Neurological System

Neurological System Overview

Neurological Assessment

Health Assessment Components

  • Health History

  • Physical Assessment

  • Vital Signs

  • Level of Consciousness (LOC)

  • Cranial Nerve Function

  • Motor & Sensory Function

  • Deep Tendon Reflexes

  • Pupillary Response

Signs & Symptoms of Increased Intracranial Pressure (ICP)

Early Signs

  • Headache

  • Vomiting

  • Changes in vital signs

  • Changes in LOC

  • Asymmetric pupils or "setting sun sign"

  • Infants: high-pitched cry, bulging fontanels, increased head circumference (HC), irritability

Late Signs

  • Significant deterioration in LOC

  • Decreased motor & sensory responses

  • Respiratory distress

  • Bradycardia

  • Fixed and dilated pupils

  • Decerebrate or decorticate posturing

Cushing's Triad

  • Indicates Increased ICP
      - Systolic Blood Pressure: Increased
      - Pulse: Bradycardia
      - Respiration: Abnormal patterns

Posturing

  • Decorticate: Flexion; indicates damage to cerebral hemisphere

  • Decerebrate: Extension; indicates more extensive brain damage

Common Labs & Diagnostic Tests

  • Lumbar Puncture

  • Head & Neck Radiograph

  • Fluoroscopy

  • Cerebral Angiography

  • Ultrasound

  • CT/MRI/PET

  • Electroencephalogram (EEG)

  • Intracranial Pressure Monitoring

Medications

  • Antibiotics

  • Anticonvulsants

  • Benzodiazepines

  • Analgesics

  • Osmotic Diuretics

  • Corticosteroids

Medical Treatments

  • Shunt Placement

  • Ventilation

  • Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST)

  • Vagal Nerve Stimulator

  • Ketogenic Diet

Head Injury

Pathophysiology

  • Types of Head Injuries:
      - Concussion
      - Contusion/Laceration
      - Hematoma: Epidural and Subdural
      - Shaken Baby Syndrome (abusive head trauma)

Screening

  • Pupillometry

  • Glasgow Coma Scale (GCS)

Etiology

  • Head or Neck Trauma

Pediatric Considerations

  • Large head size and weak neck muscles

Risk Factors & Epidemiology

  • More common in males

  • High mortality rate

Symptom Onset and Duration

Symptoms

  • Concussion: Immediate or delayed onset; symptoms may last up to 4 weeks
      - Nonspecific symptoms such as headache, fatigue, trouble sleeping, speech/processing/memory/attention difficulties, nausea/vomiting, visual disruptions, tinnitus

  • Contusion/Laceration: Typically immediate onset; more severe
      - Symptoms include loss of consciousness (LOC), vomiting, seizures, speech/vision/hearing problems, lacerations

  • Hematoma: Rapid onset; severe
      - Changes in consciousness, headache, speech impairment, paralysis, breathing difficulties, bradycardia, coma, death

  • Shaken Baby Syndrome: Immediate symptoms within 4-6 hours; severe outcomes
      - Symptoms include vomiting, irritability, poor feeding, breathing difficulties, pupillary changes, seizures, long-term consequences

Lab Testing and Diagnostic Studies

  • Serial Neurological Testing

  • CT or MRI: Assess for bleeding

  • Monitor CBC if hemorrhage suspected

Treatments and Therapies

  • Concussion: Rest, NSAIDs

  • Contusion/Laceration: Manage ICP, control external bleeding

  • Hematoma: Surgical drainage required

  • GCS: Mortality rates increase as GCS scores decrease

  • Some traumatic brain injuries can cause lifelong psychosocial changes

Head Injury Prevention

  • Safety Measures:
      - Helmets for sports and play
      - Secure properly in vehicles

  • Socialization: Encourage within 48 hours after mild TBI; limit environmental noise and stimuli

  • Education for Parents:
      - Focus on manifestations, management strategies, required rest, and activity return plans

Discussion Question

  • Ethical and Legal Implications: Discuss managing a pediatric head injury case with suspected abuse.
      - How should nurses approach to ensure child's safety while maintaining professional and ethical standards?

  

Febrile Seizures

Pathophysiology

  • Seizures caused by sudden rises in body temperature

  • Classified as simple or complex

Risk Factors

  • Ages 6 months to 5 years

  • Temperature over 38° C (100.4° F)

  • Previous febrile seizure or family history of febrile seizures

Clinical Manifestations

  • Seizure activity coinciding with fever

  • Typically brief, lasting up to 2 minutes

Lab Testing and Diagnostic Studies

  • Determine underlying cause of fever

Treatments and Therapies

  • Fever Reduction Methods

  • Hospitalization in cases of serious infection, prolonged seizures, or unresponsive child

  • Vaccinations: Can prevent illnesses causing febrile seizures

  • Parent Education:
      - Remain calm during seizures, record timing, place child on side with tilted head; do not restrain or place objects in mouth

