Ped Neuroscience

Increased ICP

manifestations (infants):

• tense bulging fontanel

• separated cranial sutures

• high-pitched cry

• increased FOC

• distended scalp veins

• sun-setting sign

manifestations (children):

• HA

• N/V

• blurred vision

• seizures

• decline/diminished performance

• lethargy

LATE MANIFESTATIONS:

• bradycardia

• decreased response to verbal and sensory

• pupil size and reactivity altered

• decerebrate or decorticate posturing

• cheyne-stokes respirations

• pailledema

• decreased LOC / coma

Hydrocephalus

causes: congenital (chiari malform., idiopathic intracranial HTN, dandy-walker syndrome); acquired (meningitis, trauma, brain tumor, hemorrhage), obstructive vs nonobstructive

assessment: INCREASED ICP

diagnosis: serial FOC, progressive neuro signs, CT/MRI

nursing care: TREAT CAUSE

• congenital = surgical intervention

  • choroid plexus cauterization

  • shunts

  • chiari decompression

• pre-op

  • daily FOC

  • freq neuro checks

  • monitor signs ICP

  • family surgical prep

• post-op

  • pain control

  • freq neuro checks

  • surgical site assess

  • VS monitoring

  • through GI assessment → peritoneal shunt

Neural Tube Defects - Spina Bifida

Occulta: may go undiagnosed if asymptomatic, skin depression or port-wine stain, bowel and bladder sphincter

Cystica: US and elevated alpha fetoprotein, dependent on level of defect → motor and sensor defects (meningocele or myelomeningocele)

nursing care:

• pre-op

  • radiant warmer

  • sterile moist non-adherent dressing

  • prevent infection

  • site assess

  • neuro check

• post-op

  • pain control

  • prone position

  • feeding

  • surgical site assess

  • neuro checks

• no latex

Neural Tube Defects

Anencephaly: defect in neural tube formation

Chiari Malformation: cerebrum extends below opening and into upper spinal canal

Myelomeningocele: sac w CSF, meninges, and spinal cord

Seizures

Acute

Focal

Generalized

Unknown Onset

Febrile → fever lowers the threshold for seizures (self resolving)

Epilepsy

Chronic: 2 or more unprovoked seizures more than 24 hours apart

Seizure: Diagnostics

medical and family history

seizure observation

EEG

Labs: CBC, BMP, glucose, urine, lumbar puncture, toxicology, anticonvulsant levels*

epilepsy monitoring unit

Seizure: Treatment and Nursing Care

Treatment:

• medication manage → action plan

  • clonazepam, levetiracetam,

• diet → keto

• surgical intervention → vagal nerve stimulator / epilepsy surgery

Nursing Care:

• maintain airway → suction and O2

• turn child onto side

• O2 monitor

• nothing in mouth

• timing

• rescue meds

Meningitis

manifestations: Kerning, Brudzinski, nuchal rigidity, photophobia, irritability, HA, vomiting

diagnosis: lumbar puncture → positioning, comfort measure, monitor site

nursing care: droplet precautions, ANTIMICROBIAL THERAPY, manage shock

TBI - Concussions (accidental trauma)

assessment: HA/dizziness, N/V, diplopia, increased emotional behavior, foggy thinking, difficult sleeping or staying awake

EMERGENCY findings: unequal pupils, difficult to arouse, worsening HA, LOC, repeated vomiting, inability to recognize, numbness

nursing care: rest and recovery time, progress as tolerated, low stimulation, prevention

TBI - Nonaccidental Traumas

assessment: hematomas, retinal hemorrhages, skull fractures

nursing care: shaken baby → extensive interview, CARE team consult, full skeltal survery, CPS report

Cerebral Palsy

assessment: varying degrees in disturbances in movement, muscle tone, coordination

types: spastic, dyskinetic, ataxic, mixed

nursing care: baclofen, PT/OT, orthotics, surgery