NURSING CARE

OF A FAMILY
WHEN A CHILD
HAS A
NEUROLOGIC
DISORDER

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THE NERVOUS SYSTEM

 Neurologic disorders
severely alter the child’s
life; some result in life-
threatening complications.
 Prevention must be the
highest priority
 Neural tissue does not
regenerate
 Nervous system
degeneration is likely
permanent.

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 THE NERVOUS SYSTEM
 Nursing care focuses on
prevention or measures to
help the child and family
develop strategies for dealing
with the associated loss in
mental or physical functioning,
making the child comfortable,
and providing an environment
conducive to the child’s
development and self-esteem.

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THE NERVOUS SYSTEM

 Anatomy and physiology

 Neurons(nerve cells)
 Cerebrospinal fluid
 Central nervous system
 Peripheral nervous system

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INTRACRANIAL PRESSURE

Group of signs and symptoms that occur with

many neurologic disorders

Causes
• Increase in CSF volume
• Blood entering the CSF
• Cerebral edema
• Head trauma or infection
• Space-occupying lesions
• Hydrocephalus or Guillain-Barré syndrome

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NEUROCUTANEOUS SYNDROMES

 Sturge-Weber syndrome
 Neurofibromatosis (von Recklinghausen
disease)

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CEREBRAL PALSY

 Pyramidal or spastic type

 Extrapyramidal or dyskinetic type
 Ataxic type
 Mixed type

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 Bacterial meningitis

Group B streptococcal infection

INFECTION Encephalitis
OF THE
NERVOUS Reye syndrome
SYSTEM
Guillain-Barré syndrome

Botulism

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INFLAMMATORY DISORDERS

 Carpal tunnel syndrome

 Facial palsy (Bell palsy)

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PAROXYSMAL DISORDERS

 Epilepsy (recurrent seizures)

 Breath holding
 Headache

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SPINAL CORD INJURY

Phases of recovery
 First
 Second
 Third

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ATAXIC DISORDERS

 Ataxia-telangiectasia
 Friedreich ataxia

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2020 NATIONAL HEALTH GOALS RELATED TO
NEUROLOGIC DISORDERS IN CHILDREN

 Increase the proportion of children or youth

with disabilities who spend at least 80% of
their time in regular education programs from
a baseline of 56.8% to a target level of
73.8%.
 Reduce the number of people 21 years of age
and younger with disabilities who are in
congregate care facilities from a baseline of
28,890 to 26,001.

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2020 NATIONAL HEALTH GOALS RELATED TO
NEUROLOGIC DISORDERS IN CHILDREN

 Increase the proportion of people with

epilepsy or uncontrolled seizures who
receive appropriate medical care.
 Reduce emergency department visits for
nonfatal traumatic brain injuries from
407.2/100,000 population to
366.3/100,000.

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NURSING PROCESS: NEUROLOGIC
DISORDERS

 Assessment
 Nursing diagnosis
 Outcome identification and planning
 Implementation
 Outcome evaluation

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 ASSESSING
NEUROLOGIC
DISORDERS
#1

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ASSESSING NEUROLOGIC DISORDERS

 Health history
 Neurologic examination
 Cerebral function
 Orientation, immediate recall, memory,
 Stereognosis- ability to recognize an object by
touch
 Graphesthesia- ability to recognize shape that
has been traced on the skin
 Kinesthesia- ability to distinguish movement

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ASSESSING NEUROLOGIC DISORDERS
CRANIAL NERVE FUNCTION

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ASSESSING NEUROLOGIC DISORDERS

 Cerebellar function
 Test for balance and coordination
 Motor function
 Evaluate muscle size, strength, and tone
 Sensory function
 Ability to distinguish light touch, Pin,
vibration, hot, and cold.

20

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ASSESSING NEUROLOGIC DISORDERS

 Diagnostic testing
 Lumbar puncture-CSF analysis
 Ventricular tap-CSF analysis
 X-rays
 Cerebral angiography- cerebral blood vessels
 Myelography-spinal cord
 Computed tomography- densities and multiple
layers of the brain
 Magnetic resonance imaging- differences in tissue
composition
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 22
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ASSESSING NEUROLOGIC DISORDERS

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ASSESSING NEUROLOGIC DISORDERS

 Diagnostic testing
 Nuclear medicine studies
 Brain scan-injection of radioactive material
 Positron emission tomography-imaging after
injection of positron-emitting radiopharmaceuticals
 Echoencephalography
 Ultrasound of head or spinal cord)
 Electroencephalography
 Non-invasive measurement of the brain’s
electrical fields
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 26
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ASSESSING INCREASED
INTRACRANIAL PRESSURE

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DECORTICATE AND DECEREBRATE
POSTURING

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ASSESSING NEUROCUTANEOUS SYNDROMES

