26.3: Recognizing Common Neurological Disorders
By the end of this section, you will be able to:
- Examine common cognitive disorders affecting the neurological system
- Recognize common spinal cord disorders affecting the neurological system
- Recall common developmental disorders affecting the neurological system
It is essential that nurses are able to recognize common neurological disorders. This can be done by a proper neurological exam, as previously discussed. The ability to recognize disorders allows the nurse to properly and timely intervene, when necessary, to promote optimal outcomes and quality of life. Neurological disorders may be categorized as cognitive, spinal cord, or developmental disorders. These disorders have various impacts on patients, including pain, seizures, communication and learning difficulties, motor and sensory dysfunction, memory difficulties, and behavior difficulties.
Common Cognitive Disorders
Cognitive disorders are any disorder that affects an individual’s cognitive functions, such as how the brain processes and stores information, which affects behavior, memory, communication, learning, perception, problem-solving, and the ability to reason (Dhakal & Bobrin, 2023). Headaches and facial pain can be associated with some cognitive impairment. There are several common degenerative disorders, such as dementia , Alzheimer, Parkinson, and Huntington diseases, and multiple sclerosis; seizure disorders, such as epilepsy ; cerebrovascular accidents; and neurological infections.
Headaches and Facial Pain
A headache, or cephalalgia , is a common complaint. Headaches range greatly in severity of pain and frequency of occurrence. For example, some patients experience mild headaches once or twice a year, whereas others experience disabling migraine headaches more than 15 days a month. Severe headaches such as migraines may be accompanied by symptoms of nausea or increased sensitivity to noise or light. A headaches that occurs independently and is not caused by another medical condition is referred to as a primary headache . Migraine, cluster, and tension-type headaches are types of primary headaches. A secondary headache is a headache that is a symptom of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled out of place. They may result from underlying conditions, including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke , tumors, and nerve disorders such as trigeminal neuralgia , a chronic pain condition that typically affects the trigeminal nerve on one side of the cheek.
Not all headaches require medical attention, but some types of headaches can signify a serious disorder and require prompt medical care. Signs and symptoms of headaches that require immediate medical attention include a sudden, severe headache unlike any the patient has ever had; a sudden headache associated with a stiff neck; a headache associated with convulsions, confusion, or loss of consciousness; a headache occurring after a blow to the head; or a persistent headache in a person who was previously headache free.
Degenerative Disorders
Degenerative disorders are those that lead to the increasing deterioration of normal cells or function of the nervous system over time. These disorders affect many activities, like balance, movement, speaking, breathing, cardiac function, and cognitive abilities. Examples of degenerative disorders include dementia, Alzheimer disease, Parkinson disease, Huntington disease, and multiple sclerosis.
Dementia
Dementia is a chronic condition of impaired cognition caused by brain disease or injury and is marked by personality changes, memory deficits, and impaired reasoning. Dementia can be caused by a group of conditions, such as Alzheimer disease, vascular dementia , frontal-temporal dementia, and Lewy body disease. Clinical manifestations of dementia include forgetfulness, impaired social skills, and impaired decision-making and thinking abilities that interfere with daily living. Most dementia cases are irreversible and progressive; however, a small percentage of cases are reversible, such as dementia that results from a removable brain tumor, excessive drug or alcohol use, toxins, infections, autoimmune disorders, subdural hematoma, and vitamin deficiencies (Huang, 2023). Appropriate assessment and nursing care can improve the safety and quality of life for those affected by dementia.
As dementia progresses and cognition continues to deteriorate, nursing care must be individualized to meet the needs of the patient and family. Providing patient safety and maintaining quality of life while meeting physical and psychosocial needs are important aspects of nursing care. Unsafe behaviors put individuals with dementia at increased risk for injury. These unsafe or inappropriate behaviors often occur because the patient has a need or emotion but not the ability to express it, such as pain, hunger, anxiety, or the need to use the bathroom. The patient’s family or caregivers require education and support to recognize that behaviors are often a symptom of dementia and/or a communication of a need and to help them best meet the needs of their family member.
Alzheimer Disease
Alzheimer disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It is the most common cause of dementia. In most people with Alzheimer disease, signs and symptoms first appear when the individual is in their mid-60s. One in 10 Americans age 65 years or older has Alzheimer disease (Alzheimer’s Association, 2021).
