Caring for the Child with a Neurological or Sensory Condition - PowerPoint PPT Presentation

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Caring for the Child with a Neurological or Sensory Condition

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Title: Caring for the Child with a Neurological or Sensory Condition


1
Chapter 29
  • Caring for the Child with a Neurological or
    Sensory Condition

2
A P Review
  • Nervous system
  • Central nervous system
  • Brain and spinal cord
  • Peripheral nervous system
  • Sensory-somatic
  • Autonomic

3
Altered States of Consciousness
  • Arousal or level of consciousness awareness of
    the environment
  • Content of thought all cognitive functions that
    ensure awareness of affective states, self, and
    environment

4
The Unconscious Child
  • Unconsciousness is a state in which a childs
    cerebral function is depressed and ranges from
    stupor to coma

5
Caring for the Unconscious Child
  • Evaluating neurological status
  • The pediatric Glascow Coma Scale
  • Eye opening, verbal response, and motor response

6
Caring for the Unconscious Child
  • Monitor vital signs
  • Manage the airway
  • Manage bladder and bowel elimination
  • Maintain hydration nutrition
  • Provide proper hygiene
  • Position and perform exercise

7
Persistent Vegetative State
  • A complete unawareness of the environment
    accompanied by sleepwake cycles.
  • The diagnosis is established if it is present for
    1 month after acute or nontraumatic brain injury
    or has lasted for 1 month in children with
    degenerative or metabolic disorders or
    developmental malformations
  • Family support is needed

8
Increased Intracranial Pressure
  • Intracranial pressure (ICP) is the pressure of
    the cerebral spinal fluid (CSF) in the
    subarachnoid space between the skull and the
    brain. A child can have increased ICP as a result
    of many internal or external factors.
  • Signs and symptoms
  • See Table 29-2

9
Increased Intracranial Pressure
  • Nursing care
  • Close monitoring (neurologic status)
  • Maintenance of a patent airway
  • Monitor vital signs closely (hyperthermia)
  • Administer IV fluids
  • Monitor fluid balance (I O)
  • Protect child from injury
  • Administer antiseizure medications
  • Provide emotional support
  • Administer medications to decrease cerebral edema
  • Analgesia and sedation
  • A craniotomy is recommended when all other
    measures have been unsuccessful

10
Seizure Disorders
  • Signs and symptoms
  • See Table 29-3
  • Nursing care
  • Complete a detailed history
  • Ensure airway management
  • Maintain anticonvulsant therapy
  • Implement seizure precautions (padded side rails,
    oxygen, suction equipment, IV access, and
    anticonvulsant medications)
  • Provide continuous cardiac, respiratory, and
    oxygen monitoring
  • Instruct caregivers instructed in CPR
  • Keep school nurses and teachers informed about
    the condition
  • Encourage medical alert identification bracelet

11
Inflammatory Neurological Conditions
12
Meningitis
  • Signs and symptoms
  • Mildly ill with general vague or subtle symptoms
    (lethargy, malaise, irritability, vomiting,
    fever, and diarrhea)
  • Kernig and/or Brudzinski sign
  • Nursing care
  • Assess neurological status, anterior fontanel in
    infants, and seizure activity
  • Provide comfort care
  • Educate family and child about disease and
    treatment options
  • Explain long-term parenteral access and IV
    antibiotics

13
Encephalitis
  • Signs and symptoms
  • Disorientation, confusion, headache, high fever,
    photophobia, lethargy, aphasia, hallucinations,
    seizures, nuchal rigidity, and coma
  • Nursing care
  • Viral is treated with antiviral medication
  • Bacterial is treated with a narrow-spectrum
    antibiotic
  • Other medications include antipyretics,
    anticonvulsants, analgesics, and
    anti-inflammatories
  • Provide intravenous fluids and nutrition
  • Implement seizure precautions
  • Monitor fluid balance
  • Do not suction or give percussion

14
Brain Abscess
  • Signs and symptoms
  • Localized headache, fever, drowsiness, stupor,
    confusion, general or focal seizures, focal motor
    or sensory impairments, ataxia, nausea and
    vomiting, papilledema, and hemiparesis
  • Nursing care
  • Assess neurological status, assess response to
    treatment, administer medications, and provide
    supportive care
  • Monitor serum labs
  • Surgery required if no response to antimicrobial
    therapy (postoperative care) or does not meet
    criteria for medical therapy

