Pediatric Nursing: Neurological and Cognitive Problems Flashcards
1
Q
Cerebral Palsy: description and assessment
A
- disorder characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system.
- most common clinical type is spastic, which represents an upper motor neuron type of muscle weakness.
- less common types: athetoid, ataxic, and mixed.
Assessment: - extreme irritability and crying, feeding difficulties, abnormal motor performance.
- alterations of muscle tone (stiff and rigid arms or legs)
- delayed developmental milestones and persistence of primitive reflexes after 6m.
- abnormal posturing (opisthotonos).
- seizures may occur.
2
Q
Cerebral Palsy: Interventions
A
- goal of management is early recognition and interventions to maximize child’s abilities.
- includes physical, occupational, and speech therapy, education and recreation.
- assess the child’s developmental level and encourage communication and interaction on child’s level rather than chronological age level.
- provide safe environment, appropriate toys, and provide parents with information and support.
3
Q
Head Injury
A
- is the pathological result of any mechanical force to the skull, scalp, meninges, or brain.
- open head injury occurs when there is a fracture of the skull or penetration by an object.
- closed head injury is the result of blunt trauma (more serious because of the chance of increased ICP); can also be caused by shaken baby syndrome.
- manifestations depend on the type and amount of increased ICP.
- child’s level of consciousness provides the earliest indication of an improvement or deterioration of the neurological condition.
4
Q
Early Signs of Increased IPC
A
- slight change in VS
- slight change in level of consciousness
- infant: irritability, high-pitched cry, bulging fontanel, increased head circumference, dilated scalp veins, Macewen’s sign (cracked pot sound on percussion of the head), setting sun sign (sclera visible above the iris)
- child: headache, nausea, vomiting, visual disturbances (diplopia), seizures.
5
Q
Late Sings of Increased IPC
A
- significant decrease in level of consciousness
- bradycardia
- decreased motor and sensory responses
- alterations in pupil size and reactivity
- decorticate (flexion) posturing
- decerebrate (extension) posturing
- cheyne-stokes respirations
- coma
6
Q
Head Injury: interventions
A
- monitor the airway and adm oxygen as prescribed.
- assess injuries (spinal cord)
- position head in midline to avoid jugular vein compression and elevate 15-30 degrees (if not contraindicated) to facilitate venous drainage.
- monitor VS and neurological function.
- keep stimuli to a minimum.
- withhold sedating meds during the acute phase.
- initiate seizure precautions (raise and pad side rails)
- monitor for decreased responsiveness to pain.
- maintain NPO status, Iv fluids, electrolyte alterations.
- assess wounds and dressings, and monitor for nose or ear drainage (test for glucose; positive indicate CSF)
- adm tepid sponge baths or hypothermia blanket if hyperthermia occurs.
- avoid suctioning through the nares.
- adm acetaminophen, anticonvulsants, ATB, corticosteroids or osmotic diuretic (to reduce cerebral edema) as prescribed.
- monitor for signs of brainstem involvement (deep, rapid, or intermittent and gasping respirations; wide fluctuations or slowing pulse; widening pulse pressure or extreme fluctuations in BP; sluggish, dilated, or unequal pupils).
- monitor for signs of epidural hematoma (asymmetrical pupils).
7
Q
Hydrocephalus: description and types
A
- an imbalance of CSF absorption or production caused by malformations, tumors, hemorrhage, infections, or trauma.
- results in head enlargement and increased ICP.
Types: - communicating: occurs as a result of impaired absorption within the subarachnoid space. No obstruction in the ventricular system.
- non-communicating: obstruction of CSF flow in the ventricular system occur.
8
Q
Hydrocephalus: assessment
A
Infant:
- increased head circumference
- thin, widely separated bones of the head and Macewen’s sign.
- anterior fontanel tense, bulging, and non-pulsating.
- dilated scalp veins, frontal bossing, and setting sun eyes.
Child:
- behavior changes (irritability, lethargy)
- headache on awakening, nausea and vomiting, ataxia and nystagmus.
Late signs:
- high, shrill cry and seizures.
9
Q
Hydrocephalus: Surgical Interventions
A
- the goal of surgical treatment is to prevent further CFS accumulation by bypassing the blockage and draining the fluid from the ventricles to a location where it may be reabsorbed.
