Neurological Disorders

Infant Assessment Signs

high pitched cry

bulging fontanelle

increased head circumference

poor feeding

vomiting

bulging scalp veins

sunset eyes

Older Kid Assessment Signs

HA

vomiting

change in LOC

photophobia

phonophobia

difficulty communicating

LOC

EARLIEST indicator of improvement or deterioration

Glasglow Coma Scale

15: normal

3: worst score possible

8: in a coma, not responsive to control their own airway

Craniosynostosis

Premature closure of sutures

Treatment:

• assess size and symmetry of head

• surgery→ reshape baby’s head

Positional Plagiocephaly

positional deformity due to cranial molding during infancy (flat back of head)

Teach:

• importance of tummy time

• positional changes (regularly)

• before 6 or 7 months

Hydrocephalus

Increased production of CSF:

• dilates ventricles

• compresses the brain

• enlargement of the skull

Congenital

Acquired:

• infection

• Neoplasm

• Trauma

Hydrocephalus Intervention

ventriculoperitoneal shunt

tube inside the ventricle externalized behind the patient’s ear

pressure valve drains fluid out

cerebrospinal fluid is drained and reabsorbed into the abdomen

Hydrocephalus Nursing Care

Measure head circumference daily (open fontanelles and sutures)

Observe signs of increased ICP

Neurologic Assessment

Positioning: usually supine - head of bed is raised gradually

Shunt Complications

scheduled revisions

mechanical difficulties

shunt infection

Peritonitis

Meningocele

protrusion of the meninges and spinal fluid (type of spina bifida)

• no neural elements

• no neurologic deficits

Myelodysplasia: Post-op Nursing Care

Maintain prone or side lying position

Monitor for signs of hydrocephalus (increased ICP)

Avoid latex products

Head Injuries

Prevention is KEY

Major Causes of Head Injuries

falls

motor vehicle accidents

bicycle injuries

lesions, bleeds, infection, near drowningsM

Mild Head Injury (Concussion)

may or may not lose consciousness

confusion, vomiting, irritability, sleepy

Signs of Progression

Difficulty arousing, increasing agitation, marked changes in vital signs (HR, BP, resp)

Severe

Increased ICP, bulging fontanelle, seizures

retinal hemorrhage

hemiparesis(one-sided muscle weakness), quadriplegia (paralysis of all four limbs), extraocular palsies (damaged eye nerves)

unsteady gait

cerebral edema 24-72 hours

Myelomeningocele

a type of spina bifida where the spinal cord, meninges, and fluid protrude through a spinal defect, often resulting in various neurological defects.

When does Myelomeningocele develop?

It develops within the first 28 days of pregnancy, influenced by genetics, nutrition, and medications.

Complications of Myelomeningocele

80-85% of cases may lead to hydrocephalus.

Effects of location on Myelomeningocele

If located below L2, it results in flaccid paralysis and sensory deficits

Pre-op Care for Myelodysplasia

1. Cover the sac with a sterile dressing.

CSF Leakage

Monitor closely for any leaks.

Positioning of the Infant

Keep the infant in a prone position with knees slightly bent.

Neck and Spine Stabilization

Always stabilize the neck and spine and elevate the head of the bed (HOB) to 30 degrees if there is no neck injury.

Hemorrhages in the retina

non accidental head trauma

sign of shaken baby syndrome or other forms of abuse.

Bacterial Meningitis

Infection

inflammation of the meninges (lining of the brain) and CSF

higher morbidity and mortality than viral meningitis

Group Strep B

A type of bacteria that can cause serious infections in newborns, including pneumonia and meningitis, particularly if transmitted during childbirth.

Strep pneumoniae

A type of bacteria that can lead to meningitis, particularly in young children

7-11 years old

Neisseria Meningitides

a bacterium that causes meningitis and can lead to outbreaks, especially in crowded settings. It can result in severe health complications and is vaccine-preventable. (11-17 years)

Bacterial Meningitis Assessment Findings infants

Fever

poor feeding

marked irritability

vomiting

bulging fontanel

high-pitched irritable cry

seizures

nuchal rigidity

opisthotonic position

Bacterial Meningitis Findings (Children)

Fever

Confusion, delirium, headache, vomiting, and neck stiffness.

back pain, hemorrhagic rash (meningococcal meningitis) and photophobia

Diagnosis of Bacterial Meningitis

Cultures (blood, urine, CSF)

Lumbar puncture

Spinal fluid pressure elevated

Elevated WBCs

Decreased glucose/increased protein

Management of Bacterial Meningitis

Intravenous antibiotics (immediately), supportive care (hydration, ventilation, raise HOB), and possibly corticosteroids to reduce inflammation.

Complications: hydrocephalus, seizures, hearing loss

Primary Prevention: Bacterial Meningitis

Vaccination

Hib

pneumococcal vaccine (prevnar)

meningococcal (11-18 years)

Secondary Prevention: Bacterial Meningitis

Early recognition and initiation of proper treatment

• administer antibiotics as soon as possible

Tertiary Prevention: Bacterial Meningitis

Pediatric ICU

Chronic complications: hydrocephalus management

Seizure Disorders

malfunction of electrical system in brain

abnormal electrical discharge

Nursing Interventions for Seizures

advocate for a safe environment, NPO, take seizure precautions monitor and document seizure activity, administer medications as prescribed.

Long-term Seizure Management

Medications (anticonvulsants)

Ketogenic diet - low carb, eats your own body fat for energy

Surgery- take out identified lesions or areas of the brain causing seizures.

VNS- settle the seizure (stimulating the vagus nerve)

Febrile Seizures

Seizures occurring in children (1-5) due to high fever, usually harmless and often resolved without treatment.

Cerebral Palsy

A group of neurological disorders affecting movement and coordination, caused by brain damage during fetal development or infancy.

Spastic Cerebral Palsy

a type of cerebral palsy characterized by stiff and tight muscles, leading to difficulty in movement and coordination. (increased muscle tone)

more common

Flaccid Cerebral Palsy

a type of cerebral palsy marked by weak and floppy muscles, resulting in decreased muscle tone and poor posture.

Cerebral Palsy Assessment Findings

includes various motor function tests, reflex responses, and developmental milestones to evaluate the severity and impact of the disorder on the individual's mobility and coordination.

don’t assume cognitive impairment

Baclofen

a muscle relaxant used to treat spasticity and improve motor function in conditions such as cerebral palsy.

Diazepam

a medication that acts as a muscle relaxant and anxiolytic, often used to alleviate muscle spasms and improve spasticity in neurological disorders.

Botox

a neuromodulator used to reduce spasticity and muscle overactivity by blocking nerve signals to the muscles.

Goals of Therapy with Cerebral Palsy

focus on improving mobility, reducing spasticity, enhancing function, and promoting independence in daily activities.