Epilepsy

Pathophysiology

  • Defined as two or more unprovoked seizures occurring at least 24 hours apart

  • Classified as generalized, focal, combined, or unknown

Etiology & Risk Factors

  • Genetic mutations

  • History of trauma, infections, developmental disorders, or alcohol exposure

  • Structural brain changes

  • Higher occurrence in children compared to young adults

Clinical Presentation

  • Recurrent seizures with motor and/or non-motor symptoms
       - Generalized: Jerking, weakness, spasms, eyelid movements, staring
       - Focal: Starts with aura, may involve impaired awareness, automatisms, muscle spasms

Lab Testing and Diagnostic Studies

  • Electroencephalogram (EEG)

Treatments and Therapies

  • Anti-Seizure Medications

  • Diet: High fat, low carbohydrates, moderate protein

  • Vagus Nerve Stimulation

  • Surgery: If severe and unresponsive to treatment

Impact on Overall Health

  • Psychosocial Effects: Reinforcement of considerations for pediatric clients regarding social and personal development

  • Health Promotion: Individual factors and self-care skills

  • Client Education: Vital for managing health and promoting well-being

Discussion Question

  • Challenges in Adolescents with Epilepsy: Discuss unique challenges they face transitioning to adulthood and how nurses can facilitate continuity of care and support developmental needs

Hydrocephalus

Pathophysiology

  • Characterized by enlarged ventricles due to cerebrospinal fluid (CSF) build-up

  • Types: Acquired, congenital, communicating, obstructive, expected pressure, and ex-vacuo

Screening

  • Large head size

  • Sunset Sign: Eye sign that indicates abnormality

Risk Factors

  • Typically affects young children and infants

  • Strong genetic connection, may associate with other neurological disorders

Clinical Presentation

  • Symptoms vary by age and severity:
      - Infants: Large head size, bulging fontanels, downward-deviated eyes, low muscle tone
      - Toddlers/Older: Headaches, vision issues, developmental delays, personality changes

Lab Testing and Diagnostic Studies

  • Neuroimaging

Treatments and Therapies

  • Essential to restore expected CSF flow and reduce pressure on the brain and skull

  • Shunt Insertion: Direct CSF flow to chest or abdominal cavity

Impact on Overall Health

  • Psychosocial Effects: Support and promote healthy development

  • Health Promotion: Tailored intervention strategies for individual needs

  • Client Education: Vital for understanding the condition and self-management skills

Nursing Process: Hydrocephalus

  • Recognize Cues: Monitor fetal brain development for signs of hydrocephalus

  • Analyze Cues: Identify enlarged ventricles and associated manifestations

  • Prioritize Hypotheses: Act promptly to reduce risk of neurological damage

  • Generate Solutions: Focus on strategies to lower CSF pressure

  • Take Actions: Implement interdisciplinary interventions

  • Evaluate Outcomes: Monitor for shunt malfunctions and neurological status

Spina Bifida

Pathophysiology

  • Definition: Most common neural tube defect
      - Occulta: No obvious protrusion, intact skin, tuft of hair
      - With Meningocele: Obvious protrusion involving meninges only
      - With Myelomeningocele: Meninges and spinal cord protruding

Screening

  • Prenatal Testing:
      - AFP Blood Test
      - Ultrasound
      - Amniocentesis

Risk Factors

  • Family history

  • Folic acid deficiency

  • Environmental exposures

Clinical Presentation

  • Varies by type
      - Outward defect
      - Weakness, sensory loss, urinary or bowel dysfunction

Lab Testing and Diagnostic Studies

  • Ultrasound

  • MRI

  • CT

  • Lumbar Puncture

Impact on Overall Health

  • Psychosocial Effects: Address mental health and social skills

  • Health Promotion: Collaborative strategies to enhance health outcomes

  • Self-Care Skills: Encourage independence and management of conditions

Botulism

Pathophysiology

  • Caused by Clostridium botulinum toxin leading to paralysis from head down.

Etiology

  • Foodborne

  • Infantile

Epidemiology

  • Approximately 100 cases per year in children; 20% related to honey consumption.

Clinical Presentation

Early Signs

  • Constipation, weak cry or suck

Symptoms of Progression

  • Nausea, vomiting, diarrhea, weakness, paralysis

Lab Testing and Diagnostic Studies

  • Stool Testing: Culture, toxin assay, Mouse inoculation test

Treatments and Therapies

  • Inpatient treatment including mechanical ventilation as needed

  • Botulism Antitoxin and Botulism Immunoglobulin

Drowning

Pathophysiology

  • Respiratory impairment following liquid submersion.

  • Water temperature affects breath-holding time and cerebral oxygen consumption.

Risk Factors

  • Unprotected access to water

  • Risk-taking behaviors during adolescence

Epidemiology

  • Third most prevalent cause of injury-related death in children globally.

Clinical Presentation

  • Varies according to duration of submersion and water temperature.

Lab Testing and Diagnostic Studies

  • Basic Life Support protocols are crucial for management.

Discussion Question

  • Community Education Programs: How can nurses design educational initiatives on pediatric drowning prevention?

  • Key messages for various target audiences should be emphasized for maximum impact.