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: Mc. Donald, 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 3 rd ventricle Aqueduct of Sylvius into 4 th 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 3 rd and 4 th ventricles (noncommunicating hydrocephalus)

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. of part of choroid plexus to production of CSF. ® Removal ® 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 ® 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.