Paediatric Nursing Skills for Australian Nurses

Introduction

Paediatric neurological conditions encompass disorders involving the brain, spinal cord, nerves and muscles, including epilepsy, cerebral palsy, meningitis, genetic/metabolic diseases and muscular dystrophy (ANZCNS, 2016). These conditions often require both acute care in hospital and ongoing support in the community, and paediatric nurses need to be equipped with a variety of skills to provide optimal care for these children and their families. Paediatric nursing skills relating to seizure management and the management of paediatric patients with problems related to cerebrospinal fluid (CSF) drainage will be discussed in this chapter.

Some paediatric neurological conditions interfere with normal CSF drainage in the brain, and this can lead to the accumulation of CSF and raised intracranial pressure which has damaging consequences for cerebral perfusion and the child's brain. Skills will be outlined that relate to long-term management of abnormalities of CSF drainage – that is, ventriculoperitoneal (VP) shunts – as well as short-term management and monitoring of cerebral perfusion in paediatric patients with external ventricular drains.

Managing paediatric seizures

Seizure activity in children can be sudden and frightening. Rapid response and treatment are essential to terminate the seizure and protect the child from secondary injury. Seizures can be caused from trauma to the brain, such as hypoxic ischaemia and cerebral haemorrhage, raised intracranial pressure or metabolic disturbances including diabetic ketoacidosis or electrolyte imbalances, infections (intracranial infections such as meningitis, encephalitis, abscess or sepsis), malformations and epilepsy (Hellström-Westas, Boylan & Ågren, 2015; Lawton & Deuble, 2016).

In paediatric patients, seizures are often considered in terms of being febrile or non-febrile. Febrile seizures are also referred to as febrile convulsions.

A febrile convulsion is the most common cause of convulsions in paediatric patients, and usually occurs between 6 months and 6 years of age, with the most common age of presentation being 18 months of age. The fever is usually above 38ºC and may be caused by childhood infections such as otitis media, or tooth, throat or respiratory tract infection (Millichap & Millichap, 2016; Paul, Kirkham & Shirt, 2015).