Neurological Disease Flashcards
Care of child with common neurological system
It usually encompass a wide array of problems resulting from congenital problems, acquired dysfunction, infection or trauma
What would occur during fetal development?
Central nervous system arises from the neural tube during embroyonic development
Cerebrum and cerebellum begin to develop at week 8 to 12
What would occur during extra-uterine life?
Number of brain neurons increases rapidly - CNS Myelinization
What would occur during infant?
Neurologic system is incompletely integrated at birth
Most functions are primitive reflexes and most disappear by the time infant is 12 mths
All cranial nerves myeliniated except optic and olfactory nerves.
What would occur during toddler/preschooler? ( 1 to 6 years )
Brain reaches 80% of adult size by 2 yrs
Myelination almost complete by 2 yrs, enabling child to increase movement and to be toilet trained.
(1 to 6 yrs)
Specialisation of hemispheres -hand preferences
Limbic system matures to better regulate sleep, wakefulness, and emotion.
What would occur during school age? ( 6 to 12 years )
Brain reaches 90% of adult size by 7 yrs
(6 to 12 yrs) Brain reaches adult size by 12 yrs
Myelination is complete, the child is better able to listen, remember
Nerve impulse transmission improves - allows better balance and greater gross-and fine-motor development
What would occur during adolescent?
Brain growth continues. Neurons do not increase in number, but there is increase in the no. of support cells.
There is expansion in cognitive development
What are the differences between child and adult in nervous system response?
Neonate :
• Spinal cord ends at L3 in neonate
Adults :
in adults, L1 to L2
• Children
have 65-140mls of CSF a
•adult have 90-150mls
What is the growth of nervous system from child to adult?
• Child’s brain constantly undergoes organization in function and
myelinization – full impact of insult not immediately apparent
• Open sutures and fontanels – early signs of increased in intracranial
pressure may not be apparent in infant
What are the common neurological condition in children?
- Seizure disorders
2. Increased intracranial pressure conditions
What are seizure disorders?
- Neonatal seizures
- Febrile seizures
- Epilepsy
- Head Injury
- Migraines
- Cerebral Palsy
What are the increased intracranial pressure condition?
- Craniocerebral trauma
- Hydrocephalus
- Brain Tumour
- Meningitis or encephalitis
- Intracerebral haemorrhage
What are the neurological assessment?
Health History
- Onset, duration, location, precipitation
Cardinal signs and symptoms
- Headache
- Fainting and dizziness
- Altered level of consciousness
- Abnormal gait, movement or coordination
- Developmental lags or loss of milestones
Explore
- Prenatal: Maternal drug use, illness
- Personal: Prematurity, birth trauma, congenital disorder
- Family History: Chromosomal, seizure/neurological disorder
What are the examination for neurological disorders?
Vital signs
• Measure head circumference (<2 years): increase in ICP
• Altered vital signs: hypertension, tachycardia leading to bradycardia
Assessment of cerebral tissue performance
• Conscious Level: conscious, confusion, disorientation, lethargy, coma
• Behavioral: appearance, affect/mood, interaction, speech
• Development: alterations in cognitive, psychosocial, gross or fine motor
• Pupillary response
• Assess taste, olfaction and tactile sense
• Movements: abnormal movement, balance or gait
• Reflexes and muscle tones
• Fontanels (<18months) - fullness
what are the laboratory studies and diagnostic tests for neurological disorders?
• Blood studies – FBC, blood culture, test for toxic substance
• Urinalysis – infection or toxicology
• Lumbar Puncture (LP) – measure presses and obtain CSF
for chemistries and detect infection
• Radiography – skull fractures
• Electroencephalogram (EEG)– abnormal electrical brain wave discharges
• Echoencephalography – abnormal structure
• Computer Tomography (CT) – tissue and structure
• Magnetic Resonance Imaging (MRI) – visualization of structure and tissue
features at more detail level
• Nuclear brain scan (radioactive contrast) – identifies focal brain lesion,
CSF pathway
What is seizure?
Defined as an abnormal electrical discharge in the brain
What are the types of seizures?
- Generalized seizure
2. Focal or partial seizure
What is generalised seziure?
• Tonic refers to the muscle becoming stiff • Clonic means the muscles in the arms and legs contracts repeatedly to produce jerking movements
What is focal or partial seizure?
• Abnormal discharge occurs in only one area of the brain • Eg. Motor, somatosensory/special sensory symptoms
What are the subtle clinical manifestations of neonatal seizures?
- Sucking, lip smacking or other oral-buccal-lingual movement
- Bicycling or pedaling movement
- Rhythmic ocular movements eg. Horizontal eye deviation
- Occasionally apneic spells
What is the management for neonatal seizure?
