Chapter 16 NEURO
● CNS develops in the first 3-4 weeks of gestation
● Premature babies more risk for brain damage and hemorrhage. Moreover, they will have difficulty sucking and swallowing,
leading to feeding and growth issues.
● The head size accounts for a ¼ of the body height in infants, it continues to grow until they are 5
Neurological assessment
● It should proceed from least invasive to most invasive. The use of toys and familiar objects, as well as
incorporating play, will help promote cooperation from the child.
● Health history
○ Family history of genetic disorders with neurologic manifestations, seizure disorders, or headaches.
○ History of present illness
■ when symptoms started and how they have progressed as well as treatments used at home
■ Common S+S related to neurological disease
● Nausea and vomiting
● Headaches (early morning, frequent or persistent)
● Changes in gait
● Visual disturbances
● Increased irritability
● Loss of motor function
● Changes in LOC
● Altered muscle tone
● Areas to inspect
○ Level of consciousness (LOC) → earliest indication
■ Parents will be the first to notice
■ Eye-opening, motor response, verbal response
● Full consciousness
● Confusion
○ Disorientation exists
● Obtunded
○ Limited responses and falls asleep unless stimulation
● Stupor
○ only responds to vigorous stimulation
● Coma
○ Cannot be aroused even with painful stimuli
○ Vital signs
○ head, face, neck
○ Cranial nerves function
○ Motor function
○ Reflexes
○ Sensory function
○ Increased intracranial pressure (ICP)
, 1. Smell
2. 3 4 6 Follow a toy or a bright color object
5. Suck and bite
7. Taste and salivation
8. Response to voice, whisper test
9 + 10 Gag reflex and swallowing
11. head and trunk position when seated
12. Tongue movements
Doll`s eyes maneuver (assessing cranial nerves III, IV, VI
● Normal
○ When you move the head of the child to the right, the eyes should look to the left
symmetrically and vice versa
Assessing oculomotor function
● Note nystagmus or sunset appereance
● Nystagmus
○ involuntary, rapid, rhytmic eye movement
● Sunsetting
○ The sclera of the eyes is showing over the top of the iris
○ Indicate increased ICP
○ Seen in Hydrocephalus
, Pupillary response
● A. Pinpoint
○ observed in poisonings, brain stem dysfunction, and opiate use
● B. Dilated
○ But reactive are seen after seizures,
○ Fixed associated with stem herniation secondary to increased ICP
● C. One dilated but reactive
○ Associated with intracranial mass
Motor function assessment
A. Decorticate → Damage of cerebral cortex
B. Decerebrate → Damage at the level of the brain stem
Increased intracraneal pressure
● Possible causes of ICP:
○ head trauma, birth trauma, hydrocephalus, infection, brain tumors
Neurological diagnostics tests
Lumbar puncture
● Measure ICP and obtain CSF analysis
, ● To diagnose hemorrhage, infection or obstruction
● measurement of the spinal fluid pressure
● Positioning
○ Newborn → upright with head flexed forward
○ Child, older infant → on the side with head flexed forward and knees flexed to abdomen
● Nursing actions
○ Proper positioning
■ Use distraction technique to remain in propert positioning (storytelling, music)
○ Keep child flat for 1 hour if ordered
○ Apply EMLA cream to puncture site 30-60 min before procedure
Electroencephalogram (EEG)
● Measures teh electrical activity of the brain
● Diagnoses seizure and brain death
● Nursing actions
○ Patient must remain still (sedation if necessary)
○ Inform of what anticonvulsant the patient is taking
○ Morning anticonvulsant may be held
Head ultrasound
● Assess intracranial hemorrhage
Computed tomography (CT)
● Diagnose congenital abnormalities
○ Neurla tubes defects, hemorrhage, tumors, fractures
○ Nursing actions
■ with contrast → check for allergies
Magnetic Resonance Imaging (MRI)
● Provides info about bones and tissues
● Diagnoses congenital abnormalitites
○ Neural tube defects,normal vs abnormal brain tissue
● Nursing actions
○ No metal allowed
○ If contrast → check for allergies
Procedures and Treatments for Neurologic Disorders
● Ventricular shunt placement > Hydrocephalous
● Hyperventilation to promote vasoconstriction > to decrease ICP
● Physical, Occupational, or Speech Therapies (PT/OT/ST)
● External ventricular drainage (EVD) > hydrocephalous, meningitis, encephalitis
● Ventricular tap >ICP
● Vagal nerve stimulator
● Ketogenic diet > seizures
○ High fats, adequate protein and very low carbs
○ Mild state of dehydration
● Medications
○ Antibiotics, anticonvulsants, benzodiazepines, analgesics/narcotics, diuretics, steroids
