1. Mental Health
1.1. Developmental disability
1.1.1. Definition
1.1.1.1. Any significant delay in development
1.1.1.1.1. Physical
1.1.1.1.2. Cognitive
1.1.1.1.3. Behavioral
1.1.1.1.4. Emotional
1.1.1.1.5. Social
1.1.1.2. Usually manifests before age 22 & is indefinite
1.1.1.3. Relative to typical sequence/timing of development
1.1.2. Disorders
1.1.2.1. Not related by etiology
1.1.2.2. Have a common feature: developmental delay
1.1.2.2.1. Gross motor
1.1.2.2.2. Fine motor
1.1.2.2.3. Language
1.1.2.2.4. Social-adaptive
1.2. Cognitive impairment
1.2.1. Definition
1.2.1.1. Any mental difficulty
1.2.1.1.1. Intellectual ability
1.2.1.1.2. Adaptive behavior
1.2.1.2. Significantly below average
1.2.1.3. "Mental retardation" (negative term)
1.2.2. Etiology
1.2.2.1. Familial
1.2.2.2. Social
1.2.2.3. Environmental
1.2.2.4. Organic
1.2.2.4.1. "Biological"
1.2.2.4.2. Earlier = more severe
1.2.2.4.3. Usual cause of severe impairment
1.2.2.4.4. Can be identified in 2/3 of cases
1.2.2.4.5. Many disorders
1.2.2.5. Unknown
1.2.3. IQ ranges
1.2.3.1. 55-70 = mild
1.2.3.2. 35-50 = moderate
1.2.3.3. 20-35 = severe
1.2.3.4. <20 = profound
1.2.4. Early signs
1.2.4.1. Non-responsive
1.2.4.2. Irritable
1.2.4.3. Slow, poor feeding
1.2.4.4. Poor eye contact during feeding
1.2.4.5. Diminished spontaneous activity
1.2.5. Intervention
1.2.5.1. ASAP!!
1.2.5.2. Maximize potential
1.2.5.3. Start when CNS is malleable/responsive
1.2.5.4. Routine G/D screen for all pediatrics!
1.2.6. Prevention
1.2.6.1. Primary
1.2.6.1.1. Avoid triggering conditions
1.2.6.1.2. No parental rubella infections
1.2.6.1.3. Current vaccines
1.2.6.1.4. Genetic counseling
1.2.6.1.5. Education
1.2.6.2. Secondary
1.2.6.2.1. Early ID, tx to prevent cerebral damage
1.2.6.2.2. Prenatal diagnosis and/or carrier ID
1.2.6.2.3. Newborn screening
1.2.6.3. Tertiary
1.2.6.3.1. Minimize long-term consequences
1.2.6.3.2. Early ID
1.2.6.3.3. Rehab
1.2.6.3.4. Parental education
1.2.6.3.5. Preschool
1.2.6.3.6. Counseling
1.2.7. Ultimate goal
1.2.7.1. Promote optimum development
1.2.7.2. As individuals, w/i family and community
1.2.8. Health maintenance
1.2.8.1. Same as other kids
1.2.8.2. Reinforce AG r/t accidents
1.2.8.3. Treat acc. to developmental age
1.2.8.4. May be more difficult to detect illness
1.3. Sensory impairment
1.3.1. Hearing
1.3.1.1. Vocabulary
1.3.1.1.1. Hard of hearing
1.3.1.1.2. Deaf
1.3.1.2. Etiology
1.3.1.2.1. Family history
1.3.1.2.2. Anatomic malformation
1.3.1.2.3. LBW
1.3.1.2.4. Maternal prenatal drug abuse
1.3.1.2.5. Ototoxic drugs
1.3.1.2.6. Chronic ear infections
1.3.1.2.7. Severe prenatal asphyxia
1.3.1.2.8. Perinatal infections
1.3.1.2.9. Cerebral palsy
1.3.1.2.10. Down's syndrome*
1.3.1.2.11. Environment
1.3.1.3. Pathology
1.3.1.3.1. Conductive HL
1.3.1.3.2. Conductive-type HI
1.3.1.3.3. Sensorineural HL
1.3.1.3.4. Mixed CS Loss
1.3.1.3.5. Central auditory imperception
1.3.1.4. Therapy
1.3.1.4.1. Medical
1.3.1.4.2. Nursing
1.3.1.5. Prevention
1.3.1.5.1. Genetic counseling
1.3.1.5.2. OTM care
1.3.1.5.3. Prenatal measures
1.3.1.5.4. Avoid triggers
1.3.1.5.5. Maternal nutrition
1.3.2. Vision
1.3.2.1. Can't be corrected w/standard Rx
1.3.2.1.1. Partial sight
1.3.2.1.2. Legal blindness
1.3.2.2. Etiology
1.3.2.2.1. Perinatal infection
1.3.2.2.2. Trauma
1.3.2.2.3. Meningitis
1.3.2.2.4. Retinopathy of prematurity
1.3.2.2.5. Trauma
1.3.2.2.6. Other disorders
1.3.2.2.7. Unknown causes
1.3.2.3. Types of dysfunction
1.3.2.3.1. Refraction errors
1.3.2.3.2. Cataracts
1.3.2.3.3. Glaucoma
1.3.2.3.4. Trauma
