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Chapter Overview

  • Focus on the development, functions, and conditions related to the nervous system in children.

The Development of the Nervous System

  • Early Embryonic Development: The nervous system begins to form.

  • Later Intrauterine Development: The fetus starts responding to stimuli.

  • Post-Birth Development: The nervous system continues its development.

  • Major Components:

    • Central Nervous System (CNS): Includes the brain and spinal cord.

The Central Nervous System (CNS)

  • Components of CNS:

    • Brain and spinal cord.

    • Brain Structure:

      • Cerebrum: Centers around consciousness, divided into:

        • Frontal lobe

        • Temporal lobe

        • Parietal lobe

        • Occipital lobe

      • Diencephalon: Includes thalamus and hypothalamus.

      • Cerebellum and Brainstem included in the CNS.

Peripheral Nervous System (PNS)

  • Comprised of:

    • 12 Pairs of Cranial Nerves

    • 31 Pairs of Spinal Nerves

    • Links CNS to limbs and organs.

Cranial Nerves

  • List of 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

Autonomic Nervous System (ANS)

  • Manages involuntary body functions.

  • Divided into:

    • Sympathetic Nervous System (SNS):

      • Emergency response, often referred to as "Fight or Flight."

    • Parasympathetic Nervous System:

      • Influences muscle tone, relaxation of sphincter muscles, referred to as "Rest and Digest."

Autonomic Innervation of Body Structures

  • Sympathetic Responses:

    • Eye: Dilation

    • Heart: Increased rate & force

    • Lungs: Dilation

  • Parasympathetic Responses:

    • Eye: Constriction

    • Heart: Decreased rate

    • Lungs: Constriction

    • Gut: Increased motility

Anatomy of the Brain

  • Three Protective Membranes:

    • Dura Mater

    • Arachnoid Membrane

    • Pia Mater

  • Cerebrospinal Fluid (CSF):

    • Formed in the brain’s lateral ventricles.

Intracranial Pressure Balance

  • Maintained by:

    • CSF production/absorption.

    • Blood vessel dilation/constriction.

    • Hormonal production affecting urine output.

Myelination

  • Protective coating formation around nerve fibers essential for:

    • Motor control and coordination.

    • Cognitive maturity.

Pediatric Neurological Assessment

  • Methods of Assessment:

    • Physical examination, including reflexes:

      • Moro

      • Sucking

      • Fencing/Tonic

      • Plantar

      • Palmer

      • Babinski’s

      • Rooting

      • Stepping

      • Crawling

Levels of Consciousness

  • Categories of Consciousness:

    • Fully Conscious: Alert & oriented.

    • Confused: Reduced awareness.

    • Disoriented: Not oriented to person, place, or time.

    • Lethargic: Sluggish and difficult to rouse.

    • Obtunded: Loss of environmental sensitivity.

    • Coma: Deep unconsciousness.

The Senses

  • Types:

    • Auditory

    • Olfactory

    • Tactile

    • Visual

    • Gustatory

    • Proprioception: Sense of body position in space.

Congenital Neurological Disorders

  • Examples include:

    • Cerebral Palsy

    • Anencephaly

    • Microcephaly

    • Encephalocele

    • Spina Bifida

    • Meningocele.

Cerebral Palsy (CP)

  • Can occur during fetal development or birth.

  • Caused by anoxia before or during the birthing process up to the second year of life.

Types of Cerebral Palsy

  • Ataxic

  • Spastic

  • Hypotonic

  • Dyskinetic

  • Mixed

Evaluating Cerebral Palsy

  • Signs and Symptoms:

    • Tight muscles, "scissor" movements, joint contractures.

    • Paralysis or weakness.

    • Presence of tremors or floppy extremities.

Cerebral Palsy Nursing Interventions

  • No treatment or cure.

  • Focus on support, symptom management, and promoting mobility.

Neural Tube Defects

  • Examples include:

    • Anencephaly

    • Microcephaly

    • Encephalocele

    • Spina Bifida

    • Types of Meningocele.

Evaluating Neural Tube Defects

  • Techniques include

    • Early fetal assessment via ultrasound.

    • Monitoring neurological deficiencies and head circumference.

Interventions for Neural Tube Defects

  • Care for abnormal sacs, assess for leaks or infection, and manage fluid balance.

Nursing Considerations

  • Vigilant monitoring for latex allergies, education on motor limitations, and importance of folic acid.

Neurological Injuries

  • Conditions like drowning, intraventricular hemorrhage, lead poisoning, meningitis, Reye's syndrome, spinal cord injuries, and traumatic brain injuries.

Drowning and Near Drowning

  • Highest risk in toddlers and adolescents; intervention focuses on CPR and maintaining airway.

Intraventricular Hemorrhage (IVH)

  • Presents as a brain bleed, prevalent in premature infants; minimal handling and transfusion if needed.

Lead Poisoning

  • Irreversible brain function impairment; exposure through contaminated sources.

  • Evaluated through lab tests and managed through identification of sources and treatment as required.

Meningitis

  • Inflammation of brain membranes; commonly bacterial or viral; may present special risks in children under five.

Reye's Syndrome

  • Non-inflammatory encephalopathy associated with salicylate use, progression involves monitoring for GI symptoms and treating complications.

Traumatic Brain Injury (TBI)

  • Types include primary and secondary injuries; requires immediate airway management and stabilization.

Protecting the Head from Injury

  • Guidelines for infants through adolescents to prevent head injuries, including the use of safety devices and proper handling techniques.

Concussion and Contusion

  • Concussion involves a transient loss of consciousness, while contusion refers to bruising of brain tissue due to trauma.

Evaluating TBI

  • Monitor airway, vital signs, and intracranial pressure, using Glasgow Coma Scale.

Other Neurological Disorders

  • Include brain tumors, migraines, cognitive impairment, hydrocephalus, increased intracranial pressure, and seizure disorders.

Brain Tumors in Childhood

  • Common childhood malignancy second to leukemia; often requiring extensive treatment and family support.

Evaluation and Intervention for Migraines

  • Migraines include a range of headache types and require thorough assessment and management strategies.

Cognitive Impairment (CI)

  • Significant limitations in intellectual functioning assessed through IQ levels; requires tailored interventions and family support.

Hydrocephalus

  • Characterized by abnormal CSF accumulation; requires careful assessment and potentially shunt placement.

Increased Intracranial Pressure (IICP)

  • Caused by various factors; critical to monitor for symptoms and provide interventions to stabilize the condition.

Seizure Disorder Overview

  • Seizures as a symptom of underlying CNS issues ; divided into types with varying treatments based on severity.

Evaluating Seizures

  • Comprehensive evaluation of family history, environmental exposures, and seizure presentation to guide management.

Interventions and Considerations for Seizures

  • Safety and medication management; education for families on medication adherence and recognition of seizure signs.