Neurological Conditions

Cerebral palsy cause

caused by sudden brain damage or abnormal brain development that happens before birth or early in life (ex: during delivery and a lack of O2) -perinatal stroke, preterm birth, hypoxic-ischemic encephalopathy

Hydrocephalus is a result of

congenital malformations such as a neural tube defect

Complications of a TBI

epidural hematomas and hemorrhages fixed and dilated ipsilateral pupil and contralateral weakness and paralysis inc ICP and brain herniation subdural hematoma and hemorrhages

Head injuries (TBI) common causes

falls are the most common cause -also MVA, bicycle accidents, child abuse

Symptoms of meningitis

fever petechial rash stiff neck hypothermia irritability poor feeding vomiting altered mental status

Hydrocephalus definition

improper CSF production and absorption

Meningitis

inflammation of the protective membranes covering the brain and spinal cord *is a medical emergency *is common in college students or where people live communally

Elements of a neuro assessment

mental status-ask developmentally appropriate questions cranial nerves deep tendon reflexes strength cerebellar function-balance, gait, finger to nose sensation

Nursing care for cerebral palsy

nutrition concerns: affects gut motility, may have feeding tube Communication concerns: nonverbal or talk slowly social needs medications: anti epileptics muscle relaxants at risk for fractures, skin breakdown, falls, scoliosis, loss of mobility may have seizures

Neuro assessment is based on

observation and interaction with the child

EEGs are used for

records electrical activity generated by cerebral cortex used to diagnose seizures and record brain activity

What symptoms would we see if something is wrong with the shunt?

respiratory distress

Seizure management

safety first- ABC's and seizure precautions call for help turn patient on their side monitor vitals hold feeds it is okay to suction if needed

The difference between seizures and epilepsy

seizures are sudden, uncontrollable electrical changes in the brain epilepsy is recurrent seizures (2 or more) that are not caused by infection, hypoglycemia, and trauma

Neural tube defects signs to look for

signs of increased ICP -headache -change in LOC/mental status -vomiting -poor feeding

Signs of increased ICP in older kids

slight VS/LOC changes headaches N/V visual changes seizures

Signs of increased ICP in infants

slight VS/LOC changes irritability high pitched cry bulging fontanel inc OFC

Most common neural tube defects

spina bifida and anencephaly

Cushing's triad

three classic signs—bradycardia, hypertension, and respiratory distress—seen with pressure on the medulla as a result of brain stem herniation

Types of generalized seizures?

tonic-clonic absense (staring) atonic (drop) myoclonic (jerking)

treatment of hydrocephalus

ventriculoperitoneal shunt -allows CSF to drain properly

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis?

IV fluids at 1 ½ times regular maintenance this could cause fluid overload and lead to increased ICP

symptoms of hydrocephalus

Infants: -rapid increase in orbital frontal cortex -bulging fontanel -dilated scalp veins Older child: -behavioral changes -headaches -N/V -ataxia -rapid eye movements (nystagmus)

Education for a TBI

Instruct parent to stay with child for 24 hours Wake the child every 2 hours to assess for LOC closely observe the child for 2-3 days seek emergency care if: -worsening headache -slurred speech -excessive vomiting -gait disturbances, difficulty walking

Prophylaxis medications for seizures

Keppra Depakote/valproic acid Lamictal

Assessment during a seizure

ABC's time the seizure observe for -behavior -sensation -motor function -speech

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows that clarification is needed when the mother says:

"My child's 7-year-old brother is also at high risk for a febrile seizure." most children over the age of 5 do not have febrile seizures

A child with a VP shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse's best response.

"You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

How common are seizures in children?

1 in 10 children will have a seizure in the first 16 years of life

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first?

Administer blow-by oxygen and call for additional help seizure increases the body's metabolic rate and demand for oxygen, child can become hypoxic

TBI assessment

Ask what happened Did they lose consciousness for any period of time? Any vomiting? altered mental status "have they not seemed like themself since this happened" assess ABC's Assess pupil response check for hypoglycemia if change in LOC, lethargic

Nursing care for mild TBI

Assess -pupils -LOC (even at night) -drainage from ears/nose (CSF leak?) Avoid sedation if possible Nutrition -npo at first -check electrolyte levels with CMP -risk of aspiration of vomiting Rehabilitation

Cerebral palsy definition

Permanent disorder of the development of movement and posture that causes activity limitation (affects a persons ability to move, maintain balance and posture) -is permanent, but not progressive

Febrile seizures

Seizures that result from sudden high fevers (>101.5), particularly in children (6 months-5 years old).

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first.

Send the spinal fluid and blood samples to the laboratory for cultures *next, administer IV antibiotics

The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response.

Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving." -posturing is a reflex that indicates too much stimulation

How to help a child get a CT scan after a TBI

administer Ativan, versed, or an intranasal med to distract the child

Nursing care meningitis

antibiotics assist in lumbar puncture for diagnosis reduce inflammatory response with steroids protect airway if a bacterial infection: isolation precautions, negative pressure room

How do you assess altered state of consciousness in a 3 year old?

ask them to say their name and identify their parents

Cloudy CSF indicates

bacterial meningitis

Rescue medications for seizures

benzodiazepines -Ativan: IV or IM -Versed: intranasal -not given during seizure because they cant inhale -diastat-rectal phenobarbital or bolus antiseptic if epileptic

Late signs of increased ICP

bradycardia decreased LOC lethargy decreased motor/sensation altered PERRLA posturing coma

What could it be beside a seizure?

breath holding spells tics syncope migraines daydreaming ADD/ADHD

How is hydrocephalus acquired?

• Tumor • Infection • Hemorrhage