Pediatric Neurological & Cognitive Disorders — Nursing Priorities, Interventions, and NCLEX Tips | Chapter 35: Saunders NCLEX-PN Review

This chapter from Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri provides an in-depth review of pediatric neurological and cognitive disorders, focusing on NCLEX-priority nursing interventions, safety protocols, and long-term patient care strategies. Whether preparing for the NCLEX-PN or enhancing clinical practice, this guide covers conditions from cerebral palsy to autism spectrum disorders with actionable, test-relevant detail.

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Cerebral Palsy

Cerebral palsy is a group of disorders affecting movement, muscle tone, and posture, often due to brain injury before or during birth. NCLEX nursing priorities include early recognition, individualized care planning, and integration of mobility aids. Multidisciplinary approaches—physical therapy, occupational therapy, and speech therapy—are essential for maximizing functional ability.

Head Injury & Increased Intracranial Pressure (ICP)

Traumatic brain injuries in pediatrics require prompt assessment for early ICP signs such as headache, vomiting, and irritability, as well as late signs like decerebrate or decorticate posturing. NCLEX-focused interventions include maintaining airway, elevating the head of the bed 30°, avoiding activities that increase ICP, and frequent neurological checks.

Hydrocephalus & Shunt Care

Hydrocephalus involves abnormal accumulation of cerebrospinal fluid (CSF), often requiring ventriculoperitoneal (VP) shunt placement. Nursing care includes monitoring for signs of shunt malfunction (vomiting, lethargy, irritability), maintaining proper head positioning, and educating parents on infection signs.

Meningitis — Bacterial vs. Viral

Bacterial meningitis is a medical emergency requiring respiratory isolation and prompt antibiotic therapy. Diagnosis includes lumbar puncture with CSF analysis—bacterial infections typically show cloudy CSF, elevated protein, decreased glucose, and increased WBC count. Viral meningitis generally has milder symptoms and different CSF findings. NCLEX tip: remember Kernig’s and Brudzinski’s signs as classic indicators.

Additional Pediatric Neurological Emergencies

• Submersion Injury: Monitor for hypoxia-induced brain injury and cerebral edema; long-term follow-up may be needed.
• Reye’s Syndrome: Linked to aspirin use in viral illness; presents with hepatic dysfunction and cerebral edema. Provide quiet environment and monitor ICP.

Seizure Disorders

Seizure management includes maintaining airway safety, keeping suction equipment ready, and postictal observation. Types include tonic-clonic, absence, and myoclonic seizures. Never place objects in the mouth during a seizure; instead, turn the patient on their side and protect from injury.

Neural Tube Defects & Spina Bifida

Spina bifida ranges from occulta (mild) to cystica (severe with sac protrusion). Nursing care involves protecting the sac from rupture, monitoring for infection, and recognizing latex allergies common in these patients.

Behavioral & Developmental Disorders

• ADHD: Managed with behavior therapy, structured routines, and stimulant medications; monitor for side effects like decreased appetite or insomnia.
• Autism Spectrum Disorder (ASD): Emphasize structured routines, safety measures, and sensory regulation.
• Intellectual Disability: Focus on adaptive functioning skills, individualized education plans, and family education. Down syndrome patients require monitoring for cardiac defects and thyroid disorders.

NCLEX-PN Nursing Priorities

• Airway maintenance and seizure safety
• ICP monitoring and management
• Infection prevention, especially with shunt care and meningitis
• Comprehensive neurological assessment

Conclusion

Mastering pediatric neurological and cognitive disorders is crucial for NCLEX-PN success and safe clinical practice. From emergency interventions to long-term developmental support, this chapter equips nurses with evidence-based strategies for optimal patient outcomes.

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