Presented by Marlene Meador RN, MSN, CNE

Head to torso ratio Cranial bones- thin, pliable, suture lines not

fused Brain vascularity and small subarachnoid

space Excessive spinal mobility Wedge shaped cartilaginous vertebral

bodies

LOC & behaviorVital Signs and respiratory statusEyesReflexes and motor functionCranial nerve function

Modified Glasgow Coma Scale for ages 3 and younger

Infants Irritability &

restlessness Fontanelles / FOC Poor

feeding/sucking Skull & scalp veins Nucal rigidity,

seizures (late signs)

Children Headache Vomiting Irritable, lethargic,

mood swings Ataxia, spasticity Nucal rigidity Deterioration in

cognitive ability Vital sign changes

What assessment findings should the nurse monitor?

What emergency equipment should the nurse have on hand at all times for a child with IICP?

What diagnostic procedures would the nurse anticipate for this child?

What priority interventions must the nurse include with respect to these diagnostic procedures?◦What specific teaching is required?◦What additional lab/serum tests would you anticipate?

Corticosteroids Anti-inflammatory Contraindications-

acute infections Monitor I&O Protect from

infection Add K+ foods Discontinue

gradually

Osmotic diuretic Reduce fluid Contraindications-

intracranial bleeding Monitor I&O carefully Monitor electrolytes Teaching

What equipment is essential? Vital signs & neuro signs Additional assessment findings Activity level Hydration status Positioning Parent teaching

Febrile- rapid temp rise above 39°C (102°F) Generalized- loss of consciousness, involves

both cerebral hemispheres onset at any age Tonic/Clonic- impaired consciousness,

abnormal motor activity, posturing, automatisms

Absence- may confuse with daydreaming or inattentiveness

EEGCT, MRILumbar punctureCBCMetabolic screen for glucose, phosphorus and lead levels

Assessment findingsPriority interventions◦Prevention ◦During seizure◦Following seizure

McKinney has detailed Nursing Care Plan

Phenobarbital- CNS depressant- assess for sedation, VS, serum levels, ◦ Teach- S&S of toxicity, no ETOH, adhere to

regime

Carbamazepine- sedative/anticonvulsant ◦ hold med if lab values =◦ Teach- S&S of toxicity

Phenytoin- anticonvulsant◦ Safety measures- on-hand equipment◦ Teach- oral care, sun exposure

What is most important nursing intervention when a child is experiencing a seizure?

What is most important teaching regarding seizure medication?

Bacterial Potentially fatal; abx

given prophylactically if

bacterial suspected. May kill within 24 hrs

C/S take 72 hrs to process

Infants at greatest risk

Nuchal rigidity Severe headaches Contagious

Viral Same s/s but milder and

shorter duration May follow a viral

infection May be accompanied by

rash Nuchal rigidity Ataxia Not contagious

Why does bacterial meningitis present more of a risk than viral meningitis?

How do the manifestations of meningitis differ between infants and young children

Infant Child/Adolescent

Fever (not always present)

Poor feeding Vomiting Irritability Seizures High-pitched cry

Fever Headache Photophobia Nuchal rigidity Altered LOC Anorexia/ vomiting Diarrhea Drowsiness

What findings differentiate between bacterial and viral meningitis?

What specific interventions does the nurse include for this procedure?◦Monitor VS & neuro VS◦LOC◦Teaching

Ceftriaxone Sodium (Rocephin®)- who must receive this medication?

Cefatoxime Sodium (Claforan ®)- Dexamethasone- special nursing care

Antipyretics

What intervention must the nurse initiate to protect the patients and staff when a diagnosis of bacterial meningitis is suspected?

Hydro= Water Cephaly= of the head/brain

What priority nursing assessment of a newborn monitors for this condition?

What assessment findings occur in the older child?

What diagnostic measures confirm this diagnosis?

LP-dangerous MRI; CT scan Skull X-ray Measure FOC Provide for safety, informed consent, support for child and family, accurate H&P

Shunt placement- surgical procedure to place a tube that drains CSF into the atrioventricular or peritoneal cavity.

