Presented by
Marlene Meador RN, MSN, CNE
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Head to torso ratio
Cranial bones- thin, pliable, suture lines not
fused
Brain vascularity and small subarachnoid
space
Excessive spinal mobility
Wedge shaped cartilaginous vertebral bodies
 LOC
& behavior
 Vital Signs and respiratory status
 Eyes
 Reflexes and motor function
 Cranial nerve function
Modified Glasgow Coma Scale for ages 3 and younger
Infants
 Irritability &
restlessness
 Fontanelles / FOC
 Poor
feeding/sucking
 Skull & scalp veins
 Nucal rigidity,
seizures (late signs)
Children
 Headache
 Vomiting
 Irritable, lethargic,
mood swings
 Ataxia, spasticity
 Nucal rigidity
 Deterioration in
cognitive ability
 Vital sign changes
 What
assessment findings should the
nurse monitor?
 What
emergency equipment should
the nurse have on hand at all times for
a child with IICP?
What diagnostic procedures would the
nurse anticipate for this child?
 What priority interventions must the nurse
include with respect to these diagnostic
procedures?
◦ What specific teaching is required?
◦ What additional lab/serum tests would
you anticipate?
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Corticosteroids
 Anti-inflammatory
 Contraindicationsacute infections
 Monitor I&O
 Protect from
infection
 Add K+ foods
 Discontinue
gradually
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Osmotic diuretic
Reduce fluid
Contraindicationsintracranial bleeding
Monitor I&O carefully
Monitor electrolytes
Teaching
What equipment is essential?
 Vital signs & neuro signs
 Additional assessment findings
 Activity level
 Hydration status
 Positioning
 Parent teaching
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Febrile- rapid temp rise above 39°C (102°F)
Generalized- loss of consciousness, involves
both cerebral hemispheres onset at any age
Tonic/Clonic- impaired consciousness, abnormal
motor activity, posturing, automatisms
Absence- may confuse with daydreaming or
inattentiveness
 EEG
 CT,
MRI
 Lumbar puncture
 CBC
 Metabolic screen for glucose,
phosphorus and lead levels
 Assessment
findings
 Priority interventions
◦Prevention
◦During seizure
◦Following seizure
McKinney has detailed Nursing Care Plan
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Phenobarbital- CNS depressant- assess for
sedation, VS, serum levels,
◦ Teach- S&S of toxicity, no ETOH, adhere to regime
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Carbamazepine- sedative/anticonvulsant
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Phenytoin- anticonvulsant
◦ hold med if lab values =
◦ Teach- S&S of toxicity
◦ Safety measures- on-hand equipment
◦ Teach- oral care, sun exposure
 What
is most important nursing
intervention when a child is
experiencing a seizure?
 What
is most important teaching
regarding seizure medication?
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Bacterial
Potentially fatal; abx
given
prophylactically if
bacterial suspected.
May kill within 24 hrs
C/S take 72 hrs to
process
Infants at greatest risk
Nuchal rigidity
Severe headaches
Contagious
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Viral
Same s/s but milder and
shorter duration
May follow a viral
infection
May be accompanied by
rash
Nuchal rigidity
Ataxia
Not contagious
 Why
does bacterial meningitis
present more of a risk than viral
meningitis?
 How
do the manifestations of
meningitis differ between infants
and young children
 Fever (not always
present)
 Poor feeding
 Vomiting
 Irritability
 Seizures
 High-pitched cry
Infant
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Fever
Headache
Photophobia
Nuchal rigidity
Altered LOC
Anorexia/ vomiting
Diarrhea
Drowsiness
Child/Adolescent
What findings differentiate between
bacterial and viral meningitis?
 What specific interventions does the nurse
include for this procedure?
◦ Monitor VS & neuro VS
◦ LOC
◦ Teaching
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Ceftriaxone Sodium (Rocephin®)- who
must receive this medication?
 Cefatoxime Sodium (Claforan ®) Dexamethasone- special nursing care
 Antipyretics
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What intervention must the
nurse initiate to protect the
patients and staff when a
diagnosis of bacterial
meningitis is suspected?
Hydro= Water Cephaly= of the head/brain
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What priority nursing assessment of a
newborn monitors for this condition?
What assessment findings occur in the
older child?
What diagnostic measures confirm this
diagnosis?
LP-dangerous
 MRI; CT scan
 Skull X-ray
 Measure FOC
 Provide for safety, informed consent,
support for child and family, accurate
H&P
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Shunt placement- surgical procedure
to place a tube that drains CSF into
the atrioventricular or peritoneal
cavity.
