PN-112-neurlogical conditions

Schizophrenia

\-Chronic, severe, disabling disorder

\-Characterized by delusion, hallucination, and thought disorder

Anorexia

1\.Refusal to maintain normal body weight

2\.Tremendous fear of gaining weight

3\.View themselves as “fat” even when underweight

4\.Denial of condition

5\.Females: amenorrhea

Assessments for autism

\-Minimal interaction with others, withdrawn, not respond to name

\-Desire for limited touching

\-Lack of separation anxiety

\-Use of peripheral vision, instead of making eye contact

\-Minimal meaningful speech, repetition of words (echolalia)

\-Mixing up grammar

\-Act deaf

\-Lack of startle response

\-Perform socially unacceptable behaviors

\-Distress and resistance to change in daily routine

3 clinical characteristics of ADHD

impulsivity, inattention, and hyperactivity

Spina bifida Myelomeningocele

protrusion of the sac that contains cerebral spinal fluid, meninges, and spinal cord

Types of cerebral palsy

-Ataxic

\-Spastic

\-Hypotonic

\-Dyskinetic

\-Mixed

Nervous system development

\-Among first systems to develop

\-Last to fully mature throughout childhood

Senses of the nervous system

-Hearing

\-Olfactory (smell)

\-Vision

\-Touch

\-Taste

Components of the CNS

Brain and spinal cord

Frontal lobe

controls speech, voluntary muscle movements, and personality

Temporal lobe

controls taste, hearing, and smell

Occipital lobe

controls visual stimuli interpretation

Parietal lobe

controls sensory coordination and interpretation

Thalamus

relay for pain, pressure, and temperature

Hypothalamus

controls autonomic nervous system, releases adh and oxytocin. Controls hunger and thirst

PNS function

connects brain to areas of body

Pairs of cranial nerves

12

Pairs of spinal nerves

31

Afferent neurons

transmit info from organs skin and tissue to the brain

Efferent neurons

transmit regulatory and control information from the brain to the body

Autonomic nervous system

Regulates: salivation, digestion, respirations, perspiration, urination, cardiovascular function, and sexual arousal.

Sympathetic nervous system

Emergency responses- “fight or flight” response

Intracranial pressure at birth

sutures and fontanels allow for extra cerebral spinal fluid

Intracranial pressure after skull fuses

maintained by: production or absorption of CSF, blood vessel dilation and constriction within brain. Production and regulation or urine producing horomones

Health history nervous system assessment

Risk factors: accidents, child abuse, prenatal factors, family history

Nervous system physical examination

\-LOC

\-Skin color

\-Breathing effort

\-Short/long term memory

\-Speech

\-Swallowing ability

\-Strength of hand grips and legs

\-Incontinence in previously potty-trained child

\-Balance, coordination, gait

\-Posturing

\-Vital Signs

\-Pupils

Infant nervous system assessment

\-Fontanels

-Reflexes

\-Moro

\-Sucking

\-Startle

\-Fencing/tonic neck

\-Dancing/step

Diagnostic studies for the nervous system

\-Electrolytes

\-CBC

\-Serum lead

\-Blood culture

\-Lumbar puncture

\-Urinalysis

\-EEG

Anticonvulsants

to prevent or manage seizure activity

Examples of anticonvulsants

\-Gabapentin (Neurontin)

\-Clonazepam (Klonopin)

Diuretics

decrease increased ICP

Examples of diuretics

\-Mannitol (Osmitrol)

\-Furosemide (Lasix)

Neuromuscular blockers

blockers- prevent resistance to mechanical ventilation & agitation

examples of Neuromuscular blockers

-Pancuronium (Pavulon)

\-Rocuronium (Zemuron)

Cerebral palsy

\-Birth accident

\-Non-progressive injury of brain and nervous system

\-Directly related to hypoxia to brain structures

\-Mild to severe

Assessment for cerebral palsy

\-Tight muscles

\-“Scissor” movements

-Joint contractures

\-Paralysis

\-Tremors

\-Floppy extremities or overextension of joint areas

\-Change in ability to: suck, swallow, or manage secretions

\-Pain

Interventions for cerebral palsy

\-No treatments or cure

\-Support & Symptom management

\-Interventions to promote mobility & socialization

\-Medications

\-Surgical procedures

Neural tube defects

\-Group of disorders r/t inappropriate closure of the neural tube during embryonic development

\-Possibly caused by insufficient folic acid during birth or conception.

