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Pediatric Alterations in Neuro and MS

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Elizabeth Koldoff

on 6 May 2014

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Transcript of Pediatric Alterations in Neuro and MS

Elizabeth Koldoff, MS, RN
Defects account for about 40% of infant deaths
The nervous system at birth -
complete but immature

YOUNGER
OLDER
Muscular
Dystrophy

Scoliosis
Developmental Dysplasia
Club Foot
Cerebral Palsy
Neural Tube Defects
Hydrocephalus
Reyes Syndrome
Increased
Intracranial Pressure


Progressive
disease characterized by weakness and muscle wasting ---> chronic disability
Duchenne's is an x-linked disorder so usually seen in males
S or C shaped curvature of the spine greater than 10%
Abnormal development of the hip
Foot twisted out of normal position.
Early treatment is essential - serial casting can correct issue without surgery
This is a group of permanent disorders characterized by abnormal muscle tone and lack of coordination
Caused by insult to fetal or infant brain
The neural tube is the fetal tissue that develops into the brain
A significant decrease has been seen in these defects due to improved pre-natal care and vitamins with folic acid
Imbalance between the production and absorption of CSF
Associated with myelomeningocele
Acute encephalopathy usually following a viral infection
Rapid or prolonged increases in ICP are a serious threat to life
Causes - meningitis, hypoxia, poisoning, seizures, trauma
London, Pg. 1651
CAST CARE
SKIN CARE
Keep clean and dry
No powders/lotions
Don't poke sharp obects in cast
CAST CARE
Keep dry
Check edges of cast
Elevate
ASSESS
q 15 x 2h, q2 x first 24h, q4h x 2 days
distal pulses, cap refill, color, warmth, edema
sensation and movement
circle drainage and note date/time
Report unrelieved pain
End of Lecture!!!
You can do this!!
The end of the semester is near!!!
IMMOBILITY CARE
RESPIRATORY
Assess breathing and lung sounds
Incentive spriometer
Deep breathe/cough/turn
INTEGUMENTARY/MUSCULOSKELETAL
Assess skin
Change position q2h
Pad and position
ROM as necessary
GI
Assess for constipation
Increase fluids and fiber
Musculoskeletal Alterations
Protects vital organs, supports weight, control motion, store minerals, and supply red blood cells
Long bones are more porous and less dense than adults
Important to see a pediatric orthopod
Objectives:
Explore alterations in children with neuro and ms disorders
Discuss impact of various health issues on child and family
Describe physiological problems related to disorder
Apply nursing process and judgement to plan of care
Neurological
and
Musculoskeletal
Alterations

NEUROLOGICAL
COMPARISONS
BY AGE
Causes cerebral edema, hypoglycemia and fatty changes in the liver
Neurological Alterations
AVPU
Glasgow Coma Scale for Children


EARLY
Headache
Visual disturbances
Nausea and vomiting
Dizziness or vertigo
Slight change in vital signs
Pupils not as reactive or equal
Sunsetting eyes
Clight change in LOC
Restlessness

Infant has above plus:
Irritability
Bulging fontanelle
Wide sutures
Increased head circumference
Dilated scalp veins
High-pitched cry
Signs of ICP
LATE
Significant decrease in LOC
Seizures
Cushings Triad
Increase systolic BP and wide PP
Bradycardia
Irregular respirations
Fixed and dilated pupils
Papilledema
AVPU
Glasgow Coma Scale for Children
Reyes Syndrome S/S
Nausea
Vomiting
Mental status changes
Seizures
Progressive unresponsiveness
FINAL stages: coma, seizures, flaccidity, loss of deep tendon reflexes, and respiratory arrest
Reyes Syndrome DX
Abrupt change in LOC
Spinal tap
CT Scan
Lab work
Liver enzymes and ammonia level are high
PTT is prolonged
Hypoglycemia
A liver biopsy is a definitive DX
Reyes Nursing Care
Assess respiratory and neurological status
Note any changes


Monitor lab values
Monitor intake and output
Prevent immobility complications – P. 1655
Teach family about dx process, medications, when to call MD, and community resources
Neural Tube Defects
Anencephaly – brain does not develop above brainstem
Encephalocele – protrusion of meningeal tissue protrudes through a defect in the skull.
Spina bifida oculta - mildest form of spina bifida. Spinal cord remains intact and usually is not visible.
Neural tube Defects cont…
Meningocele – protrusion involves meninges and a sac like cyst that contains CSF in the midline of back, lumbosacral area.

