1. Neurological Disorders in the Pediatric Patient Presented by Marlene Meador RN. MSN, CNE

2. Review of CNS of the Pediatric Patient Head to torso ratio Cranial bones- thin, pliable, suture lines not fused Brain vascularity and small subarachnoid space Excessive spinal mobility Wedge shaped cartilaginous vertebral bodies

3. Neurological Assessment: LOC & behavior Vital Signs and respiratory status Eyes Reflexes and motor function Cranial nerve function (p 842 table 33-4) page 1467 discuses Modified Glasgow Coma Scale for ages 3 and younger ( p 1469, table 52-1)

4. Increased Intracranial Pressure- IICP or ICP (p 1468, Box 52-1) Infants Irritability & restlessness Fontanelles / FOC Poor feeding/sucking Skull & scalp veins Nucal rigidity, seizures (late signs) Children Headache Vomiting Irritable, lethargic, mood swings Ataxia, spasticity Nucal rigidity Deterioration in cognitive ability Vital sign changes

5. Priority nursing diagnosis for a child with IICP? What assessment findings should the nurse monitor? What emergency equipment should the nurse have on hand at all times for a child with IICP?

6. Nursing interventions: What diagnostic procedures would the nurse anticipate for this child? What priority interventions must the nurse include with respect to these diagnostic procedures? What specific teaching is required? What additional lab/serum tests would you anticipate?

7. Medications used to treat IICP: Corticosteroids Anti-inflammatory Contraindications-acute infections Monitor I&O Protect from infection Add K+ foods Discontinue gradually Osmotic diuretic Reduce fluid Contraindications- intracranial bleeding Monitor I&O carefully Monitor electrolytes Teaching

8. Quick Review: Priority nursing interventions/ rationale What equipment is essential? Vital signs & neuro signs Additional assessment findings Activity level Hydration status Positioning Parent teaching

9. International Classification of Seizures ( p 1489 Box 52-5) Febrile- rapid temp rise above 39°C (102°F) Generalized- loss of consciousness, involves both cerebral hemispheres onset at any age Tonic/Clonic- impaired consciousness, abnormal motor activity, posturing, automatisms Absence- may confuse with daydreaming or inattentiveness

10. Nursing Interventions: Assessment findings Priority interventions Prevention During seizure Following seizure p 1490 Nursing Care Plan

11. Medications used to control seizures in children Phenobarbital- CNS depressant- monitor: sedation, VS, serum levels, Teach- S&S of toxicity, no ETOH, adhere to regime Carbamazepine- sedative/anticonvulsant hold med if lab values = Teach- S&S of toxicity Phenytoin- anticonvulsant Safety measures- on-hand equipment Teach- oral care, sun exposure

12. Quick Review: What is most important nursing intervention when a child is experiencing a seizure? What is most important teaching regarding seizure medication?

13. Meningitis: Why does bacterial meningitis present more of a risk than viral meningitis? (p. 1494) How do the manifestations of meningitis differ between infants and young children (p. 1494)

14. Meningitis: Infant Fever (not always present) Poor feeding Vomiting Irritability Seizures High-pitched cry Child/Adolescent Fever Headache Photophobia Nuchal rigidity Altered LOC Anorexia/ vomiting Diarrhea Drowsiness

15. Lumbar Puncture- nursing interventions What findings differentiate between bacterial and viral meningitis? What specific interventions does the nurse include for this procedure? Monitor VS & neuro VS LOC Teaching

16. Nursing Care & Medications for treatment of meningitis: Ceftriaxone Sodium (Rocephin®)- who must receive this medication? Cefatoxime Sodium (Claforan ®)- Dexamethasone- special nursing care Antipyretics

17. Clinical Judgment: What intervention must the nurse initiate to protect the patients and staff when a diagnosis of bacterial meningitis is suspected?

18. Hydrocephalus: What priority nursing assessment of a newborn monitors for this condition? What assessment findings occur in the older child? What diagnostic measures confirm this diagnosis?

19. Diagnostic of Hydrocephaly: LP-dangerous MRI; CT scan Skull X-ray Measure FOC Provide for safety, informed consent, support for child and family, accurate H&P (added 2010)

20. Correction of Hydrocephaly: Shunt placement- surgical procedure to place a tube that drains CSF into the atrioventricular or peritoneal cavity. Atrioventricular- drains into atrium (not used as frequently) Ventricular peritoneal- drains into the peritoneal cavity

21. Nursing Care: Pre Operatively: Baseline VS, monitor for IICP, What teaching/interventions for parents? Post-op: Monitor shunt function (how?) Positioning and activity VS, neuro VS & I&O Teaching

22. Long-term Nursing care for the child with hydrocephaly Home care needs S&S of IICP S&S of infection S&S of seizures Emergency numbers of Pediatrician & neurosurgeon Refer to home care, social services and support groups

23. Spina Bifida: (see p 1470) What common nutritional supplement is encouraged for all women of childbearing age? Discuss the 6 types of neural tube defects: Anecephaly Encephalocele Spina bifida occult Meningocele Meningomyelocele

24. Priority nursing diagnosis and interventions: At risk for infection- Protect Position At risk for injury- Protect Position

25. Pre/post-op nursing goals: what interventions should receive highest priority? Prevent infection- monitor VS, incision care Monitor for IICP- Parent/child interaction- Prevent muscle wasting- Long-term care- latex allergies, urinary cath,

26. Nursing care of the child with Cerebral palsy: (p.1477) Assessment (historical) data- Lab findings- Priority goal- (p 1480-early detection) Priority complication- “at risk for” Long-term complications Additional support to include in care

27. Head Injuries in the Pediatric Client Anatomy predisposes infant/young to injury Pathophysiology of “Shaken Baby Syndrome”

28. Nursing care of child experiencing a closed head injury: (p 1483) Assessment findings- Immediate nursing interventions- Legal implications Why is it not prudent for the nurse to discuss suspicions of abuse with the parents or primary caregiver?

29. Pervasive Developmental Disorders / Autism (p. 1549) Home Setting Reduce environmental stimuli Communicate via age- appropriate touch & verbalization Keep toys or other items out of reach if child uses them for harmful self-stimuli Ritualistic ADLs Encourage therapists & support groups Acute Care Setting Keep at least 1 constant caregiver. Encourage parents to stay with,keep room quiet & limit number of staff Anxiety/aggression when touched by strangers Constant monitoring by nurse or parents Allow to maintain rituals of ADLs Encourage therapists & support groups

30. Down’s Syndrome (chromosomal anomaly associated with Trisomy 21) (p 1543) Nursing assessment findings: Facial (forehead, eyes, nose, tongue,) Ears Neck Hands & feet Abdomen If the nurse visualizes any of the outward signs of Down’s syndrome, what is the next immediate priority nursing assessment?

31. Health Promotion How does the nurse promote health of the child with Down’s syndrome? Initial assessment of newborn Parental perception (focus on the positive) {why is blame-laying a concern? Across cultures…} Initiate long-term assistance Speech Occupational Nutritional Financial assistance

32. For questions or concerns Contact Marlene Meador RN, MSN, CNE Email: mmeador@austincc.edu mmeador@austincc.edu