1.3.2.4. Nursing assessment
1.3.2.4.1. Infancy
1.3.2.4.2. Childhood
1.3.2.5. Nursing care
1.3.2.5.1. In-patient care
1.3.2.5.2. Prevention
1.3.2.6. Emergency injuries
1.3.2.6.1. Foreign body
1.3.2.6.2. Chemicals/UV
1.3.2.6.3. Hematoma
1.3.2.6.4. Penetrating vs. non-penetrating
1.3.3. Deaf/blind
1.3.3.1. Profound effects on development
1.3.3.2. Motor milestones usually achieved
1.3.3.3. Other development usually delayed
1.3.3.4. "Finger spelling" vs "Tadoma method"
1.3.3.5. Developing future goals
1.3.3.5.1. Communicating ability
1.3.3.5.2. Movement ability in infants
1.4. Communicative impairment
1.4.1. Definition
1.4.1.1. Inability to receive or process speech
1.4.1.2. Inability to represent concepts or symbols
1.4.1.3. Inability to transmit and use symbols
1.4.1.4. May need alternative communication
1.4.2. Etiology
1.4.2.1. Cognitive impairment**
1.4.2.2. Other causes
1.4.3. Types
1.4.3.1. Language
1.4.3.1.1. Overview
1.4.3.1.2. Disorders
1.4.3.2. Speech
1.4.3.2.1. Disorders
1.4.4. Autism
1.4.4.1. Spectrum disorder
1.4.4.1.1. Neurodevelopmental w/brain dysfunction
1.4.4.1.2. Intellectual and behavioral
1.4.4.1.3. Males > females
1.4.4.1.4. Unknown cause (genes?)
1.4.4.1.5. Onset before age 3 usually
1.4.4.1.6. 5 types
1.4.4.2. Diagnostic criteria
1.4.4.2.1. Communication impairments
1.4.4.2.2. Impaired reciprocal social interaction**
1.4.4.2.3. Behavioral abnormalities
1.4.4.2.4. Cognitive impairments (3/4 of cases)
1.4.4.2.5. May have:
1.4.4.3. Other manifestations
1.4.4.3.1. Repetitive behaviors
1.4.4.3.2. Extreme intolerance
1.4.4.3.3. Emotionally labile*
1.4.4.3.4. Fascinated w/repetitive words or songs
1.4.4.3.5. Don't accept change
1.4.4.3.6. Don't pick up on social/emotional cues
1.4.4.4. Nursing care
1.4.4.4.1. Wide variation in response
1.4.4.4.2. Most promising treatment
1.4.4.4.3. Medications
1.4.4.4.4. In-patient care
1.4.4.4.5. Family support
1.5. Anticpatory guidance
1.5.1. Proactive, development-based counseling
1.5.2. Focuses on child's need at each stage
1.5.3. Practical, contemporary info before major milestones
2. Neurological (Lee)
2.1. A&P review
2.1.1. Brain
2.1.1.1. Protected by skull
2.1.1.2. Covered in meninges
2.1.1.2.1. Dura mater
2.1.1.2.2. Arachnoid
2.1.1.2.3. Pia mater
2.1.1.3. CSF circulates
2.1.1.3.1. Made by choroid plexus
2.1.1.3.2. Shock absorber
2.1.1.3.3. Nutrients & wastes
2.1.1.3.4. Maintains ICP
2.1.1.4. Forms very early
2.1.1.4.1. By 4th week >> neural tube
2.1.1.4.2. Lots of things can go wrong
2.1.2. Skull
2.1.2.1. Softer as an infant
2.1.2.2. Fontanels
2.1.2.2.1. Anterior: Closed by 18-24 mo
2.1.2.2.2. Posterior: Closed by 2-3 mo
2.1.2.3. Sutures
2.1.2.3.1. Begin to harden @ 6 mo
2.1.2.3.2. Fuse until age 12
2.1.2.4. Heaviest part of body
2.1.2.4.1. Center of gravity
2.1.2.4.2. Where babies tend to land when they fall
2.1.2.4.3. Weak neck muscles for support
2.1.3. Spinal cord
2.1.3.1. Greater mobility b/c slower ossification
2.1.3.2. Serious risk for C1/C2 compression fracturers in neonates
2.1.4. Nervous system
2.1.4.1. Nerve cells
2.1.4.1.1. Born w/full amount
2.1.4.1.2. Immature
2.1.4.2. Glial cells, dendrites
2.1.4.2.1. Increase until age 4
2.1.4.3. Brain growth until age 12-15
2.1.4.4. Myelination
2.1.4.4.1. Incomplete @ birth
2.1.4.4.2. Cephalocaudal progression
2.2. Pressure
2.2.1. CPP: Needed to perfuse the brain
2.2.2. ICP: Force exerted by brain, CSF, blood in skull
2.2.2.1. Components
2.2.2.1.1. Brain tissue 80%
2.2.2.1.2. Blood 10%
2.2.2.1.3. CSF 10%
2.2.2.1.4. (compensatory relationship)