- in a ventriculoperitoneal shunt, the CFS drains into the peritoneal cavity from the lateral ventricle.
- in a ventriculoatrial shunt, CFS drains into the right atrium of the heart from the lateral ventricle, bypassing the obstruction (used in older children and in children with pathological conditions of the abd).
- shunt revision may be necessary as the child grows.
- an alternative to shunt placament is endoscopic third ventriculostomy, in which a small opening in the floor of the third ventricle is made that allows CFS to bypass the fourth ventricle and return to the circulation to be absorbed.
10
Q
Hydrocephalus: Preop e Postop Interventions
A
PreOp:
- monitor intake and output and give small, frequent feedings until NPO status is prescribed.
- reposition the head frequently and use special devices such as an egg crate mattress under the head to prevent pressure sores.
PostOp:
- monitor VS, neurological signs, signs of infection, intake and output.
- position the child on the unoperated side and keep the child flat (if prescribed) to avoid rapid reduction of intracranial fluid.
- observe for ICP and measure head circumference.
- provide comfort measures and adm meds as prescribed.
- struct parents on care.
11
Q
Meningitis
A
- an infectious process of the CNS caused by bacteria or viruses that may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinuses or ear, or systemic infections.
- diagnosis is done by testing CSF obtained by lumbar puncture.
- if bacterial: fluid is cloudy with increased pressure, WBC count, protein, and decreased glucose levels.
- bacterial can be caused by, most commonly, Haemophilus influenzae tybe b, Streptococcus pneumoniae, or Neisseria meningitidis; meningococcal occurs in epidemic form and can be transmitted by droplets from nasopharyngeal secretions.
- viral is associated with mumps, paramyxovirus, herpesvirus, and enterovirus.
12
Q
Meningitis: assessment
A
- signs ans symptoms vary depending on type, age, and duration of the preceding illness.
- fever, chills, headache, vomiting, diarrhea, poor feeding or anorexia, nuchal rigidity, poor or high shrill cry, altered level of consciousness (lethargy or irritability).
- bulging anterior fontanel in an infant.
- positive Kernig’s and Brudzinski’s sign.
- muscle or joint pain, petechial or purpuric rashes (meningococcal), ear that chronically drains (pneumococcal).
13
Q
Meningitis: Interventions
A
- provide respiratory isolation precautions and maintain for at least 24h after ATB is initiated.
- adm ATB, antipyretics, antiseizures as prescribed.
- perform neurological assessment and assess for inappropriate antidiuretic hormone secretion, causing fluid retention and dilutional hyponatremia.
- monitor for signs of thromboemboli, nutritional status, intake and output, hearing loss.
- determine close contacts of the child, they need prophylactic treatment.
- pneumococcal vaccine is recommended after 2m.
14
Q
Submersion Injury
A
- survival of at least 24h after submersion in a fluid medium.
- hypoxia/asphyxiation is the primary problem because it results in extensive cell damage; cerebral cells sustain irreversible damage after 4-6 min of submersion.
- additional problems include aspiration and hypothermia.
- outcome may be good if submersion was less than 5 min and the child and the child exhibits neurological responsiveness, reactive pupils, and a normal cardiac rhythm.
- if spontaneous purposeful movement and normal brainstem function are not apparent 24h after the event, the child most likely suffered severe brain damage.
- Interventions: provide ventilatory and circulatory support, monitor respiratory status, for aspiration pneumonia, neurological status.
15
Q
Reye’s Syndrome
A
- an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver.
- diagnosis is made by lab studies and liver biopsy.
- exact cause is unclear, but most commonly follows a viral illness such as influenza or varicella.
- AAS is not recommended, use acetaminophen or ibuprofen instead.
- early diagnosis and aggressive treatment are important; the goal is to maintain effective cerebral perfusion and control increasing ICP.
Assessment: - history of systemic viral illness 4-7 days before, fever, nausea, vomiting, signs of altered hepatic function (lethargy), progressive neurological deterioration, increased blood ammonia levels.
Interventions: - provide rest and decrease stimulation, assess neurological status, monitor for signs of increased ICP, of altered hepatic function, intake and output, signs of bleeding and impaired coagulation.