 Atrioventricular- drains into atrium
(not used as frequently)
 Ventricular peritoneal- drains into the
peritoneal cavity
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Pre Operatively:
◦ Baseline VS, monitor for IICP,
◦ What teaching/interventions for parents?
 Post-op:
◦ Monitor shunt function (how?)
◦ Positioning and activity
◦ VS, neuro VS & I&O
◦ Teaching
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Home care needs
S&S of IICP
S&S of infection
S&S of seizures
Emergency numbers of Pediatrician &
neurosurgeon
Refer to home care, social services and
support groups
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Most common defect of the CNS
Occurs when there is a failure of the
osseous spine to close around the
spinal column.
What common nutritional supplement
is encouraged for all women of
childbearing age?
What common nutritional supplement is
encouraged for all women of
childbearing age?
 Discuss the 3 types of neural tube
defects:
◦ Spina bifida occult
◦ Meningocele
◦ Meningomyelocele
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Visualization of the defect
 Motor sensory, reflex and sphincter
abnormalities
 Flaccid paralysis of legs- absent
sensation and reflexes, or spasticity
 Malformation
 Abnormalities in bladder and bowel
function
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 Immediate
surgical closure
 Prior
to closure keep sac moist &
sterile
 Maintain
NB in prone position with
legs in abduction preoperatively
Pre-Operative:
 Meticulous skin care
 Protect from feces or urine
 Keep in isolette
Assess surgical site
 Monitor VS and neuro VS
 Institute latex precautions
 Encourage contact with parents/care
givers
 Positioning
 Skin Care
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 Antibiotic
therapy
 Prevent UTI
 Education
 Emphasize
the normal,
positive abilities of the child
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At risk for infection◦ Protect
◦ Position
At risk for injury◦ Protect
◦ Position
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Static Encephalopathy- spastic CP
most common type (80%)
◦ Nonspecific term give to disorders
characterized by impaired
movement and posture
◦ Non-progressive
◦ Abnormal muscle tone and
coordination
Jittery (easily startled)
 Weak cry (difficult to comfort)
 Experience difficulty with eating
(muscle control of tongue and swallow
reflex)
 Uncoordinated or involuntary
movements (twitching and spasticity)
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Alterations in muscle tone
◦ Abnormal resistance
◦ Keeps legs extended or crossed
◦ Rigid and unbending
 Abnormal posture
◦ Scissoring and extension (legs feet in
plantar flexion)
◦ Persistent fetal position (>5 months)
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 EEG,
CT, or MRI
 Electrolyte levels and metabolic
workup
 Neurologic examination
 Developmental assessment
 Increased
incidence of respiratory
infection
 Muscle contractures
 Skin breakdown
 Injury
 Anatomy
injury
predisposes infant/young to
 Pathophysiology
of
“Shaken Baby Syndrome”
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Assessment findingsImmediate nursing interventionsLegal implications
Why is it not prudent for the nurse to discuss
suspicions of abuse with the parents or primary
caregiver?
 Not
clearly understood
 Characterized by impaired social,
communicative, and behavioral
development
 Usually noted in the first year of
life
Home Setting
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Reduce environmental stimuli
Communicate via ageappropriate touch &
verbalization
Keep toys or other items out of
reach if child uses them for
harmful self-stimuli
Ritualistic ADLs
Encourage therapists &
support groups
Acute Care Setting
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Keep at least 1 constant
caregiver. Encourage
parents to stay with,keep
room quiet & limit number of
staff
Anxiety/aggression when
touched by strangers
Constant monitoring by
nurse or parents
Allow to maintain rituals of
ADLs
Encourage therapists &
support groups
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Trisomy 21- the most common
chromosomal abnormality resulting in mild
to profound mental retardation
Failure of chromosomes to separate
 Advanced maternal age
 No other socio-economic or
geographic factors have been
identified
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Primary concern with cardiac and GI
anomalies
What are the most obvious indications of
Down’s Syndrome in a newborn
How does the nurse promote health of the child
with Down’s syndrome?
 Primary focus on the parents and care
givers to provide support and achieve a
realistic view of the child’s capabilities
 Support siblings
 Refer to family counseling services
 Support parents in feelings of guilt and
chronic sorrow
Contact Marlene Meador RN, MSN, CNE
Email: mmeador@austincc.edu