Overview of Pediatric Neurological Dysfunction

Introduction

• Focus on anatomy and physiology of the neurological system, assessment, intracranial pressure, procedures, and dysfunctions such as head injuries, submersion injuries, infections, seizures, and malformations.

Brain Anatomy and Development

• Functions: Enables reasoning, intellectual function, personality expression, mood, and environmental interaction.
• Development: Begins in the 3rd week of gestation and matures in the mid to late twenties, with the prefrontal cortex maturing last, crucial for planning, prioritization, and decision-making.

Brain Protection

• Cranium: 8 bones protect the brain.
• Galea Aponeurotica: Provides extra protection as a fibrous band.
• Sub Galeal Space: Aids in relieving intracranial pressure by blood shunting.

Brain Structures

• Divisions: Forebrain, midbrain, hindbrain.
• Midbrain, Medulla, Pons: Part of hindbrain, forming the brain stem.

Blood-Brain Barrier

• Cellular structures prevent harmful substances from entering interstitial spaces, impacting drug therapy efficacy.

Neurological Assessment

• Consciousness: Includes alertness and cognition (response to stimuli, verbal, and motor responses).
• Vital Signs: Pulse, respiration, and blood pressure are indicators of circulation adequacy and consciousness causes.
• Temperature: Changes may indicate infection or drug effects.
• Pupils: Size and reactivity offer clues to dysfunction.
• Motor Function and Reflexes: Movement and reflexes provide information on cerebral dysfunction.

Glasgow Coma Scale

• Scores range from 3 (worst) to 15 (best), evaluating eye, verbal, and motor responses.

Intracranial Pressure (ICP)

• Symptoms: Headache, personality changes, irritability, fatigue.
• Causes: Tumors, fluid accumulation, bleeding, edema.
• Interventions: Identification of Cushing Triad symptoms (bradycardia, irregular respirations, hypertension).

Nursing Care for Intracranial Pressure

• Respiratory Effectiveness: Maintain airway, avoid CO2 buildup.
• Monitoring: Consciousness, pupil reaction, vital signs.
• Positioning: Elevate head, midline positioning, avoid jugular compression.

Procedures

• Includes lumbar puncture, ventriculostomy, EEG, radiography, CT, MRI.

Head Injuries

• Causes: Falls, objects, vehicle accidents.
• Consequences: Leading cause of death in children over 1 year.

SIADH and DI

• SIADH: Fluid retention, hyponatremia.
• DI: Polyuria, polydipsia with treatment involving hormone replacement and fluid management.

Submersion Injuries

• Prevention: Supervision and avoiding distractions near water.
• Consequences: Hypoxia, aspiration, hypothermia.

Neurological Infections

• Types: Bacterial meningitis, nonbacterial meningitis, brain abscesses, encephalitis, rabies.
• Management: Isolation, antimicrobial therapy, hydration, ventilation.

Reye's Syndrome

• Symptoms: Vomiting, altered consciousness.
• Management: Fluid monitoring, liver function recovery.

Seizures and Epilepsy

• Causes: Infections, trauma, genetic disorders.
• Management: Control seizures, document episodes, ensure safety.

Headaches

• Types: Migraine, tension-type, secondary headaches.
• Management: Document pattern, assess associated symptoms.

Hydrocephalus

• Causes: Congenital or acquired conditions.
• Management: Surgical intervention typically via shunt.

Chiari Malformations

• Types 1 and 2: Structural defects causing hydrocephalus.
• Management: Often surgical, involving shunt insertion.

Conclusion

• Importance of comprehensive management and prevention strategies for pediatric neurological conditions.