Neurological Disorders in the Pediatric Patient 3783

8/3/2019 Neurological Disorders in the Pediatric Patient 3783

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Neurological DisordersNeurological Disorders

in the Pediatric Patientin the Pediatric Patient

Presented by Hassan Adroub


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Meningitis

Meningitis

Bacterial MeningitisVs.

Viral Meningitis


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Bacterial

Meningitis

Bacterial

Meningitis

Potentially Fatal


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Viral

Meningitis

Viral

Meningitis

Same signs and symptoms, may bemilder and self-limiting. Usually

lasts a few days


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Assessment

Assessment

Infants & Young Children

Fever not always presentLethargy

Alterations in sleep and feeding

habits

Nuchal rigidity (late sign)


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Assessment:

Assessment:

Childhood & AdolescenceHyperthermia

S&S ofIICP


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Complications of

Meningitis

Complications of

Meningitis

Intravascular coagulation with

thrombocytopenia

CSF obstruction

Nerve Damage


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Diagnostic Tests:Diagnostic Tests:

Lumbar Puncture

Serum Glucose

Level

Blood Cultures


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NursingC

areNursingC

are Assess

Antibiotic therapy

Monitor lab values

Strict I&O

Isolation

MonitorFOC


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NursingC

are cont...NursingC

are cont... CSF culture

Temperature control

Seizure activity

Environment

Planning Education


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Hydrocephalus

Hydrocephalus

Hydro= Water

Cephaly= of the head/brain


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Etiology and Pathophysiology:

Etiology and Pathophysiology:

Congenital anomalies

Trauma

Unknown causes


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Types ofH

ydrocephalusTypes ofH

ydrocephalus

Non-communicating or Obstructive

Communicating


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Clinical

Manifestations

Clinical

Manifestations

Infants- prior to fusion of cranial sutures

1. Changes in assessment of skull

2. Forehead

3. Eyes4. Behavior changes


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Clinical

Manifestations

Clinical

Manifestations

After closure of cranial sutures:

1. Eyes

2. S & S ofIICP


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Diagnostic TestsDiagnostic Tests LP

MRI/ CT scan

Skull X-ray


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Interventions:Interventions:

SurgicalSurgical

Shunting to bypass the point of obstruction

by shunting the fluid to another point of

absorption


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Complications of Shunts

Complications of Shunts

Infections

Blocked shunts

Seizures


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Nursing InterventionsNursing Interventions Monitor VS and neurological status

Assess functioning of the shunt

Assess operative site

Assess for infection

Positioning of the patient

Activity of patient Promote nutrition

Education


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Critical Thinking

Critical Thinking

What is the most important assessment data

on a child who has just had a shunt

placement for hydrocephalus?

What is the most important teaching for the

parents or caregivers?


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SpinaB

ifidaSpinaB

ifida

Most common defect of the CNS

Occurs when there is a failure of the osseous

spine to close around the spinal column.


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Clinical

Manifestations:

Clinical

Manifestations:

Visualization of the defect

Motor sensory, reflex and sphincter

abnormalities Flaccid paralysis of legs- absent sensation

and reflexes, or spasticity

Malformation Abnormalities in bladder and bowel

function


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Diagnostic Tests:Diagnostic Tests:

Prenatal detection

Ultrasound

Alpha-fetoprotein

Following Birth:

NB assessment X-ray of spine

X-ray of skull


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Surgical InterventionSurgical Intervention Immediate surgical closure

Prior to closure keep sac moist & sterile

Maintain NB

in prone position with legs inabduction


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Nursing Interventions:Nursing Interventions:Pre-OP:

Place in prone position

Sterile moist dressing with normal saline orantibiotic solution

Maintain proper abduction of legs and alignmentof hips

Meticulous skin care Protect from feces or urine

Keep in isolette


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PostPost--Op Nursing InterventionsOp Nursing Interventions Assess surgical site

Monitor VS and neuro VS

Institute latex precautions

Encourage contact with parents/care givers

Positioning Skin Care


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Nursing Interventions cont...Nursing Interventions cont... Antibiotic therapy

Prevent UTI

Education

Emphasize the normal, positive

abilities of the child


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Critical Thinking

Critical Thinking

Would you expect a 5-year-old with

meningomyelocele to have bladder/bowel

sphincter control?

Which type of neural tube defect is most

likely to have no outward signs orsymptoms?


