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Pediatric Neurological Assessment for the Bedside Nurse

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Mary Jo Mitchell

on 20 July 2013

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Transcript of Pediatric Neurological Assessment for the Bedside Nurse

Pediatric Neurological Assessment for the Bedside Nurse

Where to Start?
Obtain a history-know your patient's baseline (i.e. starting point)
What is your patient's neurological baseline (prior to injury or surgery)?
What was their neurological exam post injury or surgery?
*Obtain a thorough RN to RN shift report.
Engage the family-ask questions (LOC, behavior). Involve them in monitoring the patient. Does your patient have specific s/s of a VP Shunt malfunction? Listen.

Assess your patient
Motor and Sensory function
Strength-is it equal?
finger grasps
push, pull
Sensation


Individual focus areas
What are you looking for and what should you expect to find?
Something is not right!?
Unexpected or new findings=Investigate
What, when, why?
Look at the big picture
Communicate your concerns (charge nurse and provider)
Reassess
Case Studies
#1 - 10yr old post op Chiari decompression 3 days ago. Poor appetite, nauseated, awake, alert, oriented, minimal ambulation. Good uop, No stool since surgery. Emesis x2 this after breakfast.
a. increased ICP-call MD immediately
b. CSF leak
c. needs to stool
Objectives
Define the components of a pediatric neurological exam for the hospital and/or clinic setting.
Explain early warning signs of neurological change in the pediatric patient.

"Head to toe"
Level of consciousness-starts when you enter the room.
Coma scale
12 cranial nerves-focus on 8
Optic II-vision
Oculomotor III, Trochlear IV, Abducens VI- Focusing, Tracking, Conjugate, pupil control
Glossopharyngeal IX/Vagus X-swallow, gag
Hypoglossal XII-tongue movement
Mary Jo Mitchell, BSN, RN, CPN
Clinical Resource Nurse/6th floor
Neurosurgery Liaison
The Children's Hospital Colorado
13123 E. 16th Avenue
Aurora, CO 80045

The Brain
Disclosures

No relevant financial relationships with any commercial interests.

Mary Jo Mitchell, RN, BSN, CPN
Upon completion of this lecture, participants will be able to:
#2 - 4yr old post op VP Shunt revision last night. Was reported to be waking appropriately through the night.
This am c/o HA, multiple emesis, sleepy, confusion. Good
uop, No stool since surgery, tolerated PO post op last night.
a. expected post op pain-needs medication
b. still recovering from anesthesia
c. increased ICP-shunt malfunctioning
Early Warning Signs
#1 - Change in level of consciousness, behavior
Persistent headaches
vomiting
irritability
acute seizures
Late Signs:
Change in vitals
Change in pupil response
Thank you:
For the opportunity to share my passion of Neuroscience nursing with you.
To my talented actors.
References
Boston Children’s Hospital. Neurological Exam. Neurological Exam. Retrieved June 25, 2013 from http://www.childrenshospital.org/az/Site1350/mainpageS1350P1.html

Nadine Nielsen, ARNP, CPNP April 3, 2008. Neurological Assessment of the School Age Child. Retrieved June 25, 2013 from
http://webcache.googleusercontent.com/search?q=cache:EcNjoDT1Fj4J:www.seattlechildrens.org/WorkArea/linkit.aspx%3FLinkIdentifier%3Did%26ItemID%3D7144+pediatric+neurological+exam+by+a+nurse&cd=5&hl=en&ct=clnk&gl=us

January 18, 2012. Parts of the Brain and Major Functions. Chalksmart.org. Retrieved June 25, 2013 from http://www.chalksmart.org/2012/01/parts-of-brain-and-major-functions.html

Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. February 9, 2009. Partial Focal Seizure. Medline Plus. Retrieved June 25, 2013 from http://www.nlm.nih.gov/medlineplus/ency/article/000697.htm

Learning Pediatrics. (Image of sunsetting infant). Retrieved June 25, 2013 from http://learningpediatrics.blogspot.com/2011/06/appearance-of-sunset-sign-in-infant.html

Millodot: Dictionary of Optometry and Visual Science, 7th edition. © 2009 Butterworth-Heinemann. Nystagmus. The Free Dictionary by Farlex. (Image of nystagmus). Retrieved June 25, 2013 from http://medical-dictionary.thefreedictionary.com/nystagmus

Possible findings/Terminology
Nystagmus-abnormal/jerky movements of the eye(s)
Hemiparesis-muscle weakness on one side of the body.

*Affected location and subsequent symptoms:
Frontal lobe-decision making-safety
Pituitary gland-ADH-monitoring uop and Na+ levels
Hypothalamus-temp, thirst, hunger
Hippocampus-memory

Sunsetting
Ataxia-lack of muscle coordination.
Complex partial seizure-affecting awareness/memory of events before, during, and immediately after the seizure, and affecting behavior.

Generalized seizures (grand mal or tonic/clonic)-entire body involvement.
Full transcript