2.2.2.2. Normal is 5-15 mmHg
2.2.3. Controlled by cerebral vessels
2.2.3.1. Decreased CO
2.2.3.2. Increased ICP
2.2.3.3. Constricted neck vessels
2.3. IICP
2.3.1. Early signs
2.3.1.1. Headache
2.3.1.2. Diplopia/blurry vision
2.3.1.3. Vomiting (w/o nausea)
2.3.1.4. AM nausea (esp for brain tumors)
2.3.1.5. Sluggish pupils
2.3.1.6. Slight change in LOC/VS
2.3.1.7. Possible seizures
2.3.1.8. Infant signs
2.3.1.8.1. Tense, bulging fontanel
2.3.1.8.2. Irritable/non-consolable
2.3.1.8.3. High-pitched cry
2.3.1.8.4. Poor feeding
2.3.1.8.5. Sun-setting eyes (pressure on orbits)
2.3.1.8.6. Separated sutures
2.3.1.8.7. Increased fronto-occipital circumference
2.3.2. Late signs
2.3.2.1. Decreased LOC (coma)
2.3.2.2. Altered pupils
2.3.2.2.1. Unilateral dilated: mass
2.3.2.2.2. Fixed dilated: impending herniation**
2.3.2.3. Decreased sensory/motor responses
2.3.2.4. Posturing
2.3.2.4.1. Decorticate
2.3.2.4.2. Decerebrate
2.3.2.4.3. Opisthotonus
2.3.2.5. Periodic/irregular RR
2.3.2.5.1. OMINOUS sign of brainstem dysfunction
2.3.2.5.2. Will progress to apnea if IICP isn't resolved
2.4. Nursing care
2.4.1. Baseline data
2.4.2. S/S IICP
2.4.3. I&O
2.4.3.1. SIADH
2.4.3.1.1. Low or no UOP
2.4.3.1.2. Edema
2.4.3.1.3. Overhydration
2.4.3.2. Neurogenic DI
2.4.3.2.1. Polyuria
2.4.3.2.2. Polydipsia
2.4.3.2.3. High Na+
2.4.3.2.4. Low specific gravity
2.4.4. Dark, quiet room
2.4.5. Limit stress/painful activities
2.4.6. HOB 30
2.4.7. Head/neck midline & neutral**
2.4.8. Seizure precautions for all
2.4.9. Mouth care
2.4.10. Turning
2.4.11. Passive ROM
2.4.12. Skin care
2.4.13. Stool softener r/t constipation
2.4.14. Suction sparingly (increases IICP)
2.4.15. O2 at the bedside
2.4.16. Nutrition
2.4.16.1. S/S overfeeding
2.4.16.1.1. Distension
2.4.16.1.2. Gagging
2.4.16.1.3. Coughing
2.4.16.1.4. Vomiting
2.4.17. Family support
2.4.17.1. Encourage involvement
2.4.17.2. Explain all procedures
2.4.17.3. Unrealistic expectations
2.4.17.4. Chronic sorrow
2.5. Seizure disorders
2.5.1. Abnormal electrical discharges
2.5.1.1. Involuntary movement
2.5.1.2. Behavior and sensory alterations
2.5.2. Generalized
2.5.2.1. Etiology
2.5.2.1.1. Diffuse electrical activity
2.5.2.1.2. Both brain hemispheres
2.5.2.1.3. Spreads simultaneously through cortex, brain stem
2.5.2.2. Bilateral & symmetrical
2.5.2.3. Sub-types
2.5.2.3.1. Tonic-clonic
2.5.2.3.2. Absence
2.5.2.3.3. Myoclonic
2.5.2.3.4. Lennox-Gastaut syndrome
2.5.2.3.5. Infantile spasms
2.5.3. Partial
2.5.3.1. Pathology
2.5.3.1.1. Abnormal electrical activity
2.5.3.1.2. 1 hemisphere or region of cerebral cortex
2.5.3.1.3. Spread regionally
2.5.3.1.4. Manifestations r/t lobe affected
2.5.3.2. Manifestations
2.5.3.2.1. Begins w.aura or abrupt behavioral alteration
2.5.3.2.2. May progress to generalized seizure
