Caring for the Child with a Neurological or Sensory Condition

1
Chapter 29

• Caring for the Child with a Neurological or
  Sensory Condition

2
A P Review

• Nervous system
• Central nervous system
• Brain and spinal cord
• Peripheral nervous system
• Sensory-somatic
• Autonomic

3
Altered States of Consciousness

• Arousal or level of consciousness awareness of
  the environment
• Content of thought all cognitive functions that
  ensure awareness of affective states, self, and
  environment

4
The Unconscious Child

• Unconsciousness is a state in which a childs
  cerebral function is depressed and ranges from
  stupor to coma

5
Caring for the Unconscious Child

• Evaluating neurological status
• The pediatric Glascow Coma Scale
• Eye opening, verbal response, and motor response

6
Caring for the Unconscious Child

• Monitor vital signs
• Manage the airway
• Manage bladder and bowel elimination
• Maintain hydration nutrition
• Provide proper hygiene
• Position and perform exercise

7
Persistent Vegetative State

• A complete unawareness of the environment
  accompanied by sleepwake cycles.
• The diagnosis is established if it is present for
  1 month after acute or nontraumatic brain injury
  or has lasted for 1 month in children with
  degenerative or metabolic disorders or
  developmental malformations
• Family support is needed

8
Increased Intracranial Pressure

• Intracranial pressure (ICP) is the pressure of
  the cerebral spinal fluid (CSF) in the
  subarachnoid space between the skull and the
  brain. A child can have increased ICP as a result
  of many internal or external factors.
• Signs and symptoms
• See Table 29-2

9
Increased Intracranial Pressure

• Nursing care
• Close monitoring (neurologic status)
• Maintenance of a patent airway
• Monitor vital signs closely (hyperthermia)
• Administer IV fluids
• Monitor fluid balance (I O)
• Protect child from injury
• Administer antiseizure medications
• Provide emotional support
• Administer medications to decrease cerebral edema
  
• Analgesia and sedation
• A craniotomy is recommended when all other
  measures have been unsuccessful

10
Seizure Disorders

• Signs and symptoms
• See Table 29-3
• Nursing care
• Complete a detailed history
• Ensure airway management
• Maintain anticonvulsant therapy
• Implement seizure precautions (padded side rails,
  oxygen, suction equipment, IV access, and
  anticonvulsant medications)
• Provide continuous cardiac, respiratory, and
  oxygen monitoring
• Instruct caregivers instructed in CPR
• Keep school nurses and teachers informed about
  the condition
• Encourage medical alert identification bracelet

11
Inflammatory Neurological Conditions
12
Meningitis

• Signs and symptoms
• Mildly ill with general vague or subtle symptoms
  (lethargy, malaise, irritability, vomiting,
  fever, and diarrhea)
• Kernig and/or Brudzinski sign
• Nursing care
• Assess neurological status, anterior fontanel in
  infants, and seizure activity
• Provide comfort care
• Educate family and child about disease and
  treatment options
• Explain long-term parenteral access and IV
  antibiotics

13
Encephalitis

• Signs and symptoms
• Disorientation, confusion, headache, high fever,
  photophobia, lethargy, aphasia, hallucinations,
  seizures, nuchal rigidity, and coma

• Nursing care
• Viral is treated with antiviral medication
• Bacterial is treated with a narrow-spectrum
  antibiotic
• Other medications include antipyretics,
  anticonvulsants, analgesics, and
  anti-inflammatories
• Provide intravenous fluids and nutrition
• Implement seizure precautions
• Monitor fluid balance
• Do not suction or give percussion

14
Brain Abscess

• Signs and symptoms
• Localized headache, fever, drowsiness, stupor,
  confusion, general or focal seizures, focal motor
  or sensory impairments, ataxia, nausea and
  vomiting, papilledema, and hemiparesis
• Nursing care
• Assess neurological status, assess response to
  treatment, administer medications, and provide
  supportive care
• Monitor serum labs
• Surgery required if no response to antimicrobial
  therapy (postoperative care) or does not meet
  criteria for medical therapy

