Chapter 46: Cerebral & Neurologic Dysfunction in Children

Cerebral & Neurologic Dysfunction in Children establishes that the brain, blood, and cerebrospinal fluid must maintain a stable volume to prevent the dangerous escalation of intracranial pressure, a condition that can arise from tumors, bleeding, or edema. Nursing professionals must be vigilant in identifying early, subtle manifestations of neurological distress, such as irritability, projectile vomiting, and personality changes, which may progress to late, ominous signs like bradycardia and decreased motor responses. The pediatric version of the Glasgow Coma Scale is highlighted as a fundamental tool for standardizing the assessment of consciousness, specifically adjusted to account for an infant's developmental reflexes. The text provides a deep dive into the management of the unconscious child, where maintaining a patent airway and monitoring for cerebral hypoxia are the highest priorities. It details various traumatic brain injuries, including concussions, contusions, and the specific dangers of epidural and subdural hematomas, particularly in cases of suspected child abuse. Additionally, the chapter covers environmental emergencies like submersion injuries, emphasizing how the duration of hypoxia impacts long-term survival. Infectious processes, such as bacterial and viral meningitis, encephalitis, and the metabolic crisis of Reye Syndrome, are examined with a focus on diagnostic lumbar punctures and the life-saving necessity of routine vaccinations. Extensive attention is given to the classification and treatment of epilepsy, discussing everything from focal and generalized seizures to advanced interventions like the ketogenic diet and vagus nerve stimulation. Finally, the chapter addresses structural malformations like hydrocephalus, outlining the surgical placement and complications of ventriculoperitoneal shunts. Throughout these clinical discussions, the text emphasizes the nurse's role in providing compassionate family support, helping caregivers navigate the profound stress of acute injury and the challenges of chronic neurological disability.