 Sturge-Weber
syndrome
 Port-wine birthmark on
skin of upper part of the
face that follows the
trigeminal nerve;
hemiparesis on side
opposite lesion;
intractable seizures,
cognitive challenge;
glaucoma; calcification
of involved cerebral
cortex
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 Neurofibromatosis
 Irregular, excessive
skin pigmentation
followed by café-au-
lait spots followed by
soft cutaneous
tumors, possible
seizures followed by
subcutaneous
tumors; hearing
impairment, vision
loss

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THERAPEUTIC TECHNIQUES FOR NEUROCUTANEOUS
SYNDROMES

Sturge-Weber syndrome
 Patient education; long-term follow-up,
if child has accompanying seizures
Neurofibromatosis (von
Recklinghausen disease)
 Little therapy available to halt tumor
growth; if lesions causing acoustic or
optic degeneration, surgical removal;
emotional support for child, family.
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 ASSESSING
CEREBRAL PALSY
 All types
 History (possible anoxia during
prenatal life or at birth);
 physical assessment (possibly
strabismus, refractive
disorders, visual perception
problems, visual field defects,
speech disorders);
 possibly attention deficit
disorder or autism spectrum
syndrome;
 commonly cognitive challenge,
recurrent seizures; possible
cerebral asymmetry

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 ASSESSING INFECTION
OF THE NERVOUS
SYSTEM #1
 Bacterial meningitis
 History (2 or 3 days of upper
respiratory infection) followed
by intense headache, sharp
pain when head bent forward;
followed by possible
opisthotonos, inability to follow
light through full visual fields,
bulging fontanelles; if caused
by Haemophilus influenzae,
septic arthritis; if caused by
Neisseria meningitidis, papular
or purple petechial skin rash;
followed by sudden
cardiovascular shock, seizures,
nuchal rigidity, apnea

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THERAPEUTIC TECHNIQUE FOR INFECTION OF THE
NERVOUS SYSTEM

Bacterial meningitis
 Antibiotic therapy, possibly through
intrathecal injections; possible
corticosteroid or osmotic diuretic;
standard precautions; respiratory
precautions for 24 hours after start of
antibiotic therapy; possible prophylactic
for family members
Group B streptococcal infection
 Antibiotic therapy
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ASSESSING INFECTION OF THE NERVOUS
SYSTEM #2

• Headache; high temperature;

ataxia; muscle weakness or
Encephali paralysis; diplopia; confusion;
irritability; possible nuchal rigidity,
tis positive Brudzinski or Kernig sign;
lethargy; coma

• Lethargy; vomiting; confusion;

Reye combativeness; occurs after viral
infection or influenza treated with
syndrome aspirin

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THERAPEUTIC TECHNIQUE FOR INFECTION OF THE
NERVOUS SYSTEM #2

Encephalitis
 Supportive therapies: antipyretic; mechanical
ventilation; acyclovir; carbamazepine;
dexamethasone or osmotic diuretic
Guillain-Barré syndrome
 Supportive until paralysis peaks; prednisone;
plasmapheresis or transfusion of immune
serum globulin; cardiac and respiratory
function must be closely monitored;
subcutaneous fractionated or unfractionated
heparin
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 37
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 Guillain-Barré syndrome
• Peripheral neuritis; decreased
tendon reflexes; muscle
ASSESSING paralysis and paresthesia
INFECTION begin in legs and spread to
arms, trunk, head; facial
OF THE weakness; difficulty
NERVOUS swallowing; severe respiratory
Botulism
involvement
SYSTEM
• Age (<6 months); weakness;
hypotonia; listlessness; weak
cry; diminished gag reflex
followed by flaccid paralysis of
bulbar muscles

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 39
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Carpal tunnel

• Numbness; sharp pain;

burning in thumb and
second, third, fourth ASSESSING
fingers INFLAMMATOR
Facial palsy (Bell Y DISORDERS
palsy)
• Abrupt onset; possibly
associated with herpes
or Lyme disease
infection

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THERAPEUTIC TECHNIQUES FOR INFLAMMATORY
DISORDERS
 Carpal tunnel
 Splint to wrist; oral anti-inflammatory;
possibly corticosteroid injection; if not
successful, stricture at carpal canal can be
relieved.
 Facial palsy (Bell palsy)
 In adults, prednisone; if herpes-related,
acyclovir.
 In children, prednisone use is variable;
 Possibly eye drops three or four times daily
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ASSESSING PAROXYSMAL DISORDERS

 Recurrent seizures(Epilepsy)
 Pregnancy history
 history of events that occurred immediately
before seizure
 accurate description of seizure
 child’s overall behavior in last few weeks
(bedwetting, failing marks);
 physical, neurologic exam; blood studies;
lumbar puncture; possible CT, MRI, skull
radiograph, EEG
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 ASSESSING PAROXYSMAL DISORDERS

 Breath holding
 Anger or stress; cyanosis; slumping to floor;
momentarily unconscious
 Headache
 History of when headache usually occurs;
events preceding; usual duration, frequency,
intensity, description, associated symptoms;
actions taken to treat; physical exam with
funduscopic exam; blood pressure
measurement; if aura documented, EEG
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THERAPEUTIC TECHNIQUES FOR PAROXYSMAL
DISORDERS

 Recurrent seizures
 Antiseizure mediation; patient, family education
 Breath holding
 Reassurance; patient education; iron
supplementation, if indicated
 Headache
 Sleep or lying down; acetaminophen, NSAID first-
line medical treatment for headaches, including
migraines; specialized mediation plan, if indicated
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SPINAL CORD INJURY

 Results when the spinal cord becomes

compressed or severed by the vertebrae; further
cord damage can result in hemorrhage, edema,
or inflammation at the injury site as the blood
supply becomes impeded.

