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pediatric neurologic
care for pediatric neurological conditions
| Question | Answer |
|---|---|
| Bacterial Meningitis | Meningitis is the most common infection of the central nervous system. Definition: an inflammation of the meninges, the covering of the brain and spinal cord. |
| Most Common Causative Agent: | Streptococcus pneumoniae and Neisseria meningitidis, which "are responsible for bacterial meningitis in 95% of children older than 2 months of age.” |
| Route of infection by organisms that invade the meninges indirectly by way of the blood stream: | Teeth. Sinuses. Tonsils. Lungs. |
| Symptoms | May be preceded by a URI and several days of GI distress. Signs and Symptoms result from intracranial irritation.emesis, fever, h/a, stiff neck, light aversion, drowsiness, joint pain, fittingRestlessness. High pitch cry in infants. |
| more symptoms | Convulsions are common. Coma. Opisthotonos (involuntary arching of the back due to muscle contractions) in severe cases. Petechiae. |
| Lumbar puncture Diagnostic Evaluation | fluid is clear early in disease process, cloudy as disease progresses. Increased protein. Decreased glucose. High white cell count. Gram stain and culture of CSF. History and physical. |
| Medical Treatment | IV fluids. IV antibiotics. Respiratory isolation. Sedative. Anticonvulsant. |
| Nursing Care | Prepare isolation room. Disposable equipment. Indirect lighting. Caution with side rails. Minimal stimulation. Frequent vital signs, neurological checks & monitor I & O. Control fever. Observe for signs of increased ICP. |
| Observe for residual effects: | Weakness of limbs. Speech. Mental confusion. Behavior problems. Developmental deficiencies. |
| What is the most common causative agent of bacterial meningitis in children? | Streptococcus pneumoniae and Neisseria meningitidis. |
| What is the importance of clustering nursing care? | To allow maximum rest and keep stimulation to a minimum. |
| Inflammation of the brain. Causative agents include: | Togaviruses and herpes virus type 1 and 2. Following URI. Rubella or rubeola. Lead poisoning. Bacteria, spirochetes and fungi. |
| Infants are at the greatest risk of fatality and residual effects. | In rare instances can be a reaction to vaccinations such as diphtheria, tetanus and pertussis (DTP). |
| Encephalitis Manifestations | Vomiting. Stiff neck (nuchal rigidity). Delirium. Muscle twitching. Abnormal eye movements. Headache, drowsiness, coma. Convulsions. Fever. Cramps. Abdominal pain. |
| Residual Effects | Slowed speech. Slowed mental processing & motor ability. Brain damage. Mental retardation. Seizures. |
| Nursing Care | Sedatives & antipyretics. Nutrition & hydration. Seizure precautions. Quiet environment, good oral hygiene, skin care, position changes. |
| Nursing Care | Oxygen as ordered. Record I & O. Prevent complications of immobility. Observe for neuro changes. Keep parents informed & involved. |
| Which age group is most at risk for residual damage as a result of encephalitis? | Infants. |
| Reye’s Syndrome | an acute non-inflammatory encephalopathy and hepatopathy, with no reasonable explanation for the cerebral and hepatic abnormalities. |
| Primarily affects children. The younger the child the higher the morbidity and mortality rates. | Incidence:Reye’s Syndrome |
| Etiology: Reye’s Syndrome | actual cause unknown. Usually associated with a viral illness which may be quite mild (flu, chickenpox). Use of aspirin to treat symptoms associated with onset of syndrome. |
| Reye’s Syndrome DiagnosTic evaluation Lab results: | Elevated ammonia levels. Cerebral edema with ICP. Definitive diagnosis: Liver biopsy. |
| Reye’s Syndrome Clinical Staging Stage I: | Vomiting. Lethargy. Drowsiness. Liver dysfunction. Follows commands. Brisk papillary reaction. |
| Stage II: Reye’s Syndrome Clinical Staging Con’t | Disorientation. Combative. Delirium. Hyperventilation. Hyperactive reflexes. Appropriate response to pain. Liver dysfunction. Sluggish pupillary response. |
| Stage III: | Obtunded. Coma. Hyperventilation. Decorticate rigidity. |
| Stage IV: | Deepening coma. Decerebrate rigidity. Loss of oculo-cephalic reflexes. Large and fixed pupils. Minimal liver dysfunction. |
| Stage V: | Seizures. Loss of deep tendon reflexes. Respiratory arrest. Flaccidity. No evidence of liver dysfunction. |
| Reye’s Syndrome Medical Treatment | Care same as with a child with altered LOC and increased ICP. Accurate I & O. Vital signs including CVP and CO. Observe for signs of impaired coagulation. |
| Goals: | Reduce ICP. Maintain patent airway. Maintain cerebral oxygenation. Maintain fluid & electrolyte balance. |
