Professional Documents
Culture Documents
Institute of Nursing
Nicanor Reyes St., Manila
Submitted by:
BSN 105
Group 19B
CRUZ, Dave Neilmer
CRUZ, Janelle
CUNANAN, Tristan John
DALISAY, Kenneth
DALUSONG, Eidelle Anne
Submitted to:
Cerebral Palsy
Cerebral Palsy (CP) is brain damage that occurs in an infant before, during, or soon after
birth. This simply means that there has been some injury to the brain during development which
has resulted in difficulty transmitting the necessary impulses from the brain to the muscles for
coordinated movement. This results in some degree of motor dysfunction.
Many children born prematurely will develop some movement difficulties related to early
neurological injury. These impairments emerge slowly over time and are typically not evident
during the newborn period. Most mild motor abnormalities noticeable during the first few
months of life will improve and may completely resolve with time. When motor impairment
persists, a diagnosis of cerebral palsy may be considered. About 10% of children born at birth
weights of less than 1000 grams will eventually receive a diagnosis of cerebral palsy a
permanent condition.
Diagnosing cerebral palsy in children born prematurely is often a difficult process which
requires observing the child's development over time.
Cerebral Palsy comes in a variety of different forms and with a continuum of severity.
CP can be so mild that it is only noticeable when the individual is stressed or involved in certain
activities. It can be so severe as to limit most voluntary movement. It can take several years for
the full impact of a child's cerebral palsy to become apparent. However, children do not switch
from one form of cerebral palsy to another or from one impairment level to another, after the
condition is fully expressed. For example, a child well beyond infancy with mild cerebral palsy
effecting the legs only is not at risk to develop a different or more severe form of cerebral palsy
later in development.
Most former preemies with CP will have spastic diplegia. Spastic diplegia involves an
involuntary increase of muscle tone (tightness or stiffness) that primarily affects the limbs, with
legs and feet being much more affected than the arms and hands. Children with spastic diplegia
from injury before or around the time of birth almost always have some difficulty with their
hands, though the legs will be much more obviously affected.
Other subtypes of spastic cerebral palsy besides spastic diplegia include spastic
hemiplegic and spastic quadriplegia. The prefixes "hemi-" and "quadri-," like "di-" refer to the
location of the impairment. Children with hemiplegia have movement of the limbs on one side
of the body, but not the other. The full extent of the motor disability impairment is not realized
until fairly late with spastic hemiplegia, often as late as three years of age. Epilepsy is relatively
more common in children with hemiplegia (Russman, 1992), but these children are also very
likely to function well in general. Quadriplegia interferes with the impairment of all four limbs,
typically with the head and trunk involved as well. Quadriplegia most often occurs in children
who have had severe deprivation of oxygen to the brain because of reduced oxygen in the blood
and decreased blood flow to the brain (Eicher & Batshaw, 1993). Quadriplegia tends to be
identified earlier than other forms of cerebral palsy and can sometimes be diagnosed in the first
six months of life.
The diagnosis of CP can be very complex. One reason for the difficulty is the
simultaneous processes of development and healing (what would be called "recovery of
function" in an older patient who had previously acquired skills). An infant leaving neonatal
intensive care may have strong indications of neurologically based muscle tone abnormality, yet
the brain's remarkable ability to adapt during the recovery process is most apparent during the
early months of infancy. At the same time, however, the normal developmental process
continues - proceeding from early infancy where motor control is minimal to the sophisticated
coordination of muscle groups necessary for complex movement.
Normal newborns have little voluntary muscle control. New skills unfold in a predictable
manner as the baby grows and develops. Just as it takes time for these abilities to develop, it
takes time for it to become apparent which of them may have been affected by early injury.
(Remember, the early injury may still be resolving or healing.)