15
Reye Syndrome

• Signs and symptoms
• Lethargy, vomiting, drowsiness, liver dysfunction
• Nursing care
• Conduct neurological assessment
• Administer IV fluids
• Administer corticosteroids and/or diuretics
• Monitor oxygen saturation (supplemental oxygen)
• Insert arterial line (blood gases)
• Take seizure precautions
• Limit invasive procedures
• Provide emotional support

16
Guillain-Barré Syndrome

• Signs and symptoms
• Three phases acute, second, recovery
• Nursing care
• Plasma exchange and IV immunoglobulin therapy
• Give corticosteroids
• Monitor progression
• Insert indwelling urinary catheter
• Assess pain level
• Prevent contractures and loss of function
  (passive ROM)
• Provide skin care
• Suggest age-appropriate activities

17
Developmental Neurological Conditions
18
Spina BifidaNeural tube defects (NTDs)

• Signs and symptoms
• Vary depending on the level of the lesion and
  defect
• Spina bifida occulta
• Meningocele
• Myelomeningocele
• Types
• Meningocele
• Myelomeningocele
• Spina bifida occulta

19
Spina Bifida

• Nursing care
• Place newborn in prone position (prevent injury
  to sack)
• Provide postoperative care for laminectomy
  closure of defect
• Evaluate orthopedic function
• Prevent joint contractures
• Assess bladder and bowel function
• Provide skin care
• Assess neurological status
• Measure head circumference and assess fontanel
• Manage pain

20
Hydrocephalus

• Signs and symptoms
• Increased ICP
• Macewen sign
• Nursing care
• Understand shunt function and complications
• Obtain history and physical (life-threatening
  conditions)
• Discuss pharmacological measures or surgical
  procedure
• Perform nursing actions related to ICP
• Measure head circumference
• Give preoperative and postoperative antibiotics
• Assess neurological status
• Assess for shunt malfunction (eye assessment)
• Assess abdominal status (pain, bowel sounds, and
  circumference)
• Elevate HOB 30

21
Cerebral Palsy

• Signs and symptoms
• Vary individually depending on the area of the
  brain involved and the extent of damage
• Four categories
• Spastic
• Ataxic
• Athetoid or dyskinetic
• Mixed

22
Cerebral Palsy

• Nursing care
• Use splints and braces
• Promote self-care
• Administer medications (reduce muscle spasms,
  spasticity, anxiety, and seizure)
• Surgery (selective dorsal rhizotomy)
• Address feeding problems
• Provide intellectual stimulation
• Ensure safe environment

23
Neurological Injuries
24
Near Drowning (Submersion)

• Signs and symptoms
• Cerebral edema, alteration in LOC, respiratory
  distress, cardiovascular complications,
  hypovolema
• Nursing care
• Assess and maintain airway
• Provide life support measures
• Suction secretions
• Insert NG tube
• Administer oxygen
• Assess other injures (head or spinal trauma)

25
Head InjuryTraumatic Brain Injury (TBI)

• Signs and symptoms
• Obvious signs blood on the scalp, depression of
  the skull, and an obvious penetrating wound
• Other signs and symptoms loss of consciousness,
  alteration LOC, seizures and combativeness
• Nursing care
• Provide immediate care to prevent
  life-threatening complications
• Maintain airway patency and oxygen administration
• Insert IV and administer hypertonic fluid
• Assess neurological status
• Assess ICP

26
Shaken Baby Syndrome

• Signs and symptoms
• Seizure activity, apnea, budging fontanels, coma,
  hemorrhage, bradycardia cardiovascular
  collapse
• Nursing care
• Provide respiratory and cardiovascular support
• Assess for ICP
• Insert NG tube
• Maintain seizure precautions
• Maintain adequate fluid and nutritional intake
• Assess and document visible injuries
• Discuss short- or long-term care
• Assess parental concerns

27
Spinal Cord Injury

• Signs and symptoms
• Numbness, tingling, or loss of function
• Nursing care
• Maintain airway management and respiratory
  function
• Provide cardiovascular and circulatory support
• Give steroid therapy
• Monitor fluid intake and output
• Maintain gastrointestinal function
• Provide nutritional support
• Provide emotional and social support
• Be attuned to an adolescents unique needs
• Explain lifelong care and support, circulation
  support, disability identification, and exposure
  of known and unknown physical limitations