15
Reye Syndrome
  • Signs and symptoms
  • Lethargy, vomiting, drowsiness, liver dysfunction
  • Nursing care
  • Conduct neurological assessment
  • Administer IV fluids
  • Administer corticosteroids and/or diuretics
  • Monitor oxygen saturation (supplemental oxygen)
  • Insert arterial line (blood gases)
  • Take seizure precautions
  • Limit invasive procedures
  • Provide emotional support

16
Guillain-Barré Syndrome
  • Signs and symptoms
  • Three phases acute, second, recovery
  • Nursing care
  • Plasma exchange and IV immunoglobulin therapy
  • Give corticosteroids
  • Monitor progression
  • Insert indwelling urinary catheter
  • Assess pain level
  • Prevent contractures and loss of function
    (passive ROM)
  • Provide skin care
  • Suggest age-appropriate activities

17
Developmental Neurological Conditions
18
Spina BifidaNeural tube defects (NTDs)
  • Signs and symptoms
  • Vary depending on the level of the lesion and
    defect
  • Spina bifida occulta
  • Meningocele
  • Myelomeningocele
  • Types
  • Meningocele
  • Myelomeningocele
  • Spina bifida occulta

19
Spina Bifida
  • Nursing care
  • Place newborn in prone position (prevent injury
    to sack)
  • Provide postoperative care for laminectomy
    closure of defect
  • Evaluate orthopedic function
  • Prevent joint contractures
  • Assess bladder and bowel function
  • Provide skin care
  • Assess neurological status
  • Measure head circumference and assess fontanel
  • Manage pain

20
Hydrocephalus
  • Signs and symptoms
  • Increased ICP
  • Macewen sign
  • Nursing care
  • Understand shunt function and complications
  • Obtain history and physical (life-threatening
    conditions)
  • Discuss pharmacological measures or surgical
    procedure
  • Perform nursing actions related to ICP
  • Measure head circumference
  • Give preoperative and postoperative antibiotics
  • Assess neurological status
  • Assess for shunt malfunction (eye assessment)
  • Assess abdominal status (pain, bowel sounds, and
    circumference)
  • Elevate HOB 30

21
Cerebral Palsy
  • Signs and symptoms
  • Vary individually depending on the area of the
    brain involved and the extent of damage
  • Four categories
  • Spastic
  • Ataxic
  • Athetoid or dyskinetic
  • Mixed

22
Cerebral Palsy
  • Nursing care
  • Use splints and braces
  • Promote self-care
  • Administer medications (reduce muscle spasms,
    spasticity, anxiety, and seizure)
  • Surgery (selective dorsal rhizotomy)
  • Address feeding problems
  • Provide intellectual stimulation
  • Ensure safe environment

23
Neurological Injuries
24
Near Drowning (Submersion)
  • Signs and symptoms
  • Cerebral edema, alteration in LOC, respiratory
    distress, cardiovascular complications,
    hypovolema
  • Nursing care
  • Assess and maintain airway
  • Provide life support measures
  • Suction secretions
  • Insert NG tube
  • Administer oxygen
  • Assess other injures (head or spinal trauma)

25
Head InjuryTraumatic Brain Injury (TBI)
  • Signs and symptoms
  • Obvious signs blood on the scalp, depression of
    the skull, and an obvious penetrating wound
  • Other signs and symptoms loss of consciousness,
    alteration LOC, seizures and combativeness
  • Nursing care
  • Provide immediate care to prevent
    life-threatening complications
  • Maintain airway patency and oxygen administration
  • Insert IV and administer hypertonic fluid
  • Assess neurological status
  • Assess ICP

26
Shaken Baby Syndrome
  • Signs and symptoms
  • Seizure activity, apnea, budging fontanels, coma,
    hemorrhage, bradycardia cardiovascular
    collapse
  • Nursing care
  • Provide respiratory and cardiovascular support
  • Assess for ICP
  • Insert NG tube
  • Maintain seizure precautions
  • Maintain adequate fluid and nutritional intake
  • Assess and document visible injuries
  • Discuss short- or long-term care
  • Assess parental concerns

27
Spinal Cord Injury
  • Signs and symptoms
  • Numbness, tingling, or loss of function
  • Nursing care
  • Maintain airway management and respiratory
    function
  • Provide cardiovascular and circulatory support
  • Give steroid therapy
  • Monitor fluid intake and output
  • Maintain gastrointestinal function
  • Provide nutritional support
  • Provide emotional and social support
  • Be attuned to an adolescents unique needs
  • Explain lifelong care and support, circulation
    support, disability identification, and exposure
    of known and unknown physical limitations