Preemies often have very low muscle tone neonatally (e.g., they are "floppy") and the
abnormally increased muscle tone (the "tightness" associated with spastic CP) is often not
apparent until after the first few months at home. Tone may appear normal during this period of
transition. The initial low tone often resolves with recovery; but, as a child with CP starts to
need voluntary movement, it becomes apparent that there is going to be difficulty with some
movements. As more muscles are called into voluntary action, further difficulties with movement
may appear.
During the first year it can be very difficult to determine at what point the infant has
maximized whatever recovery is going to be made, and at what point the emerging muscle tone
problems are indications of long-term impairment. The timing can be very different from one
child to another. For this reason, it is not unusual for a child with mild CP not to be diagnosed
until after the second year. Since CP is a permanent condition, doctors like to wait until they are
very sure that what they are seeing is not going to go away before they give a diagnosis. Usually
only the more severe cases of CP can be diagnosed within the first several months corrected age,
while milder cases tend not to be diagnosed until it becomes apparent that the muscle tone or
control problems are not going to resolve with development.
Autism
Autism has a strong genetic basis, although the genetics of autism are complex and it is
unclear whether ASD is explained more by rare mutations, or by rare combinations of common
genetic variants.[4] In rare cases, autism is strongly associated with agents that cause birth defects.
Controversies surround other proposed environmental causes, such as heavy metals, pesticides or
childhood vaccines; the vaccine hypotheses are biologically implausible and lack convincing
scientific evidence. The prevalence of autism is about 1–2 per 1,000 people; the prevalence of
ASD is about 6 per 1,000, with about four times as many males as females. The number of
people diagnosed with autism has increased dramatically since the 1980s, partly due to changes
in diagnostic practice; the question of whether actual prevalence has increased is unresolved.
Parents usually notice signs in the first two years of their child's life. The signs usually
develop gradually, but some autistic children first develop more normally and then regress.
Although early behavioral or cognitive intervention can help autistic children gain self-care,
social, and communication skills, there is no known cure. Not many children with autism live
independently after reaching adulthood, though some become successful. An autistic culture has
developed, with some individuals seeking a cure and others believing autism should be tolerated
as a difference and not treated as a disorder.
Autism is a highly variable neurodevelopmental disorder that first appears during infancy
or childhood, and generally follows a steady course without remission. Overt symptoms
gradually begin after the age of six months, become established by age two or three years, and
tend to continue through adulthood, although often in more muted form. It is distinguished not
by a single symptom, but by a characteristic triad of symptoms: impairments in social
interaction; impairments in communication; and restricted interests and repetitive behavior.
Other aspects, such as atypical eating, are also common but are not essential for diagnosis.
Autism's individual symptoms occur in the general population and appear not to associate highly,
without a sharp line separating pathologically severe from common traits.
Brain Tumor
A brain tumor is an intracranial solid neoplasm, a tumor (defined as an abnormal growth
of cells) within the brain or the central spinal canal.
Brain tumors include all tumors inside the cranium or in the central spinal canal. They are
created by an abnormal and uncontrolled cell division, normally either in the brain itself
(neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann
cells), lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges),
skull, pituitary and pineal gland, or spread from cancers primarily located in other organs
(metastatic tumors).
Any brain tumor is inherently serious and life-threatening because of its invasive and
infiltrative character in the limited space of the intracranial cavity. However, brain tumors (even
malignant ones) do not automatically cause death. Brain tumors or intracranial neoplasms can be
cancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or
benign neoplasms differs from those commonly used in other types of cancerous or non-
cancerous neoplasms in the body. Its threat level depends on the combination of factors like the
type of tumor, its location, its size and its state of development. Because the brain is well
protected by the skull, the early detection of a brain tumor only occurs when diagnostic tools are
directed at the intracranial cavity. Usually detection occurs in advanced stages when the presence
of the tumor has side effects that cause unexplained symptoms.
Primary (true) brain tumors are commonly located in the posterior cranial fossa in
children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can
affect any part of the brain.
