Republic of the Philippines

Mindanao State University

College of Health Sciences
Marawi City

Alterations in Nervous System

Presented to:
PROF. Norhanie A. Lininding, RN, RM, MN

In Partial Fulfillment
of the Requirements for the Subject
NSG124 Care of Mother, and Child at Risk or with Problems (Acute and Chronic
RLE) – XxYy1
nd
2 Semester, A.Y. 2022-2023

By:

Cairoden, Janisah A.
Carim, Sittie Esnaira L.
Dalidig, Aliah L.

April 2023
 Hydrocephalus
- The term hydrocephalus is derived from the Greek words “hydro” meaning
water and “cephalus” meaning head. As the name implies, it is a condition in
which the primary characteristic is excessive accumulation of fluid in the brain.
- Hydrocephalus is an excess of CSF in the ventricles or the subarachnoid
space (Moe, Benke, & Bernard, 2008).
- it is also classified regarding whether it occurs at birth (congenital) or from
an incident later in life (acquired).
ETIOLOGY
- The cause of congenital hydrocephalus is unknown, although maternal
infection such as toxoplasmosis or infant meningitis may be factors (Smith &
Henderson, 2007).
- The most common causes of acquired hydrocephalus are: Head
trauma. Stroke. Brain or spinal cord tumors.
SIGNS AND SYMPTOMS
- The signs and symptoms of hydrocephalus vary somewhat by age of onset.

• Infants show symptoms of increased intracranial pressure, such as

decreased pulse and respirations, increased temperature and blood
pressure, hyperactive reflexes, strabismus, and optic atrophy.
• Changes in the head
• Eyes fixed downward (sunsetting of the eyes)
• Sleepiness or sluggishness (lethargy)
• Nausea and vomiting
RISK FACTORS
In many cases, the cause of hydrocephalus is unknown. However, a number of
developmental or medical problems can contribute to or trigger hydrocephalus.
Newborns
Hydrocephalus present at birth (congenital) or shortly after birth can occur because
of any of the following:
• Abnormal development of the central nervous system that can obstruct the
flow of cerebrospinal fluid
• Bleeding within the ventricles, a possible complication of premature birth
• Infection in the uterus — such as rubella or syphilis — during pregnancy,
which can cause inflammation in fetal brain tissues.
Other contributing factors
Other factors that can contribute to hydrocephalus among any age group include:
• Lesions or tumors of the brain or spinal cord
 • Central nervous system infections, such as bacterial meningitis or mumps
• Bleeding in the brain from a stroke or head injury
• Other traumatic injury to the brain
NURSING DIAGNOSIS
• Risk for ineffective cerebral tissue perfusion related to increased intracranial
pressure as evidenced by impaired brain blood flow.
ASSESSMENT
• Assess vital signs hourly, noting for any irregularity in breathing and heart
rate, and rhythm, and measure the pulse pressure.
• Assess neurological status (such as mental status, motor, and balance,
reflexes (for newborns and infants), and cranial nerves.
• Examine the pupils by noting the size, shape, equality, and position of the
pupils, and their response to light.
• Measure the client’s head circumference and appearance of the anterior
fontanelle.
MEDICAL MANAGEMENT
• Diuretics. Acetazolamide and furosemide treat posthemorrhagic
hydrocephalus in neonates
• Anticonvulsants.
• Antibiotics. (penicillin)
SURGICAL MANAGEMENT
• Shunt- surgical insertion of a drainage system.
A shunt drains excess cerebrospinal fluid from
the brain to another part of the body, such as
the abdomen, where it can be more easily
absorbed.

