What is the most sensitive indicator of neuro status?
The level of consciousness.
Assess for restlessness, irritability, and confusion.
Describe:
Cerebral palsy
A brain injury or malformation that occurred before, during, or after birth.
It primarily affects body movement and muscle coordination.
What is the goal for treatment for a child with cerebral palsy?
To encourage as much independence as possible since cerebral palsy is not curable.
- use mobilizing devices such as a motorized wheelchair
- provide activities and toys based on developmental level (not age)
- use resources such as PT, OT, ST
What are the signs and symptoms of cerebral palsy?
Due to delayed growth:
- very irritable and crying
- feeding difficulties
- stiff and rigid arms or legs
- delayed developmental milestones
- abnormal posturing
Describe:
Hydrocephalus
Fluid in the brain caused by malformations, tumors, hemorrhage, infections, or trauma.
What are the characteristic signs and symptoms of hydrocephalus?
- increased head circumference
- bulging fontanels
- “setting sun” eyes - bulging eyes that look downward
Treatment:
Hydrocephalus
Surgery to drain the fluid by inserting a shunt that gets drained into the abdominal cavity.
It is called a ventriculoperitoneal shunt.
How is a child positioned after a ventriculoperitoneal shunt?
- on the unoperated side to prevent pressure on the shunt valve
- flat to avoid rapid reduction of intracranial fluid
What is the priority assessment for hydrocephalus and post ventriculoperitoneal shunt surgery?
Increased ICP signs:
- high, shrill cry
- poor feeding
- irritability or lethargy
Increase HOB 15 - 30 degrees if increased ICP occurs.
Describe:
Reye’s syndrome
An acute encephalopathy that follows a viral illness such as influenza or varicella; or by taking aspirin.
The child will have cerebral edema and fatty changes in the liver.
What are the characteristic signs and symptoms of Reye’s syndrome?
Due to neuro changes and damage to the liver:
- decreased LOC
- hepatotoxicity
- increased ammonia levels, ALT and AST
- bleeding
- edema
Interventions:
Reye’s syndrome
Reye’s syndrome is not curable. Interventions focus on treating symptoms and preventing complications:
- corticosteroids to reduce brain swelling
- diuretics to decrease fluids in the brain - mannitol
- monitoring for liver failure
What are all of these spinal abnormalities?
Neural tube defects that are congenital.
How are spinal neural tube defects prevented?
Have pregnant mother take folic acid supplements.
What are the characteristic signs and symptoms of neural tube defects?
Depend on how severe the defect is:
- flaccid paralysis of legs
- altered bowel and bladder function
- hip and joint deformities
- hydrocephalus
What is the intervention if the neural tube defect is open?
Protect the sac and cover it with a sterile moist (normal saline), non-adherent dressing.
Change frequently to avoid contamination of stool and possible infection.
How is a neural tube defect treated?
Surgery to close the area.
Impairments may still occur due to the severity of the defect.
Describe:
Attention Deficit Hyperactivity Disorder (ADHD)
A behavior disorder that is exhibited by severe inattention, overactivity, and being impulsive.
These children can have lower intellectual development, sleep disturbances, behavior and emotional disorders, and difficulty with relationships.
What are the characteristic signs of ADHD?
- fidgets and squirmy while sitting
- easily distracted by sounds and sights
- can’t follow through with directions
- talks A LOT and interrupts
- may try dangerous activities without thinking about consequences
Interventions:
ADHD
- behavioral therapy
- stimulant meds
- a consistent environment
- appropriate classroom placement
Meds:
ADHD
Stimulants:
- amphetamines
- methylphenidate
- lisdexamfetamine
- dextroamphetamine
Describe:
Autism Spectrum Disorders
Neurodevelopmental disorders that have an unknown cause.
Children exhibit unusual social behaviors.
What are the characteristic behaviors of autism?
- lack of social play, repetitive behaviors
- doesn’t imitate others
- impaired or abnormal speech
- does not use gestures to talk
- unable to do imaginative play
- rocking or head-banging
- doesn’t like changes in routine
Interventions:
Autism
- be consistent with routines
- communicate with how child responds best
- avoid placing demands
- safety precautions for head-banging
