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nervous system consists of
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largest part of the brain is what and consists of what
- cerebrum
- 2 hemispheres and several lobes
-
frontal lobe controls...
- personality
- emotions
- complex intellectual fxn
- voluntary mvmt
-
parietal lobes ctrl...
sensory inputs (pain, pressure, temp)
-
temporal lobes ctrl...
- taste
- smell
- hearing
- speech
- language
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occipital lobe ctrls...
vision
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cerebellum ctrls...
- motor coordination
- posture
- equilibrium
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brain stem regulates...
resp. and cardiac fxns
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difference btw brain of child vs adult
- top heavy; head is larger in prop. to body
- neck musc not well dev
- thin cranial bones
- highly vascular brain
- excessive spinal mobility
- immature musc, joint capsules & ligaments of cervical spine
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confusion def
disoriented to time, place, person
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delirium def
state of confusion, fear, agitation, anxiety
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obtunded def
limited response to the envt; i.e. child falls asleep unless given verbal or tactile stimulation
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stupor def
response to rigorous stimulation only
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coma def
the child cannot be aroused
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name 5 altered states of consciousness
- confusion
- delirium
- obtunded
- stupor
- coma
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clinical manifestations of decline in a child's LOC (6)
- awake, alert, appropriate
- slight disorientation
- restless, fussy, irritable
- drowsy but responds to loud and/or painful stim
- unresponsive
- decorticate or decerebrate posturing
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dx'ic lab tests for child neuro
- CBC
- blood chem
- clotting factor
- blood cultures
- toxicology assessment of blood and urine
- UA/UC
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dx'ic tests for child neuro
- lumbar puncture
- EEG
- CT
- MRI
- skull xray
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remember what 3 things re: ped GCS
- eye opening
- verbal response
- motor response
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what is most important aspect of GCS in a child and why
motor response; because children cannot control their reflexes, though they may keep their eyes shut when you ask them to open them b/c they're afraid, etc.
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RN assess what re: ped neuro (MAIN 4 TO KNOW)
- responsiveness
- airway
- breathing
- circulation
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most common injury in childhood is...
head trauma
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TBI causes what in a child (3)
- intellectual impairment
- szs
- physical disability
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primary vs secondary head trauma
- primary = occurs at time of insult
- secondary = body's response to initial injury d/t hypoxia, hemmorage, edema
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mild head injury
- remains conscious, OR
- loses consciousness for less that 5 min.
- child may have amnesia re: event
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moderate head injury
- loses consciousness for 5-10 min.
- child may have amnesia re: event
- HA
- N/V
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severe head injury
- unconscious more than 10 min.
- may show signs increased ICP
- changes in resp efforts/periods of apnea
- tachycardia (blood loss, hypoxia, pain)
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RN assessment re: head trauma - what 3 things in particular
- collaborate
- prevent complications
- promote recovery
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SC injury - complete vs incomplete
- complete = irreversible; lose all sensory, motor, autonomic fxn below level of injury
- incomplete = involves varying degrees of sensory, motor, and autonomic fxn
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s/s hypovolemic shock
- tachycardia
- increased RR
- weak peripheral pulses
- pallor
- cold extremities
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s/s neurogenic shock
- hypotension
- bradycardia
- warm and dry extremities
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s/s spinal shock
- flaccid, areflexic extremities
- hypotension
- bradycardia
- flushed, dry skin
- loss of sphincter ctrl w/ urinary retention
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injury from what vertebrae = high risk for autonomic dysreflexia
- T6 and above
- sometimes as low as T10
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s/s spinal cord injury
- hypovolemic shock
- increased ICP
- resp depression
- neurogenic shock
- spinal shock
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SCIWORA
- "spinal cord injury w/o radiographic abn"
- initial films or CTs show no bony deformity and child is believed free of injury, BUT profound or progressive paralysis comes on stat or w/in 48 hrs
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spinal cord injury how dx
- by observation
- neuro exam
- radiologic studies (CT, xray, MRI)
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cerebral palsy is caused by (3)
- brain anoxia (pre-,peri-,post-natal)
- premature
- low weight
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cerebral palsy def
- non-progressive
- motor and posture dysfxn
- may have cog. and lang. delays
-
s/s cerebral palsy
- delay in fine and gross motor skills
- poor vision
- hearing loss
- cog. deficits
- speech/lang. delays
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higher incidence of cerebral palsy in who (2)
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assess all children at each health care visit for...