2.5.3.3. Etiology
2.5.3.3.1. Lesions or tumors
2.5.3.3.2. AVMs
2.5.3.3.3. Scar tissue r/t previous brain sx
2.5.3.4. Simple
2.5.3.4.1. Onset at any age
2.5.3.4.2. Causes
2.5.3.4.3. Less <30 seconds
2.5.3.4.4. Manifestations
2.5.3.5. Complex
2.5.3.5.1. Onset age 3 - adolescence
2.5.3.5.2. Immediate impaired consciousness
2.5.3.5.3. Lasts 30 sec to 5 min
2.5.3.5.4. Manifestations
2.5.4. Febrile
2.5.4.1. Generalized w/fever (>102F) & acute illness
2.5.4.1.1. Flu
2.5.4.1.2. Strep throat
2.5.4.1.3. OM
2.5.4.2. Occurs during temp rise
2.5.4.2.1. Need antipyretics on hand
2.5.4.2.2. Rarely treated w/anticonvulsants
2.5.4.3. Recurs in 30-40% of kids
2.5.5. Status epilepticus
2.5.5.1. Continuous or recurrent seizures lasting >20 min
2.5.5.1.1. W/o return to baseline neuro state
2.5.5.1.2. Compromises airway
2.5.5.1.3. BMR rises
2.5.5.2. Nursing care
2.5.5.2.1. Airway***
2.5.5.2.2. O2
2.5.5.2.3. VS if you can
2.5.5.2.4. Watch O2 sats
2.5.5.2.5. NG tube r/t aspiration
2.5.5.2.6. Anti-pyretics
2.5.5.2.7. IV access ASAP
2.5.6. Seizure meds
2.5.6.1. Phenobarbital
2.5.6.2. Phenytoin
2.5.6.3. Dilantin
2.5.6.4. Tegretol
2.5.6.5. Depakote
2.5.6.6. Lamictal
2.5.6.7. Topamax
2.5.6.8. Keppra
2.5.6.9. Trileptal
2.5.7. Safety
2.5.7.1. Showers only
2.5.7.2. Don't bathe alone
2.5.7.3. Stay with them
2.5.7.4. Drug serum levels r/t anti-seizure meds
2.5.7.5. Helmet
2.5.7.6. No open flames
2.5.7.7. Avoid areas that increase fall risk
2.5.7.8. Surgery to remove affected area
2.5.8. Medication safety
2.5.8.1. No abrupt DC
2.5.8.2. Don't crush or chew
2.5.8.3. May empty capsule into food
2.5.8.4. Have sedating effects
2.5.8.5. Must adjust dosage w/g
2.6. Meningitis
2.6.1. Bacterial
2.6.1.1. Definition
2.6.1.1.1. Inflammation of meninges
2.6.1.1.2. R/T bacterial infection
2.6.1.1.3. More serious than viral
2.6.1.1.4. Often fatal
2.6.1.2. Risk groups
2.6.1.2.1. Infants, newborns
2.6.1.2.2. R/T infection risk
2.6.1.2.3. R/T complications
2.6.1.2.4. Potential for deficits
2.6.1.3. Secondary to
2.6.1.3.1. OM
2.6.1.3.2. Sinusitis
2.6.1.3.3. Cellulitis of head/neck
2.6.1.3.4. TB
2.6.1.3.5. Septic arthritis
2.6.1.3.6. Surgery or trauma
2.6.1.4. Pathophysiology
2.6.1.4.1. Bacteria in blood >> CNS >> subarachnoid
2.6.1.4.2. Inflammatory process begins
2.6.1.5. Manifestations
2.6.1.5.1. Infants
2.6.1.5.2. Children
2.6.1.5.3. CSF changes
2.6.1.6. Nursing care
2.6.1.6.1. Respiratory isolation (!!)
2.6.1.6.2. Immediate antibiotics
2.6.1.6.3. Complications
2.6.2. Viral
2.6.2.1. Characterized by increased BCs & protein in CSF
2.6.2.2. Usually caused by enterovirus
2.6.2.3. Symptoms resolve in 3-10 days
2.6.2.4. Manifestations
2.6.2.4.1. Appear less ill
2.6.2.4.2. Irritable
2.6.2.4.3. Fever
2.6.2.4.4. HA
2.6.2.4.5. Photophobia
2.6.2.4.6. GI distress
2.6.2.4.7. UR symptoms