28
Nontraumatic Neurological Conditions
29
Headaches

• Types
• Primary headaches
• Secondary headaches
• Tension
• Migraine
• Cluster

30
Headaches

• Signs and symptoms
• Primary (triggers i.e., stress)
• Secondary (organic disorder i.e., trauma)
• Subtypes (tension, migraine, cluster)
• Nursing care
• Provide pharmacologic and nonpharmacologic care
• Discuss prophylactic measures
• Give intramuscular or intranasal medications
• Promote rest and stress reduction strategies

31
Sensory Conditions
32
Eye Disorders

• Hyperopia (farsightedness)
• Myopia (nearsightedness)
• Correction
• Concave lenses or contact lenses
• Laser assisted surgery

33
Astigmatism

• Irregular curvature or uneven contour of the eye
• Correction
• Corrective lenses
• Surgery
• Complaints of headache, blurry vision, or
  dizziness ophthalmologist referral

34
Amblyopia

• Signs and symptoms
• Strabismus or anisometropia are the most common
  causes
• Correction
• Occlusion therapy (patching of the normal eye) is
  done to restore strength and function of the
  lazy eye

35
Strabismus

• Nonparallelism in the different fields of gaze
  causing visual lines to cross even when focused
  on the same object
• Correction
• Ocular patching of the stronger eye, glasses, and
  pharmacotherapy
• Early identification and recognition

36
Color Blindness

• X-linked recessive inheritable color vision
  deficiency
• Color blindness is detected using colored charts
  called the Ishihara Test plates
• Child can learn to compensate with support from
  family members, teachers, and friends

37
Nystagmus

• Rapid irregular involuntary eye movement caused
  by a disorder of the central nervous system
• Correction
• Extraocular surgery

38
Cataracts

• Signs and symptoms
• Excessive tearing, extraocular movements,
  photophobia, lens appears cloudy, or there is a
  white or dulled red reflex
• Correction
• Prevent loss of visual acuity
• Laser procedure
• Postoperative (monitor nausea, emesis, pain,
  hemorrhage and signs of infection)
• Postoperative eye drops
• Follow-up care for visual acuity
• Educate family
• Early identification and recognition

39
Glaucoma

• Signs and symptoms
• Bupthalmos (enlarged eye globe), epiphora
  (excessive tearing), and photophobia (sensitivity
  to light)
• Correction
• Preoperative maintain quiet environment
• Antiglaucoma medications
• Analgesia and anxiety reduction strategies
• Pre- and postoperative care (teach parents)

40
Retinoblastoma

• Signs and symptoms
• Absence or abnormality of the red reflex
• A whitish or yellow color of the pupil called
  leukocoria
• Correction
• Laser, radiation, cryotherapy, or enucleation

41
Eye Injuries
42
Foreign Bodies

• Penetration
• Immediate transport to ER for removal
• Corneal abrasion
• Treatment
• Topical antibiotic solutions or ointments,
  analgesics, eye patch

43
Hyphema

• Hemorrhage into the anterior chamber of the eye
• Treatment
• Rest, possible evacuation
• Monitor increased intraocular pressure
• Promote decreased activity
• HOB 30
• Patch both eyes

44
Chemical burns

• Usually occur as a result of an accident
• Treatment
• Rapid eye flushing for 15 to 30 minutes followed
  by pH analysis of the chemical agent
• Eye patching

45
Hearing Loss
46
Hearing Loss

• Causes
• 1/3 of all cases are due to genetic causes
• 1/3 of all cases are due to non-genetic
  influences
• 1/3 of all cases are due to unknown causes

47
Hearing Loss

• Diagnostic testing
• Universal infant hearing screening before 1 month
  of age is recommended
• Treatment
• Based on underlying pathologic conditions,
  presence of organic diseases, the severity of
  hearing loss, the degree of frequency loss, and
  any CNS abnormalities
• Amplification aids (hearing aid)
• Nursing care
• Provide emotional, educational, and collaborative
  support for the child and family

48
Language Disorders

• Communication
• A process of complex interaction involving the
  exchange of information, feelings, ideas, and
  interactions
• Receptive language
• Expressive language
• Nursing care
• Recognize speech and language developmental delays