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), 461-464.

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.

HydrocephalusCSF 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)

Obstruction of CSF through the 3rd and 4th ventricles (noncommunicating hydrocephalus)

Remember…

Hydrocephalus is often a sequalae of other developmental defects – most common is Spina Bifida and/or myomeningocele

Clinical ManifestationsHead enlargementBulging fontanels w/o head

enlargementDilated scalp veins“Cracked-pot” percussion soundAbnormal eye position (PRLA)Neurological changes

Diagnostic TestsMRI

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 (VP) shunt

Ventriculoatrial (VA) shunt

Preoperative CarePrevent 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 optimal nutritional status.

Keep eyes free of irritation.

Major ComplicationsMalfunction - ICP

Infection Brain Abscess

Subdural hematoma

Nursing DiagnosesRisk for head trauma r/t impaired

cerebrospinal fluid absorption.

Risk for infection r/t presence of infective bacterial organisms

Nursing CoventionsFrequent occipitofrontal

circumference (OFC)Frequent LOCFrequent fontanel checks Close monitoring of VS, NVS, and

feeding patterns Keep flat after surgery unless ICPMonitor 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 CarePrevent 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 Interventions

Urological 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 – TypesPartial 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 and document seizure pattern.

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.