1. Pediatric Nursing

2. Neurological Assessment  Assessment children under 2 years  normal growth and development parameters  parents evaluation of their child  developmental milestones  history prenatal birth history post natal

3. Neurological Assessment  Behavior personality, affect, level of activity, social interaction, attention span  Motor function muscle - size, tone, strength abnormal movements  Sensory function discrimination of touch with eyes closed

5. Increased Intracranial Pressure  Causes tumors accumulation of fluid within the ventricular system bleeding edema in cerebral tissues  early signs and symptoms are often subtle and assume many patterns

6. Assess for signs of Increased Intracranial Pressure  Level of consciousness (LOC) earliest indicator of changes in neurological status 1. Alertness  arousal-waking state  ability to respond to stimuli 2. Cognitive abilities  process stimuli  produce verbal and motor responses

7. Increased Intracranial Pressure Signs/symptoms  Lack of painful stimuli is abnormal and is reported immediately  as ICP increases LOC decreases  3. V ital Signs  pulse variable, may be rapid or slow, bounding or feeble  B/P normal or elevated with a widening pulse pressure, at shock level  Respiration's varies

8. Increased Intracranial Pressure Signs/symptoms Temperature  elevated especially with infections and intracranial bleeding  subnormal in a coma of toxic origin  Pupils size and reactivity bilateral vs unilateral sudden fixed and dilated pupils is a neurosurgical emergency  pressure from herniation of the brain through the tentorium

9. Neuromuscular - Signs/symptoms  Neuromuscular Movement strength, spontaneous movements asymmetric or absent movements tone  may be increased or decreased tremors, twitching, spasms purposeless flapping hyperactive or flaccid

10. Increased Intracranial Pressure Signs/symptoms  Posturing decorticate  adduction and flexion decerebrate  rigid extension and pronation

11. Diagnosis Procedures  Lumbar puncture measure pressure and sample for analysis  Subdural tap r/o subdural effusions, relieves ICP  EEG measures electoral activity detects abnormalities

12. Diagnosis Procedures  Computer Tomography (CT) visualizes horizontal and vertical cross section of the brain distinguishes density  MRI permits tissue discrimination unavailable with other techniques

13. Diagnosis Procedures  Labs CSF blood glucose electrolytes Ca, Mg, Na clotting studies liver function tests blood cultures drug titre

14. Cerebral Trauma Head Injury  Etiology falls, MVA, bicycle injuries head is larger, heavier children curious incomplete motor development  Concussion  Contusion/laceration  Fracture

15.  Fatal bacterial meningitis

16. Meningitis  Inflammation of the meninges  Spread vascular dissemination  OM or URTI exudate covers the brain  brain becomes hyperemic and edematous

18. Meningitis  Causative Organism H. Influenza, type B S. Pneumoniea N. Meningitis  Meningococcus  Signs and Symptoms FUO lethargy

19. Meningitis Signs/symptoms irritable vomiting and/or diarrhea signs of meningeal irritation guarding of the neck  nuchal rigidity  cries when moved poor feeding

20. Meningitis Diagnosis  Labs CSF  culture, glucose, protein, cell count, gram stain Blood Culture  r/o sepsis Urine Culture  r/o UTI Chemistry panel  electrolytes, glucose, BUN, creatinine

21. Meningitis Treatment  Antibiotics administer within 1 hour of diagnosis type is based on age and causative organism  neonate - ampicillin / claforan  3 months to 3 years - ampicillin / ceftriaxone  older children - penicillin / chloramphemicol

22. Meningitis Treatment  Fluid Management fine balance between dehydration and cerebral edema  child may be dehydrated due to v/d, poor po, fever  2/3 maintenance of IV replacement  fluid restriction

23. Meningitis Nursing Care  High Risk for spread of infection needs resp. isolation for first 24 hrs of antibiotic therapy

24. Meningitis Nursing Care  Fluid Volume Deficit: less than body requirements r/t dehydration NPO/fluid restriction I & O daily weights Labs  specific gravity and electrolytes IV fluid - careful, conservative replacement

25. Febrile Convulsions  Age most common between 6 months and 3 years  Occurrence Seizure accompanied by fever without CNS infection  Occurs during the temperature rise  Treatment fever - tylenol seizure - ativan, valium

26.  Tonic clonic seizure Tonic – stiff Clonic - jerking  Rescue position

27.  Assessment seizure precautions emergency treatment  rescue position  Nursing Care protect from injury open airway accurately observe and record happenings

28. Hydrocephalus

29. Hydrocephaly  Abnormal condition characterized by an increase volume of normal cerebrospinal fluid under increased pressure with in the intracranial cavity Communicating  obstruction is located in the subaranoid cistern or within the subarachnoid space Non-communicating  blockage is within the ventricles

30. Hydrocephaly - Pathology  3 possible mechanisms leading to hydocephalus 1. Over production of CSF 2. Defective absorption of CSF 3. Obstruction of CSF  3 major causes inflammation congenital malformations tumors

31. Hydrocephalus Signs/symptoms  Signs of increased fluid pressure tense or bulging anterior fontanel scalp becomes thin and shiny vein dilate cranial suture lines begin to separate  Other clinical symptoms vomiting wide bridge between eyes bulging eyes - sunset eyes

32. Hydrocephalus Signs/symptoms  Severe Form head size increases rapidly infant’s cry is shrill, high pitched hyperirritability, restlessness  Older Children no head enlargement ataxia papilledema Alter mental status spasticity strabismus H/A

33. Hydrocephalus Treatment  Surgical VP (ventriculo-peritoneal) Shunt  Nursing Care Pre-op  assessments daily head circumference size and fullness of anterior fontanel behavior nutrition - vomiting

34. Hydrocephalus - Nursing Care  fluid and electrolyte needs  positioning  prevent pressure ulcers  support the neck  good skin care  neuro assessments LOC irritable child/infant vital signs observe for seizures

35. Hydrocephalus Nursing Care  Post-op monitor feeding and behavior patterns assess for increasing ICP and cerebral irritability HOB flat or set elevation Shunt observation  infection - along the line or cerebral  abdominal girth  valve function, blockage, separation emotional needs - hold and cuddle teaching