Neuro Peds

non adherent dressing with sterile saline, antiseptic, or antibiotic

Don't remove.  cont to add sterile solution to the dressing

remove it, cover with new non-adhesive dressing with sterile solution ordered, continue to moisturize it with sterile solution but do not remove it

appearance of the sac and the fluid/content withing it

side-lying position with small blanket or diaper roll under between the knees and ankles OR if sac is very large may have to be in prone position

do not fasten a diaper around the baby

use sterile absorbent pad underneath

facilitate frequent cleaning, prevent skin B/D, and prevent contamination of sac

temp q 1-2 h and V/S q 2-4 h depending on condition

axillary

at risk for infection

at risk for infection / IICP

qd to bid

anterior fontanel

1-2 h

1. LOC:  spontaneous eye opening & response to noise/moro reflex

2. pupil-size and reactivity

3. mvmt of face and extremities - esp noting symmetry

4. response to stimuli - soft and sharp

5. primitive reflexes - moro, grasp, and rooting

use non-latex materials to decrease chance of dev latex allergy due to repeated exposure

sterile linen

monitor temp and maintain sterility

huge risk for infection

ASAP, not later than 48 h after birth

intermittent cath q 4 h while awake

clean procedure, use water soluble lubricant, cleanse cath with soap and water & rinse with clean water, store cleansed cath in plastic bag

5 years old

suppostitory or micro-enema before breakfast then sit on toilet after breakfast

may do anal sphincter stimulation

1. wipe anus firmly with soft toilet paper

2. apply slight pressure to each side of anus

3. insert gloved finger into anal canal past internal sphincter and massage mucosal wall

1. passive ROM to prevent atrophy and contractures

2. orthopedic devices:  braces, splints, casts, and wheelchairs

3. orthopedic surgery to max mobility

CSF build-up due to malabsorption or over-production that causes enlargement and dialtion of the ventricles of the brain and IICP

congenital, acquired, and unknown

acquired:  infection, meningitis, IC bleed, or hemorrhage

• 1. serial measurement of head circumference
• 2. CT
• 3. MRI
• 4. lumbar puncture

increase of 1 inch per month

• 1. increased head circumference
• 2. bulging/full anterior fontanel
• 3. distended scalp veins
• 4. widely seperated cranial sutures

1. sunset eyes

2. vomiting without reports of nausea

3. HA that is relieved by sitting up

sclera of the eyes is visible above the iris due to retraction of the lid

1. correction of hydrocephalus

2. management of complications

3. management of psychomotor dev affected

1. hold head with palm of hand NOT fingertips

2. use a synthetic sheepskin pad, air/water mattress

3.  turn head q 2 h

be careful with the head b/c the sutures are seperated and skin is stretched thin and can damage brain

surgical placement of a shunt in the brain that will drain CSF into the peritoneal area or the R atrium of the heart

ventriculoperitoneal - peritoneum

ventriculoatrial - R atrium of heart

behind the ear - controls flow of CSF out of ventricle

infection

1 to 2 months after placement

will be very swelled up

• 1. increased temp
• 2. poor feeding
• 3. vomiting
• 4. decreased responsiveness
• 5. seizure activity
• 6. change in child's behavior
• 7. swelled shunt area

infection & shunt malfunction due to kinking, plugging, or separtion & migration r/t growth

• 1. Keep flat or no more than 30 degrees
• 2. position on side opposite shunt for 2 days
• 3. check VS q 15 min for 1 hour, q 30 min for 4  h, q 2 h for 24 hours, then q 4 h
• 4. temp q 1 to 2 h
• 5. do not feel/palpate shunt or put any pressure on it
• 6. test any drainage for glucose with reagent strips - will show halo sign if it is CSF

• 1. Observe pump for S/S of infection: red, heat, swelling
• 2. do not allow child to mess with pump - may need to put on a head covering
• 3. HOB slightly elevated
• 4. prevent constipation - can cause bowel to obstruct drainage of peritoneal tubing
• 5. ride bike with a helmut
• 6. call MD if have fever

to prevent sudden drop in ICP r/t drainage of CSF that can cause decompression and tearing of the cerebral artery

valve could open and rapidly decompress CSF

neuromuscular disorder of posture and mvmt with permanent damage that is nonprogressive

most ppl cog is not affected

• cognitive defecits
• hearing and visual impairments
• seizures

prenatal, perinatal, or postnatal

anoxia before, during, or after birth, maternal malnutrition/drug use/infection, birth injury, kernicterus, infection, trauma, stroke, poisoning, premature/low birth weight

premature/ low birth weight

static encephalopathy

bilirubin-induced brain dysfunction

area of brain injured

• 1. inability to maintain posture/balance
• 2. ataxic gait
• 3. toe walking
• 4. chorea
• 5. athetoid
• 6. difficulty holding and controlling a spoon
• 7. hyperextended head
• 8. hypersensitive gag reflex
• 9. tongue thrusting
• 10. uncoordinated mvmt of tongue, lips, and jaw

aspiration and altered nutrition r/t hyperextended head, hypersensitive gag reflex, tongue thrusting, and uncoordinated eating movements

• 1. contractures
• 2. increased suseptibility to infections
• 3. skin B/D
• 4. compromised self - image as they grow
• 5. caregiver role strain
• 6. aspiration
• 7. altered nutrition

