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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.