Transcript Care of Children Experiencing Alterations in Neurologic Function

Care of Children Experiencing
Alterations in Neurologic
Function
Marydelle Polk, Ph.D., ARNP-CS
Florida Gulf Coast University
Objectives

Review and understand basic anatomy
and physiology of the neurological
system.
 Review and use assessment skills to
identify adaptive/non-adaptive behaviors
that may be exhibited by the pediatric
client.
 Utilize lab/diagnostic data to enhance your
nursing assessments.
Objectives…con’t.
 Review
the pathophysiological
processes that occur with examples
of neurologic deficits:
* Cerebral Palsy
* Epilepsy
* Spina Bifida
* Hydrocephalus
Objectives…con’t.

Identify common nursing diagnoses that
can be drawn after an assessment of a
pediatric client with alteration in
neurologic function.
 Identify and specifically describe nursing
coventions for a pediatric client with
alteration in neurologic function.
 Describe means of evaluation of nursing
coventions that correlate with medical
orders and interventions for a pediatric
client with alteration in neurologic
function.
Article:
McDonald, M.E. (1997). Use of the
ketogenic diet in treating children with
seizures. Pediatric Nursing, 23(5), 461464.
Hydrocephalus
A
condition in which the normal
circulation of the spinal fluid is
interrupted, resulting in increased
pressure on the brain, deformity, and
progressive enlargement of the head.
Hydrocephalus
 CSF
formed in the chorcoid plexuses
 to lateral ventricles  Foramen
of Monro  3rd ventricle 
Aqueduct of Sylvius into 4th ventricle
 into the Cisterna Magna  to the
cerebral and cerebellar subarachnoid
spaces – and is absorbed.
Causes of Hydrocephalus
 Impaired
absorption of CSF via the
SAS
(communicating hydrocephalus)
of CSF through the 3rd and
4th ventricles
(noncommunicating hydrocephalus)
 Obstruction
Remember…
 Hydrocephalus
is often a sequalae of
other developmental defects – most
common is Spina Bifida and/or
myomeningocele
Clinical Manifestations
 Head
enlargement
 Bulging fontanels w/o head
enlargement
 Dilated scalp veins
 “Cracked-pot” percussion sound
 Abnormal eye position (PRLA)
 Neurological changes
Diagnostic Tests
 MRI
 CT
 EEG,
echoencephalography,
 Ventriculograms
Treatment Depends on the
Cause of the
Increased Pressure.

Removal of part of choroid plexus to 
production of CSF.

Shunting of the fluid out of the brain to the
heart or to the peritoneal cavity.
Surgical Management
 Ventriculoperitoneal
 Ventriculoatrial
(VP) shunt
(VA) shunt
Preoperative Care
 Prevent
pressure sores on head by
changing child’s position, placing
child’s head on sheepskin, or by
holding the infant.
 Provide
good head support when the
child is sitting in a Fowler’s position.
Preoperative Care
 Promote
 Keep
optimal nutritional status.
eyes free of irritation.
Major Complications
 Malfunction
-  ICP
 Infection
 Brain Abscess
 Subdural
hematoma
Nursing Diagnoses
 Risk
for head trauma r/t impaired
cerebrospinal fluid absorption.
 Risk
for infection r/t presence of
infective bacterial organisms
Nursing Coventions
 Frequent
occipitofrontal
circumference (OFC)
 Frequent LOC
 Frequent fontanel checks
 Close monitoring of VS, NVS, and
feeding patterns
 Keep flat after surgery unless  ICP
 Monitor Intake and Output
Postoperative Nursing Care

Observe for shunt malfunction and valve
patency: watch for progressive increase in
head circumference and s/s of  ICP.

Observe for infection:

Position child flat on the un-operative
side.
Postoperative Nursing Care
 Prevent
postoperative complications:
turn q 3-4 hours, evaluate lung
sounds, and assess for signs of
infections.
 Protect
the operative site: avoid
pressure on the site; ensure sterile
dressing changes.
Spina Bifida
 The
failure of the posterior portion of
the lamina of the bony spine to form,
which causes an opening in the
spinal column.
Actions are Dependent on
Severity of Condition
 Neurological
 Urological
Interventions
Interventions
 Orthopedic
Interventions
Actions are Dependent on
Severity of Condition
 Neurological
Interventions
+ Observe for s/s of hydrocephalus
+ Measure head circumference daily
+ Observe for s/s of  ICP
Actions are Dependent on
Severity of Condition

Urological Interventions
+ If child is catheterized, use sterile
technique
+ Keep a careful record of I/O
+ Observe for s/s of urinary tract infection
Actions are Dependent on
Severity of Condition

Orthopedic Interventions
+ Provide opportunities for the child to
exercise and develop unaffected areas.
+ Prevent contractures through proper
positioning.
Epilepsy
A
series of seizures that result from
focal or diffuse discharges in the
cortical neurons – symptoms of
abnormal brain function
Epilepsy – Types
 Partial
Seizures
+ Simple Partial
+ Complex Partial
 Generalized
Seizures
+ Absence
+ Tonic-Clonic
+ Myoclonic
Epilepsy – Nursing Care
 Prevent
injury during a seizure
 Observe
and document seizure
pattern
 Administer
and monitor medications
 Administer
post-seizure procedures
Epilepsy – Nursing Care
 Prevent
injury during a seizure.
Epilepsy – Nursing Care
 Observe
pattern.
and document seizure
Epilepsy – Nursing Care
 Administer
and monitor medications.
Epilepsy – Nursing Care
 Administer
post-seizure procedures
Cerebral Palsy (CP)

A group of disorders used to describe a
group of disorders characterized by motor
and postural impairments – due to
abnormal muscle tone. CP may also
involve language, perceptual and
intellectual deficits. It is the most common
permanent physical disability of
childhood, occurring in approximately
2/1000 live births.
Cerebral Palsy (CP)
 Interventions
– multi-faceted
* Depends on the particular
manifestations of the disease.
* The child’s capacities.
Cerebral Palsy (CP)
 Classification
of CP
* Spastic
* Dyskinetic/athetoid
* Ataxis
* Mixed types
Cerebral Palsy (CP)
 Major
*
*
*
*
Focus of Interventions
Develop motor control
Develop communication skills
Provide adequate nutrition
Prevent orthopedic complications.