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UD NURS 356 - 11 - Neurological Deficits in Children

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NURS356 Exam 2 Study Guide Neurological Deficits in Children Pediatric Neurological Assessment Broadest most diverse assessment must focus on behavior cognitive perceptual development sensory motor function reflexes cranial nerves and soft signs reflexes and cranial nerves objective pull in family when you perform this assessment Every physical emotional function is controlled by neurologic impulses Listen to what family people close to child are saying about the child Realize what is normal for that child Assessment Considerations Behavior Changes Emotional change or as a result of something at school home that is gong on Cognition are things changing at school home functional screening SATS Motor abilities age specific milestones what do you expect that child to be doing as a specific age head control at 4 months of age 6 months of age stands all the time or hypertonic CP or other problem Coordination ie finger nose geared to child s age Reflexes hyperactivity vs loss loss or decrease result from cerebral insult check all Soft signs difficult gray area look to the developmental assessment look at maturational aspects of child learning disabilities Impulsive or show poor coordination Is this normal Non Specific Early Signs Very subjective listen to comments parents are making 1 NURS356 Exam 2 Study Guide As subtle as irritability lethargy nausea vomiting personality changes could be normal depending on age ex 16 year old fatigue changes in eating patterns these signs sound similar to depression but depression isn t as common in pediatrics Assessing IICP in Children use age related assessment Infants changes of cry irritability non consolable Children may c o headache behavior changes Adolescents personality behavior signs that must be differentiated signs sound similar to drug behavior diminished blood volume increased absorption of CSP brain has compensatory mechanism you don t want them to take hold WARNING Late Neuro Assessment Signs LOC changes to coma Level of consciousness diminished motor response change in motor response to commands are they hearing you and then doing what you ask diminished sensory response are they hearing talking posturing widening pulse pressures tachycardia to bradycardia to apnea even death ABCD Assessment Assessment history and physical examination diabetes event where they got hit etc what happened Behavior reported observed What does mom say about child s normal behavior Cognitive perceptual development sensory motor function something not right 2 NURS356 Exam 2 Study Guide Disability related to cerebellar function coordination LOC posturing reflexes manifests with coordination problems first Neurological Evaluation Muscular activity coordination Ataxia unable to coordinate their movements Gaits indicative of cerebral dysfunction Look for symmetry Ocular movements pupillary response Doll s head maneuver when head turns to right eyes should move left if brainstem is intact facial movements mouth function look again for symmetry reflexes Level of Consiousness Earliest indicator of improving or deteriorating neuro status Watch out for child with decreased LOC could go into a coma LOC on continuum starts with what is normal for that child in particular Observe child s response to environment alertness and cognition Glasgow Coma Scale GCS Looks at set of responses eye opening verbal response motor response provides objective criteria to evaluating LOC report what you see and how you arrived at the score READ ABOUT GCS IN BOOK Posturing Decorticate severe dysfunction of cerebral cortex Lowered extremities are adducted and arms are abducted pulled up or in Decerbrate mid brain dysfunction rigid extension outturned hands and arms Know difference Diagnostic Procedures Lumbar puncture LP measures spinal fluid pressure obtains CSF and send that sample down to lab to be analyzed for infection blood etc check spinal fluid sugar levels L3 and L4 NURSE holds child while doctor does this 3 NURS356 Exam 2 Study Guide Chin on chest and legs and knees brought up rolled into a ball Hold child very tightly so that it doesn t tickle Emla cream numbs area Scary procedure Contraindicated if you expect IICP or any type of hemorrhage due to an injury child could end up with brain hernia which is irreversible brain damage Computed tomography CT Scan distinguishes intracranial tissues structures Child has to hold absolutely still may have to be put to sleep Magnetic resonance imaging MRI permits tissue discrimination gives lots of info you cant go in with any metal child is strapped on table hold still or are sedated loud noise heard in tube scary situation Electroencephalography EEG measures electric activity of cerebral cortex looking to see if they have any seizure disorders Nursing Considerations Assessment Detailed observation frequent vital signs neurologic evaluation including LOC pupillary reaction is essential PEN LIGHT to check pupil response temperature instability due to CNS involvement sometimes low other times high Pain assessment can be extremely painful if you leave child in pain other behaviors will show up Planning nursing care respiratory management risk of obstruction or aspiration short term oral airway long term nasotracheal airway for comatose client positioning HOB elevated 30 degrees gravity force to decrease ICP ICP Monitoring Seen in PICU Purpose to obtain ventricular pressure measurements types intraventricular subarachnoid bolt epidural sensor anterior fontanel pressure monitor 4 NURS356 Exam 2 Study Guide depends on age of child Nursing considerations positioning with HOB elevated 15 30 degrees ordered and locked avoid activities that may increase ICP limit environmental stimuli think about family guilt give updates and involving them when you can but they need to understand why calm and quiet is important Other Considerations with IICP Nutrition hydration monitor I O Hydrated but not overhydrated Make sure bowel sounds are working Medications look for interactions Monitor BP as it effects ICP Thermoregulation temp every 2 hours sometimes every hour If cooler or warmer they will know when to take it Sometimes have a probe that it a constant measure of temp avoiding complications of immobility skin care positioning exercise Supporting the family Key Considerations listen for critical assessment and interventions and what nurse must consider with each Hydrocephalus Meningitis Encephalitis Reyes Syndrome Neural tube defects Cerebral Palsy


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