neurological function and dysfunction

• fetal development weeks 3 to 4
• infection, trauma, teratogens, and malnutrition can cause physical defects and may affect normal CNS development
• Birth: cranial bones not well developed or fused: increased risk for fracture, brain is highly vascular: increased risk for hemorage
• child: spine is mobile; high risk for cervical spin injury
• 12-18 months the anterior fontanels close
• 2-3 months posterior fontanel close
• Heat production and conservation

  • chemical reactions of metabolism
  • skeletal muscle contraction
  • chemical thermogenesis
  • vasoconstriction
  • shivering
  • voluntary mechanisms
• factors contributing to neurological disease in children:

  prematurity, difficult birth, infection during pregnancy, n/v, headache, chances in gait, falls, visual disturbances, recent trauma\
• physical impairments: altered speech, vision and hearing, headaches, decreased coordination, fatigue, spasticity, paralysis, seizure disorders
• cognitive impairments: problems with short and long-term memory, slowed thinking, decreased attention span, altered reading and writing abilities, difficulties with planning, sequencing and judgement
• Emotional/behavioural impairments: decreased control over emotions, depression, anxiety, agitation, decreased social awareness, decreased ability to relate to people
• confusion- A and O x3?, what is their baseline
• delirium: lack of awareness, altered perception of environment
• obtunded: slowed response, sleepy, like lethargy
• stupor: excessively deep state of unresponsiveness
• coma- completely unresponsive
• nursing physical examination:

  • LOC
  • vital signs
  • increased ICP
  • inspection.of head and neck
  • cranial nerve function
  • reflexes
  • motor and sensory function
• Glasgow coma scale- eye opening, verbal response, motor response
• neurological assessment: pupils, eyes open, motor response, stimulus response

  • hand grip
  • muscle tone
  • fontanel
  • LOC
  • eye movement
  • mood
• assessing LOC: Responsiveness to environment or stimuli
• assessing LOC: pupil size and reactivity
• assessing LOC: movement go extremities
• assessing LOC: ability to maintain an airway
• assessing LOC: changes in vitals, breathing patterns
• assessing LOC: status of cranial nerves
• assessing LOC: fontanel assessment
• assessing LOC: orientation and cognitive function
• cushion triad: bradycardia, increased BP, irregular response drive
• s/s of increased ICP: headache, n/v, increased blood pressure, decreased mental abilities, poor orientation, double vision, pupils not responding to light changes, shallow breathing, seizure, loss of consciousness, coma
• ICP caused by increased cerebral spinal fluid, tumour, infection