Neurological Disorders in the Pediatric Patient

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

2. 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

3. 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

4. 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?

5. 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?

6. 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:

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

8. 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

9. Nursing Interventions: • Assessment findings • Priority interventions • Prevention • During seizure • Following seizure

10. 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

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

12. 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)

13. 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

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

15. 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?

16. 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

17. 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

18. 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

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

20. 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

21. 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

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

23. 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?

24. 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)

25. 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?

26. 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

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