Pediatrics ch 37 Christine Limann Dyer RN CPN Pediatric Differences Head is larger in proportion to body Insufficient musculoskeletal support in neck Fontenelles not closed in young child ID: 680632
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Slide1
Alterations in Neurological Function in Pediatrics ch 37
Christine Limann Dyer, RN, CPNSlide2
Pediatric Differences
-Head is larger in proportion to body-Insufficient musculoskeletal support in neck-Fontenelles not closed in young childSlide3
-Major cause of childhood deaths-Who is more at risk?
Head InjuriesSlide4
Concussion
Signs and Symptoms-Headache-Slowness in thinking, acting, speaking-Fatigue-Memory problems
-Loss of balance
(Ball, Bindler, & Cowen, 2010)Slide5
Cerebral Contusion
Bruising of the brain secondary to blunt trauma. Can be either coup or countercoup injuries.May involve tearing of brain tissue and may lead to areas of necrosis or infarction.
(Ball, Bindler, & Cowen, 2010)Slide6
Head Trauma
Between dura and cerebellum
Result of head trauma such as falls, MVA, or shaken child syndrome
Symptoms may appear after 24-72 hours
Change in LOC, Headache, N/V, retinal hemorrhage, pupil on side of injury may be dilated
Prognosis poor
Between dura and skull
Almost never occurs in children less than 4 y/o. Blunt trauma such as MVA, assault, baseball injury
Delayed onset followed by rapid change in mental status
Headache, Fixed dialated pupils, s/s increased ICP
Prognosis good
Subdural Hematoma
Epidural HematomaSlide7
Shaken Baby
Physical abuse
Countercoup injury
Subdural Hematoma
Retinal Hemorrhage
Seizure
Check baby for fractures in the rest of their body
Countercoup injurySlide8
Injury by Severity
Concussion or mild brain injury 13-15 GCS
Moderate brain injury 9-12 GCS
Loss of consciousness
Severe Brain Injury 8 or less GCS
Coma
Increased ICP
(Ball, Bindler, & Cowen, 2010)Slide9
Nursing Actions What is the priority?
Reportable changesDecrease in coma scaleRestlessness and irritabilityPain
Changes in pupils
Changes in responses, reflexes, movements
Drainage from nose/ears
Increased thirst or urination
Change in vital signsSlide10
Drowning/Near-Drowning
Drowning is the second leading cause of accidental death in childrenDeath occurs from asphyxia while submergedCan occur with even small quantity of water (even as little as a pail of water)
Near-drowning: survived at least 24 hours after submersionSlide11
Cushing’s Triad
Bradycardia
Widening Pulse Pressure
Irregular Respirations
Increased Systolic
Decreased Diastolic
(Ball, Bindler, & Cowen, 2010)Slide12
Intracranial Infections -Meningitis
More Dangerous Group B Streptococcus and gram-negative enteric bacilli most likely cause in newbornsNeisseria Meningitidis 2 mo-12 yr
Can also cause meningococcemia
H influenzae B and Strep Pneumoniae are now less common because of vaccination
-Fever, vomiting, irritable, hemorrhagic rash, headache, nuchal rigidity, seizures
Treatment:
Antibiotics
Does not appear as ill as the child with bacterial meningitis
Caused by
enteroviruses
, mumps, vericella
Irritable, fever, lethargy, headache, may have stick neck or back pain
Usually resolves in 3-10 days
Treat with antibiotics until bacterial meningitis is ruled out
Bacterial Meningitis
Viral Meningitis
Both Diagnosed by
Lumbar Puncture-LPSlide13
Intracranial Infections-Reye’s Syndrome
Infection in the brain – acute encephalopathyMay cause permanent tissue damage to
brain and liver
Associated with use of
aspirin
with
viral illness
such as chicken pox or influenza b
Symptoms: nausea/vomiting, mental changes, seizures, progressive unresponsiveness Slide14
