27
Chapter 27: Child with a Neurological Condition
1. The Development of the Nervous System
Early embryonic development: formation of the nervous system begins.
Later intrauterine development: fetus able to respond to stimuli.
After birth: the nervous system continues to mature.
Central Nervous System (CNS): Consists of the brain and spinal cord.
2. Central Nervous System (CNS)
The CNS consists of:
Brain: Center of consciousness.
Divided into:
Cerebrum
Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
Diencephalon
Thalamus
Hypothalamus
Cerebellum
Brainstem
3. Peripheral Nervous System (PNS)
Cranial Nerves: 12 pairs
Spinal Nerves: 31 pairs
4. Cranial Nerves
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal
5. Autonomic Nervous System (ANS)
Manages involuntary body functions.
6. Sympathetic Nervous System (SNS)
Responsible for emergency responses.
Triggers the "fight or flight" response.
7. Parasympathetic Nervous System
Influences:
Muscle tone.
Relaxation of sphincter muscles.
Promotes "rest and digest" functions.
8. Anatomy of the Brain
Protective Membranes:
Dura mater
Arachnoid membrane
Pia matter
Cerebral spinal fluid (CSF) is produced in the brain’s lateral ventricles.
9. Intracranial Pressure Balance
Maintained by:
Production/absorption of CSF.
Blood vessel dilation/constriction.
Hormone production/circulation.
10. Myelination
Protective coating forms around nerve fibers necessary for motor control, cognitive maturity, and coordination.
11. Pediatric Neurological Assessment
Components:
Physical examination: Reflexes
Detailed health history.
Lab studies
Diagnostic tests including:
Moro’s Reflex
Sucking Reflex
Fencing/Tonic Reflex
Plantar Reflex
Palmer Reflex
Babinski’s Reflex
Rooting Reflex
Stepping Reflex
Crawling Reflex
Step Reflex
12. Levels of Consciousness
Full consciousness: Alert and oriented.
Confused: Reduced awareness and clear thinking.
Disoriented: Not oriented to person, place, or time.
Lethargic: Sluggish and hard to arouse.
Obtunded: Less sensitive to surroundings.
Coma: Deep unconsciousness.
13. The Senses
Types of Senses:
Auditory
Olfactory
Tactile
Visual
Gustatory
Proprioception: Sense of body position in space and effort.
14. Congenital Neurological Disorders
Types include:
Cerebral Palsy
Anencephaly
Microcephaly
Encephalocele
Spina Bifida (Type 1 and Type 2)
15. Cerebral Palsy (CP)
Can occur during fetal development or birth.
Common cause is anoxia occurring before, during, or after birth up to the second year of life.
16. Types of Cerebral Palsy
Types include:
Ataxic
Spastic
Hypotonic
Dyskinetic
Mixed
17. Evaluating Cerebral Palsy
Signs and Symptoms:
Tight muscles and joint contractures.
Scissors movements of arms and legs.
Muscle weakness or paralysis.
Presence of tremors or floppy extremities.
Pain may be present.
18. Nursing Considerations for Cerebral Palsy
No treatment or cure available.
Focus on symptom management to promote mobility and socialization.
Family education on airway maintenance and safety.
19. Neural Tube Defects
Types include:
Anencephaly
Microcephaly
Encephalocele
Spina Bifida (Type 1 and Type 2)
20. Anencephaly
Child is born with absence of both hemispheres, retaining only the brainstem and cerebellum.
21. Microcephaly
Characterized by an abnormally small head and brain.
Associated with Zika virus, which results in congenital Zika syndrome.
22. Encephalocele
Abnormal sac of fluid causes the brain and meninges to protrude through the skull defect.
Brain tissue may be encased within the sac.
23. Spina Bifida
Types:
Myelomeningocele: Vertebral column partially open, containing CSF, meninges, and spinal cord portions.
Meningocele: Abnormal protrusion of a sac containing CSF due to defect in spinal column.
24. Evaluating Neural Tube Defects
Early assessment includes ultrasounds.
Monitor for neurological deficiencies, head circumference, and bowel/bladder function.
25. Neural Tube Defect Interventions
Handle abnormal sac with care and assess for leaks or infections.
Keep the sac moist with saline-soaked gauze.
Provide family education and fluid balance care post-operation.
26. Nursing Considerations for Neural Tube Defects
Consider latex allergy and educate families about motor limitations and folic acid.
27. Neurological Injuries
Common types:
Drowning and Near Drowning
Intraventricular Hemorrhage (IVH)
Lead Poisoning
Meningitis
Reye’s Syndrome
Spinal Cord Injury (SCI)
Traumatic Brain Injury (TBI)
28. Drowning and Near Drowning
Peak incidence in toddlers and adolescents.
