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Ped Neuro Alteration

Pediatric Neurological Alterations

KNOW ETIOLOGY; DIAGNOSIS; TREATMENT; NURSING INTERVENTIONS For Meningitis, Encephalitis, Seizure Disorders, Neural Tube Defects, and Cerebral Palsy
What causes meningitis? Inflammation of meninges caused by bacterial or viral or fungal organisms. HIB, Strep Pneumonia, Neisseria Meningitidis.
What are some organisms that cause meningitis in neonates? GBS, E coli, Listeria monocytogenes
How do you prevent meningitis? Hib vaccine, Pneumococcal, and Meningococcal vacines.
What are some sources of infection? Invade Directly; Blood stream- teeth, sinuses, tonsils, ears; neuro procedures; fracture skull.
What are the nursing interventions for Meningitis? Assist with lumbar puncture, Place child in isolation, admin antibiotics, manage fever, hydrate, V/S, NEURO checks, I&O's, Daily weight, HOB >30-45, monitor fontanel, decrease enviro stimuli.
How do you diagnosis Meningitis? Lumbar Puncture; Analysis of CSF (Fluid cloudy; increase of WBC's and Proteins).
What causes Encephalitis? Inflammation of the CNS, viral (measles, mumps, rubella, varicella, CMV, rabies, West Nile, HSV), or Bacterial (lyme disease, syphilis, TB).
What are some nursing measures for Encephalitis? Same care as meningitis, Observe loss of LOC, Monitor ICP, May cause long term damage or death.
What are the causes of Seizure disorders? Abnormal brain structure, fever, sepsis, metabolic abnormality. 50% have no known cause.
What is epilepsy? State of 2 or more spontaneous seizures of any type that are not related to fever or to any type of acute cerebral insult.
What is Status Epilepticus? Seizure lasting longer than 30 min. Serial seizures with no or short interval between seizures.
What are the two types of seizures? Partial (one part of the brain); Generalized (over the entire brain alters consciousness).
What are the three types of Partial Seizures? Simple partial, Complex partial (w/ impaired consciousness), Partial seizures evolving to generalized tonic-clonic convulsions (GTC).
What characterizes a Generalized Seizure? Generalized toni-clonic (grand-mal), Absence (petite-mal), Atonic, Myoclonic.
What are some signs of Absence Seizures? Vacant stare, Eyes roll upward, Lack of response.
What are the signs of Myoclonic Seizures? Jerking of arms, shoulders, and head, usually happen in the after awakening.
How do you manage Seizures? Turn on side; lower to floor; no restraints; stay w/ child; NPO; Discourage bystanders; Stay calm; Prevent injury; Airway; Oxygen if needed; V/S; Meds; Record characteristics of seizure.
What are important characteristics of a seizure? Time, Responsiveness of child, movements, mobility and tone, sensation and perception, Describe behavior after return to consciousness.
Nursing interventions for Seizures? Suction, ambu bag at bedside, Padded side rails, remove harmful objects, teach about meds and Side effects.
What are the med treatments for seizures? Start small increase until affective or Sx's. Add another drug in first does not work. Dilantin, Tegretol, Phenobarbitol.
What are some non med treatments for seizures? Ketogenic Diet (high fat, low carbs); Vagus Nerve Stimulation (implant in chest); Surgical therapy (remove area).
How does one get Spina Bifida? It is a Congenital defect of the neural tube vertebral arches of the spinal vertebrae (During embryological development)
What are the two types of Spina Bifida and what is the difference between them? Occulta and Cystica; Cystica involves a protrusion of spinal tissue.
What are the two major forms of SB cystica and what makes them different from each other? Meningocele and Myelomeningocele. The latter has nerve roots in the protruding sac.
What are the nursing managements Pre-OP for Spina Bifida? Sterile moist dressing on sac, keep clean, Prone position, observe leakage of CSF, Neuro assessment, Latex-free enviro.
What are the nursing managements Post-Op for Spina Bifida? Prevent infection, Observe Signs of Infection, Monitor ICP, Observe Shunt malfunction, Prone positioning.
How does one get Hydrocephalus? Congenital or acquired; It is the Dilation of ventricles caused by an imbalance in the rate of production and rate of absorption of CSF. Brain is compressed against the skull.
What are the treatments for Hydrocephalus? Ventriculoperitoneal shunt or Ventriculatrial shunt. Shunt fluid to an area of the body where it can be absorbed.
What are some nursing managements Post-Op? Keep Flat, Position on inoperative side, Monitor head circum., fontanels, pain, infection, drainage and gauze for halo sign (glucose).
What is Cerebral Palsy (CP)? Non progressive, permanent neuromuscular disorder, Impaired movement and posture.
What causes CP? Anoxia/ prematurity/ difficult delivery/ prenatal brain abnormalities; Infection; Head injury.
What are the different effects of Cerebral Palsy? Quadriplegia; Diplegia (all four limbs are involved legs more severe), Hemiplegia (one side of body), Triplegia (3 limbs), Monoplegia (One limb affected).
What are the types of CP? Spastic CP 70-80% cases (increased resistance to stretching); Athetoid CP 10-20% (Difficulty in controlling and co-ordinating movement); Ataxic CP 5-10% (disturbed sense of balance and depth perception).
What are the Treatments for CP? Meds/Surgery/mechanical aides/Therapy Services PT, OT, Speech.
What are the CP treatment goals? Optimize motor abilities; Prevent injury; Promote social and educational opportunities.
Created by: zj mepn