28
Nontraumatic Neurological Conditions
29
Headaches
  • Types
  • Primary headaches
  • Secondary headaches
  • Tension
  • Migraine
  • Cluster

30
Headaches
  • Signs and symptoms
  • Primary (triggers i.e., stress)
  • Secondary (organic disorder i.e., trauma)
  • Subtypes (tension, migraine, cluster)
  • Nursing care
  • Provide pharmacologic and nonpharmacologic care
  • Discuss prophylactic measures
  • Give intramuscular or intranasal medications
  • Promote rest and stress reduction strategies

31
Sensory Conditions
32
Eye Disorders
  • Hyperopia (farsightedness)
  • Myopia (nearsightedness)
  • Correction
  • Concave lenses or contact lenses
  • Laser assisted surgery

33
Astigmatism
  • Irregular curvature or uneven contour of the eye
  • Correction
  • Corrective lenses
  • Surgery
  • Complaints of headache, blurry vision, or
    dizziness ophthalmologist referral

34
Amblyopia
  • Signs and symptoms
  • Strabismus or anisometropia are the most common
    causes
  • Correction
  • Occlusion therapy (patching of the normal eye) is
    done to restore strength and function of the
    lazy eye

35
Strabismus
  • Nonparallelism in the different fields of gaze
    causing visual lines to cross even when focused
    on the same object
  • Correction
  • Ocular patching of the stronger eye, glasses, and
    pharmacotherapy
  • Early identification and recognition

36
Color Blindness
  • X-linked recessive inheritable color vision
    deficiency
  • Color blindness is detected using colored charts
    called the Ishihara Test plates
  • Child can learn to compensate with support from
    family members, teachers, and friends

37
Nystagmus
  • Rapid irregular involuntary eye movement caused
    by a disorder of the central nervous system
  • Correction
  • Extraocular surgery

38
Cataracts
  • Signs and symptoms
  • Excessive tearing, extraocular movements,
    photophobia, lens appears cloudy, or there is a
    white or dulled red reflex
  • Correction
  • Prevent loss of visual acuity
  • Laser procedure
  • Postoperative (monitor nausea, emesis, pain,
    hemorrhage and signs of infection)
  • Postoperative eye drops
  • Follow-up care for visual acuity
  • Educate family
  • Early identification and recognition

39
Glaucoma
  • Signs and symptoms
  • Bupthalmos (enlarged eye globe), epiphora
    (excessive tearing), and photophobia (sensitivity
    to light)
  • Correction
  • Preoperative maintain quiet environment
  • Antiglaucoma medications
  • Analgesia and anxiety reduction strategies
  • Pre- and postoperative care (teach parents)

40
Retinoblastoma
  • Signs and symptoms
  • Absence or abnormality of the red reflex
  • A whitish or yellow color of the pupil called
    leukocoria
  • Correction
  • Laser, radiation, cryotherapy, or enucleation

41
Eye Injuries
42
Foreign Bodies
  • Penetration
  • Immediate transport to ER for removal
  • Corneal abrasion
  • Treatment
  • Topical antibiotic solutions or ointments,
    analgesics, eye patch

43
Hyphema
  • Hemorrhage into the anterior chamber of the eye
  • Treatment
  • Rest, possible evacuation
  • Monitor increased intraocular pressure
  • Promote decreased activity
  • HOB 30
  • Patch both eyes

44
Chemical burns
  • Usually occur as a result of an accident
  • Treatment
  • Rapid eye flushing for 15 to 30 minutes followed
    by pH analysis of the chemical agent
  • Eye patching

45
Hearing Loss
46
Hearing Loss
  • Causes
  • 1/3 of all cases are due to genetic causes
  • 1/3 of all cases are due to non-genetic
    influences
  • 1/3 of all cases are due to unknown causes

47
Hearing Loss
  • Diagnostic testing
  • Universal infant hearing screening before 1 month
    of age is recommended
  • Treatment
  • Based on underlying pathologic conditions,
    presence of organic diseases, the severity of
    hearing loss, the degree of frequency loss, and
    any CNS abnormalities
  • Amplification aids (hearing aid)
  • Nursing care
  • Provide emotional, educational, and collaborative
    support for the child and family

48
Language Disorders
  • Communication
  • A process of complex interaction involving the
    exchange of information, feelings, ideas, and
    interactions
  • Receptive language
  • Expressive language
  • Nursing care
  • Recognize speech and language developmental delays
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