2.6.2.4.8. Maculopapular rash
2.6.2.4.9. S/S meningeal irritation
2.6.2.5. Treatment
2.6.2.5.1. Aggressive until bacterial cause ruled out
2.6.2.5.2. On RR isolation for at least 48 hrs
2.7. Encephalitis
2.7.1. Inflammation of the brain
2.7.1.1. Usually viral r/t mosquitos
2.7.1.2. Epidemic in summer
2.7.2. @ Risk for seizures
2.7.3. Supportive care
2.7.3.1. Have IICP >> ICU >> floor
2.7.4. Manifestations
2.7.4.1. Fever
2.7.4.2. Irritability
2.7.4.3. HA
2.7.4.4. Bulging fontanel
2.7.4.5. AMS >> coma
2.8. Reye Syndrome
2.8.1. Acute encephalopathy or cerebral dysfunction
2.8.1.1. R/T toxic injury or anoxic insult
2.8.1.2. Associated w/ASA
2.8.1.2.1. Salicylate >> toxin
2.8.1.2.2. Mitochondrial liver dysfunction >>
2.8.1.2.3. Multiple OF + high brain ammonia
2.8.2. Poor prognosis w/high fatality rate
2.8.3. Manifestations
2.8.3.1. Cerebral edema
2.8.3.2. Hypoglycemia
2.8.3.3. Fatty liver
2.8.3.4. V
2.8.3.5. Neuro S/S
2.8.3.5.1. Progressive lethargy
2.8.3.5.2. Seizures
2.8.3.5.3. RR arrest
2.9. Headaches
2.9.1. Overview
2.9.1.1. Biggest side effect of ASA
2.9.1.2. May be benign or r/t structural cause
2.9.2. Migraine
2.9.2.1. Triggers
2.9.2.1.1. Stress
2.9.2.1.2. Foods
2.9.2.1.3. Caffeine
2.9.2.1.4. Salt
2.9.2.1.5. Glutamates
2.9.2.1.6. Menstruation
2.9.2.1.7. Oral contraceptives
2.9.2.1.8. Fatigue or hunger
2.9.2.2. Manifestations
2.9.2.2.1. Uni or bi, frontal or temporal
2.9.2.2.2. Pulsating or throbing
2.9.2.2.3. Sensitivity to light and sound
2.9.2.2.4. N/V
2.9.2.2.5. Can be helped by sleep
2.9.2.3. Treatment
2.9.2.3.1. Analgesics
2.9.2.3.2. NSAIDs
2.9.2.3.3. Sumatriptan
2.9.2.3.4. Avoid triggers
2.9.2.3.5. Relaxation
2.9.2.3.6. Biofeedback
2.9.3. Tension HA
2.9.3.1. Triggers
2.9.3.1.1. Stress
2.9.3.1.2. Insecurity
2.9.3.1.3. Family conflict
2.9.3.2. Manifestations
2.9.3.2.1. Bilat, dull, achy
2.9.3.2.2. "Band around the head"
2.9.3.2.3. Pain in sdrs, neck
2.9.3.2.4. No aggravating factors
2.9.3.3. Treatment
2.9.3.3.1. R&R
2.9.3.3.2. Analgesics
2.9.3.3.3. NSAIDs
2.9.3.3.4. Ice pack
2.9.4. Rebound HA
2.9.4.1. R/T med overuse (ASA)
2.9.4.2. Manifestations
2.9.4.2.1. Dull, frontal area
2.9.4.2.2. Uni or bi
2.9.4.2.3. Occurs 5+/wk
2.9.4.2.4. Variable severity, location
2.9.4.2.5. Increasing frequency, intensity
2.9.4.3. Treatment
2.9.4.3.1. Withdrawal of all HA meds
2.9.4.3.2. Clonidine r/t withdrawal
2.9.4.3.3. Substitute meds that don't cause RHA
2.10. TBI
2.10.1. Any trauma to the head >>
2.10.1.1. Change in LOC
2.10.1.2. Anatomic abnormality of the brain
2.10.2. Leading CODD in kids
2.10.3. 90% of injury-related deaths are r/t TBI
2.11. Brain injury
2.11.1. Blunt or penetrating
2.11.2. Coup (initial) and contracoup (rebound)
2.11.3. Secondary injury d/t biochem, cellular response
2.11.4. Variable by age group
