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Increased ICP, Hydrocephalus, Neuro assessment, Bacterial meningitis,…
Increased ICP
Infants
Stiff neck, dislike bright lights
Rapid breathing or grunding
Drowsy, floppy unresponsive
Unusual cry, moaning
Pale, blotchy skin spots/ rash
Refusing food and vomiting
Does not want to be touched
Fever, cold hands and feet
Convulsions/seizures
Tense, bulging fontanelle
Children and adolescents
Seizures
Irritable
Vomiting
Photophobia
Headache
Delirium
Chills
Aggressive
Fever
Hallucinations
Hydrocephalus
Causes
Hemorrhage
Infection
Tumor
Developmental malformation (chiari I and II)
DX
Head circumference
CT and MRI
Fetal ultrasound or MRI
Nursing
PostOP
Positioning - upright to drain
Observe for ICP
Observe for infection
Family support
PreOp
Observe for signs of increased ICP
Neurological assessment
Types
Non-communicating
Communicating
S/S
Childhood
Increased ICP S/S
Infancy
Macewen's sign
Frontal bossing
Bulging fontanelles
Setting sun sign
Persistent reflexes (panic mode)
Treatment
Venticuloarerial shunt
Ventiperitonial shunt
Complications
Malfunction
Infection
Pathophysiology
Increased ventricle size
Neuro assessment
AMS
Disoriented
Lethargic
Confused
Coma
Conscious
GCS
Verbal response
Motor response
Eyes open spontaneously
Orientation
Pupils
Involuntary muscle movements
Tremors
Twitches
Spasms
Dystonia
Temp
infectious or drug ingestions like salicylates, alcohol, barbiturates, bleeding
Low or high with hypothalamic such as infection
Pulse
variable rapid, slow, bounding, or feeble
Pupils
fixed and dilated pupils is a neurosurgical emergency
BP: normal, elevated or low
Bacterial meningitis
Point of entry
droplet infection
Neonatal group B strep
Greatly reduced since vaccines
E. coli
Complications
Brain abseccesses
Compression Necrosis
Deafness
Weakness/paralysis
Blindness
Hydrocephalus
Sepsis or meningococcemia
DIC
Septic shock
Adrenal hemorrhage
Purpura !!!!!!!!!!!!!
Treament
Hydration
Prognosis?
Meds?
Prevent w/ vax
Nursing
Monitor
Family support
Decrease stimuli
What is it
Acute inflammation of meninges
CSF
S/S
Increased ICP
Brudzinski's neck sign
Kernig's sign
Dx
LP
Gram stain
Blood cell count
CSF culture
Glucose
Fluid pressure
Protein
Cerebral palsy
Risk factors
Maternal
Gestational
L&D
Perinatal
Childhood or Postnatal
Unknown
Clinical manifestations
Delayed gross motor development
Abnormal motor performance
Alterations of muscle tone
Abnormal posture
Reflex abnormalities
Associated disabilities & problems
Management
Mobilizing devices
Surgery: tendon lengthening, spinal fusions, hips spasticity, function versus cosmetic
Medication: pain with surgery (can’t tell you), Botox injections (RELEASE MUSCLES), spasticity meds, seizure medications, baclofen pumps for spasticity (infection risk)
PT/OT/ST
Prognosis: 85% ambulate between ages 2-7(this is important to remember. Does not mean these patients are severely impaired)
Profound cognitive impairment may not reach adulthood
30% in the home, 50% live in independent settings
Nursing
Assist in normalization
Health maintenance needs
Support the family
Care of hospitalized child
Dx
Early recognition via careful assessment
MRI
Definition
disorder of posture and movement from static brain injury perinatally or postnatally, which limits activity
Patho
Varies
Submersion injury
Treatment
Prevent fever (no abx)
Aspiration pneumonia (48-72 hours after)
ABCs
Abscess
Patho
Hypothermia
Used to think it was neuro productive, but it is not. Jack from Titanic. The longer he is in the cold, he gets quiet, calm, and his body shuts down.
Hypoxia
Aspiration
reflex to take in a deep breath
Pulmonary edema, atelectasis, spasm of the airway, and pneumonitis
Prognosis
Should be monitored in hospital bc can have symptoms of respiratory compromise, cerebral edema 24 hours after.
How long submerged is the most important. Goal is less than 5 minutes. Salt water is better fresh water.