46

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ASSESSING SPINAL CORD INJURY

 Suspect whenever child has sustained

forceful trauma.
 Do not move a child until the back and head
are supported in straight line.
 In ED, do not attempt to move child from
stretcher until spinal X-ray films are obtained;
if helping to move the child onto the X-ray
table, use a gentle log-rolling technique.

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ASSESSING SPINAL CORD INJURY

 If resuscitation is necessary, maintain

child’s head in neutral position. To keep
neck immobilized, if a child is wearing a
football, bicycle, or motorcycle helmet or
a neck brace, do not remove these.
 Help maintain spinal immobilization
during such procedures as obtaining blood
samples or a neurologic assessment.

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SPINAL CORD RECOVERY PHASE

 First Recovery Phase

 Immediately after the injury
 Child experiences spinal shock syndrome/loss of
autonomic nervous system function
 Administration of corticosteroids can help
reduce edema and possibly protect the function
of the spinal cord
 Vasopressor agents such as dopamine may be
prescribed to maintain BP and perfusion to the
cord
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 Second Recovery Phase
 Flaccid paralysis of the shock phase is
replaced by spastic paralysis
 Spasticity Is caused by the loss of the upper
level of control or transmission of meaningful
innervation of the anterior horn
 Lower motor neurons cannot send impulses
for contraction causing flaccidity of the muscle
 UTI- most frequent infection during this phase 50

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Third Recovery Phase
Learning to live with the final
outcome or permanent limitation
of motor and sensory function.

51

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ASSESSING ATAXIC DISORDERS

Ataxia-telangiectasia Friedreich ataxia

• Telangiectasias on • Progressive cerebellar,
conjunctiva and skin at spinal cord dysfunction
flexor creases; in early occur in late adolescence;
infancy, developmental gait disturbance;
milestones not met; uncoordinated arm
develop awkward gait; movements; high-arched
possible choreoathetosis, foot; hammer toes;
nystagmus, intention scoliosis; combined
tremor, scoliosis symptoms of positive
Babinski reflex, absence
of deep tendon reflexes in
the ankle, ataxia
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THERAPEUTIC TECHNIQUES FOR ATAXIC
DISORDERS

Ataxia- • No effective treatment;

telangiecta often fatal in late
sia adolescence

• If untreated, fatal in
Friedreich young adulthood;
ataxia antioxidant therapy may
help delay this outcome

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NURSING DIAGNOSES

Risk for disuse syndrome

Interrupted family processes

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QUALITY & SAFETY EDUCATION FOR
NURSES (QSEN)

 Patient-Centered Care
 Teamwork & Collaboration
 Evidence-Based Practice
 Quality Improvement
 Safety
 Informatics

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QUESTION #1

A 3-year-old has just been admitted to the hospital

with bacterial meningitis. Which may make the child
the most afraid?
A. Masks worn by the staff
B. Headache
C. Intravenous line in his hand
D. Keeping the room lights dim

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ANSWER TO QUESTION #1

A. Masks worn by the staff

Rationale: Respiratory isolation precautions in addition to
standard precautions are instituted for the first 24 hours
after the initiation of antibiotics to prevent transmission of
the disease.

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QUESTION #2

When asking health history questions about the child

admitted with Reye syndrome, which would be
considered a common finding?
A. Parental administration of acetaminophen for fever
B. Recent streptococcal infection
C. Recent sickle-cell crisis
D. Recent influenza illness

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ANSWER TO QUESTION #2

D. Recent influenza illness

Rationale: The use of aspirin following viral illnesses such as
chicken pox or influenza has been known to lead to Reye
syndrome.

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QUESTION #3

A 12-year-old experiences absence seizures. Which of

the following is a typical manifestation of this type of
seizure?
A. Rapid blinking for 10 seconds
B. Spastic stiffening of all muscles
C. “Marching” spasms of the left or right arm
D. Stupor from which it is difficult to be roused

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ANSWER TO QUESTION #3

A. Rapid blinking for 10 seconds

Rationale: Absence seizures are seen as only a momentary
halt in motion or a change in facial expression.

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QUESTION #4

An adolescent has migraine headaches. Which drug

would the nurse expect to be prescribed for him?
A. Ergotamine tartrate (Cafergot)
B. Parathyroid hormone
C. Methotrexate
D. Clindamycin (Cleocin)

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ANSWER TO QUESTION #4

A. Ergotamine tartrate (Cafergot)

Rationale: Ergotamine tartrate constricts cerebral arteries,
relieving migraine headache.

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