dev delays
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clinical manifestations of cerebral palsy
- poor head ctrl
- clenched hands after 3 mos of age
- increased musc tone (stiffness)
- decreased musc tone (floppy/limp)
- arching of back
- inability to sit up bu 8 mos
- feeding probs (gag/choke when fed)
- favoring one side of the body
- increased irritability, crying
- scissoring of the legs
- pointing toes
- tremors or szs
- exaggerated started reflex
- failure to smile by 3 mos
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how dx cerebral palsy
- medical hx to identify the cause
- brain imagery (CT, MRI)
- genetic tests
- metabolic tests
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don't give cerebral palsy dx until what age
2 yrs
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NIs for cerebral palsy most want what for the child
- maintain mobility
- maintain maximum joint ROM
- optimize musc ctrl, balance
- optimize communication
- ADLs
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phenol blocks are effective how long for a cerepral palsy pt
3-8mos
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how do you give baclofen to a cerebral palsy pt
- oral
- intrathecal - after 4 yrs old
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meds to give cerebral palsy pt
- dantrolene sodium
- baclofen
- diazepam
- phenol blocks
- botulinum toxin A (botox) injections
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dental hygeine is esp impt for who
cerebral palsy pts
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2 surgeries for cerebral palsy pts
- orthopedic - to acheive better leg mvmt and gait ctrl, correct extremity deformities
- neurological - selective dorsal rhizotomy to improve PROM, spasticity and gait
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complementary therapies for cerebral palsy pt
- hippotherapy
- Euromed Adeli Suit (Poland)
- massage therapy
- music therapy
- aqua therapy
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hippotherapy does what
improves strength, balance, and posture
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cerebral palsy - when is underweight vs. overweight a problem
- underweight in infancy
- overweight in late childhood and adolescence
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diet concerns for cerebral palsy pts
- some ppl don't feel the food/drink in their mouth
- lifelong risk for ASPIRATION
- tactile defensiveness
- under/overwt.
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s/s hydrocephalus
- disproportionately large head
- prominent scalp veins
- translucent skin on forehead
- wide, palpable suture lines
- restlessness
- irritability
- diminished LOC
- sluggish pupils
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hydrocephalus caused by
- infection
- hemorrhage
- tumor
- structural deformity
-
hydrocephalus
imbalance in the production and absorption of CSF
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tests to help dx hydrocephalus
- CT
- MRI
- skull xray
- ultrasound
- echoencephalograph
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shunting devices are...
to divert excess CSF from head into blood stream (because it goes to BVs on its own anyway)
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pre-op hydrocephalus do what
- measure head circumference
- watch for s/s increased ICP
- asses respirations
- I/O
- monitor nutritional status
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post-op hydrocephalus do what
- VS
- neuro check
- sleep pattern
- I/O
- skin integrity
- BS
- s/s infection
- s/s increased ICP
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spina bifida develops when
during first 28 days gestation
-
cause of spina bifida
- unknown, but...
- envtal exposure to chemicals and meds
- maternal nutrition may play role
- folic acid esp
-
spina bifida def
neural tube defect that affects head and spinal column - incomplete closure
-
clinical manifestations of spina bifida
- higher deformity = greater neurological dysfxn
- sac-like protruding from neonate's back
- LE partially or completely paralyzed
- B & B sphincters may be affected
- renal impairment
- faulty kidney innervation
- orthopedic complications (flexion or extension contractures)
- hydrocephalus is common
-
meningomyelocele
spina bifida is the generic term used to describe "
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post-op spina bifida pts RN do what
- VS
- s/s infection
- hyrdocephalus
- increased ICP
- watch for CSF leakage
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NIs for spina bifida
- prevent infection
- assess neuro
- preserve neurologic and urologic fxn
- provide meticulous skin care
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how care for infant w/ spina bifida
place infant in prone position, cover defect w/ sterile dressing moistened with NS preoperatively
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