• Endoscopic third ventriculostomy- is a surgical procedure that can

be used for some people. The surgeon uses a small video camera see
inside the brain. Your surgeon makes a hole in the bottom of one of the
ventricles or between the ventricles to enable cerebrospinal fluid to flow
out of the brain.
DIAGNOSTIC AND LAB PROCEDURES
• Lumbar Puncture - A procedure where a sample of cerebrospinal fluid
is taken from your lower spine.
• CT Scan, MRI, Ultrasonography through anterior fontanelle in
infants, skull radiography, MRI cine, diffusion tensor imaging
(DTI), and Radionuclide cisternography (in NPH).
NURSING INTERVENTIONS
• Provide a non-stimulating environment and adequate rest periods.
• Elevate the head of the bed gradually about 15-45 degrees as indicated.
Maintain the client’s head in a neutral position.
• Provide oxygen therapy as needed.
• Administer diuretics, carbonic hydrase, corticosteroids as ordered.
Febrile Seizures
- Seizures associated with high fever (102° to 104° F [38.9° to 40.0° C]) are the
most common type seen in preschool children (5 months to 5 years), although
these can occur as early as 3 months or as late as 7 years of age.
Febrile seizures are classified as simple or complex:
• Simple febrile seizures. This most common type lasts from a few seconds to
15 minutes. Simple febrile seizures do not recur within a 24-hour period and
are not specific to one part of the body.
• Complex febrile seizures. This type lasts longer than 15 minutes, occurs
more than once within 24 hours or is confined to one side of your child's body.

ETIOLOGY
- The fever that triggers febrile seizure are usually cause by a viral infection,
and less commonly by a bacterial infection.
- Post-vaccination seizures
SIGNS AND SYMPTOMS
Usually, a child having a febrile seizure shakes all over and loses consciousness.
Sometimes, the child may get very stiff or twitch in just one area of the body.
A child having a febrile seizure may:
• Have a fever higher than 100.4 F (38.0 C)
• Lose consciousness.
• Shake or jerk the arms and legs
RISK FACTORS
Factors that increase the risk of having a febrile seizure include:
• Young age. Most febrile seizures occur in children between 6 months and 5
years of age, with the greatest risk between 12 and 18 months of age.
• Family history. Some children inherit a family's tendency to have seizures
with a fever. Additionally, researchers have linked several genes to a
susceptibility to febrile seizures.
NURSING DIAGNOSIS
-Hyperthermia related to antigens or microorganisms that cause inflammation,
as evidenced by high body temperature (102°F to 104°F [38.9°C to 40°C])
ASSESSMENT
• Monitor the child’s temperature (tympanic or rectal temperature).
• Assess for hydration status.
MEDICAL MANAGEMENT
• Benzodiazepine.
• Antipyretics.
• Giving your child infants' or children's acetaminophen (Tylenol, others) or
ibuprofen (Advil, Motrin, others) at the beginning of a fever may make your
child more comfortable, but it won't prevent a seizure.
SURGICAL MANAGEMENT
- No surgical procedure is needed.
Laboratory Test/Procedure
• Blood Test
• Urine Test
• A spinal tap (lumbar puncture), to find out if your child has a central nervous
system infection, such as meningitis.
NURSING INTERVENTIONS
1. Eliminate excess clothing.
2. Administer a tepid sponge bath.
3. Advise the mother to avoid applying cold water or alcohol to the child.
4. Administer antipyretic as indicated:
• 4.1. Acetaminophen (Tylenol)
• 4.2. Ibuprofen (Advil)
Neural Tube Disorders/ Defect
- The neural tube is the embryonic structure that matures to form the CNS. Because this
structure first forms in utero as a flat plate and then molds to form the brain and cord, it is
susceptible to malformation.
ETIOLOGY
- The cause is not clear but may be related to genetics, maternal nutrition (including folic
acid deficiency) during pregnancy or other factors.

2 Type of Neural Tube Disorders/ Defect

- Spina Bifida and Anencephaly

SPINA BIFIDA
- Spina bifida is part of a group of birth defects called neural tube defects. Caused by a
defect in the neural arch generally in the lumbosacral region, spina bifida is a failure of the
posterior laminae of the vertebrae to close; this leaves an opening through which the spinal
meninges and spinal cord may protrude.

