Neuro Alterations & Pediatric Variations

Development

• Nervous system is complete but immature until 4 years old.
• Brain and spinal cord develop from the neural tube.
• Children have a large head and poorly developed neck muscles.
• Thin cranial bones; skull expands until age 2, sutures unfused.
• Excess spinal mobility due to immature muscles/ligaments, incomplete vertebral ossification.
  • Risk of cervical injury or vertebral compression fractures with falls.

Pediatric Assessment

• CT: May need sedation; used for lesions, tumors, edema, structures.
• EEG: To rule out seizures, continuous brain activity, varying wear times.
• Lumbar Puncture (LP): Measures ICP/CSF, may need sedation; checks for spinal infection, meningitis.
• MRI: Assesses tissue and structure, requires longer sedation; for lesions, tumors, edema, structures.
• X-RAY: Detects skull fractures.
• EVM: Lower score is worse, optimal score is 15, used for nonverbal and "A&O" assessments.

Intracranial Pressure (ICP)

• Force by tissue, CSF, blood; decreased perfusion with increased ICP.
• Causes: Meningitis, seizure, trauma, substance abuse, stroke, brain tumors, electrolyte imbalance.
• Treatment: Evacuate cranial pressure, Mannitol, elevate HOB 30°.
• Late signs: Posturing, low heart rate/high BP, fixed large pupil, decreased motor/sensory, Cheyne-Stokes breathing, GCS <8, coma.
• Cushing’s Triad: Increased systolic with wide pulse pressure, low HR, irregular RR.

Seizures

Types & Manifestations

• Brief paroxysmal behaviors from excessive abnormal neuron firing.
• Diagnosed around age 2, mostly idiopathic unless family history.
  • Primary: No abnormality; epilepsy.
  • Secondary/Symptomatic: Structural or metabolic disease; hydrocephalus.
• Types include Focal/Partial, Generalized, Febrile, Tonic, Clonic, Tonic Clonic, Absence.
• Stages: Aura, Tonic, Clonic, Postictal.

Management & Care

• Seizure precautions: Padded side rails up, Ambu/suction ready.
• Emergency medications if >5 minutes: Midazolam, Lorazepam, Diazepam.
• Outpatient care: Swim buddy, showers, driving regulations, medical bracelet, medication adherence.
• Medications: Midazolam, Lorazepam, Diazepam, Phenytoin/Fosphenytoin, Phenobarbital.
• Nursing care includes maintaining appointments, avoiding sudden med cessation, and dietary considerations.

Hydrocephalus

• Imbalance in CSF production and absorption.
• Common in spina bifida, trauma/abuse.
• Ventriculo-Peritoneal Shunt: Redirects and reabsorbs excess CSF, needs revisions, risk of malfunction/infection.

Meningitis

• Symptoms: Poor feeding, crying, V/D, poor muscle tone, fever in infants.
• Management: Private room, droplet precautions, antibiotics, seizure precautions, watch for sepsis.
• Bacterial Meningitis: Requires antibiotics, diagnosed via lumbar puncture.

Acute Head Injury

• Complication of head trauma, seen with shaken baby syndrome.
• Symptoms: Changes in LOC, confusion, vomiting, increased ICP.
• Medications: Mannitol, steroids, anticonvulsants.

Endocrine & Metabolic Dysfunction

Pediatric Variations

• Immature but similar to adults; growth/development, puberty.
• Disorders include Diabetes Insipidus, SIADH, Precocious Puberty.

Diabetes Insipidus

• Low ADH, causes dehydration, treated with DDAVP.

SIADH

• High ADH, causes fluid overload, treated with diuretics and vasopressin.

Disorders of the Thyroid

• Congenital Hypothyroidism: Requires lifelong levothyroxine.

Disorders of the Pancreas

Diabetes Mellitus

• Type 1 common in children, requires insulin therapy.
• Management includes insulin pump therapy, BG monitoring, and sick day protocols.

Respiratory Dysfunction

Anatomical Differences in Children

• Smaller, narrower Eustachian tubes, larger tonsils.

Nose & Throat Disorders

• Nasopharyngitis, Acute Streptococcal Pharyngitis, Tonsillitis.

Otitis Media

• Inflammation/infection, treated with antibiotics and possibly ear tubes.

Respiratory System Variations

• Shorter and narrower airways.

Respiratory Distress & Upper Airway Disorders

Foreign Body Aspiration

• Leading cause of unintentional death <5 years old.

Sudden Infant Death Syndrome (SIDs)

• Prevention includes sleeping on back, avoiding bed sharing.

Acute Respiratory Tract Infections

• Epiglottitis, Croup, Influenza, Bronchiolitis, Pneumonia.

Chronic Lung Disorders

Asthma

• Reversible constriction and inflammation, managed with bronchodilators and steroids.

Cystic Fibrosis

• Multisystem recessive disorder, managed through medication and dietary adjustments.