NU 230 Neurosensory
Child maltreatment
• Neglect - failure of guardian to provide basic needs and adequate care
• Physical or emotional
• Abuse - deliberate infliction of physical injury
• Physical, emotional, or sexual
• May be caused by lack of knowledge, lack of resources
• TEN4 rule
• Bruising on child under 4 years of age, typically signs of abuse.
Talking to kids about abuse
• Provide private place to talk, do not promise that you won’t tell, avoid leading questions
• Red flags for abuse:
• Parent answers questions asked of child, stories not matching, parent refusing treatment/testing
Abusive head trauma (shaken baby syndrome)
• Caused by violent shaking, shearing forces
• #1 risk factor: crying
ADHD
• Distractibility, difficulty completing tasks, inattention, hyperactivity, impulsiveness
• Management
o Behavioral therapy, positive reinforcement, organizational charts, frequent breaks, safety measures from
impulsivity
Down syndrome (Trisomy 21)
• Diagnosis based on manifestations, chromosomes o Low birth weight, short stature, depressed
nasal bridge, short stubby digits, hypertonicity, hyper flexibility, protruding tongue, upward
slanted eyes
• Management: No cure; want to manage complications: o Cardiac defects, Increased risk for
respiratory problems , Hypothyroidism
ASD (autism spectrum disorder)
• Issues with social interaction, Repetition, restricted likes/actions, o Inability to maintain eye
contact or socially interact/ communicate
o Early red flags: no smile by 3 mos, no eye contact, no babbling by 12 mos, no words by 16 mos
• Management:
, o Support family, highly structured behavioral program, positive reinforcement, increase social awareness of
others, decrease stimulation
Brain tumors
• Manifestations: Depends on location
• Headache (especially upon awakening), vomiting, vision changes, can cause ICP
• Diagnosed by: MRI, biopsy, CT • Management:
• surgical removal preferred, Radiation/chemo
• Quiet, dim lit environment; restrict visitors, minimal stimulation
ICP (increased cranial pressure)
• Pressure accumulated due to CSF or blood
• Manifestations o Bulging fontanels, shrill high-pitched cry, irritability, drowsiness, increased head
circumference, H/A, forceful or projectile vomiting, distended scalp veins, separated suture lines, lethargy
• If sutures are separated = too much ICP
• Management = Direct ICP monitoring, Osmotic diuretics (Mannitol), strict I&O, Positioning- HOB 15-30,
Cluster care,
Quiet dimly lit environment, No airway suctioning unless necessary o When positioning to 30 degrees,
want to move entire body, not just head o Dressing does not get moved for any reason when
monitor is placed and if saturated, notify MD.
• NEURO exam:
• Temperature = increases with neuro issue
• BP/HR- changes in these are more important than direction they are headed
• RR- often deep and irregular
• Pupils may present as pinpoint or dilated
Pinpoint pupils greater then 5 = brainstem damage
• Motor function- spontaneous vs painful stimuli
Posturing- occurs when control of motor function is lost
Posturing
• Decorticate = Rigid flexion with arms held tightly to body; legs extended and rotated inward; cerebral cortex problem
• Decerebrate = Rigid extension and pronation of arms and legs; cerebral brainstem
Care for unconscious child
• Ensure adequate circulation, clear airway, effective breathing, frequent neuro assessments, VS assessments, pain
assessment and management, quiet dim lit environment,
• Main priority = airway… have suction nearby,
2
Child maltreatment
• Neglect - failure of guardian to provide basic needs and adequate care
• Physical or emotional
• Abuse - deliberate infliction of physical injury
• Physical, emotional, or sexual
• May be caused by lack of knowledge, lack of resources
• TEN4 rule
• Bruising on child under 4 years of age, typically signs of abuse.
Talking to kids about abuse
• Provide private place to talk, do not promise that you won’t tell, avoid leading questions
• Red flags for abuse:
• Parent answers questions asked of child, stories not matching, parent refusing treatment/testing
Abusive head trauma (shaken baby syndrome)
• Caused by violent shaking, shearing forces
• #1 risk factor: crying
ADHD
• Distractibility, difficulty completing tasks, inattention, hyperactivity, impulsiveness
• Management
o Behavioral therapy, positive reinforcement, organizational charts, frequent breaks, safety measures from
impulsivity
Down syndrome (Trisomy 21)
• Diagnosis based on manifestations, chromosomes o Low birth weight, short stature, depressed
nasal bridge, short stubby digits, hypertonicity, hyper flexibility, protruding tongue, upward
slanted eyes
• Management: No cure; want to manage complications: o Cardiac defects, Increased risk for
respiratory problems , Hypothyroidism
ASD (autism spectrum disorder)
• Issues with social interaction, Repetition, restricted likes/actions, o Inability to maintain eye
contact or socially interact/ communicate
o Early red flags: no smile by 3 mos, no eye contact, no babbling by 12 mos, no words by 16 mos
• Management:
, o Support family, highly structured behavioral program, positive reinforcement, increase social awareness of
others, decrease stimulation
Brain tumors
• Manifestations: Depends on location
• Headache (especially upon awakening), vomiting, vision changes, can cause ICP
• Diagnosed by: MRI, biopsy, CT • Management:
• surgical removal preferred, Radiation/chemo
• Quiet, dim lit environment; restrict visitors, minimal stimulation
ICP (increased cranial pressure)
• Pressure accumulated due to CSF or blood
• Manifestations o Bulging fontanels, shrill high-pitched cry, irritability, drowsiness, increased head
circumference, H/A, forceful or projectile vomiting, distended scalp veins, separated suture lines, lethargy
• If sutures are separated = too much ICP
• Management = Direct ICP monitoring, Osmotic diuretics (Mannitol), strict I&O, Positioning- HOB 15-30,
Cluster care,
Quiet dimly lit environment, No airway suctioning unless necessary o When positioning to 30 degrees,
want to move entire body, not just head o Dressing does not get moved for any reason when
monitor is placed and if saturated, notify MD.
• NEURO exam:
• Temperature = increases with neuro issue
• BP/HR- changes in these are more important than direction they are headed
• RR- often deep and irregular
• Pupils may present as pinpoint or dilated
Pinpoint pupils greater then 5 = brainstem damage
• Motor function- spontaneous vs painful stimuli
Posturing- occurs when control of motor function is lost
Posturing
• Decorticate = Rigid flexion with arms held tightly to body; legs extended and rotated inward; cerebral cortex problem
• Decerebrate = Rigid extension and pronation of arms and legs; cerebral brainstem
Care for unconscious child
• Ensure adequate circulation, clear airway, effective breathing, frequent neuro assessments, VS assessments, pain
assessment and management, quiet dim lit environment,
• Main priority = airway… have suction nearby,
2