Etiology
- Low folic acid intake during pregnancy. having a family history of spina bifida. medicines –
taking certain medicines such as valproic acid (used to prevent seizures) during pregnancy
has been linked to an increased risk ofhaving a baby with spina bifida.

SIGN AND SYMPTOMS

- Spina bifida symptoms
- Bladder and bowel problems (incontinence)
- Sexual dysfunction.
- Weakness and loss of sensation below the defect.
- Inability to move the lower legs (paralysis) and other cognitive impairments.
- Orthopedic malformations such as club feet or problems of the knees or hips.
- Area on the back that looks abnormal, such as a small hairy patch, dimple, or birthmark, or
a pouch-like bulge (sac)
- No feeling below the place on the spine where the sac is.

Risk factors
- Folate deficiency
- Family history of neural tube defects.
- Some medications
- Diabetes
- Obesity

Nursing Diagnosis

• Disturbed Body Image related to Biophysical, psychosocial factors of child, possibly

evidenced by Feelings of helplessness and hopelessness; Verbal expression of
negative feelings about body and functional disabilities.

• and functional disabilities.

Nursing Interventions and Rationales

1. Encourage expression of feelings and concerns and support communication of the
child with parents and peers. Provides an opportunity to vent feelings to reduce
anxiety and negative feelings.
2. Encourage parents to sustain support and care for the child. Encourages
acceptance of the child.
3. Encourage independence and maximize functioning with the use of aids for
dressing, bathing, grooming, eating, mobility, toileting, and acknowledge on attempts
at self-care activities. Promotes ADL capability by use of assistive aids as needed
depending on the disability.
4. Advise parents to maintain consistent behavior rules for the child as other children
in the family and to integrate care and activities into the family routine. Provides a
sense of belonging to the family.
5. Notice any positive achievements and avoid mentioning negative comments.
Enhances body image and confidence.
6. Provide touching and hugging, age-appropriate activities with other children.
Conveys caring and concern for the child and enhances socialization.
7. Encourage and teach the use of assistive aids for ADL. Promotes independence
and enhances body image.

DIAGNOSTIC PROCEDURE:
- AFP levels.
-Ultrasonography.
-Clinical examination.
- Other imaging studies.
NURSING MANAGEMENT
- Physical examination.
- Assessment of knowledge regarding the defect.
SURGICAL MANAGEMENT
- Surgery.
- Prenatal surgery.
- Ongoing care.
- Cesarean birth.

MEDICAL MANAGEMENT
- Traditional spina bifida treatment takes the form of surgical repair 24 to 48 hours after birth.
Your child will undergo general anesthesia. A pediatric neurosurgeon removes the MMC
sac, if one is present, and closes the surrounding tissue and skin over the defect to protect
the spinal cord.
THERAPEUTIC AGENT

• Anticholinergics (oxybutynin chloride, hyoscyamine sulfate)

• Tricyclic antidepressants (imipramine hydrochloride; may act through anticholinergic
effects)
• Alpha-adrenergic antagonists (terazosin)

ANENCEPHALY
- Anencephaly is a serious birth defect in which a baby is born without parts of the brain and
skull. It is a type of neural tube defect (NTD).

ETIOLOGY
- Anencephaly happens if the upper part of the neural tube does not close all the way. This
often results in a baby being born without the front part of the brain (forebrain) and the
thinking and coordinating part of the brain (cerebrum). The remaining parts of the brain are
often not covered by bone or skin.

SIGN AND SYMPTOMS

- Absence of bony covering over the back of the head
- Missing bones around the front and sides of the head
- Folding of the ears
- Cleft palate. A condition in which the roof of the child's mouth does not completely close,
leaving an opening that can extend into the nasal cavity.
- Congenital heart defects
- Some basic reflexes, but without the cerebrum, there can be no consciousness and the
baby cannot survive

RISK FACTOR (maternal)

- diabetes mellitus

- obesity

- exposure to high heat (such as a fever or use of a hot tub or sauna) in early
pregnancy,

- the use of certain anti-seizure medications during pregnancy.