Meningomyelocele (Myelodysplasia) protrusion of meninges, CSF, nerve roots, & portion of spinal cord occurs.
Meningomyelocele
The higher the defect on the spinal cord, the greater the neurological disorder

Nursing Actions
Perioperative Care
Promote mobility
Address parental concerns
Chiari II Malformation
There are 2 types:
communicating and non communicating
Non communicating = most dangerous and most common
Hydrocephalus
Hydrocephalus S/S
Infant
Increased head circumference
Thin widely separate bones of the head
Anterior fontanel tense, bulging, and non-pulsating
Dilated scalp veins
Frontal bossing
Setting sun eyes
Child
Behavior changes---irritability and lethargy
Headache on awakening
N/V
Nystagmus
Late signs
High, shrill cry and seizures
Treatment
Ventriculoperitoneal shunt (VPS)
CSF drains from lateral ventricles into peritoneal cavity
Shunt revisions may be necessary
Infection is most serious complication
TEACH parents to know signs of  ICP
Nursing Care

Pre operative


Post operative
Cerebral Palsy
Group of permanent disorders of movement and posture development causing activity limitation.
Caused by insult to fetal or infant brain
Clinical Manifestations
Hypotonia
Ridigity
Spasticity
Athetosis
Ataxia
Hemiplegia
Diplegia
Quadriplegia
CP Video
Nursing Considerations for CP
Assess for
Developmental Delays
Dietary concerns
Complications of Immobility
Skin Breakdown
Constipation
Muscle atrophy and contractures
Implementation
Provide adequate nutrition: Hi Calorie diet, plenty of fluids, Aspiration Precautions
Maintain skin integrity: Keep C/D, Positioning
Promote mobility: ROM
Teach dx management, medications, community resources
Clubfoot
Congenital
Foot is twisted out of normal position
More common in boys
Cause is unknown
Can be caused from abnormal uterine position
Clubfoot treatment
Early treatment is essential
Manipulation and casting are performed weekly for about 8-12 weeks
If it’s not corrected surgery is required.
Assessment
Interventions
Birth to 6 months – Pavlik harness to maintain flexion and abduction and external rotation
6-18 months --- reduction by traction, then closed or open reduction in surgery. Placed in spika cast for 3 months

CAST/IMMOBILITY CARE
Scoliosis
S or C shaped curvature of the spine
More than 10 degrees is abnormal
Most common form = idiopathic scoliosis
Occurs most often in female between 10 and 13 during their growth spurt
Scoliosis varies in degrees…
Mild scoliosis
Curvature of 10 – 20 degrees
Intervention: Exercises
Moderate scoliosis
Curvature of 20-40 degrees
Intervention: Boston brace
Severe scoliosis
Curvature of 40 degrees or more
Surgery to repair - spinal fusion
Duchenne Muscular Dystrophy
X-linked disorder; usually seen in males
Progressive weakness and muscle wasting  >>>>>> chronic disability


Diagnostics
Increased Creatine Kinase (Normal Value: 60-400 iu/L)
Decreased Dystrophin
Creatinine
Clinical Manifestations
Delayed walking, Frequent falls
Easily tires when walking, running, climbing stairs
Toe walking, Waddling gait
Lordosis
Positive Gowers maneuver
Mental retardation possible
Gowers Maneuver
Prognosis
Treatment
Stem cell therapy
Steroids
Rehab

Wheel chair bound by 12 years
Death usually occurs during adolescence from respiratory or cardiac failure.
Nursing Care
Promote independence and mobility
Provide psychosocial support
Monitor cardiac and respiratory functioning
Assess urinary and bowel function
Provide good nutrition
Teach dx management, medications, developmentally appropriate activities, importance of physical therapy, community resources
Yahoo!
Duchenne Video
Nursing Care for  ICP
Monitor VS
Maintain Patent Airway
Administer medication as ordered
Mannitol
Corticosteroids
Dilantin
Hypertonic IV solutions
Elevate HOB
Protect from injury
Monitor and maintain normal body temperature
Teach family s/s of increased ICP
Full transcript