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Course: Pediatric Nursing

Topic: Nursing Care of Child with Neurological Disorders (VI)

The Nurses International Community

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Module Goals

Learners will be able to:

Identify factors associated with Cerebrovascular Disorders
Identify common signs and symptoms
Discuss common laboratory and diagnostic tests
Discuss common medications and other treatment interventions
Explain the role of the nurse in caring for children with cerebrovascular disorders and nursing interventions

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Cerebrovascular Disorders in Children

An important cause of brain injury in the pediatric population, leading to substantial mortality and morbidity
These include:

Arterial ischaemic stroke (AIS)
Arteriovenous malformation (AVM),
Cerebral venous sinus thrombosis (CVST),
Hemorrhagic stroke

Sinha & Ramji, 2021

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Types of Cerebrovascular Disorders

Arteriovenous Malformation (AVM):

Blood vessels in the brain or spinal cord are tangled and abnormally connected
Arteries and veins are snarled and directly connected, disrupting proper blood flow
May cause damage by bleeding into the brain, by lowering the amount of oxygen that reaches the brain

Doernbecher Children's Hospital, 2022

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Types of Cerebrovascular Disorders(Continued)

Aneurysm:

A weakening of the artery wall resulting in an abnormal bulge and risk of rupture.

Stroke:

An interruption of blood flow due to a blocked or burst blood vessel in the brain.

Stenosis:

The narrowing of a blood vessel that may lead to decreased blood flow to the brain.

CHOC, 2022

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Types of Cerebrovascular Disorders ( Continued)

Transient Ischemic Attack (TIA):

A temporary period of symptoms similar to stroke, (mini stroke)
Symptoms last less than 24 hours and do not cause permanent damage

Moyamoya Disease:

A rare disorder that affects the large arteries at the base of the brain
The arteries become narrowed, reducing blood flow
Can cause TIA, stroke and seizures

CHOC, 2022

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Critical Thinking Question

A weakening of the arterial wall resulting in an abnormal bulge and risk of rupture is called ……………….

Stroke
Aneurysm
Stenosis
TIA

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Types of Cerebrovascular Disorders(Continued)

Developmental Venous Anomalies (DVAs):

Unusual vein formations, particularly small veins
The small veins drain into a larger vein and are most often found in the brain (not dangerous)

Cavernous Malformation:

Abnormal clusters of tiny and enlarged blood vessels with pockets of blood may occur in the brain, spinal cord or the nerves of the skull

Capillary Telangiectasia:

A group of abnormally large capillaries in the brain

CHOC, 2022

Contact info: info@nursesinternational.org

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Cerebrovascular Disorders-Causes

Include genetic and acquired causes:

Arteriopathy:

Abnormalities in the arteries of the brain may be due to inflammation or tearing

Arterial Thrombosis: A blood clot forms in the brain
Embolus (embolic stroke):

When a blood clot forms anywhere in the body and travels to the brain, blocking blood flow

Cerebral Venous Thrombosis:

Blood clot forms in the brain’s venous sinuses

Atherosclerosis: The hardening and narrowing of arteries

CHOC, 2022

Contact info: info@nursesinternational.org

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Cerebrovascular Disorders-Sign and Symptoms

Dizziness
Vomiting
Neck Pain or Stiffness
Headache
Weakness on one side of the body
Numbness on one side of the body
Seizures
Slurring or loss of speech
Problems with vision or coordination
Confusion
Loss of consciousness

CHOC, 2022

Contact info: info@nursesinternational.org

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Cerebrovascular Disorders-Signs and Symptoms (Continued)

To determine if a child is having a stroke, remember the acronym B.E.F.A.S.T. and watch for these signs:

B: Balance changes�E: Eye/vision changes�F: Facial drooping�A: Arm or leg weakness�S: Speech difficulties�T: Time – make note of the time symptoms started and seek

medical attention immediately!

CHOC, 2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

A child is admitted to a neurological unit with cerebrovascular accidents.

What are the sign and symptoms a nurse would expect to see in the child?

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Cerebrovascular Disorders-Diagnosis

CT Scan
MRI
Magnetic Resonance Angiography (MRA): looks specifically at the blood vessels
Cerebral Angiogram
CT Angiogram: produce highly detailed images of the arteries.
Echocardiogram (ECHO)
Transcranial Doppler (TCD): to detect problems that affect the blood flow in the brain
Electroencephalogram (EEG)
Blood Tests

CHOC, 2022

Contact info: info@nursesinternational.org

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Cerebrovascular Disorders-Treatment

Monitor for changes
Lifestyle modification: good hydration, diet and exercise
Thrombectomy: If an artery is blocked by a blood clot a thrombectomy done to reestablish blood flow
Neurovascular surgery
Fetal therapy: can play a role in diagnosing some malformations, such as vein of Galen malformation, before birth
Rehabilitation: Sometimes a malformation isn't discovered until after a child has a stroke, seizure or other problem

CHOC, 2022

(CHOC, 2022)

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Cerebrovascular Disorders-Nursing Management

Monitor Vitals
Monitor Neuro Vitals
Breathing and oxygenation
Ambulation and muscle movement
Intake and output
Position change
Administer medications as prescribed
Provide oxygen if saturations are less than 94%

Khaku, Tadi, & Gunn, 2021

(CHOC, 2022)

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

A child who has suffered a cerebrovascular accident (CVA) is very weak to move on his own. To help the child avoid pressure ulcers, the nurse should:

Perform passive range-of-motion (ROM) exercises
Reduce the client’s fluid intake
Change the position every two hours
Wrinkle free bed

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Red Flags

If a child has:

Vomiting, seizure and the child becomes unconscious
Weakness on one side of the body
Numbness on one side of the body

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Sinha, R., & Ramji, S. (2021). Neurovascular disorders in children: an updated practical guide. Translational pediatrics, 10(4), 1100–1116. https://doi.org/10.21037/tp-20-205

Doernbecher Children's Hospital. (2022). Pediatric Cerebrovascular Disorders. https://www.ohsu.edu/doernbecher/pediatric-cerebrovascular-disorders

CHOC.(2022). Pediatric Cerebrovascular Diseases. https://www.choc.org/neuroscience/cerebrovascular-disease/

Khaku, A.S., Tadi, P., & Gunn, A.A. (2021, Sep 29). Cerebrovascular Disease (Nursing). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568674/

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