Chapter 49: Neurologic Disorders in Children Nursing Care

Nursing care planning is grounded in the Healthy People 2030 objectives, aiming to improve the proportion of children receiving necessary services for conditions like autism spectrum disorder and promoting prevention measures, such as helmet use to prevent injury. A thorough assessment involves a detailed health history and a six-part neurological examination, including evaluation of cerebral function (level of consciousness, memory, orientation), cranial nerves, cerebellar coordination (balance and gait), motor skills, and sensory interpretation (stereognosis, kinesthesia, graphesthesia). Diagnostic procedures frequently used include computed tomography (CT) scans, magnetic resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture for cerebrospinal fluid (CSF) analysis. A critical and serious clinical presentation covered is increased intracranial pressure (ICP), often indicated by subtle changes such as increased temperature and blood pressure combined with decreased pulse and respiratory rates, leading to characteristic decorticate or decerebrate posturing as pressure on the brainstem grows. Among the common pediatric disorders reviewed is Cerebral Palsy (CP), a nonprogressive motor dysfunction arising from brain damage or abnormal development, categorized into spastic (excessive muscle tone), dyskinetic (involuntary writhing movements), and ataxic (poor coordination) types. Infectious disorders discussed include bacterial meningitis, an infection of the meninges requiring antibiotic therapy and close monitoring for residual effects like hearing loss; Reye syndrome, linked to aspirin use during viral infections; and Guillain-Barré Syndrome (GBS), an immune-mediated ascending paralysis. Paroxysmal disorders feature prominently, particularly recurrent seizures (epilepsy), which are classified as generalized (e.g., absence/petit mal, tonic-clonic/grand mal) or partial (focal). Urgent care is required for status epilepticus, and patient safety during seizures is paramount. The chapter also addresses Spinal Cord Injury (SCI), highlighting the three recovery phases from spinal shock to permanent functional limitations, requiring extensive rehabilitation and management of immobility effects like pressure ulcers and urinary tract infections. Other conditions include neurocutaneous syndromes (Sturge-Weber, Neurofibromatosis) and various headaches (migraine, tension).