2.11.4.1. Infants
2.11.4.1.1. SBS
2.11.4.1.2. Abuse
2.11.4.1.3. Falls
2.11.4.1.4. MVC
2.11.4.2. Toddlers
2.11.4.2.1. Falls
2.11.4.2.2. MVCs
2.11.4.3. School-age
2.11.4.3.1. MVCs
2.11.4.3.2. Sports
2.11.4.3.3. Diving
2.11.4.4. Teens
2.11.4.4.1. MVCs (drug/alcohol)
2.11.4.4.2. Sports
2.11.4.4.3. Firearms
2.11.5. Manifestations
2.11.5.1. Loss of consciousness
2.11.5.1.1. >10 min = severe
2.11.5.1.2. >> W/ S/S IICP d/t
2.11.5.2. Seizures
2.11.5.3. Projectile vomiting
2.11.5.4. HA
2.11.5.5. Confusion
2.11.5.6. Loss of balance/altered gait
2.11.5.7. Amnesia r/t incident
2.11.6. Sub-types
2.11.6.1. Intracranial hematoma
2.11.6.1.1. Subdural
2.11.6.1.2. Epidural
2.11.6.1.3. Both can cause herniation
2.11.6.2. Concussion (mild TBI)
2.11.6.2.1. Caused by direct blow
2.11.6.2.2. Secondary to
2.11.6.2.3. Causes AMS, but not necessarily LOC
2.11.6.2.4. Three grades of severity
2.12. Skull fractures
2.12.1. Linear
2.12.1.1. Just a crack
2.12.1.2. Most common
2.12.1.3. No treatment needed
2.12.1.4. Impact to large area
2.12.1.4.1. Overlying hematoma
2.12.1.4.2. Soft tissue swelling
2.12.2. Depressed
2.12.2.1. Break causes fragments >> depress into tissue
2.12.2.2. Associated w/post-injury seizures
2.12.3. Compound
2.12.3.1. Exposed cranial bone
2.12.3.2. Surgical debridement
2.12.4. Basilar
2.12.4.1. At base of skull
2.12.4.2. Has dural tear & transient CN damage
2.12.4.3. Nursing care
2.12.4.3.1. Battle sign behind mastoid
2.12.4.3.2. Black eyes
2.12.4.3.3. CSF leakage through ear or nose
2.12.4.3.4. NG tube contraindicated
2.13. Spinal cord injury
2.13.1. 2 per 100,000 children
2.13.1.1. Usually cervical
2.13.1.1.1. 60% cervical
2.13.1.1.2. 20% thoracic
2.13.1.2. R/T MVC or falls
2.13.2. Gliding r/t incomplete ossification
2.13.2.1. For children <9 yrs old
2.13.2.1.1. VC can lengthen about 2 inches
2.13.2.1.2. SC can only lengthen 1/4in w/o a tear
2.13.2.2. Limited swelling = reversible
2.13.2.3. Severed or torn = permanent
2.13.3. Complete or incomplete
2.13.3.1. Complete = permanent
2.13.3.2. Higher = more severe
2.13.4. Consequences
2.13.4.1. hTN
2.13.4.2. Incontinence
2.13.4.3. Poor thermoregulation
2.13.4.4. Spinal shock
2.13.4.4.1. Loss of reflexes
2.13.4.4.2. Flaccidity
2.13.4.4.3. Some return after 72 hrs
2.13.4.5. Neurogenic shock
2.13.4.5.1. Loss of vasomotor tone
2.13.4.5.2. ANS compromised
2.13.5. Aggressive treatment
2.13.5.1. Fix swelling ASAP
2.13.5.2. Maintain function
2.13.5.3. Rehab
2.14. Submersion injury
2.14.1. Definitions
2.14.1.1. Drowning vs. near-drowning
2.14.1.2. Submersion injury = when child survives
2.14.2. Risk groups
2.14.2.1. 1-4 yo
2.14.2.2. Males 15-24 yo
2.14.3. Pathology
2.14.3.1. Panics & tries to swim
2.14.3.2. Aspirates small amount of water in oropharynx
2.14.3.3. Laryngospasm
2.14.3.3.1. Hypoxia***
