Pediatric nursing Intensive
By Archie Alviz
NEUROLOGIC DISORDERS
● MYELOMENINGOCELE
○ Spinal cord and meninges protrude through the
vertebrae -> poaching
○ Affects movement of child
○ Results to lower motor neuron damage (paralysis down
the point of injury)
■ Flaccidity
■ Lack of sensation of the LE
■ Loss of bowel and bladder control
○ s/sx:
■ (+) sac-like cyst
● Contains meninges, spinal cord, nerve roots
● (-) sensation below sac
● Usually at lumbar area
■ Dribbling of urine
■ Stool retention
○ Dx: Amniocentesis
● Get small of amniotic fluid sample and test it
● Increase AFP - neural tube defects
○ Decreased AFP - down syndrome
○ Management:
■ X trauma and infection
■ Position: side-lying to X putting pressure on sac
■ Clean buttocks and genitals after each voiding and
defecation to X infection
■ Put protective covering on sac (sterile gauze
moistened w/ PNSS)
■ Observe sac for oozing of fluid or pus (infection)
■ Crede bladder: apply a downward pressure on the
bladder using thumbs to move urine to the urethra
■ Assess amount of sensation and movement below
the sac
●
HYDROCEPHALUS
○ Excess CSF in the ventricles and subarachnoid spaces
○ N: 90-200
○ Causes:
■ Overproduction of CSF
■ Obstruction
■ Lack of absorption
○ s/sx: same w/ increased ICP
■ Enlarged head
■ Sunset eyes
■ Macewens sign - percussion produces cracked pot
sound d/t separated suture lines and bulging
fontanels
■ Prominent scalp veins
■ Bulging fontanels
■ Shrill cry
■ Cushing’s triad: hyper, brady, brady
○ Dx: Transillumination: (+) fluid-filled in hydrocephalus
○ Management:
■ Ventriculoperitoneal shunt
● Surgery
● Excess CSF shunted to peritoneum to be
absorbed
■