Hospital care
Oxygen
Intubation
Family support
Losing it
Making decision
Prevention
Supervision around pools and covers
Seizures and epilepsy
Definitions
Epilepsy
2 or more unprovoked seizures more than 24 hours apart
Seizures
transient occurrence of signs and/or symptoms due to abnormal excessive and synchronous neuronal activity in the brain
Classiciations
Partial
Simple with sensory signs
Focal
Simple with motor signs
Generalized
Tonic-clonic (grand mal)
Atonic or akinetic (drop attack)
Myoclonic
Acute v chronic
Dx
Description of seizure
History of pt and family
Physical & neuro exam
Rule out other causes
CT or MRi
LP
EEG (Electroencephalogram)
Treatment
Ketogenic diet
High fat, very low card, adequate protein
Vagus nerve stimulation (VNS)
Noninvasive programming
Implant in subQ tissue
Medications
Side effects: sleepiness, mood changes, ataxia
Drug to drug interactions
Surgery
Remove blood or tumor
Prognosis
Intractable
Refractory
Status epilepticus
Nursing
Safety: pad bed rails, waterproof mattress, never swim alone, showers, never grab tongue, turn on side
Explain what happened after
Don't try to stop
Educate prevention/triggers and medication compliance
Observe and document: description, onset, behavior, movement, face, eyes, respiratory effort, incontinent, postictal (REAL VS NOT)
Muscular Dystrophies (MD)
What is it
Inherited X-linked
(only boys)
Clinical Manifestations
Calf hypertrophy
Loss of ambulation by age 12
Progressive weakness, wasting, contractures
Death by respiratory or cardiac failure
Onset 3-5 years
parent reports difficulty standing from the sitting position
Waddling gait (gluteus Medius and maximus) and lordosis (abdominal muscles), fall frequently
Most severe & most common
Progressive, gradual degeneration
Weakness
Degeneration of muscles
Increasing disability
Increasing deformity
Dx
Symtoms
Confirmation by genetic testing
Treatment
Maintaining optimum function
Palliative care
No cure
Nursing care
Quality of life considerations
Support independence of child
Multidiscipline
Family support
Head injury
Nursing care
Assessment: ABC’s, mental status, pupillary responses (abnormal), , motor responses. Stabilize the spine!!
Management: usually nonsurgical management is enough. Surgery if frontal bones are involved (car injury, tbi)
Family support: emotional support. Teaching to observe for wound infections, hand washing, emotional. Teach to hold.
Prognosis: likely to be noted as developmental milestones are missed. May develop epilepsy, ADHD, or psychiatric disorders.
90% recover with no problems.
Rehabilitation: starts as soon as possible and will continue outpatient. Focuses on strengths and needs (Rusk vs inpatient)
Prevention: sleeping on top bunk, seat belts, helmets, abuse prevention (Kadyn). Shaken Baby: subdural hematoma, retinal hemorrhages. Teaching what to do if baby is crying constantly and stressed.
Etiology
Struck/hit
MVCs
Falls
Pathophysiology
Contusions and lacerations
Fractures
Concussions
Complication
Subdural or epidural hematoma
Spina Bifida
Myelomeningocele
Dx
Clinical manifestations
Examine meningeal sac
MRI, US, CT
Neuro eval
Prenatal dx – US
Prognosis
Early detection
Correction
Infection prevention
S/S
poor anal sphicter tone
joint deformations
Vary
Prevention
Folic acid supplementation
Pathophysiology
Risk factors
malnutrition (folic acid deficiency)
chemical
drugs
genetics
@ 20 days gestation neural tube forms
Treatment
Prevent infection
Bowel Control
Musculoskeletal
Avoid wounds
Physical therapy
GU
Neurogenic bladder
Prevent infection (straight cath)
Care of sac
Prevent infection
Positioning
Moist dressing to protect sac
Prep for surgical repair
Prone in radiant warmer
Post Op care
Side lying
Comfort
Monitoring: infection, s/s of ICP
Education
Family support and home care
Development
Avoid injury
Parent involvement
Resources
Latex allergy risk
Types
SB cystica – visible defect (sac-like protrusion)
SB Occulta – not visible externally
Defintion
midline defects involving failure of the osseous (bony) spine to close
Posturing
Flexion (in)
occurs with dysfunction of cerebellar cortex or corticospinal tracts. plantar flexed feet (stronger muscles take over weak ones)
Extension
dysfunction of the midbrain or lesions on the brainstem