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Pediatric Neurological Disorders: 



1. Cerebral Palsy: Nursing Care and Interventions

Definition

Cerebral Palsy (CP) is a group of non-progressive neurological disorders caused by brain damage or abnormal development, affecting movement, posture, and muscle coordination. It often occurs before birth, during delivery, or in the neonatal period.

Causes

  1. Prenatal:

  2. Perinatal:

  3. Postnatal:

Signs and Symptoms

Investigations

  1. MRI or CT scan: Identifies brain abnormalities.
  2. Electroencephalogram (EEG): Detects seizures.
  3. Genetic testing: To rule out genetic causes.
  4. Developmental assessments: Evaluates milestones and motor functions.

Medical and Surgical Treatment

  1. Medical:

    • Antispasmodic drugs: Baclofen, diazepam.
    • Antiepileptics: For seizure control.
    • Botulinum toxin injections: To reduce spasticity.

  2. Surgical:

    • Orthopedic surgeries: To correct deformities and improve mobility.
    • Selective dorsal rhizotomy (SDR): Reduces spasticity by cutting nerve roots.

Nursing Interventions

  1. Promote optimal mobility through physical and occupational therapy.
  2. Assist in feeding to prevent aspiration.
  3. Educate caregivers on medication administration and managing seizures.
  4. Provide emotional support to the family.
  5. Implement safety measures to prevent falls.

2. Hydrocephalus

Definition

Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles, leading to increased intracranial pressure.

Causes

Signs and Symptoms

  • Enlarged head circumference (in infants).
  • Bulging fontanelle.
  • Vomiting, irritability, or lethargy.
  • Sunsetting eyes (downward gaze).
  • Developmental delays.

Investigations

  1. Ultrasound: For prenatal diagnosis.
  2. MRI/CT scan: Confirms ventriculomegaly.
  3. Lumbar puncture: Measures CSF pressure.

Medical and Surgical Treatment

  1. Medical: Diuretics (e.g., acetazolamide) to reduce CSF production (temporary relief).
  2. Surgical:

Nursing Interventions

  1. Monitor head circumference and fontanelles in infants.
  2. Assess for signs of increased intracranial pressure (vomiting, irritability).
  3. Maintain a sterile environment to prevent infections post-surgery.
  4. Educate parents on shunt care and signs of malfunction.
  5. Encourage early intervention therapies for developmental delays.

3. Neural Tube Defects (NTDs)

Definition

Neural tube defects are congenital anomalies resulting from the failure of the neural tube to close completely during embryonic development. Common NTDs include spina bifida, anencephaly, and encephalocele.

Causes

  • Folate deficiency during pregnancy.
  • Maternal diabetes or obesity.
  • Exposure to teratogens (e.g., certain medications, alcohol).
  • Genetic predisposition.

Signs and Symptoms

  • Spina Bifida: Weakness or paralysis of the lower limbs, loss of bowel and bladder control, and visible spinal deformities.
  • Anencephaly: Absence of parts of the brain and skull; incompatible with life.
  • Encephalocele: Sac-like protrusion of brain tissue through the skull.

Investigations

  1. Maternal serum alpha-fetoprotein (MSAFP): Elevated levels indicate NTDs.
  2. Ultrasound: Detects neural tube defects prenatally.
  3. MRI: Evaluates severity in spina bifida cases.

Medical and Surgical Treatment

  1. Medical:

  2. Surgical:

    • Closure of spina bifida defect post-birth.
    • Repair of encephalocele.

Nursing Interventions

  1. Educate pregnant women on the importance of folic acid.
  2. Assist with post-operative wound care in NTD surgeries.
  3. Prevent infections by maintaining hygiene around exposed neural tissue.
  4. Promote physiotherapy to enhance mobility in spina bifida cases.
  5. Provide emotional and psychological support to families.

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