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Cerebral Palsy (

CP)

Cerebral Palsy (

CP)

Static Encephalopathy- spastic CP most

common type (80%)

Nonspecific term give to disorders

characterized by impaired movement and

posture

Non-progressive Abnormal muscle tone and coordination


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Assessment

Assessment

Jittery (easily startled)

Weak cry (difficult to comfort)

Experience difficulty with eating (muscle

control of tongue and swallow reflex)

Uncoordinated or involuntary movements

(twitching and spasticity)


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Assessment cont...

Assessment cont...

Alterations in muscle tone

Abnormal resistance

Keeps legs extended or crossed Rigid and unbending

Abnormal posture

S

cissoring and extension (legs feet in plantarflexion)

Persistent fetal position (>5 months)


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Diagnostic Tests:Diagnostic Tests: EEG, CT, or MRI

Electrolyte levels and metabolic workup

Neurologic examination

Developmental assessment


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Complications

Complications

Increased incidence of respiratory infection

Muscle contractures

S

kin breakdown

Injury


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Goals & Interventions:

Goals & Interventions:

Early detection


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Mental Retardation

Mental Retardation

Significant sub average, general intellectual

functioning existing concurrently with

deficits in adaptive behavior and manifested

during the developmental period.

American Association of Mental Deficiency


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Down SyndromeDown Syndrome

Trisomy 21- the most common

chromosomal abnormality resulting in mild

to profound mental retardation


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Assessment

Assessment

See syllabus

Primary concern with cardiac and GI

anomalies

What are the most obvious indications of

Downs Syndrome in a newborn?


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Goals and Interventions

Goals and Interventions

Primary focus on the parents and care givers

to provide support and achieve a realistic

view of the childs capabilities

Support siblings

Refer to family counseling services

Support parents in feelings of guilt and

chronic sorrow


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Hyperfunction/

Hypofunction

Hyperfunction/

Hypofunction

Pediatric Seizures

Febrile seizures- occur as a result of rapidly

increasing core temperature (101.8 F 38.8C)

General seizures- occur as a result of insult ofthe nervous system


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Clinical

Manifestations

Clinical

Manifestations

Tonic-clonic- absence seizures, minor

motor-atonic

Partial seizures- partial simple or partial

complex


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Diagnostic Tests:Diagnostic Tests: EEG

CT, MRI

Lumbar puncture

CBC

Metabolic screen for glucose, phosphorus

and lead levels


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JitterinessJitteriness vsvs-- SeizureSeizure

Jittery

Responsive

Gaze Okay

Seizure

Not responsive to

stimuli

Abnormal gaze


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Goals:

Goals:

Primary focus to identify the cause and

eliminate the seizure with minimum side

effects using the least amount of medication

while maintaining a normal lifestyle for the

child.


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InterventionsInterventions Febrile seizures

Seizure precautions

During seizure activity

Education


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A

utismA

utism Most severe pervasive developmental

disorder of childhood. Moderate to severely

incapacitating with lifelong developmentaldisabilities

Etiology/Pathophysiology

Cause unknown

Possible genetic or prenatal hypoxic event


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Clinical Manifestations ofAutismClinical Manifestations ofAutism

Developmental disturbances of verbal and social

language skills

Abnormal response to sensation/stimuli (difficultydistinguishing self from environment)

Repetition of self-stimuli

May have savant capabilities

Does not show pain with injuries

Dependent on severity of condition


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DiagnosisDiagnosis

Extensive and thorough interview of family

regarding behaviors

Behaviors classically begin before age 3

Direct observation of child


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Nursing Care ofHospitalizedNursing Care ofHospitalized

Child with AutismChild with Autism Attempt to maintain childs daily routines

from home- very ritualistic

Work closely with family to decrease

anxiety

Provide for the childs safety-particularly if

ritual self stimulation is potentially harmful(head banging, biting)


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Shaken Baby SyndromeShaken Baby Syndrome

Intracranial & retinal bleeding

Physical abuse causing a whip-lash induced

trauma to the childs brain


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Nursing InterventionsNursing Interventions

Assessment- observe forS&S of:

Hemorrhage to sclera

Apnea

Seizures

Respiratory irregularities

Increased intracranial pressure (ICP) Drowsiness or lethargy


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Long Term PrognosisLong Term Prognosis

Complete recovery is rare

Mental retardation

Cerebral Palsy

Death


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Legal ImplicationsLegal Implications

Nurses must report suspected child abuse to ChildProtective Services (CPS).

It is not your obligation to prove the abuse you mustreport any suspicion. CPS will document andfollow through on the case

*rememberthe abuser may not be the person yoususpect, and disclosure to the wrong individualmay endanger the child.

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Neurological Disorders in the Pediatric Patient 3783