Pediatric Neurological Dysfunction

Introduction

• Discussion includes: anatomy and physiology of neurological system, assessment, intracranial pressure, procedures, and dysfunctions (head injuries, submersion injuries, infections, seizures, malformations).

Brain Anatomy and Development

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

Brain Protection

• Cranium: Composed of 8 bones protecting the brain.
• Galea Aponeurotica: Fibrous band overlying the cranium for extra protection.
• Sub Galeal Space: Relieves intracranial pressure through blood shunting.

Brain Structures

• Divisions: Forebrain, midbrain, hindbrain.
• Midbrain, Medulla, Pons: Part of the hindbrain, forming brain stem connecting hemispheres, cerebellum, and spinal cord.

Blood-Brain Barrier

• Cellular structures preventing harmful substances from entering interstitial spaces.
• Affects drug therapy efficacy.

Neurological Assessment

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

Glasgow Coma Scale

• Scores between 3 (worst) and 15 (best), includes eye, verbal, motor responses.

Intracranial Pressure (ICP)

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

Nursing Care for Intracranial Pressure

• Prioritize Respiratory Effectiveness: Maintain airway, avoid carbon dioxide buildup.
• Monitor: Consciousness, pupil reaction, vital signs.
• Positioning: Head elevation, midline positioning, avoid jugular compression.

Procedures

• Lumbar puncture, ventriculostomy, EEG, radiography, CT, MRI.

Head Injuries

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

SIADH and DI

• SIADH: Fluid retention, hyponatremia.
• DI: Polyuria, polydipsia. Treatment includes hormone replacement and fluid management.

Submersion Injuries

• Prevention: Supervision, avoiding distractions around 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 via shunt.

Chiari Malformations

• Type 1 and 2: Structural defects causing hydrocephalus.
• Management: Often surgical with shunt insertion.

Conclusion

• Comprehensive management and prevention strategies for pediatric neurological conditions.