Cerebral Dysfunction

Pediatric Department

FIKES UNMUH JEMBER

Review

Anatomy and physiology of nervous system– cerebral structure and

function– development of neurologic

system– intracranial pressure

Evaluation of neurologic status

1. Assessment general aspect- hystory- physical examination

2. Consciousness- level of consciousness- GCS in children

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3. Neurologic examination- vital sign- skin- eyes- motor function- posturing

4. Special diagnostic procedur- LP- Subdural tap- MRI and CT scan- Electroenchepalography

MeningitisEncephalitisHIV EncephalopathyReye SyndromeBrain abscessRabiesEpilepsy

Intracranial Infections

Bacterial Meningitis in children

Bacterial meningitis remain a significant cause of illness in pediatric age groups

Ninety percent of reported case occur in 1 month to 5 years age

The mortality rate of untreated bacterial meningitis approaches 100 percent and, even with optimal therapy, there is a high failure rate

1993 ------------------ 2/100.000

Definition

Meningitis is an infection that causes inflammation of the membranes covering the brain and spinal cord.

Meningitis "aseptic meningitis.“ "purulent meningitis."

Etiology

Age group

Causes

Neonates

Group B Streptococci, Escherichia coli, Listeria monocytogenes

InfantsNeisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae

Children

N. meningitidis, S. pneumoniae

AdultsS. pneumoniae, N. meningitidis, Mycobacteria, Cryptococci

Pathofisiology Infeksi

Penyebaran

Produk bakteri

Meningeal inflamasi akumulasi leukosit kerusakan jaringan

Exudate

Gangguan pada cerebral

Clinical Manifestations Headache nuchal rigidity fever and altered mental status photophobia irritability and delirium seizures Kernig's sign Brudzinski's sign bulging fontanelles skin rashes paradoxical irritability poor feeding, a weak suck, and a high-pitched cry

Clinical Manifestations in infant

Clinical Manifestations in children

Brudzinski’s sign and Kernig’s sign

Diagnosis

physical examinationblood testsX-ray examination of the chest.cerebrospinal fluid intracranial pressure CT or MRI scan

Lumbar Puncture

Therapeutic management

Isolation

IV-Antibiotics/hydration

Protect and Maintain Airway

Treat symptoms(supportive care)seizure meds

Extreme temperature

ComplicationsSeizuresObstruction of CSF

(hydrocephaly)Brain abcessesdeafnessblindnessMental handicappParalysisHemiparesis/qudriparesisLearning disorderHyperactive disorder

Meningitis in the neonatal period is more likely to cause developmental problems than later meningitis.

Prognosis

Varies depending on appropriate treatment

Neonates have highest mortalityaround 10% for other infants and

childrenmay have long term effectsPrevent with HIB vaccine

Protect self and others from infectionAdminister Antibiotics immediatelykeep room quiet and dark reduce stimuli as much as possibleClient may be in ICUFamily SupportObservation: vital sign, neurologic,

unconscious Fluid and nutrisi

Nursing Considerations

Nursing care of the child with meningitisAssessment :

Signs & Symptom

Diagnosa Keperawatan– Inadequate airway– Risk for injury– Fluid volume deficit

Definisi 1Suatu keadaan dimana seorang individu mengalami suatu ancaman yang nyata atau potensial dalam status pernafasan sehubungan dengan ketidakmampuan untuk batuk secara efektif

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Kriteria mayor:Batuk takefektif atau tidak ada batukKetidakmampuan untuk mengeluarkan

sekresi jalan nafas

Kriteria minor:Bunyi nafas abnormalFrekuensi, kedalaman, dan irama

pernafasan abnormal

Planning

Tujuan

Kriteria hasil

Rencana intervensi dan rasional

Implementasi

Evaluasi SubyektifObyektifAnalisaPlanning