Hydrocephalus – Cerebrospinal fluid build up
Communicating hydrocephalus – no blockage. Either a problem with over production of CSF or problem with absorptionNon-communicating- obstruction
Aqueduct of sylviusSlide15
Causes of Hydrocephalus
MyelomeningoceleDandy-Walker SyndromeChiari Malformation
Aqueduct of sylvius stenosis
Intraventricular hemorrhage in premature infants
Post infectious meningitis
Brain tumors
Congenital malformation
Non-CongenitalSlide16
Hydrocephalus- clinical manifestations
Newborns and infantsBulging fontanelsIncreased head circumference
Sun set eyes
Irritability
High-pitched, catlike cry
Visible scalp veins
Children
Headache
Visual disturbance
Nausea/vomiting
Pupils sluggish
Decrease in consciousness
Seizures
Cushing’s Triad
Widening pulse pressure
Bradycardia
Irregular respirations
(Ball, Bindler, & Cowen, 2010)Slide17
Hydrocephalus TreatmentVentriculoperitoneal shunt (VP Shunt)Slide18
SeizuresMost common neurologic dysfunction in kids
Caused by malfunctions of brain’s electrical systemInfections or high feverChemical imbalance of the body that causes loss of metabolism
Congenital conditions or trauma
Genetic factors and family history
Brain tumors and neurological problems
Habits of the mother like smoking, alcohol consumption, drugs and certain medications
(Hockenbery & Wilson, 2010)Slide19
Types of SeizuresAbsence – (3-12 years old)5-10 sec. Lip smacking, staring, twitching, brief loss of consciousness
Partial (focal) – Less than 30 sec., one extremityGeneralized (tonic-clonic or grand mal)Febrile DependentEpilepsy – Chronic disorderSlide20
Febrile SeizuresUsually higher than 38.9 C or 101F
Usually short in duration. Instruct parents to call 911 if longer than 5 minutesUse antipyretics and cooling measures
(Mayoclinic.com, 2010)Slide21
Nursing actions with patients with seizures
BeforeWhere there triggers such as change in temperature, light?During
Maintain airway
Role to side if possible
Time changes started
Part of the body involved and movement
Incontinence
After
Do they remember what happened?
(Ball, Bindler, & Cowen, 2010)Slide22
Treatment for SeizuresCommon pharmacological choices
Ativan -LorazepanDiazepam – Diastat
(can be given rectally)
Phenobarbital or Phenytoin
Remind parents not to stop once the seizures are controlled until directed by a doctor.
Other types of treatment
Vagal Nerve stimulator
Ketogenic Diet
(Ball,
Bindler
, & Cowen, 2010)Slide23
Nursing Role:Provide adequate Nutrition Promote safety and physical mobility
Maintain Skin Integrity Prevent ConstipationCerebral Palsy
(Ball,
Bindler
, & Cowen, 2010)
Abnormal muscle tone, lack of coordination, spasticity. Symptoms very depending on age and type of CNS injury. Slide24
Spina Bifida
Surgery to close the repair usually occurs within 24-48 hours. Some cases can be repaired in utero. May need VP shunt.Ongoing therapyMobility-Braces, wheelchair
Neurogenic bowel and bladderSlide25Slide26
References
Ball, J., Bindler, R., & Cowen, K. (2010).Child Health Nursing: Partnering with Children & Families 2nd Ed. Upper Saddle River, NJ. Pearson. Hockenberry, M. & Wilson, D. (2010).
Wong’s Nursing Care of Infants and Children 8
th
Edition.
St. Louis, MO. Elsevier.
Mayoclinic.com (2010). Febrile Seizure. Retrieved from http://www.mayoclinic.com/health/febrile-seizure/DS00346/DSECTION=symptoms
Saewyc, E. (2007). Health Promotion of the Adolescent and Family. In Hockenberry, M. & Wilson, D. (Eds.)
Wong’s Nursing Care of Infants and Children 8
th
Edition
(pp. 811-848
)
. St. Louis, MO. Elsevier.