neurological disorder 2

• Purpose: analyze CSF diagnose infection, hemorrhage, obstruction to CSF to
• contraindicated: any infection at insertion site and incr ICP
• apply emla 1 hr cream, sometimes consciously sedation
• position them appropriately- hold the patient
• needle in back L3-L$
• strict aspestic tech
• collect 3 tubes w/ 2-3ml CSF
• analyze glucose/protein-, culture and sensitivity- last tube most clean
• GLUCOSE: bacteria will feed on the glucose- low
• Protein- will be high if bacteria

• sit the baby up to back open- have them hold still
• older kids lie them on their side- have them hold still...it should not hurt. feel pinch

family/patient education: reduces fear and apprehension- explain what to expect during procedure

• Nursing: Post procedure care:
• lie flat for 30min- 1 hr as order or according to policy- bc we don't want air to go up to the brain. sometimes air gets introduce inside
• increase fluids- to incr CSF
• comfort measure and analgesia for headaches
• encourage parents to comfort child

• CT
• Nursing
• - protect from radiation exposure
• - sedation necessary for children who cannot hold still

• MRI
• Nursing:
• -assess for internal or external metal devices
• - sedation for children who can't hold still
• - assess for allergies if contrast is order
• - encourage fluids if not contraindicated

• Cerebreal angiography: visual of brain blood vessels
• - assess allergy bc contrast
• - after procedure- HOB up and incre fluids if u can

• Head and Neck injury
• nursing - helps identify ICP, skull defect etc

• PET- similar to MRI/CT
• EEG

• most common seizure of childhood
• defined as generalized seizure lasting < 15 minutes that occurence in 24 hour period and is associated with fever without any CNS infection.
• most often affects children <5 yrs 3m-5y
• self limiting seizure
• rapid rising seizure
• most in boys
• should have follow up with HCP
• Complications are rare: motor coordination deficit, intellectual disability, behavior problems

• HCP will:
• determine cause of fever
• provide fever control
• seizure medications
• - PO or rectal diazepam? generic name rectal if seizing
• - safe and effective in terminating febrile seizure activity
• - used in high risk children or those with anxious parents

• monitor VS, incr risk with rapid raise in temp
• 102.2 or 39c
• S/S:
• - stiffening of entire body, jerkingof arms and legs
• - complete lack of response to any stimuli, loss of consciousness
• - eyes deviated, staring, rolling back, moving back and forth
• - urinary incontenience
• - nosey breathing, labor, slower than normal
• Documentation:
• - onset and duration of procedure
• - characterics of patients after the seizure: LOC, apnea, cynanosis, motor activity, incontinence
• collect and document complete Hx as dx is based on hx and PE
• determine source of fever

• initiates safety/seizure precautions: pad side rails, remove objects that can cause injury, have suction and o2 equipment available
• parental support and reassurance
• Provide family education:
• - controlling fever- give med when suspected fever comes
• - safety during seizure activity
• - med teaching: po or rectal diazepam
• - when to call HCP
• - when to call 911
• - all seizure activity needs prompted medical attention

• family education: safety is key
• main goals:
• - protect airway and patient safety
• - remain calm and with child
• - remove objects from mouth
• - remove funiture of sharp objects
• - place child on side or abd clear mouth or suction bulb
• - perform jaw thrust or chin lift for noisy or labored breathing
• - do not restrain or try to stop seizure movements
• - do not hold tongue or put anything in mouth
• - document length, movement see other slide
• Control fever and not PO meds until the child is stable and conscious
• - give antipyretics- acteminophen suppositories
• - remove clothing
• - cool wash cloth neck and face
• - sponge bath do not immerse seizing child in tub

• Call HCP:
• after a brief repeated febrile seizure and follow home care

• Call 911:
• - serious trouble breathing, stops breathing
• - any injury occur
• - this is the first one
• - seizure last more than 5 mins
• - cyanosis
• - unresponsive to painful stimuli after seizure

• inflammation of the meninges most common infection of the CNS
• encephalitis: inflammation of the brain
• myelitis: inflammation of the spinal cord
• Causes:
• Bacteria:
• - Streptococcuspneumoniae
• - neisseria meningitis
• - Hib
• Virus: aspetic not contagious
• TB: mycobacteriumtuberculosis (not seen very often, may see it from foriegn)

• life threaten bacterial infection, imflammation of the meninges, potentially fetal
• causes:
• neonate: GBS most common, Group D strep, e.coli (transmitted in utero)
• after neonatal: streppneomia, chlamydia,
• most often it comes from something else in the body look at previous slide
• bacteria invades brain tissues causing infection and inflammation of meninges

• triad symptoms:
• Fever
• Headache
• meningeal signs: nuchal rigidity, brudzinski and kernig
• other: irritabilty, lethargy, seizure, convulsions
• neonate: poor feeding, fever, hypothermia, shill cry, apnea, apathy, jaundice, bulging fontannals, pallor, hypotonia, hypoglycemia
• infants and children: nuchal rigidity, opisthotonos, photophobia, altered senses, anorexia, N/V
• addi s/s: petechia rash, projectile vomiting, chills, hypotension, diplopia, sunset eyes, alter mental status, coma