Tuberous Sclerosis
Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare, multi-system genetic disease
that causes benign tumours to grow in the brain and on other vital organs such as the kidneys,
heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental
delay, behavioral problems, skin abnormalities, lung and kidney disease. TSC is caused by
mutations on either of two genes, TSC1 and TSC2, which encode for the proteins hamartin and
tuberin respectively. These proteins act as tumour growth suppressors, agents that regulate cell
proliferation and differentiation.
The name, composed of the Latin tuber (swelling) and the Greek skleros (hard), refers to the
pathological finding of thick, firm and pale gyri, called "tubers," in the brains of patients
postmortem. These tubers were first described by Désiré-Magloire Bourneville in 1880; the
cortical manifestations may sometimes still be known by the eponym Bourneville's disease.
Multiple Sclerosis
MS affects the ability of nerve cells in the brain and spinal cord to communicate with
each other. Nerve cells communicate by sending electrical signals called action potentials down
long fibers called axons, which are wrapped in an insulating substance called myelin. In MS, the
body's own immune system attacks and damages the myelin. When myelin is lost, the axons can
no longer effectively conduct signals. The name multiple sclerosis refers to scars (scleroses—
better known as plaques or lesions) in the white matter of the brain and spinal cord, which is
mainly composed of myelin. Although much is known about the mechanisms involved in the
disease process, the cause remains unknown. Theories include genetics or infections. Different
environmental risk factors have also been found.
Almost any neurological symptom can appear with the disease, and often progresses to
physical and cognitive disability. MS takes several forms, with new symptoms occurring either
in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).
Between attacks, symptoms may go away completely, but permanent neurological problems
often occur, especially as the disease advances.
There is no known cure for MS. Treatments attempt to return function after an attack,
prevent new attacks, and prevent disability. MS medications can have adverse effects or be
poorly tolerated, and many patients pursue alternative treatments, despite the lack of supporting
scientific study. The prognosis is difficult to predict; it depends on the subtype of the disease, the
individual patient's disease characteristics, the initial symptoms and the degree of disability the
person experiences as time advances. Life expectancy of patients is nearly the same as that of the
unaffected population.
Subtypes include:
1. relapsing remitting,
2. secondary progressive,
3. primary progressive, and
4. progressive relapsing.
The primary progressive subtype describes the approximately 10–15% of individuals who never
have remission after their initial MS symptoms. It is characterized by progression of disability
from onset, with no, or only occasional and minor, remissions and improvements.
Progressive relapsing MS describes those individuals who, from onset, have a steady neurologic
decline but also suffer clear superimposed attacks. This is the least common of all subtypes.[6]
Epilepsy
Epilepsy (from the Ancient Greek ἐπιληψία (epilēpsía) — "to seize") is a common chronic
neurological disorder characterized by recurrent unprovoked seizures. These seizures are
transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the
brain. Epilepsy is more likely to occur in young children, or people over the age of 65 years;
however, it can occur at any time. As a consequence of brain surgery, epileptic seizures may
occur in recovering patients.
Epilepsy is usually controlled, but cannot be cured with medication, although surgery may be
considered in difficult cases. However, over 30% of people with epilepsy do not have seizure
control even with the best available medications. Not all epilepsy syndromes are lifelong – some
forms are confined to particular stages of childhood. Epilepsy should not be understood as a
single disorder, but rather as syndromic with vastly divergent symptoms but all involving
episodic abnormal electrical activity in the brain.
The brain is the center that controls and regulates all voluntary and involuntary responses
in the body. It consists of nerve cells that normally communicate with each other through
electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that
temporarily interrupts normal electrical brain function.
There are several different types of seizures in children, including the following:
• focal seizures
Focal seizures take place when abnormal electrical brain function occurs in one or more
areas of one side of the brain. Focal seizures may also be called partial seizures. With
focal seizures, particularly with complex focal seizures, the child may experience an aura
before the seizure occurs. An aura is a strange feeling, either consisting of visual changes,
hearing abnormalities, or changes in the sense of smell.