Nursing Diagnosis
- Grieving related to Death of infant as evidenced by crying, verbal expression of
distress, anger, loss, guilt.

Nursing Interventions
1. Assess the client’s/couple’s information and understanding of events surrounding the
death of the fetus/infant. Provide more accurate information and correct misconceptions
based on the couple’s readiness and ability to listen effectively. Emotional reactions may
prevent the couple’s ability to process information and interpret the significance of events.
2. Communicate therapeutically with patients and family members and allow them to
verbalize feelings. Sharing feelings with a healthcare provider may help the patient find
significance in the experience of loss.
3. Support patients and significant others who share mutual fears, concerns, plans, and
hopes for each other. Keeping secrets won’t help during this time. These times of stress can
be used as an opportunity for growth and family development.
4. Encourage significant others to manage their own self-care needs for rest, sleep, nutrition,
leisure activities, and time away from the patient. Alteration in normal activities is evident
during this time of stress. Care should be taken to treat these symptoms so that emotional
reconstitution is not complicated by illness.
5. Strengthen the patient’s efforts to go on with his or her life and normal routine. Allow the
patient and family to feel that they are enabled to do this by supporting them.
6. Consider the patient’s or family’s denial about the loss for it is part of the grieving process.
The nurse needs to recognize and understand these events as a time during which an
individual or family member incorporates his or her strength to go on to the next stage of
grief.
DIAGNOSTIC PROCEDURE
- Alpha-fetoprotein.
- Amniocentesis.
- Ultrasound (also called sonography).
- Blood tests
SURGICAL MANAGEMENT
No surgical intervention has been reported in the management of anencephaly.

MEDICAL MANAGEMENT
- There is no medical treatment for anencephaly.

BACTERIAL MENINGITIS
- Meningitis is, as the name implies, infection of the cerebral meninges. It tends to occur
most frequently in children younger than 24 months of age and most often in winter.

ETIOLOGY
- Meningitis can be caused by infectious and non-infectious processes. The infectious
etiologic agents of meningitis include bacteria, viruses, fungi, and less commonly parasites.

SIGNS AND SYMPTOMS

Symptoms of meningitis develop suddenly and can include:
- a high temperature (fever)
- being sick
- a headache
- a rash that does not fade when a glass is rolled over it (but a rash will not always develop)
- a stiff neck
- a dislike of bright lights
- drowsiness or unresponsiveness
-seizures (fits)

RISK FACTOR
- infants under 1 year of age and people ages 16 to 21.
- Certain medical conditions
Nursing Diagnosis
- Risk for Infection Transmission related to contagious nature of organism.
Nursing Interventions
1. Assess neurologic status and vital signs constantly. Determine oxygenation from arterial
blood gas values and pulse oximetry.
2. Insert cuffed endotracheal tube (or tracheostomy), and position patient on mechanical
ventilation as prescribed.
3. Assess blood pressure (usually monitored using an arterial line) for incipient shock, which
precedes cardiac or respiratory failure.
4. Rapid IV fluid replacement may be prescribed, but take care not to overhydrate patient
because of risk of cerebral edema.
5. Reduce high fever to decrease load on heart and brain from oxygen demands.
6. Protect the patient from injury secondary to seizure activity or altered level of
consciousness (LOC).
DIAGNOSTIC PROCEDURE
- Lumbar puncture.
- CT scan.
- Blood studies.
- Chest radiography.
- Cultures and bacterial antigen testing.
- Serum procalcitonin testing.
MEDICAL MANAGEMENT
- Crystalloid infusion.
- Seizure precautions.
- IVT and oxygen administration
SURGICAL MANAGEMENT
- No surgical Management needed