Nursing Education on Pediatric Disorders

Overview of Pediatric Neurological Disorders

Central Nervous System (CNS) consists of brain and spinal cord.
Growth and development differences, particularly in brain and spinal cord:
- Development from the neural tube (important to note what supplement is required for proper neural tube development: Folic Acid).
- Gestational Development of Neural Tube: 3-4 weeks gestation.
Increased Risk of Hemorrhage in newborns and infants due to high brain vascularity.
- Premature infants have the highest risk for intracranial hemorrhages.
- Vitamin K shot administered at birth to assist with clotting due to insufficient levels in infants; levels sufficient by days 10-14.
- Vitamin K is also involved as an antidote for certain blood thinners (e.g., warfarin).

Myelination: Covers and protects nerves, increasing speed and accuracy of nerve firing, leading to better coordination as children age.
Head Size & Proportion:
- Infants have a proportionally larger head relative to body size leading to "top-heavy" posture, resulting in higher fall risk due to underdeveloped neck muscles.

Shunt Placement:
- Catheter places excess cerebrospinal fluid (CSF) into the peritoneal cavity for absorption and excretion.
- Used mainly in conditions like hydrocephalus.
- Important for monitoring signs of increased intracranial pressure (ICP):
- Watch for changes in neurologic status and level of consciousness (LOC).
Therapies:
- Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy:
- Aimed at improving motor function and addressing developmental delays in neuro disorders.
- Emphasis on intercommunication among nurses and interdisciplinary teams, with case coordination being key for complex cases.
Ketogenic Diet:
- High-fat, low-carb diet developed for difficult-to-treat seizures, inducing ketosis and potential mild dehydration.
- Requires monitoring of intake/output, growth, and nutritional status, with regimen lasting at least three months before reevaluation.

Level of Consciousness (LOC): Critical in neurologic assessment. Parents often note initial changes.
- Categories of Consciousness:
- Full Consciousness: Awake, alert, oriented to person, place, and time (developmentally appropriate).
- Confusion: Disorientation/confusion in responses to questions.
- Obtunded: Limited response, falls asleep without stimulation.
- Stupor: Response only to vigorous stimulation.
- Coma: Unresponsive to all stimulation.
Assessment Considerations:
- Understanding developmental delineations in consciousness responses.
Neurological Exam:
- Assess for facial symmetry, cranial nerve function, and head circumference in children under 3 years.
- Regular measurement of head circumference to identify potential concerns like hydrocephalus or microcephaly.
- Assessing for signs of increased ICP with early (headache, vomiting, changes in LOC) and late (decreased responsiveness, bradycardia) indicators.

About 50% of epilepsy cases start in childhood, with causes ranging from fever to head trauma,
toxins, and cardiac dysrhythmias.
Anticonvulsant Medications:
- Phenytoin: Requires serum level monitoring to prevent gingival hyperplasia.
- Phenobarbital: Monitor for excessive sedation.
- Valproic Acid: Appropriate for certain seizure types; monitor serum levels.
- Carbamazepine: Be cautious of its interactions with phenytoin and valproic acid.
Single Drug Therapy: Goal is to minimize interactions, require serum monitoring.

More common under age five with a peak incidence from 12-18 months, primarily in males or those with a family history.
Typically benign; do not require medication unless recurrent.
Important to manage the underlying cause of fever and educate parents.

Frequent in the first month of life and often necessitate aggressive treatment due to potential for significant long-term deficits.
Commonly treated with phenobarbital at higher doses.

Head circumference sharply below the average for age/sex, potentially resulting from congenital conditions (e.g., rubella, toxoplasmosis) or nutritional deficiencies.
Associated with developmental delays, and treatments focus on familial support and referrals to appropriate therapies.

Malformations involving the downward displacement of cerebellar tonsils into the neck.
Symptoms vary from headaches to weakness in infancy; generally diagnosed through MRIs.

Condition characterized by excess CSF leading to unusual head size; shunt placement is a common intervention, necessitating ongoing education and monitoring for signs of infection or malfunction.

Medical emergency with a rapid progression requiring lumbar puncture, blood cultures, and IV antibiotics.
Common pathogens include E. coli, S. pneumoniae, and Group B Streptococcus.
Symptoms include fever, vomiting, headache, photophobia, a stiff neck, and can lead to serious complications if not treated promptly.

Affects predominantly infants and children; typically less severe than bacterial; the same initial management approach is taken until bacterial causes are ruled out.

Leading cause of death in children under three is nonaccidental injury (e.g., shaken baby syndrome).
Mechanisms: fragile brain structure and the impact of acceleration/deceleration on the undeveloped cervical spine.
- Bruising near ears (Battle’s sign) might indicate a skull fracture; hence, requires immediate evaluation.

Importance of monitoring child safety, use of appropriate helmets, and life vests during water activities.
Adequate supervision and education for chronic conditions and seizure management are vital for caregivers.