A child may experience one or many seizures. While the exact cause of the seizure may not be
known, the more common seizures are caused by the following:
Clinical Manifestations
Partial Seizures may be associated with facial movements or grimaces, jerking in one part of
the body, sensory experiences of sights, smells, or sounds, tingling, an alteration in level of
consciousness
Generalized seizures may be associated with unconsciousness, uncontrolled jerking of arms
and legs, short period of apnea, salivation of frothing at the mouth tongue biting, postictal
stage. Aura may occur.
Diagnostic Tools
Medical History
Basic laboratory evaluation
Lumbar puncture, MRI, EEG
Treatment
Identification of type of seizure and reverse the cause if possible
Medications
Resective surgery
Vagus nerve stimulation
Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD)
ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting
about 3% to 5% of children globally and diagnosed in about 2% to 16% of school aged children.
It is a chronic disorder with 30% to 50% of those individuals diagnosed in childhood continuing
to have symptoms into adulthood. Adolescents and adults with ADHD tend to develop coping
mechanisms to compensate for some or all of their impairments. 4.7 percent of American adults
are estimated to live with ADHD.
ADHD is diagnosed two to four times as frequently in boys as in girls, though studies suggest
this discrepancy may be due to subjective bias of referring teachers. ADHD management usually
involves some combination of medications, behavior modifications, lifestyle changes, and
counseling. Its symptoms can be difficult to differentiate from other disorders, increasing the
likelihood that the diagnosis of ADHD will be missed. Additionally, most clinicians have not
received formal training in the assessment and treatment of ADHD, particularly in adult patients.
ADHD and its diagnosis and treatment have been considered controversial since the 1970s. The
controversies have involved clinicians, teachers, policymakers, parents and the media. Topics
include the actuality of the disorder, its causes, and the use of stimulant medications in its
treatment. Most healthcare providers accept that ADHD is a genuine disorder with debate in the
scientific community centering mainly around how it is diagnosed and treated. The American
Medical Association concluded in 1998 that the diagnostic criteria for ADHD are based on
extensive research and, if applied appropriately, lead to the diagnosis with high reliability.
Dystonia
• "periventricular" means around or near the ventricles, the spaces in the brain containing
the cerebrospinal fluid
• "leuko" means white
• "malacia" means softening
With PVL, the area of damaged brain tissue can affect the nerve cells that control motor
movements. As the baby grows, the damaged nerve cells cause the muscles to become spastic, or
tight, and resistant to movement. Babies with PVL have a higher risk of developing cerebral
palsy (a group of disorders that prevent the child from controlling their muscles normally), and
may have intellectual or learning difficulties. PVL may occur alone or in addition to
intraventricular hemorrhage (bleeding inside the brain).
It is not clear why PVL occurs. This area of the brain is very susceptible to injury, especially in
premature babies whose brain tissues are fragile. PVL may happen when the brain receives too
little oxygen. However, it is not clear when the trigger for PVL occurs - before, during, or after
birth. Most babies who develop PVL are premature, especially those born before 30 weeks
gestation. Other factors that may be associated with PVL include early rupture of membranes
(amniotic sac) and infection inside the uterus.
Intraventricular Hemorrhage
Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, the spaces in the
brain containing the cerebral spinal fluid.
It is not clear why IVH occurs. Bleeding can occur because blood vessels in a premature baby's
brain are very fragile and immature and easily rupture. Babies with respiratory problems such as
hyaline membrane disease, or other complications of prematurity, are more likely to have IVH.
The smaller and more premature the baby, the more likely IVH will occur. Nearly all IVH occurs
within the first three days of life.
Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to
cells can lead to brain injury.
Grades 1 and 2 are most common, and often there are no further complications. Grades 3 and 4
are the most serious and may result in long-term brain injury to the baby. Hydrocephalus (too
much cerebral spinal fluid in the brain) may develop after severe IVH.