2.14.3.3.2. (more panic, hypoxia >> water swallowing & vomiting)
2.14.3.3.3. Aspiration**
2.14.3.3.4. (reflex inspiration >> aspiration)
2.14.3.3.5. Hypothermia*
2.14.4. Complications
2.14.4.1. Neurologic impairment common
2.14.4.2. Submerged <5-10 min
2.14.4.2.1. Resuscitated at the scene >>
2.14.4.2.2. Few symptoms & consequences
2.14.4.3. ALWAYS transport to hospital for 24hr
3. Neurological (Jackson)
3.1. Microcephaly
3.1.1. Cranial size way smaller than average
3.1.1.1. Small brain size
3.1.1.2. Growth frontal lobe severely stunted
3.1.2. Two forms
3.1.2.1. Primary
3.1.2.1.1. Genetics
3.1.2.1.2. Toxin exposure
3.1.2.2. Secondary
3.1.2.2.1. After birth
3.1.2.2.2. Infections
3.1.2.2.3. Trauma
3.1.2.2.4. Metabolic disorder
3.1.2.2.5. Maternal anorexia in 3rd trimester
3.1.2.2.6. Genetic conditions
3.1.3. Manifestations
3.1.3.1. Autistic behavior to mild motor impairment
3.1.3.2. Mental retardation
3.1.3.3. Decerebrate posturing
3.1.3.4. Complete unresponsiveness
3.2. Hydrocephalus
3.2.1. CSF
3.2.1.1. 500 mL/d
3.2.1.2. Poor reabsorption >> enlarged ventricles
3.2.2. Pathology
3.2.2.1. Communicating
3.2.2.1.1. Normal CSF flow
3.2.2.1.2. Impaired absorption
3.2.2.2. Non-communicating
3.2.2.2.1. Blockage
3.2.3. Manifestations
3.2.3.1. Fetal death in utero
3.2.3.2. C section required r/t HC
3.2.3.3. Rapid increase in HC
3.2.3.4. Signs of IICP
3.2.3.5. Early signs
3.2.3.5.1. Bulging fontanels
3.2.3.5.2. Can't hold up head
3.2.3.5.3. Poor feeding
3.2.3.5.4. Irritable/lethargic
3.2.3.6. Late signs
3.2.3.6.1. Apnea/brady
3.2.3.6.2. Shrill, high-pitched cry
3.2.3.6.3. Sunsetting eyes
3.2.3.6.4. Will not feed
3.2.3.6.5. Vomiting
3.2.4. Diagnostics
3.2.4.1. Prenatal ultrasound
3.2.4.2. Daily HC
3.2.4.3. Ultrasound, CT, MRI
3.2.5. Intelligence borderline in 1/3 cases
3.2.6. VP Shunt
3.2.6.1. Therapeutic management
3.2.6.1.1. Head/abdominal incisions
3.2.6.1.2. Tubing redirects excess CSF to peritoneal cavity
3.2.6.2. Premedicate w/antibx
3.2.6.3. Complications
3.2.6.3.1. Mechanical
3.2.6.3.2. Infection
3.2.6.4. Nursing care
3.2.6.4.1. Daily HC
3.2.6.4.2. Pre-op care
3.2.6.4.3. Post-op care
3.2.6.4.4. Discharge
3.3. Neural tube defects
3.3.1. Anencephaly
3.3.1.1. No brain, only brain stem
3.3.2. Encephalocele
3.3.2.1. Herniated brain/meninges
3.3.2.2. Defect in skull >> sac on head
3.3.3. Spina bifida occulta
3.3.3.1. "Hidden split spine"
3.3.4. Meningocele
3.3.4.1. Sac-like cyst of meninges filled w/CSF
3.3.4.2. Protrudes from spine r/t VC defect
3.3.4.3. Doesn't affect spinal cord
3.3.5. Myelomeningocele (SB)
3.3.5.1. Pathology
3.3.5.1.1. Unknown cause
3.3.5.1.2. May be caused by environment
3.3.5.1.3. Bowel/bladder control
3.3.5.1.4. Muscle imbalance
3.3.5.1.5. Hydrocephalus
3.3.5.1.6. Arnold-Chiari II malformation