Evaluation includes:
Airway and ventilation quality.
Vital signs and level of consciousness.
Interventions:
CPR and medical support, including IV fluids and warmth.
29. Intraventricular Hemorrhage (IVH)
Rupture of vascular network leads to brain bleeding, especially in premature infants.
Evaluation involves CT/MRI scans and lab tests.
Interventions focus on reducing stimuli and possible transfusion therapy.
30. Lead Poisoning
Irreversibly impairs brain function, potential for encephalopathy.
Sources include contaminated soil, lead-based paints, and old plumbing.
Evaluation includes lab tests at ages 1 and 2 and environmental assessments.
31. Signs and Symptoms of Lead Poisoning
Treatment involves chelation therapy for high lead levels.
Symptoms: abdominal cramping, personality changes, and metallic taste.
32. Meningitis
Inflammation of brain or spinal cord membranes, often viral/bacterial in nature.
Can affect any age but most common in infants.
Symptoms: poor feeding habits, fever, irritability, bulging fontanels.
33. Meningitis Interventions
Involves lab tests, blood cultures, spinal taps, and antibiotics.
Nursing considerations include monitoring IV fluids and measuring ICP.
34. Reye’s Syndrome
Non-inflammatory encephalopathy associated with liver issues and salicylates (aspirin).
Evaluation includes monitoring systemic signs like vomiting and confusion.
35. Reye’s Syndrome Nursing Interventions
Careful monitoring for neurological status, providing hydration, and managing for potential complications.
36. Spinal Cord Injury (SCI)
Types:
Complete SCI: total loss below injury.
Incomplete SCI: partial preservation.
Evaluated via neuro exams, CT/MRI for assessment.
37. Traumatic Brain Injury (TBI)
Develops from direct trauma with potential secondary complications.
38. Protecting the Head from Injury
Strategies stratified by age from neonates to adolescents focusing on head support, proper seating, and supervised environments.
39. Concussion
Mild traumatic brain injury, potential for personality changes, seeks medical attention for any contact sports-related injuries.
40. Contusion
Localized brain bruising due to trauma causing tissue tearing.
41. Evaluating TBI
Focus on airway management, monitoring vitals, neuro checks, and signs of increased ICP.
42. TBI Interventions
Include airway management and low-stimulation environment.
43. Other Neurological Disorders
Include brain tumors, migraines, cognitive impairment, hydrocephalus, increased intracranial pressure, and seizure disorders.
44. Brain Tumors
Most common solid malignancy in childhood, classified by location and grades.
Medulloblastoma is the most prevalent among children under seven.
45. Evaluating Brain Tumors
Look for increased ICP, focal neurological signs, and physiological symptoms.
46. Migraines
Types include chronic daily headaches, tension headaches, and cluster headaches.
47. Evaluating Migraines
History-taking, physical exams, and head CTs for signs of infection.
48. Migraine Interventions
Involve treating any infections, hospitalization, and potential counseling.
49. Cognitive Impairment (CI)
Limitations in intellectual functioning categorized by IQ levels.
50. Evaluating Cognitive Impairment
Assess developmental status, motor and psychosocial tasks.
51. Hydrocephalus
Imbalance in CSF flow leading to increased pressure; evaluates symptoms like vomiting and irritability.
52. Hydrocephalus Interventions
Placement of VP shunt and education for families on monitoring for increased ICP.
53. Nursing Considerations for Hydrocephalus
Managing large heads associated with neurological impairments and support for the family.
54. Increased Intracranial Pressure (IICP)
Consequences include potential brain herniation and other neurological complications.
55. Evaluating IICP
Look for specific physical signs like sunset eyes and posturing.
56. IICP Interventions
Include stabilization of the airway and managing ICP through various medical interventions.
57. Nursing Considerations for IICP
Continuous monitoring for sudden changes, managing risk factors like diabetes insipidus.
58. Seizure Disorders
Characterized by disrupted electrical communication in the brain that leads to seizures.
59. Types of Seizures
Classifications include:
Infantile spasms
Simple partial seizures
Complex partial seizures
Tonic-clonic seizures
Absence seizures
Myoclonic seizures
Febrile seizures
Status epilepticus
60. Common Causes of Seizures
Include metabolic factors, structural CNS lesions, infections, and genetic disorders.
61. Evaluating Seizures
Involves family history assessment and thorough clinical evaluation of the child.
62. Seizure Interventions
Focus on maintaining a safe environment, administering medications, and monitoring therapeutic blood levels.
63. Nursing Considerations for Seizures
Education on medication adherence, monitoring for side effects, and strategies for seizure control.