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A comprehensive overview of intracranial regulation and intussusception, focusing on the assessment, management, and treatment of these conditions in children. It includes detailed information on the neurological assessment of infants and children, the signs and symptoms of increased intracranial pressure (icp), and the various diagnostic tests used to evaluate icp. The document also covers the pathophysiology, clinical manifestations, and therapeutic management of intussusception, a common cause of intestinal obstruction in children. It provides insights into the importance of informed consent, the role of parental involvement in healthcare decisions, and the legal considerations surrounding the care of minors.
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what reappearance of infant reflexes indicates a pathologic condition what decisions involving the care of older children and adolescents should include their assent when venous pressure = arterial pressure arterial flow stops what delay or deviation from expected milestones helps identify infants/children at high-risk for intracranial irregularity
intracranial regulation assessment family history. health history - maternal health history (pregnancy and delivery). physical evaluation of infant/child what the assent of children and adolescents should include developmentally appropriate awareness. telling them what they can expect. assessment of their understanding. an expression of their willingness to accept proposed treatment classic symptoms of intussusception currant jelly-like stools what parents or legal guardians have full responsibility for the care of their minor children. they are required to give informed consent clinical manifestations of intisussecption
baseline neurologic information, observation, health history, developmental milestones, physical assessment (fontanels for infant), family history eligibility for giving informed consent for divorced parents consent needs to come from the parent who has legal custody advantage of ultrasound-guided hydrostatic (saline) enema no ionizing radiation is needed the earliest indicator of IICP LOC - deterioration or improvement nursing assessment for intracranial regulation vital signs, skin, eye, motor function, posturing, reflexes recurrence of intussusception
rare, after conservative treatment, or whether the reversal was surgical or spontaneous age of majority in most states 18 may be used before hydrostatic reduction of intussusception is attempted IV fluids, NG decompression, antibiotic therapy may cause an elevation in temperature infection process, some med intoxication when informed consent must be obtained before any invasive procedure the most common cause of intestinal obstruction intussusception
intussusception intestinal obstruction. unknown etiology. occurs when a proximal segment of the bowel invaginates into the distal segment. pulls the mesentery with it more common in males than females. potentially life threatening what the reflexes are replaced by as an infant matures purposeful movement how many times consent must be obtained for each invasive procedure - one universal consent is not sufficient what intussusception results in venous and lymphatic obstruction. ischemia. blood and mucous leak into the intestine emancipated minor
legally under the age of majority, but has legal capacity as an adult under the law. this is petitioned in court and can be due to pregnancy, marriage, high school graduation, independent living, or military service conditions in which minors are "medically emancipated" / adolescents have consent confidentiality STIs, pregnancy, contraceptive advice, mental health services, substance abuse, consent to abortion (this is controversial) what surgery for intussusception involves manually reducing the invagination. resection of any nonviable intestine may cause an increase or decrease in temperature hypothalamic involvement child maltreatment a broad term that includes intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children
specific reflexes to check for intracranial regulation Moro and Tonic neck CPS child protective services what the nurse is to monitor before intussusception surgery/procedure all stools percentage of physical abuse of confirmed child maltreatment cases 17.6% post-procedural care management for intussusception vital signs and pain assessment. observe/maintain dressing and incision. assess for return of bowel sounds
the categories of the glasgow coma scale eye opening, verbal response, motor response. the higher the number, the better percentage of sexual abuse of confirmed child maltreatment cases 9.2% what to observe after spontaneous or hydrostatic reduction for passage of water-soluble contrast material (if used). stool patterns (intussusception may recur) most important indicator of neurologic dysfunction level of consciousness percentage of medical neglect of confirmed child maltreatment cases 2.4%
idiopathic nephrosis, childhood nephrosis, minimal-change nephrotic syndrome (MCNS) early signs of increased ICP in infants tense, bulging fontanel. separated cranial sutures. macewen (cracked-pot) sign. irritability and restlessness. drowsiness. increased sleeping. high- pitched cry. increased fronto-occipital circumference. distended scalp veins. poor feeding. crying when disturbed. setting-sun sign the most common form of child maltreatment child neglect neglect the failure of a parent/guardian to provide for the child's basic needs and adequate level of care MCNS minimal change nephrotic syndrome
the early signs of increased ICP in infants to focus on irritability and restlessness. high-pitched cry. poor feeding types of child neglect physical, emotional 80% of nephrotic syndrome cases minimal-change nephrotic syndrome early signs of increased ICP in children headache. nausea. forceful vomiting. diplopia, blurred vision. seizures. indifference, drowsiness. decline in school performance. diminished physical activity and motor performance. increased sleeping. inability to follow simple commands. lethargy physical neglect involves the deprivation of food, clothing, shelter, supervision, medical care, and education
congenital form of nephrotic syndrome inherited as an autosomal recessive disorder physical abuse deliberate infliction of physical/bodily injury on a child, usually by the child's caregiver pathophysiology of nephrotic syndrome the cause is unknown/not completely understood. thought to be immune- mediated, metabolic, biochemical, physiochemical. a disturbance in the basement membrane of the glomeruli causes increased permeability to proteins, especially albumin, leading to hyperalbuminuria, which reduces serum albumin resulting in hypoalbuminemia, decreasing colloidal osmotic pressure in the capillaries and causing fluid to accumulate as fluid shifts from the plasma to the interstitial space and body cavities (edema and ascites). this leads to a decrease in the vascular fluid volume, leading to hypovolemia, stimulating the release of ADH, aldosterone, and RAS. there will be tubular reabsorption of sodium and water in an attempt to increase the intravascular volume. there will also be an increase in serum lipids, cholesterol, and triglycerides lumbar puncture a spinal needle is inserted usually between the 3rd and 4th lumbar vertebrae
universally accepted definition of what constitutes as major and minor physical abuse does not exist age for nephrotic syndrome between 2-7 years old nursing considerations for intracranial regulation maintain airway, perform routine care, provide adequate nutrition, provide skin care, perform ROM activities, provide sensory stimulation, provide family support and education SBS shaken baby syndrome common gender with nephrotic syndrome twice as likely to be male
clinical manifestations: edema/ascites (puffiness of face, labial or scrotal swelling); weight gain although anorexic; proteinuria (>3+ on dipstick) with hyaline casts, oval fat bodies, and a few RBCs in the urine; hypercholesterolemia; hypoalbuminemia congenital hydrocephalus developmental malformation number of children with shaken baby syndrome / traumatic brain injury in the US 1200 - 1400/year percentage of children with shaken baby syndrome / traumatic injury that die 25 - 30% what there is not in nephrotic syndrome hematuria or hypertension
acquired hydrocephalus infection vs trauma what happens in shaken baby syndrome / traumatic brain injury babies have a large head-to-body ratio, weak neck muscles, and a large amount of water in the brain. violent shaking causes the brain to rotate in the skull, resulting in shearing head injury hallmark of nephrotic syndrome proteinuria: >3+ on urine dipstick communicating / non-obstructive hydrocephalus impaired absorption. congenital malformation vs acquired due to trauma, postinfectious meningitis, intraventricular hemorrhage prevention of shaken baby syndrome / traumatic brain injury
