –The child's close contacts need prophylactic treatment –Anyone who has spent at least 4 hours with the child in the 5-7 days before hospitalization needs prophylactic treatment For the child with Neisseria meningitidis, all close contacts need prophylactic treatment Rifampin colors the urine and sweat a red- orange and will stain contact lenses