Peds exam 1 review Neurological System

1. Compare how the anatomy and physiology of the neurologic system in children differs from adults. Neurologic disorders can result from congenital problems as well as from infections or traumas. Certain neurologic conditions occur in children more often than in adults and these conditions will affect their growth and development. In addition, children are at an increased risk for different neurologic problems compared to adults due to anatomic and physiologic differences. • First 3 to 4 weeks’ gestation – Infection, trauma, teratogens, and malnutrition can cause physical defects and may affect normal CNS development. • Birth – Cranial bones well developed, but not fused: increased risk for fracture. – Brain is highly vascular: increased risk for hemorrhage. • Child – Spinal cord is mobile: high risk for cervical spine injury. 2. Identify various factors associated with neurologic disease in infants and children. Prematurity, difficult birth, infection during pregnancy, falls and recent trauma 3. Discuss common laboratory and other diagnostic tests useful in the diagnosis of neurologic conditions. Page (514) COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1 Test Explanation Indications Nursing Implications Lumbar puncture (LP) Withdrawal of cerebrospinal fluid (CSF) from the subarachnoid space for analysis To diagnose hemorrhage, infection, or obstruction Can obtain measurement of spinal fluid pressure Assist with proper positioning (Fig. 16.6). Help child maintain position and remain still. Maintain strict asepsis. Assist with collection and transport of specimen. Encourage fluids after procedure, if not contraindicated. Keep child flat for 1 hour if ordered. Apply EMLA cream to puncture site 30–60 minutes before procedure to reduce pain, if ordered. Head and neck X-ray Radiographic image of the head and neck will show skull and spine structures Detects skull and spinal fractures; shows location and course of ventricular catheters; reveals information about increased Children may be afraid. Allow a parent or family member to accompany the child. If the child is unable or unwilling to stay still for the radiograph, restraint may be necessary. The This study source was downloaded by from CourseH on :01:30 GMT -06:00 Test Explanation Indications Nursing Implications intracranial pressure (ICP) and skull defects time of restraint should be limited to the amount of time needed for the radiograph. Fluoroscopy Radiographic examination that uses continuous xrays to show live up-todate images Can assess cervical spine for instability during movement Same as head and neck radiographs. Child will need to cooperate with flexion and extension of neck. Cerebral angiography X-ray study of cerebral blood vessels. Involves injection of a contrast medium and use of fluoroscopy Can assess for vessel defects or spaceoccupying lesions Same as head and neck radiographs. Assess for allergy to contrast medium. Push fluids following procedure, if not contraindicated, to help flush out contrast medium. Ultrasound Use of sound waves to locate the depth and structure within soft tissues and fluid Used to assess intracranial hemorrhage in newborns, and ventricular size Better tolerated by nonsedated children than CT or MRI Can be performed portably at bedside Computed tomography (CT) Noninvasive x-ray study that looks at tissue density and structures. Images a “slice” of child’s tissue To diagnose congenital abnormalities, such as neural tube defects, hemorrhage, tumors, fractures Machine is large and can be frightening to children. Procedure can be lengthy and child must remain still. If unable to do so, sedation may be necessary. Can be performed with or without use of contrast medium; if used, assess for allergy. Encourage fluids post procedure, if not contraindicated. Electroencephalogra m (EEG) Measures electrical activity of the brain To diagnose seizures and brain death Must remain still. If unable to do so, sedation may be necessary, but should be avoided if possible because sedatives can alter the EEG reading. Inform technician of what anticonvulsants the child is taking. Morning anticonvulsants may need to be held. This study source was downloaded by from CourseH on :01:30 GMT -06:00 Test Explanation Indications Nursing Implications Magnetic resonance imaging (MRI) Use of magnetic field to show different tissue compositions Used to assess tumors and inflammation; used to diagnose congenital abnormalities, such as neural tube defects; shows normal versus abnormal brain tissue Child may not have any metal devices, internal or external, while undergoing MRI (ensure hospital gown does not have metal snaps). Procedure can be lengthy and child must remain still. Child is placed in long narrow tube and the machine makes a booming noise when it is turned on and off during the procedure; therefore, can be difficult to gain cooperation. If the child is unable to remain still, sedation may be necessary. Can be performed with or without use of a contrast medium. If contrast medium is used, assess for allergy. Encourage fluids post procedure, if not contraindicated. Positron emission tomography (PET) Similar to CT or MRI, but radioisotope is added. Measures physiologic function Provides information on brain functional development. Can assist in identifying seizure foci. Can assess tumors and brain metabolism Procedure can be lengthy and child must remain still. If unable to do so, sedation may be necessary. Intravenous access will be needed for the procedure. Encourage fluids post procedure, if not contraindicated, to help body eliminate radioisotopes. Single photon emission computed tomography (SPECT) Use of radiopharmaceuticals to provide 3-dimensional splices; less expensive and more available than PET Used to detect brain death, presence of encephalitis, hydrocephalus, to localize epileptic foci, assess metabolic activity, evaluate brain tumors, assessment of childhood development disorders Similar to PET In uncooperative children do not use sedation until after injection because it may affect brain activity Secure child’s head Sudden distractions or loud noises can alter the distribution of radionuclide Cisternography Radiopharmaceuticals injected intra