Pediatric Neurologic Disorders: Ma. Tosca Cybil A. Torres, RN, MAN
Pediatric Neurologic Disorders: Ma. Tosca Cybil A. Torres, RN, MAN
Pediatric Neurologic Disorders: Ma. Tosca Cybil A. Torres, RN, MAN
Disorders
Absence of the
cerebral
hemispheres.
Anencephaly
• Occurs when the upper end of the neural
tube fails to close in early uterine life
• Diagnosed by elevated AFP in maternal
serum or on amniocentesis
• Confirmed by sonogram.
Anencephaly
100% mortality
rate.
Microcephaly
• Disorder in which brain growth
is so slow that it fails more than
three standard deviations below
normal on growth charts.
• Causes:
• Intrauterine infection (rubella,
cytomegalovirus, toxoplasmosis)
• Severe malnutrition or anoxia in
infancy
Spina bifida ("split spine")
• a developmental birth defect involving the neural
tube: incomplete closure of the embryonic neural
tube results in an incompletely formed spinal cord.
• meningeal membranes that cover the spinal cord may or may not form a
sac enclosing the spinal elements
Meningocele
• least common form
• Meninges covering the spinal cord herniate through
the unformed vertebrae
• Protrusion may be covered with a layer or skin just
the clear dura
Encephalocele
Cranial meningocele or
myelomeningocele.
Most often occur in
the occipital area
Medical-Surgical Treatment
• no cure for nerve damage
• Closure of the opening on the back
• if spina bifida is detected during
pregnancy, then open fetal surgery
can be performed
Nursing diagnoses
• Risk for infection
• Risk for impaired cerebral tissue perfusion
• Risk for impaired skin integrity
• Impaired physical mobility
Pre-operative care
• Place infant in supine
• If in side lying, place a towel or pillow in between the
infant’s legs
• Place a piece of plastic below the meningocele on the
child’s back like an apron and secure it with a tape
• Apply a sterile wet compress of saline, antiseptic, or
antibiotic gauze over the lesion
• Keep infant warm assess for seepage of any clear liquid
Post operative care
• Place infant in prone until the skin incision
is healed
• Same careful precautions are observed.
• Assess for signs of increased ICP
Cerebral Palsy
Cerebral Palsy
A group of nonprogressive
disorders of upper motor
neuron impairment that
result in motor dysfunction.
Cerebral Palsy
• Cause is UNKNOWN.
• Associated with low birth weight, prebirth,
or birth injury
• Intrauterine anoxia and direct birth injury
may contribute to the development of CP
• Occurs in 2:1000 births
Types of Cerebral Palsy
Spastic
S/Sx:
• Hypertonic muscles
• Abnormal clonus
• Exaggerated DTRs
• Abnormal reflexes (eg. Babinski)
• When held in ventral position, arching of back and abnormal
extension of arms and legs are observed
• Failure to demonstrate parachute reflex when lowered
suddenly
• Scissor’s gait
• Hemiplegia, tetraplegia or paraplegia
• astereognosis
Types of Cerebral Palsy
Dyskinetic or Athetoid
S/Sx:
• Abnormal involuntary movement
• Athetoid means “wormlike”
• Early in life, child is limp and flaccid. Later, in
place of voluntary movements, the child makes
slow, writhing motions.
• Drooling
• Speech impairment
• Choreoid movements
• Disordered muscle tone (dyskinetic)
Types of Cerebral Palsy
Ataxic
S/Sx:
• Awkward, wide based gait
• Unable to perform finger-to-nose exam or perform
rapid, repetitive movements or fine coordinated
motions.
Mixed
Assessment
• History
• PE-all forms of CP may have sensory
alterations
• Strabismus
• visual perception problems
• Visual field defects
• Speech problems
• deafness
25% to 75% of children
with CP are cognitively
challenged.
50% have recurrent
seizures.
Physical findings that suggest CP
Help parents
understand their
child’s condition
Nursing Intervention
Assist in ambulation.
Prevent contractures.
Choose toys and activities
appropriate to the child’s
intellectual, developmental,
and motor levels, NOT
chronologic age.
Ensure adequate
nutrition.
Provide alternative form of
communication
SPINAL CORD INJURY
Causes:
• Trauma
• Tumor
• Ischemia
• Developmental disorders
• Neurodegenerative diseases
• Transverse myelitis
• Vascular malformations
SPINAL CORD INJURY
• RTI
• Lumbar puncture
• Skull fracture
• Meningocele
• Myelomeningocele
Assessment
• History
• S/Sx:
• Irritable
• Headache
• Seizure/shock
• Brudzinski’s sign
• Kernig’s sign
• Opisthotonos
• Cranial nerve paralysis (III & VI)
• Papilledema
Neonate