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Neurological Disorders in the Pediatric Patient. Presented by Marlene Meador RN. MSN, CNE. Neurological Assessment:. LOC & behavior Vital Signs and respiratory status Eyes Reflexes and motor function Cranial nerve function (p. 1673)

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neurological disorders in the pediatric patient

Neurological Disorders in the Pediatric Patient

Presented by

Marlene Meador RN. MSN, CNE

neurological assessment
Neurological Assessment:
  • LOC & behavior
  • Vital Signs and respiratory status
  • Eyes
  • Reflexes and motor function
  • Cranial nerve function (p. 1673)

Page 1672 discuses Modified Glasgow Coma Scale for ages 3 and younger

increased intracranial pressure iicp or icp
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

Increased Intracranial Pressure- IICP or ICP
priority nursing diagnosis for a child with iicp
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?
nursing interventions
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?
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

Medications used to treat IICP:
quick review priority nursing interventions rationale
Quick Review: Priority nursing interventions/ rationale
  • What equipment is essential?
  • Vital signs & neuro signs
  • Additional assessment findings
  • Activity level
  • Hydration status
  • Positioning
  • Parent teaching
seizures p 1675 1676
Seizures ( p 1675-1676)
  • Febrile- rapid temp rise above 39°C (102°F)
  • Focal- impaired consciousness, abnormal motor activity, posturing, automatisms
  • Generalized- loss of consciousness, muscles rigid, rhythmic jerking
  • Absence- may confuse with daydreaming or inattentiveness
nursing interventions1
Nursing Interventions:
  • Assessment findings
  • Priority interventions
    • Prevention
    • During seizure
    • Following seizure
medications used to control seizures in children
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 _____
    • Teach- S&S of toxicity
  • Phenytoin- anticonvulsant
    • Safety measures- on-hand equipment
    • Teach- oral care, sun exposure
quick review
Quick Review:
  • What is most important nursing intervention when a child is experiencing a seizure?
  • What is most important teaching regarding seizure medication?
meningitis
Meningitis:
  • Why does bacterial meningitis present more of a risk than viral meningitis?

(p. 1682)

  • How do the manifestations of meningitis differ between infants and young children (p. 1682)
lumbar puncture nursing interventions
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
nursing care medications for treatment of meningitis
Nursing Care & Medications for treatment of meningitis:
  • Ceftriaxone Sodium (Rocephin®)- who must receive this medication?
  • Cefatoxime Sodium (Claforan ®)-
  • Dexamethasone- special nursing care
  • Antipyretics
hydrocephalus
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?
nursing care
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
long term nursing care for the child with hydrocephaly
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
spina bifida see p 1697
Spina Bifida: (see p. 1697)
  • 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
    • Spina bifidacystica
    • Meningocele
    • Meningomyelocele
priority nursing diagnosis and interventions
Priority nursing diagnosis and interventions:
  • At risk for infection-
    • Protect
    • Position
  • At risk for injury-
    • Protect
    • Position
pre post op nursing goals what interventions should receive highest priority
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
nursing care of the child with cerebral palsy p 1702
Nursing care of the child with Cerebral palsy: (p.1702)
  • Assessment (historical) data-
  • Lab findings-
  • Priority goal
  • Priority complication- “at risk for”
  • Long-term complications
  • Additional support to include in care
head injuries in the pediatric client
Head Injuries in the Pediatric Client
  • Anatomy predisposes infant/young to injury
  • Pathophysiology of “Shaken Baby Syndrome”
nursing care of child experiencing a closed head injury p 1708 1710
Nursing care of child experiencing a closed head injury: (p. 1708-1710)
  • 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?
pervasive developmental disorders autism p 1732
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

Pervasive Developmental Disorders / Autism (p. 1732)
down s syndrome chromosomal anomaly associated with trisomy 21
Down’s Syndrome (chromosomal anomaly associated with Trisomy 21)
  • 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?
health promotion
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
for questions or concerns
For questions or concerns

Contact Marlene Meador RN, MSN, CNE

Email: mmeador@austincc.edu