Lec. 6 - CHild with neuro disorders

variations in anatomy and physiology - proportions of head sizes

• ¼ of the height of infant and young children

• 1/8 the body height of an adult

• neck muscles not developed fully

• high incidence of injury

Level of conciousness - full conciousness

• awake and alert

• oriented to time place and person - preschoolers, late toddlers may need hints

• exhibits age appropriate behavior

level of consiousness - confusion

• disorientation exists

• alert but reponds inappropriately to questions or environment

level of consiousness - obtunded

• limited response to environment

• falls asleep unless stimualtion is provided

level of conciousness - stupor

• only responds to vigorous sitmulation

level of conciousness - coma

• cannot be aroused even with vigorous stimulation

glasgow coma scale

• highest score - 10

• lowest score - 3

AVPU

• Alert and concious

• Verbal - responds to verbal stim

• pain - responds to pain stim

• unresponsive - unresponsive to any stimuli

Neuros assessment

• LOC

• vitals

• Head, face, neck

• cranial nerve fxn

• motor fxn

• reflexes

• sensory fxn

• inc. intracranial pressure

Early signs of inc. ICP

• HA

• vomit

• vision disturbances

• dizzy

• dec. pulse and resp.

• inc. BP

• unequal pupils and pupilrxn time

• sunset eyes

• ALOC

• seizures

late signs of ICP

• dec. LOC

• dec. motor/ sensory response

• bradycardia

• irregular resp.

• chyene stokes resps.

• posturing

• fixed and dilated pupils

Cushings triad - what is it

inc. ICP result of HA, brain bleed, tumors, infxn, extra fluid in brain, stroke

• results in - dec. HR, irregular resp. widened pulse pressure

cushing triad - symptoms

• weakness

• lethargy

• headache

• vommiting

• blurred vision

  • changes in behavior

cushings triad - treatment

reverse cause of inc. ICP and restoring blood flow

• IV mannitol

• hyperventilation

• elevate HOB

• sometimes drain extra fluid

• rarely perform craniotomy

Types of seizures - Febrile

convulsions of a child that are caused by fever

• loss of conciousness

  • shaking or arms and legs

types of seizures - Tonic Clonic

seizures involving rythmic jerk and relaxation over and over again

• pt unconcious during

• never put anyhting in patients mouth

types of seizures - Absemce (petit mal)

patient freezes and stares off blankyl

• can be mistaken for day dreaming

• can be induced by hypoxia

types of seizures - Myoclonic seizures

seirures occuring in certain areas

• facial tiwtches

• making noises

types of seizures - Focal

2 types:

• simple partial: no loss of conciousness

• complex partial: with loss of conciousness

types of seizures - status epilepticus

2 unrpovoked seizures at least 24 hrs apart

seizure percautions

• padding on siderails/other hard objects

• side rails raised on all sides when child in bed

• O2/suciton at bedside

• supervision during bathing, ambulation, other hazerdous activitys

• use protective helmet

• medical alert bracelet

Response to witnessing seizure

• cervical spine protection

• ease to ground if applicable

• remove anything around neck

• place in recovery position, open airway -

• do not restrain

• remove hazards

• dont open jaw/put anyhting in mouth

• document: length, movement, cyanosis, incontinence, post ictal state if present

Teaching guidelines - how to respond when child has seizure

• if child standing - ease to ground

• time the seizure episode

• loosen tight clothing, jewlery

• place child on one side, open airway

• dont restrain child

• remove hazards in area

• dont force open jaw

• document: length, movement, cyanosis, incontinence, post ictal state if present

• remain with child until fully concious

teaching guidelines - call EMS if

• child stops breathing

• injury occured

• last more than 5 mins

• first seizure

• unresponsive to painful stimuli after seizure