• 1. hyperextended neck
• 2. hypersensitive gag reflex can cause vomiting
• 3. increased incidence of GERD

meds & multidisciplinary team

meds are mus relaxants, seizure meds, and meds for GERD

apply firm pressure to tongue with spoon and manually manipulate the jaw

electroencephalogram (EEG) & MRI

electroencephalogram - measures electrical potential of the brain

1. needs to be sleep deprived

2. no sugar or caffeine but may eat

3. hair should be clean and dry with no hair care products

1. Tell the child small cups/disks will be put on their head and don't call them electrodes

2. Tell parent/child that they will not have to cut thier hair

1. may resume normal activities

2. may use acetone to remove glue

3. may wash hair

> 8 years old = no more than 4 hours

<8 years old - 1/2 of normal sleep

infants - no alterations in sleep

1. may need to sedate r/t loud sounds and claustrophobia

2. inform about loud clicking noises

3. head will be restrained

area of electrical disturbance

partial, generalized, and unclassified

• 1. tonic, clonic, or tonic-clonic
• 2. atonic
• 3. myoclonic
• 4. absence seizure

• 1. simple partial
• 2. complex partial

seizures that do not fit into generalizied or partial seizures?

• 1. prodromal
• 2. aural
• 3. tonic-clonic/ictal
• 4. postictal

precedes seizure by hours to days

drowsy, dizzy, malaise, lack of coordination, "not themselves"

peculiar sensation that precedes onset of seizure

• 1. smelling unpleasant odors
• 2. seeing flashing lights
• 3. repeated hallucinations
• 4. numbness of extremity
• 5. cheshire cat grin
• 6. automatisms

lip smacking, picking at clothing, counting out change in air, walking aimlessly

muscles contract, fall to ground, extremities stiffen, face distorts, resp muscles contract, contraction of throat, inability to swallow, collection of saliva in mouth, biting of tongue, guttural cry

lasts app. 20 seconds

hypoxia and cyanosis

preventing aspiration

put on side and/or raise HOB, Yaunker's suction should be set up at bedside and suction things that come out of mouth but don't put inside mouth

up to 5 minutes

• 1. muscles rapidly contract & relax
• 2. quick, jerky motions
• 3. blow bubbles
• 4. foamy saliva
• 5. blood in mouth from biting tongue
• 6. incontinent of stool and urine

1 - 4 h

• 1. falls to sound sleep
• 2. rouse only to painful stimuli
• 3. upon awakening will have HA
• 4. no memory of seizure

• CAESAR:
• calm - dont panic
• airway - nothing in mouth & turn on side/HOB
• evaluate but don't restrain
• safety - protect from injury - move stuff
• activity - record time and describe seizure
• remain with pt & reorient when over

dilantin/phenytoin, phenobarbital, tegretol/carbamazepine

• 1. may participate in PE and sports
• 2. avoid scuba diving, sky diving, and rock climbing
• 3. may drive if seizures have been absent for 1 year

petit mal

• 1. staring spells over 10 sec
• 2. unaware time has passed
• 3. occurs 20-100 X per day
• 4. may be accused of daydreaming
• 5. grades may suffer

Seizure ass. with fever but in absence of CNS infection

children 3 years and younger

occur while temp is climbing and is usually due to height and rapidity of change in temp

38.8 C and 102 F

otitis media, pharyngitis, and adenitis

• 1. tonic, or tonic-clonic
• 2. last less than 5 minutes
• 3. don't reoccur

attempts to lower temp and tepid baths

tepid baths do not lower temp well due to shivering increasing it and they are uncomfortable for the child

medical emergency where have continuous seizure for longer than 30 minutes or chain of seizures and doesn't return to previous LOC

respiratory failure, permenant brain damage, and death

• 1. Yaunkers
• 2. O2
• 3. drug therapy

valium IV or rectally

IV:  do not dilute or  mix with any drug or IV fluid except NS and admin into a large vein

rectal:  instill via rectal catheter connected to a syringe or use a 1mL syringe and insert into rectum 1-2 cm or 1/2 to 1 inch

meningitis

age and duration of the preceding illness

opisthotonos, Kernig's sign, and Brudzinski's sign

head and heels are bent backward and body is bowed forward

body makes a u shape

hip is flexed, then MD tries to extend the leg at the knee

if pain or contraction of the hamstring occurs then positive sign for meningitis

head is flexed - if hips automatically flex is a positive sign of meningitis

lumbar puncture

• 1. cloudy CSF
• 2. elevated WBC
• 3. increased protein
• 4. decreased glucose
• 5. bacterial organism cultured from CSF

• 1. is a medical emergency
• 2. private room with droplet precautions
• 3. will have droplet precautions for 24 h after start antibiotics
• 4. start antibiotics before causative organisms is identified
• 5. IV antibiotics X 10 days

• 1. self-limiting in 3 to 10 days
• 2. symptomatic treatment
• 3. no lasting effects

meningococcal vaccine

viral infection varicella or flu and salicylates

BC, pamprin, pepto bismol, make up, clearacil, perfume, keopectate

liver dysfunction, severe hypoglycemia, coagulation defects

support respiratory function, control hypoglycemia, and reduce brain edema

• 1. abrupt loss of postural tone- fall down
• 2. impairment of consciusness
• 3. confusion
• 4. lethargy
• 5. sleep

• 1. brief and random
• 2. contraction of muscle group
• 3. loss of muscle tone
• 4. forward falling
• 5. occur on one side of both
• 6. impairment of consciousness