session 10 Nuerological conditions and neurological assessment of the child Flashcards
what is the process for assessment for infants and children with altered levels of consciousness
ABCDE Airway Breathing Circulation Disability/ neuro statis - modified GCS ( below 8 - trapezius squeeze/intubate/ emerg CT scan/ review), LOC, S&S of ICP, dysfunction in posture Envrionment
Scenario
your allocated an 8 year old patient with global developmental delay, they cannot talk or respond. The patient fell out of their booster chair from a 4wd and landed on their head. They have been ordered hourly neruological observations. What assessments would you do on this child.
Modified glascow coma scale PEARL - pupils fixed = indicate coning or ICP neuro to review patient straight away POSTURING decorticate - bilateral cerebral damage deceborate - pons damage - neuro review
what are the signs and symptoms of intercrania pressure in an infant and child
high pitch cry tense bulging fontanelle dilated scalp veins widened sutures irritability increased head circumference vomiting, poor intake
what are the signs of MENINGITIS
headache in the frontal location photophobia estropia - crosseyed nuchal rigidity - hyper extend their neck fever V & D Irritable, lethargic, restless and alert change in feeding pattern bulging or flat anterior fontanelle alterted LOC
what is the nursing care for MENINGITIS
infection control - PPE for first 24 hrs after antibiotics are commenced (gown, gloves, mask), child nursed in isolation room, educate family/ friends of precautions required.
monitoring hydration status - strict fluid balance/ daily weight, specific gravity checks, fluids often restricted due to risk of cerebral oedema ( however if dehydrated on admission -must be rehydrated), oral care ever 4 hrs, iv site checks every 4 hrs
monitoring for signs of shock- frequent neuro obs/vital signs, fontanelle assessment, daily head circumference measurements, monitor for seizure activity, monitor skin for none blanching rashes, hearing assessment prior to discharge
acute pain and discomfort management - fever = analgesia,minimal handling photophobia - irritability = nurse in low lit room for first 48 hours
seizure management- time seizure, protect from injury (head), put oxygen near their face, stats prob on them, turn on side and suction after jerking stops, observe and monitor breathing and give gentle reassurance until recovered.
reduce anxiety of caregivers = provide emotional support
keep caregivers informed, listen to concerns and comfort, suggest breaks, involve in care - room in, care for breastfeeding mothers(hydration, meals, expressing equipment).
what is the acute seizure management
stay with patient
time the seizure
protect from injury, especially head
roll onto side after jerking stops or if food, vomit secretions in mouth.
observe and monitor breathing
gently reassure until recovered
Hospital setting - put 02 near their face, sats prob on them, turn on side and suction.
what are the classifications of seizures
Partial - simple and complex seizures
Generalised - tonic-clonic and absence
define characteristics of simple seizures
no loss of consciousness
last less than 30 seconds
no post seizure confusion
may involve one extremity
define characteristics of a complex partial seizure
onset 3yrs to adolescence
last 30 seconds to 5 minutes
post confusion
may have twitching or loss of tone
what are the characteristics of tonic clonic seizures
abrupt onset seizure 1-2 minute LOC post confusion (minutes to hours) pupils dilated, roll upward or deviate to one side drooling secretions
what are the characteristics of absence seizures
onset 3yrs -12 years remission in adolescence common
brief LOC
no post confusion
frequent attacks
may cluster
staring, gazed eye appearance, eye blinking