Spina Bifida
Spina Bifida is a congenital neural tube defect characterized by a failure of the vertebral arches
to close. This results in a cyst-like protrusion of the meninges alone (meningocele) or of the
meninges and the spinal cord (myelomeningocele) out of the vertebral column. In the case of
meningococele, the neural tissue is unexposed, and thus neural deficits are absent or minor. With
myelomeningocele, the spinal cord, in a cyst-like protrusion with its nerves, suffers injury,
inflammation, and scarring. The result is some loss in neural function, often including paralysis.
Another type of spina bifida is one in which minor irregularities in the vertebral arches exist that
are not obvious at birth. The is called spina bifida occulta(hidden). A meningocele can occur in
any area of the spine; cranial or upper cervical meningoceles are frequently associated with
hydrocephalus. A myomeningocele typically occurs in the lumber or lumbosacral area.
Causes
Although cause is unknown, a genetic predisposition may exist. Increased risk occurs with
maternal folic acid deficiency. It is recommended that all women anticipating pregnancy begin
taking folic acid supplements at least 3 months before conception.
Clinical Manifestation
Diagnostic Tools
Elevated levels of a fetal protein, called alpha-fetoprotein, in maternal serum may indicate fetal
spina bifida.
Ultrasound may diagnose the condition in utero
Complications
Hydrocephalus may occur with a meningocele or myelomeningocele.
Treatment
No treatment may be required for spina bifida occulta or meningocele.
Surgical repair of the myelomeningocele and sometimes the meningocele.
If surgical repair is performed, placement of a shunt to allow CSF drainage is necessary to
prevent hydrocephalus and a subsequent increase in intracranial pressure.
Planned cesarean section before the initiation of labor can be important in reducing the
neurologic damage seen in an infant with spinal cord defect
Hydrocephalus
Types:
A. Non-communicating Hydrocephalus
Occurs as a result of obstruction of CSF flow within the ventricular system. May occur
with a tumor as a result of a congenital irregularity in the ventricular pathways.
B. Communicating Hydrocephalus
Occurs as a result of blockage in the absorption of CSF. Causes of this type includes a
build-up of tissue (usually a neoplasm) or blood in the subarachnoid space. Head injuries
may cause this.
Effects of Hydrocephalus
Intracranial pressure increases with hydrocephalus; this can directly injure underlying nervous
tissue and compromise cerebral blood flow and the neuronal supply of oxygen and glucose.
Compensation may occur for slowly developing hydrocephalus. Rapidly developing
hydrocephalus may find compensation ineffective.
Clinical Manifestations
Enlarged head with a high-pitched cry
Acutely developing hydrocephalus causes a rapid increase in ICP and my present with severe
headache, decreased consciousness, papilledema, and vomiting
Slowly progressing hydrocephalus may present with irritability and changes in cognition or
behavior Complication may include mental retardation
Diagnostic Tools
Ultrasound may allow diagnosis in utero
After birth, diagnosis is made by clinical inspection, measurement of head circumference, and
observation of cranial suture lines
Treatment
Placement of a shunt to drain CSF in utero or after birth
Treatment of underlying cause is required
Meningitis
Meningitis is characterized by the inflammation of the meninges, the membranes lining the brain
and spinal cord. There are two types of meningitis: septic and aseptic. Septic meningitis is
caused by bacteria like meningococci, pneumococci, and Haemophilus influenza. Aseptic
meningitis is caused by viruses such as herpes simplex virus and arbovirus. It frequently occurs
from the spread of infection elsewhere in the body, for example, the sinuses, ears, or upper
respiratory tract.
Causes
Dura has been compromised(brain injury or surgery)
Systemic infection
Anatomic defects of the skull
Immunocompromise and other systemic illnesses
Otitis media or mastoiditis
Clinical Manifestations
Fever
Increased ICP (headache, decreased consciousness and vomiting)
Papilledema
Photophobia
Nuchal rigidity, Kernig’s sign, Brudzinski’s sign
Complications: Brain damage and seizures
Diagnostic Tools
CSF Profile
CT Scan, MRI
Treatment
Antibiotic Therapy
Reduction of ICP
Isolation