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Neurological Disorders
in the Pediatric Patient
Presented by
Marlene Meador RN. MSN, CNE
Neurological Assessment:
 LOC & behavior
 Vital Signs and respiratory status
 Eyes
 Reflexes and motor function
 Cranial nerve function (p. 1673)
Page 1672 discuses Modified Glasgow
Coma Scale for ages 3 and younger
Increased Intracranial
Pressure- IICP or ICP
Infants
 Irritability &
restlessness
 Fontanelles / FOC
 Poor
feeding/sucking
 Skull & scalp veins
 Nucal rigidity,
seizures (late signs)
Children
 Headache
 Vomiting
 Irritable, lethargic, mood
swings
 Ataxia, spasticity
 Nucal rigidity
 Deterioration in
cognitive ability
 Vital sign changes
Priority nursing diagnosis for a
child with IICP?
 What assessment findings should the
nurse monitor?
 What emergency equipment should the
nurse have on hand at all times for a
child with IICP?
Nursing interventions:
 What diagnostic procedures would the
nurse anticipate for this child?
 What priority interventions must the
nurse include with respect to these
diagnostic procedures?
 What
specific teaching is required?
 What additional lab/serum tests would you
anticipate?
Medications used to treat
IICP:
Corticosteroids
 Anti-inflammatory
 Contraindications-acute
infections
 Monitor I&O
 Protect from infection
 Add K+ foods
 Discontinue gradually
 Osmotic diuretic
 Reduce fluid
 Contraindicationsintracranial bleeding
 Monitor I&O carefully
 Monitor electrolytes
 Teaching
Quick Review:
Priority nursing interventions/
rationale
 What equipment is essential?
 Vital signs & neuro signs
 Additional assessment findings
 Activity level
 Hydration status
 Positioning
 Parent teaching
Seizures ( p 1675-1676)
 Febrile- rapid temp rise above 39°C (102°F)
 Focal- impaired consciousness, abnormal
motor activity, posturing, automatisms
 Generalized- loss of consciousness, muscles
rigid, rhythmic jerking
 Absence- may confuse with daydreaming or
inattentiveness
Nursing Interventions:
 Assessment findings
 Priority interventions
 Prevention
 During
seizure
 Following seizure
Medications used to control
seizures in children
 Phenobarbital- CNS depressant- monitor:
sedation, VS, serum levels,

Teach- S&S of toxicity, no ETOH, adhere to
regime
 Carbamazepine- sedative/anticonvulsant
 hold med if _____
 Teach- S&S of toxicity
 Phenytoin- anticonvulsant
 Safety measures- on-hand equipment
 Teach- oral care, sun exposure
Quick Review:
 What is most important nursing
intervention when a child is
experiencing a seizure?
 What is most important teaching
regarding seizure medication?
Meningitis:
 Why does bacterial meningitis present
more of a risk than viral meningitis?
(p. 1682)
 How do the manifestations of meningitis
differ between infants and young
children (p. 1682)
Lumbar Puncturenursing interventions
 What findings differentiate between
bacterial and viral meningitis?
 What specific interventions does the
nurse include for this procedure?
 Monitor
VS & neuro VS
 LOC
 Teaching
Nursing Care & Medications
for treatment of meningitis:
 Ceftriaxone Sodium (Rocephin®)- who
must receive this medication?
 Cefatoxime Sodium (Claforan ®) Dexamethasone- special nursing care
 Antipyretics
Hydrocephalus:
 What priority nursing assessment of a
newborn monitors for this condition?
 What assessment findings occur in the
older child?
 What diagnostic measures confirm this
diagnosis?
Nursing Care:
 Pre Operatively:
 Baseline VS, monitor for IICP,
 What teaching/interventions for parents?
 Post-op:
 Monitor shunt function (how?)
 Positioning and activity
 VS, neuro VS & I&O
 Teaching
Long-term Nursing care for the
child with hydrocephaly
 Home care needs
 S&S of IICP
 S&S of infection
 S&S of seizures
 Emergency numbers of Pediatrician &
neurosurgeon
 Refer to home care, social services and
support groups
Spina Bifida: (see p. 1697)
 What common nutritional supplement is encouraged
for all women of childbearing age?
 Discuss the 6 types of neural tube defects:
 Anecephaly
 Encephalocele
 Spina
bifida occult
 Spina bifidacystica
 Meningocele
 Meningomyelocele
Priority nursing diagnosis and
interventions:
 At risk for infection Protect
 Position
 At risk for injury Protect
 Position
Pre/post-op nursing goals:
what interventions should receive highest priority?
 Prevent infection- monitor VS, incision care
 Monitor for IICP Parent/child interaction Prevent muscle wasting-
 Long-term care
Nursing care of the child with
Cerebral palsy: (p.1702)
 Assessment (historical) data Lab findings-
 Priority goal
 Priority complication- “at risk for”
 Long-term complications
 Additional support to include in care
Head Injuries
in the Pediatric Client
 Anatomy predisposes infant/young to
injury
 Pathophysiology of “Shaken Baby
Syndrome”
Nursing care of child experiencing a
closed head injury: (p. 1708-1710)
 Assessment findings Immediate nursing interventions-
 Legal implications
 Why is it not prudent for the nurse to
discuss suspicions of abuse with the
parents or primary caregiver?
Pervasive Developmental Disorders /
Autism (p. 1732)
Home Setting
Acute Care Setting
 Reduce environmental
 Keep at least 1 constant




stimuli
Communicate via ageappropriate touch &
verbalization
Keep toys or other items out
of reach if child uses them
for harmful self-stimuli
Ritualistic ADLs
Encourage therapists &
support groups




caregiver. Encourage
parents to stay with,keep
room quiet & limit number of
staff
Anxiety/aggression when
touched by strangers
Constant monitoring by
nurse or parents
Allow to maintain rituals of
ADLs
Encourage therapists &
support groups
Down’s Syndrome (chromosomal
anomaly associated with Trisomy 21)
 Nursing assessment findings:
 Facial (forehead, eyes, nose, tongue,)
 Ears
 Neck
 Hands & feet
 Abdomen
 If the nurse visualizes any of the outward
signs of Down’s syndrome, what is the next
immediate priority nursing assessment?
Health Promotion
 How does the nurse promote health of the
child with Down’s syndrome?
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

Initial assessment of newborn
Parental perception (focus on the positive) {why is
blame-laying a concern? Across cultures…}
Initiate long-term assistance
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Speech
Occupational
Nutritional
Financial assistance
For questions or concerns
Contact Marlene Meador RN, MSN, CNE
Email: [email protected]