• important to know
• Brudzinski sign: lift neck and knees comes up
• Kernig sign: cant straighten leg bc meninges muscle spasm
• opisthotonos: hyperextended legs and head. to relieve pain

• to examine CSF
• bacteria isolated and identifed
• evidence of meningeal inflammation
• blood culture, coagulation study, serum glucose, electrolytes
• CBC

nerve deafness, blindness, etc

• medical emergency
• detoriation is rapid occurs in less than 24 hours with out treatment
• provide support and isolation precautions
• meds;
• - IV antibiotics immediately
• - analgesia, antipyrectics non pharm measures
• - corticordsteriods
• - dopamine and other intropic agents
• IV fluids
• monitor blood gas level, provide oxygen
• to decress ICP: burrow holes in cranium

• droplet precautions until 24hr of antibiotic
• hypotherimia blankets
• seizure precautions
• monitor VS, I&O
• frequent neuro checks
• dark quiet enviroment
• keep flat in bed move gently
• admin antibiotics and meds as ordered
• emotional support

• self limited, viral infection of meninges and spinal fluid with negative CSF bacterial cultures
• causes: virus
• - measles mumps herpes, echovirus, west nile virus
• Assessment: abrupt or gradual onset
• s/s: headache, fever, malaise, abd pain, nausea, vomiting, signs of meningeal irritation (less sick but check LP)
• - leg or back pain, sore throat, chest pain, generalized muscle aches or pain
• symptoms resolve spontaneously in 2-7

• DX: CBC, cultures: viral, CSF, and throat, CT, MRI, EEG
• thera: contact precautions, fever control, IVF position for comfort. antimicrobial spending results of LP
• intervention: same as other, hand washing, teach low getting it
• complication: no residual effect

• too much CSF
• excessive CSF in ventricles or subarachnoid space. communicating (too much fluid but getting where it suppose to) or non communicating (something obstructing area)
• Assessment:
• - skull enlarging
• - bulging fontennals
• - distended veins
• - thin shiny scalp skin
• - irritable or lethargy
• - high pitch cry
• - sunset eyes
• - unable to support head, head percussion crack pot sound
• - vomiting not related to food intake

• medulla effect
• rr, pulse lower
• bp up

• goal: early identification to prevent brain damage
• management depends on cause:
• - overproduction: diurectic
• - obstruction: tumor may have to do surgery
• meds: anticonvulsants for possible seizure
• - carbamazepine (tegratol)
• ventriculoperitoneal shunt insertion: thin cather underneath the skin
• drains fluids into peritoneum which is then absorbed into systemic circulation and excreted

• removes excess fluid
• leaves extra tubing to accomodate for growth- babies
• one way valve

• assist with earl detection of hydrocephalus
• measure HC < 3 yrs of age, plot on growth chart to detect deviations from normal
• note symmetry of head
• s/p VP shunt placement care

• prevent shunt occulsion: do not have child lie on side of shunt
• lie flat: to prevent rapid decompression (not draining too fast), monitor closely, incre ICP
• monitor of infection
• supports child head upright
• head skin care turn frequently
• neuro checks and motor function for changes
• monitor abdomen distension
• teach parents s/s incr ICP
• offer emotional support to fam
• refer to national hydrocephalus founds

• congential malformation that produces defects in the skull and or spinal column
• (results from the failure of neurtube closing during emnyotic development)
• Types:
• - spina bida occult: cant see changes dimple, hair tuft
• - soina bifida cystica: you can see it meningocele is coming out in the bubble has CSF, myelomenigocele (spinal cord coming out) higher up on the spine the worst pt will be
• causes:
• lack of folic acid
• exposure teretogem
• isolated birth defect
• multiple malformation syndrom

• complications
• decr motor activity below the defect or paralysis
• neurogenic bladder or bowel
• CNS infection
• hydrocephalus
• death
• add 400mcg to diet folic acid
• risk of second child with NTD inc 1:20

• sonogram/ us
• maternal alpha feto protein serus and amniocentesis
• draw labs at 15w levels would be incr if baby had NTD

• occulta: hidden
• observe: skin abnormalities over spinal defect.
• hair tuft depression or dimple
• soft fatty deposits, port wine nevi, foot weakness, bowel/bladder dysfunction
• Cystica:
• associated abnormalites
• cyanosis, club foot knee contracture hydrocephalus, curvaure of spine, flaccid movements or paralysis or intellect disabilit
• after birth observe and document spontaneous movements of lower extremities and for bladder/bowel disfunction

• utero: surgery fetoscopy surgery
• after birth
• surgical correction or closure of defect within 12-48 hrs
• shunt placement hydrocephalus

• nursing interventions: maintain latex precautions: genetic counseling
• encourage folic acid
• provide emotional support both pre op and post op
• preopertive position on abdomen moist dressing on it
• - obtain head CS, monitor I&O, monitor for infection, monitor bladder/bowel function
• post op
• on abdomen to not put pressure on wound
• monitor sensation movement below site
• prevent constipation, provide rom
• teach family clean intermittent catherization