Anencephaly

absence of both brain hemispheres. Only brainstem and cerebellum.

Microcephaly

abnormally small head associated with Zica virus  

Encephalocele

abnormal sac of fluid that causes brain tissue to herniate through an abnormal defect in the skull.

Spina bifida occulta

no signs other than the skin is dimpled at the side of the defect.

Spina bifida meningocele

protrusion of the sac containing cerebral spinal fluid, located externally to the child’s spinal cord

Assessments for neural tube defects

\-Fetal ultrasound

\-Physical

\-Bowel & bladder

Interventions for spina bifida

\-Protect sac

\-Surgery

\-post-op care

Nursing considerations for spina bifida

-Latex

\-Prevention

\-Family of child with Spina bifida

Hypotonic

A child with cerebral palsy has generalized poor muscle control with muscle dystrophy. Which type of cerebral palsy is this child experiencing?

Drowning/near drowning

\-Most common cause of death during childhood

\-90% of drownings under age 5 are in a home pool

Peak periods for drowning and near drowning

preschool age and late adolescence

Drowning

Death within 24 hours of submersion

Near drowning

live longer than 24 hours after submersion

Assessments for drowning and near drowning

\-Airway

\-Respirations

\-Heart rate & BP

\-ABG’s

\-Hypothermia

\-LOC

Interventions for drowning and near drowning

\-Immediate: CPR

\-Correction of: hypercapnia and hypoxia 

\-Correction of: shock symptoms

\-IV fluid boluses: LR or NS

\-Remove: wet clothes and wrap in blankets

Intraventricular hemorrhage

-Rupture of vascular network, bleed within the brain

\-Depending on severity: full recovery or severe brain damage. Possibly death from anoxia

\-Most common: in prematurity (less than 32 weeks) 90% occur within 3 days of birth

Assessments for intraventricular hemorrhage

\-MRI or CT

\-Repeated Hgb & Hct

\-ICP

\-Sx’s: drowsiness, poor muscle tone, absence of Moro reflex

\-Severe cases: bulging fontanels

Interventions for intraventricular hemorrhage

\-Reduce stimuli

\-Minimal handling

\-Keep head midline & relaxed

\-Ventriculostomy: catheter placed to remove subdural fluid

Nursing considerations for intraventricular hemorrhage

keep head midline comfortable and supported, prevent discomfort and crying

Lead poisoning

\-Encephalopathy

\-Exposure via: contaminated soil, clothing worn by parents who work with lead dust, lead based paints, imported candy, jewelry, and pottery.

\- serum lead level greater than 10

Assessments for lead poisoning

\-H&P- environmental history

\-Mouth- metallic taste

\-GI- abdominal cramping

\-Urinary- decreased output

\-Mentation

\- “personality change”

\-Gums- blue discoloration

\-Paresthesia

Interventions for lead poisoning

\-Serum lead level

\-All symptomatic children are treated in the hospital

Nursing considerations for lead poisoning

\-Assess for behavior changes

\-Education

\-Prevention of exposure

Meningitis

\-Inflammation of the membranes of the brain or spinal cord

\-Can be:

\--Bacterial

\--Viral

\--Chemical agents

\-Can be fatal if not promptly treated

\-Most dangerous organism is meningococcal meningitis (90% fatality rate or more)

\-Prognosis depends on the invading organism, the age of the child, and response to treatment

Assessments for meningitis

Poor feeding habits, Fever, Irritability, high-pitched cry, inconsolable, Lethargy, Bulging fontanels