| Nursing Care | Frequent evaluation: respiratory status, neuro status & vital signs. Monitor I & O. Keep parents informed, involved & reassured. Referrals as appropriate. |
| What drug should not be given to a child to treat symptoms associated with chickenpox? | Aspirin. |
| What should be monitored when caring for a child with Reye's syndrome? | Respirations, neuro status, vital signs and I & O. |
| Sepsis Pathophysiology | refers to a generalized bacterial infection in the bloodstream that can progress to systemic inflammatory response syndrome (SIRS), shock, multiorgan system failure and death. |
| Neonates/Children at risk | neutropenic, immunocompromised or in intensive care (due to invasive procedures). |
| Sepsis Manifestations | Poor temperature control. Tachypnea. Tachycardia. Hypotension. Neurological signs such as lethargy. Jaundice. |
| SEPsis Diagnostic tests | Positive blood culture. Urine culture. Cerebrospinal fluid culture. Anemia. Immature WBCs and neutropenia are ominous signs. |
| Sepsis Nursing care | Monitor neuro status and vital signs. Observe for shock. Administer IV antibiotics as ordered, 7-10 days if positive culture. Verify vaccination against H. influenza type B (Hib) for all children between 2 months and 4 years. |
| What neonate/children are most at risk for developing sepsis? | . Neutropenic, immunocompromised or in intensive care unit. |
| Seizures | Unconsciousness or altered consciousness. Involuntary movements. Caused by malfunctions of the brain’s electrical system. Changes in perception, behaviors, sensations and posture. |
| Epilepsy | Chronic seizure disorder with recurrent seizures. caused by Trauma. Hypoxia. Infections. Biochemical events. Fevers greater than 101.8 with rapid elevation. |
| Seizures most common during the first 2 years. | Acute infections are a frequent cause of seizures in late infancy and early childhood. In older children the most common factor is idiopathic. |
| Epilepsy Seizure Classification | SPartial seizures: 3 types: imple partial seizures. Complex partial seizures. Simple or complex seizures secondarily generalized |
| Generalized seizures: | May occur at any time. |
| Diagnostic Evaluation | Thorough history and physical. Diet review. Diagnostic Evaluation. Examining the seizure: Onset. Time of day. Any precipitating factors. Duration. Progression. Postictal feelings. |
| Diagnostic Evaluation | Complete neuro exam. Lab studies: CBC with white cell count. LP. CT scans, MRI and EEG. |
| Therapeutic Management | Control the seizures. Discover and correct the cause if possible. Help the child. |
| Primary therapy is | giving appropriate drugs or combination of drugs in the dosage that provides the desired effects without undesirable side effects. |
| Antiepileptic drugsPrimary drugs for partial seizures and/or tonic clonic seizures: | Carbamazepine (Tegretol). Phenytoin (Dilantin). Valproic Acid (Depakote). |
| Primary drugs for absence seizures: | Ethosuzimide (Zarontin). Valproic Acid (Depakote). |
| Therapeutic Management | Once the child is free for 2 years with a normal EEG, the therapy and medications are gradually discontinued. When seizures are caused by tumors, hematoma or other lesions, surgery is the treatment of choice. |
| Status Epilepticus | Continuous seizure that lasts more than 30 minutes. A series of seizures where the child does not regain a premorbid level of consciousness. A MEDICAL EMERGENCY. |
| Status Epilepticus Treatment is directed | Support and maintenance of vital functions. Adequate airway. Obtaining and IV. Place on monitor. |
| Nursing Care during Seizures | Protect the child from injury. Remain calm and stay with the child. Protect the child’s privacy.Do not move or restraint child. Do not place any objects in the child’s mouth. Place the child in recovery position afterwards. |
| Seizure Precautions | According to hospital and unit policies. Keep side rails elevated and padded. Waterproof mattress on bed if available. Wear medical alert bracelet. |
| Educate | Explain the drugs. Warn parents about the possible changes in behavior. Encourage normal healthy activities. Notify the school nurse and teacher. Help identify triggering factors and how to avoid them. Refer parents to Epilepsy Foundation of Amer |
| What are some possible causes of seizures? | Birth injury, Epilepsy, infection, fever, dehydration, hypoglycemia, anesthetics, drugs and poisons. |
| What should you document if you observe a child having a seizure? | Activity before seizure, body movements, change in color, respirations, muscle tone, incontinence, body parts involved, duration and appearance, behavior and LOC after the seizure. |
Created by:
redhawk101
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