- Infection
- Electrolyte derangement
- Metabolic abnormalities
What is febrile seizure?
Febrile seizures are seizures or convulsions that occur in young children and are triggered by fever.
- Seizures occurs when a child’s temperature rises to 38.5 degrees celcius or more
- Affecting about 5% of all children
- Occur in children aged 6 months to 6 year
- Tend to run in families
What is simple febrile seizure?
- Generalized seizures last less than 15mins
– typically 1-2mins is a tonic clonic - One occurrence per day
What is complex febrile seizure?
- Seizures last longer than 15mins
- Occur multiple times a day
- Or are partial seizures
What is hydrocephalus?
Hydrocephalus is an abnormal buildup of fluid in the ventricles (cavities) deep within the brain
what is congenital hydrocephalus?
It usually results from a defect,
such as Chiari’s malformation, also associated with spinal bifida
What is acquired hydrocephalus?
usually the result of an injury or illness
• Acquired hydrocephalus results from space-occupying lesion:
- Hemorrhage
- Intracranial infection
Treatment for hydrocephalus?
Direct removal of obstruction and insertion of
ventriculoperitoneal shunts to provide primary drainage of CSF to an extracranial compartment, usually peritoneum
Major complication for hydrocephalus?
Infections and malfunction
What is cerebral palsy?
A group of disabilities caused by injury or insult to the brain
- Either before or during birth
- In early infancy
• Most common permanent disability of children
What are the classifications of cerebral palsy? (CP)
- Spastic ( Hypertonic )
- Mixed
- Athetoid ( Non-spastic or dsykinetic )
- Hypotonic
- Ataxic
What is spastic cerebral palsy (70%) ? or also known as hypertonic palsy
Abnormal patter of posture and/or movement,
increased tone, pathological reflexes
most individuals with this type experience high muscle tone and exaggerated, jerky movements
What is athetoid cerebral palsy? ( dsykinetic )
This type causes issues with involuntary movement in the face, torso, and limbs.
Athetoid cerebral palsy is characterized by a combination of hypotonia (loosened muscles) and hypertonia (stiffened muscles) which causes muscle tone to fluctuate.
Involvement of basal ganglia and extra-pyramidal
tracts. Involuntary, uncontrolled, recurring stereotyped movement
What is ataxic palsy?
This type of cerebral palsy causes ataxia and issues with balance, coordination, and voluntary movement.
Ataxic cerebral palsy is caused by damage to the cerebellum, which is responsible for coordinating physical movement. Individuals with ataxic cerebral palsy often experience tremors and a reduction in muscle tone.
Wide-based gait, rapid repetitive movement and
disintegration of movement in the upper extremities when child
reaches for object
What is hypotonic ( atonic cerebral palsy )?
This cerebral palsy type is classified by low muscle tone that causes loss of strength and firmness, resulting in floppy muscles.
Instability and floppiness in muscles caused by hypotonic cerebral palsy can cause a child to miss developmental milestones such as crawling, standing, or walking.
What are the symptoms of spastic CP?
Common symptoms of spastic cerebral palsy include:
Abnormal walking
Awkward reflexes
Contractures (permanently tightened muscles or joints)
Stiffness in one part of the body
What are the symptoms of dyskinetic CP?
Common symptoms of athetoid cerebral palsy include:
Feeding issues
Floppiness in the limbs
Problems with posture
Stiff or rigid body
What are the symptoms of ataxic?
Common symptoms of ataxic cerebral palsy include:
Poor coordination Problems with depth perception Shakiness and tremors Speech difficulties Spreading feet apart when walking
What are neuromuscular disease?
- Floppy infant
2. Neuromuscular disease
Floppy infant
Decreased muscle tone
• Decreased muscle tone – down syndrome
• Neonate with decreased muscle tone – assume a “frog leg” posture with his legs abducted and
at least partially extended at the hips
What is neuromuscular disease?
Characterized by: • Hypotonia • Weakness • Decreased deep tendon reflexes • May involve the anterior horn cells, peripheral nerve neuromuscular junction or the muscles
What is muscular dystrophy?
Progressive degeneration and weakness of skeletal muscles from infection or cardiopulmonary failure
could lead to death, usually in adolescence.
Pathophysiology: Absent of dystrophin (protein) in the muscle
What is the nursing management for muscular dystrophy?
• Promote optimal family function, multiple disciplinary therapeutic measures, and support child’s
need
• Prevent physical injury – provide safe environment, protective gear
• Prevent physical deformity – use prescribed braces and other devices, perform ROM exercise
• Promote mobility – age and condition appropriate motor activities
• Assess for signs of disorder progression and complication
• Adequate fluid and nutritional intake
• Medications – sedative, muscle relaxant and anticonvulsant
• Genetic counselling