Atrioventricular- drains into atrium (not used as frequently)

Ventricular peritoneal- drains into the peritoneal cavity

Pre Operatively:◦Baseline VS, monitor for IICP, ◦What teaching/interventions for parents?

Post-op:◦Monitor shunt function (how?)◦Positioning and activity◦VS, neuro VS & I&O◦Teaching

Home care needs S&S of IICP S&S of infection S&S of seizures Emergency numbers of Pediatrician &

neurosurgeon Refer to home care, social services and

support groups

Most common defect of the CNS Occurs when there is a failure of the osseous spine to close around the spinal column.

What common nutritional supplement is encouraged for all women of childbearing age?

What common nutritional supplement is encouraged for all women of childbearing age?

Discuss the 3 types of neural tube defects:◦Spina bifida occult◦Meningocele◦Meningomyelocele

Visualization of the defect Motor sensory, reflex and sphincter abnormalities

Flaccid paralysis of legs- absent sensation and reflexes, or spasticity

Malformation Abnormalities in bladder and bowel function

Immediate surgical closure

Prior to closure keep sac moist & sterile

Maintain NB in prone position with legs in abduction preoperatively

Pre-Operative:Meticulous skin careProtect from feces or urineKeep in isolette

Assess surgical site Monitor VS and neuro VS Institute latex precautions Encourage contact with parents/care givers

Positioning Skin Care

Antibiotic therapy Prevent UTIEducationEmphasize the normal, positive abilities of the child

At risk for infection-◦Protect◦Position

At risk for injury- ◦Protect◦Position

Static Encephalopathy- spastic CP most common type (80%)◦Nonspecific term give to disorders characterized by impaired movement and posture

◦Non-progressive◦Abnormal muscle tone and coordination

Jittery (easily startled) Weak cry (difficult to comfort) Experience difficulty with eating (muscle control of tongue and swallow reflex)

Uncoordinated or involuntary movements (twitching and spasticity)

Alterations in muscle tone◦Abnormal resistance◦Keeps legs extended or crossed◦Rigid and unbending

Abnormal posture◦Scissoring and extension (legs feet in plantar flexion)

◦Persistent fetal position (>5 months)

EEG, CT, or MRIElectrolyte levels and metabolic workup

Neurologic examinationDevelopmental assessment

Increased incidence of respiratory infection

Muscle contracturesSkin breakdown Injury

Anatomy predisposes infant/young to injury

Pathophysiology of “Shaken Baby Syndrome”

Assessment findings- Immediate nursing interventions- Legal implications Why is it not prudent for the nurse to

discuss suspicions of abuse with the parents or primary caregiver?

Not clearly understoodCharacterized by impaired social, communicative, and behavioral development

Usually noted in the first year of life

Home Setting Reduce environmental

stimuli Communicate via age-

appropriate touch & verbalization

Keep toys or other items out of reach if child uses them for harmful self-stimuli

Ritualistic ADLs Encourage therapists &

support groups

Acute Care Setting Keep at least 1 constant

caregiver. Encourage parents to stay with,keep room quiet & limit number of staff

Anxiety/aggression when touched by strangers

Constant monitoring by nurse or parents

Allow to maintain rituals of ADLs

Encourage therapists & support groups

Trisomy 21- the most common chromosomal abnormality resulting in mild to profound mental retardation

Failure of chromosomes to separate

Advanced maternal age No other socio-economic or geographic factors have been identified

Primary concern with cardiac and GI anomalies

What are the most obvious indications of Down’s Syndrome in a newborn

How does the nurse promote health of the child with Down’s syndrome?

Primary focus on the parents and care givers to provide support and achieve a realistic view of the child’s capabilities

Support siblings Refer to family counseling services Support parents in feelings of guilt and

chronic sorrow

Contact Marlene Meador RN, MSN, CNE

Email: mmeador@austincc.edu