3.3.5.2. Higher = greater dysfunction
3.3.5.3. 80% are lumbar
3.3.5.4. Nursing care
3.3.5.4.1. At-birth
3.3.5.4.2. Older kids
3.3.5.4.3. Post-op
3.3.5.4.4. Discharge
3.4. Craniosyntosis
3.4.1. Premature closing of sutures
3.4.1.1. During first 18-20 mo
3.4.1.2. Males > females
3.4.2. Three subtypes
3.4.2.1. Scaphocephaly
3.4.2.1.1. Saggital suture
3.4.2.1.2. Restricted lateral growth
3.4.2.2. Brachecephaly
3.4.2.2.1. Coronal and saggital sutures
3.4.2.2.2. Excessive lateral growth
3.4.2.3. Positional plagiocephaly
3.4.2.3.1. Asymmetric
3.4.2.3.2. Flattening of occiput
3.5. Neonatal abstinence syndrome
3.5.1. Drugs readily cross placenta
3.5.1.1. Fetal death
3.5.1.2. LBW
3.5.1.3. Small HC
3.5.1.4. Prematurity
3.5.1.5. Congenital anomalies
3.5.1.6. Impaired G/D
3.5.2. Time for withdrawal
3.5.2.1. Opioid
3.5.2.1.1. 24-48 hrs post-birth
3.5.2.1.2. Hypertonic
3.5.2.1.3. Irritable
3.5.2.1.4. Tachypnea
3.5.2.1.5. Poor feeding
3.5.2.1.6. High-pitched cry
3.5.2.1.7. Seizures
3.5.2.2. Barbiturate
3.5.2.2.1. 4-14 days post-birth
3.5.2.3. Cocaine/amphetamine
3.5.2.3.1. Up to seven days after birth
3.5.3. Diagnostics
3.5.3.1. Infant urine screen (just prior to birth)
3.5.3.2. Infant meconium (last half of pregnancy)
3.5.3.3. Positive urine
3.5.3.3.1. Compare to L&D meds
3.5.4. Treatment
3.5.4.1. Calm environment
3.5.4.2. Certain meds
3.5.4.2.1. Methadone
3.5.4.2.2. Phenobarbital
3.5.4.2.3. Diazepam
3.5.4.2.4. Clonidine
3.5.4.3. No breastfeeding if mom +
3.6. Neurofibromatosis (NF-1)
3.6.1. AKA "Von Recklinghausen disease"
3.6.2. Autosomal dominant genetic disorder
3.6.2.1. Gene 17
3.6.2.2. Tumors adjacent to nerves
3.6.2.3. Skin pigment alterations
3.6.2.4. Bone deformities
3.6.3. Manifestations
3.6.3.1. Cafe-au-lait spots
3.6.3.2. Freckling in axillary/inguinal regions
3.6.3.3. Lisch nodules
3.6.3.3.1. Tan-brown
3.6.3.3.2. Benign
3.6.3.3.3. On iris of the eye
3.6.3.3.4. DIAGNOSTIC
3.6.3.4. Scoliosis
3.6.3.5. Pain
3.6.3.6. Blindness
3.7. Cerebral palsy
3.7.1. Overview
3.7.1.1. Permanent movement/posture disorder
3.7.1.2. Activity limitation
3.7.1.3. Four types
3.7.1.3.1. Spastic
3.7.1.3.2. Dyskinetic
3.7.1.3.3. Ataxic
3.7.1.3.4. Mixed
3.7.2. Pathology
3.7.2.1. Before birth
3.7.2.1.1. Complication r/t prematurity
3.7.2.1.2. Prenatal
3.7.2.1.3. Genetic factors
3.7.2.1.4. Fetal viral infection
3.7.2.2. After birth
3.7.2.2.1. Neonatal sepsis
3.7.2.2.2. Hyperbilirubinemia
3.7.2.2.3. CNS infection
3.7.2.2.4. Brain injury
3.7.3. Manifestations
3.7.3.1. Hypotonia
3.7.3.2. Rigidity
3.7.3.3. Spasticity
3.7.3.4. Athetosis
3.7.3.5. Ataxia
3.7.3.6. Diplegia
3.7.3.7. Quadriplegia
3.7.4. Nursing care
3.7.4.1. High cal diet + fiber
3.7.4.2. Skin care
3.7.4.3. Physical activity
3.7.4.4. Safety
3.7.4.5. G/D
3.7.4.6. Parental education
3.7.4.7. Emotional support