Pediatric%20Nursing

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Pediatric Nursing
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Neurological Assessment

• Assessment
• children under 2 years
• normal growth and development parameters
• parents evaluation of their child
• developmental milestones
• history
• prenatal
• birth history
• post natal

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Neurological Assessment

• Behavior
• personality, affect, level of activity, social
  interaction, attention span
• Motor function
• muscle - size, tone, strength
• abnormal movements
• Sensory function
• discrimination of touch with eyes closed

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Increased Intracranial Pressure

• Causes
• tumors
• accumulation of fluid within the ventricular
  system
• bleeding
• edema in cerebral tissues
• early signs and symptoms are often subtle and
  assume many patterns

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Assess for signs of Increased Intracranial
Pressure

• Level of consciousness (LOC)
• earliest indicator of changes in neurological
  status
• 1. Alertness
• arousal-waking state
• ability to respond to stimuli
• 2. Cognitive abilities
• process stimuli
• produce verbal and motor responses

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Increased Intracranial PressureSigns/symptoms

• Lack of painful stimuli is abnormal and is
  reported immediately
• as ICP increases LOC decreases
• 3. Vital Signs
• pulse
• variable, may be rapid or slow, bounding or
  feeble
• B/P
• normal or elevated with a widening pulse
  pressure, at shock level
• Respiration's
• varies

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Increased Intracranial PressureSigns/symptoms

• Temperature
• elevated especially with infections and
  intracranial bleeding
• subnormal in a coma of toxic origin
• Pupils
• size and reactivity
• bilateral vs unilateral
• sudden fixed and dilated pupils is a
  neurosurgical emergency
• pressure from herniation of the brain through the
  tentorium

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Neuromuscular - Signs/symptoms

• Neuromuscular Movement
• strength, spontaneous movements
• asymmetric or absent movements
• tone
• may be increased or decreased
• tremors, twitching, spasms
• purposeless flapping
• hyperactive or flaccid

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Increased Intracranial Pressure Signs/symptoms

• Posturing
• decorticate
• adduction and flexion
• decerebrate
• rigid extension and pronation

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Diagnosis Procedures

• Lumbar puncture
• measure pressure and sample for analysis
• Subdural tap
• r/o subdural effusions, relieves ICP
• EEG
• measures electoral activity
• detects abnormalities

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Diagnosis Procedures

• Computer Tomography (CT)
• visualizes horizontal and vertical cross section
  of the brain
• distinguishes density
• MRI
• permits tissue discrimination unavailable with
  other techniques

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Diagnosis Procedures

• Labs
• CSF
• blood glucose
• electrolytes
• Ca, Mg, Na
• clotting studies
• liver function tests
• blood cultures
• drug titre

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Cerebral TraumaHead Injury

• Etiology
• falls, MVA, bicycle injuries
• head is larger, heavier
• children curious
• incomplete motor development
• Concussion
• Contusion/laceration
• Fracture

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• Fatal bacterial
• meningitis

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Meningitis

• Inflammation of the meninges
• Spread
• vascular dissemination
• OM or URTI
• exudate covers the brain
• brain becomes hyperemic and edematous

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Meningitis

• Causative Organism
• H. Influenza, type B
• S. Pneumoniea
• N. Meningitis
• Meningococcus
• Signs and Symptoms
• FUO
• lethargy

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MeningitisSigns/symptoms

• irritable
• vomiting and/or diarrhea
• signs of meningeal irritation
• guarding of the neck
• nuchal rigidity
• cries when moved
• poor feeding

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MeningitisDiagnosis

• Labs
• CSF
• culture, glucose, protein, cell count, gram stain
• Blood Culture
• r/o sepsis
• Urine Culture
• r/o UTI
• Chemistry panel
• electrolytes, glucose, BUN, creatinine

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MeningitisTreatment

• Antibiotics
• administer within 1 hour of diagnosis
• type is based on age and causative organism
• neonate - ampicillin / claforan
• 3 months to 3 years - ampicillin / ceftriaxone
• older children - penicillin / chloramphemicol

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MeningitisTreatment

• Fluid Management
• fine balance between dehydration and cerebral
  edema
• child may be dehydrated due to v/d, poor po,
  fever
• 2/3 maintenance of IV replacement
• fluid restriction

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MeningitisNursing Care

• High Risk for spread of infection
• needs resp. isolation for first 24 hrs of
  antibiotic therapy

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MeningitisNursing Care

• Fluid Volume Deficit less than body
  requirements r/t dehydration
• NPO/fluid restriction
• I O
• daily weights
• Labs
• specific gravity and electrolytes
• IV fluid - careful, conservative replacement

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Febrile Convulsions

• Age
• most common between 6 months and 3 years
• Occurrence
• Seizure accompanied by fever without CNS
  infection
• Occurs during the temperature rise
• Treatment
• fever - tylenol
• seizure - ativan, valium

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• Tonic clonic seizure
• Tonic stiff
• Clonic - jerking
• Rescue position

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• Assessment
• seizure precautions
• emergency treatment
• rescue position
• Nursing Care
• protect from injury
• open airway
• accurately observe and record happenings

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Hydrocephalus
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Hydrocephaly

• Abnormal condition characterized by an increase
  volume of normal cerebrospinal fluid under
  increased pressure with in the intracranial
  cavity
• Communicating
• obstruction is located in the subaranoid cistern
  or within the subarachnoid space
• Non-communicating
• blockage is within the ventricles

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Hydrocephaly - Pathology

• 3 possible mechanisms leading to hydocephalus
• 1. Over production of CSF
• 2. Defective absorption of CSF
• 3. Obstruction of CSF
• 3 major causes
• inflammation
• congenital malformations
• tumors

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HydrocephalusSigns/symptoms

• Signs of increased fluid pressure
• tense or bulging anterior fontanel
• scalp becomes thin and shiny
• vein dilate
• cranial suture lines begin to separate
• Other clinical symptoms
• vomiting
• wide bridge between eyes
• bulging eyes - sunset eyes

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HydrocephalusSigns/symptoms

• Severe Form
• head size increases rapidly
• infants cry is shrill, high pitched
• hyperirritability, restlessness
• Older Children
• no head enlargement ataxia
• papilledema Alter mental status
• spasticity strabismus
• H/A

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HydrocephalusTreatment

• Surgical
• VP (ventriculo-peritoneal) Shunt
• Nursing Care
• Pre-op
• assessments
• daily head circumference
• size and fullness of anterior fontanel
• behavior
• nutrition - vomiting

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Hydrocephalus - Nursing Care

• fluid and electrolyte needs
• positioning
• prevent pressure ulcers
• support the neck
• good skin care
• neuro assessments
• LOC
• irritable child/infant
• vital signs
• observe for seizures

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Hydrocephalus

• Nursing Care
• Post-op
• monitor feeding and behavior patterns
• assess for increasing ICP and cerebral
  irritability
• HOB flat or set elevation
• Shunt observation
• infection - along the line or cerebral
• abdominal girth
• valve function, blockage, separation
• emotional needs - hold and cuddle
• teaching