**Opisthontonos positioning**

**-** hyperextension of the child’s neck and back, or nuchal rigidity where the child hold the neck very still

**Kernig’s sign**

**- resistance and sudden pain when knees are extended when in supine position**

**Brudzinski’s sign**

**- neck is flexed when laying supine and suddenly flex knees and hips**

Interventions for meningitis

\-Labs

\-Antibiotics

\-Corticosteroids

\-Anticonvulsants

Nursing considerations for meningitis

\-Strict respiratory isolation for 24-48 hours after starting IV antibiotics

\-Monitor for increased ICP

\-Monitor for increased head circumference

Reye’s syndrome

\-Inflammatory encephalopathy

\-Organs involved: Liver, spleen, kidneys, pancreas and lymph nodes

\-Strongly associated with use of: aspirin to treat viral infections

Early assessments for reye’s syndrome

irritability, diarrhea, rapid breathing

Late assessments for reye’s syndrome

\-Encephalopathy

\-Increased ICP

\-Metabolic dysfunction

\-Hepatic dysfunction

\-Renal damage

\-Fatty infiltration of viscera

Interventions for reye’s syndrome

\-Monitor neuro status

\-Assess for GI bleed, pancreatitis, or liver failure

\-Provide hydration: IV fluids with glucose

\-Seizure precautions

\-Monitor respiratory status

\-Elevate HOB

\-Keep free of discomfort and pain

\-Quiet environment

Nursing considerations for reye’s syndrome

know that there are 5 stages

Causes of spinal cord injuries

Trauma, tumors, infection, and congenital disorders

Complete spinal cord injury

complete loss of sensorimotor and reflex below the site

Incomplete spinal cord injury

preservation of some motor and/or sensory function below the site

Sacral sparing spinal cord injury

motor/sensory function at the anal mucocutaneous border exists

Degree of SCI disability depends on

location of the injury and immediate stabilization after the injury

Assessments for spinal cord injuries

\-Neuro exam

\-CT or MRI

\-Continual assessments

Interventions for spinal cord injuries

\-Backboard

\-Cervical collar

\-Respiratory stabilization

\-Monitored for neurogenic shock

\-Methylprednisolone within 8 hours of injury 

Nursing considerations for spinal cord injuries

-Caring for elimination needs

\-Adolescents educate about sexual function

Minor Traumatic brain injury

no change in mental status and no skull fracture. Brief loss of consciousness, lethargy, vomiting

Major traumatic brain injury

brain tissues injured, increased ICP, cerebral edema

Primary traumatic brain injury

injury that occurs at the time of the trauma.

secondary traumatic brain injury

develop as body is responding to the injury

Concussion

violent blow to the head with or without a loss of consciousness

Post-concussion syndrome

headaches, difficulty with memory, problems at school, photophobia, possible personality changes

Contusion

localized bruising of brain tissue

Assessments for traumatic brain injury

\-Airway

\-Monitor VS

\-Neuro checks

\-Increased ICP- widening pulse pressure, irregular breathing pattern, bradycardia

\-Glasgow Coma scale

Interventions for traumatic brain injuries

\-Depends on the seriousness of the injury and presenting complications

\-Low-stimulation

\-Steroids

\-ICP monitoring

Brain tumors

\-Most common solid malignancy during childhood

\-Classified according to: location and grade

Assessments for brain tumors

\-S/S of: increased ICP, other signs from tumor location

\-Common:

\--Poor school performance

\--Irritability

\--Hyperactivity

\--Forgetfulness

\--Lethargy

\-Nausea, vomiting

\-Visual changes

\-Headaches

Interventions for brain tumors

\-Depends on: size and location of tumor

\-Surgery

\-Radiation

\-Chemotherapy

Childhood migraine headaches

\-Can start as young as infancy

\-Often present differently in young children vs. adults

\-Presentation may change as they age

\-Developmentally unable to express, makes it hard to locate and treat

\-Always rule out injury

Types of childhood migraine headaches

\-Chronic daily

\-Cluster

\-Tension

\-Psychogenic

Assessments for childhood migraine headaches

\-H&P: genetic predisposition, neuro disorders, birth trauma, vision disorders

\-Risk factors: dehydration, previous head injury

\-Nausea

\-Vomiting

\-Severe head pain

\-Sensitivity to lights and sounds

Interventions/nursing considerations for childhood migraine headaches

\-Depend on type & severity

\-Holistic approach

\--Foods- nitrates and caffeine

\--Treat infections- sinusitis, meningitis, encephalitis

\--Head injury

\--Check eyesight

\-Medications

\-Rest/relaxation

\-Stimulation reduction

\-Massage

\-Warm/cold pack

Cognitive impairment

Significant limitations in intellectual functioning and adaptive behaviors

Mild cognitive impairment

mental age of 12-13

Moderate cognitive impairment

mental age of 8-10