Scientists continue to unravel the complex brain changes involved in the onset and progression of Alzheimer disease. It is thought that changes in the brain may begin a decade or more before memory and other cognitive problems appear. Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain. Previously healthy neurons stop functioning, lose connections with other neurons, and die. The damage initially appears to take place in the hippocampus and cortex —the parts of the brain essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimer disease, damage is widespread, and brain tissue has shrunk significantly.
There are 10 symptoms of early Alzheimer disease (Alzheimer’s Association, 2021):
- challenges in planning or solving problems
- changes in mood and personality
- confusion with time or place
- decreased or poor judgment
- difficulty completing familiar tasks
- forgetting recently learned information that disrupts daily life
- misplacing things and losing the ability to retrace steps
- new problems with words in speaking or writing
- trouble understanding visual images and spatial relationships
- withdrawal from work or social activities
The Alzheimer’s Association provides a variety of help and support for caregivers of those diagnosed with Alzheimer’s and dementia . This is a great resource to provide families or caregivers.
Parkinson Disease
Parkinson disease is a slow, progressive disorder that affects movement and eventually leads to death. This disorder most commonly appears in a person’s fifth decade of life, although it can occur sooner. Parkinson disease is linked with a reduced level of dopamine that results from the degeneration of dopamine storage cells in the basal ganglia region of the brain. This loss of dopamine affects the voluntary movement, because it is needed for refined motor movements and control.
The signs and symptoms of Parkinson disease have a gradual onset and include tremors, rigidity, bradykinesia (slow voluntary movements and speech), postural instability, excessive sweating, drooling, paroxysmal flushing, orthostatic hypotension, urinary retention, constipation, sexual dysfunction, depression, anxiety, dementia, delirium , hallucinations, hypokinesia (diminished movement), dysphonia (voice impairment), and dysphagia . Those with Parkinson disease may also display a pill-rolling tremor. This appears as the individual is rolling a pill or small object between their thumb and forefinger.
Huntington Disease
Huntington disease is a progressive, chronic, hereditary disease of the neurological system that results in the progression of involuntary movement and dementia. This disease is the result of a genetic mutation involving the Huntington gene ( HTT ). The basic pathophysiology of this disease is associated with premature cell death in the basal ganglia and cells that are lost in the cortex , which ultimately affect movement control, thinking, perception, memory, judgment, behavior, and voluntary muscle activity. This disease typically affects individuals between the ages of 30 and 50.
The clinical manifestations consist of motor, behavioral and psychiatric, and cognitive disturbances. Motor disturbances include unwanted involuntary movements including of distal extremities and possibly the face; hyperkinesia with chorea (rapid, jerky, involuntary movements) early in the disease, which progresses into hypokinesia with bradykinesia and dystonia; dysarthria; dysphagia; ataxia; difficulty walking or standing; frequent falls; and the Babinski sign . The Babinski sign occurs when the lateral plantar aspect of the foot is stimulated and results in dorsiflexion of the big toe (Figure 26.12).
Behavioral and psychiatric symptoms include poor attention, irritability that can lead to outbursts and aggression, impulsivity, apathy later in the disease, depression, suicidal ideation, psychoses in later stages, lack of awareness, and a lack of insight into the symptoms the individual is experiencing. Cognitive disturbances include difficulties with organizing, planning, and multitasking; dementia ; apraxia; and aphasia . Other features may include weight loss, autonomic nervous system disruption, and sleep disturbances (Ajitkumar & De Jesus, 2023).
Multiple Sclerosis
Multiple sclerosis (MS) is an immune-mediated, demyelinating, progressive disease of the CNS. The term demyelination refers to the destruction of the protective myelin that surrounds nerve fibers in the brain and spinal cord that results in impairment of nerve impulse transmissions. The peak onset for this disease is between 20 and 40 years of age. The exact cause of this disease is still an ongoing area of research. The onset and duration of MS may begin over a few days and quickly dissipate, or it may develop gradually over many years. There are four main types: relapsing-remitting MS, secondary-progressive MS, primary-progressive MS, and progressive relapsing MS. Each type varies in the progression of signs and symptoms over time.
- Relapsing-remitting MS comes in the form of attacks, also known as relapse or exacerbation. In this type, those affected recover or return to their usual level of disability in between attacks. Weeks, months, or years may occur between attacks. Periods of disease inactivity are referred to as remission.
- Secondary-progressive MS is usually seen in those who have had a history of MS attacks but then start to develop gradual, steady signs and symptoms and deterioration in their function.
- Primary-progressive MS is less common. It is characterized by increasingly worsening signs and symptoms from the first indication of the disease, with no noticeable relapses or exacerbations. Individuals may experience temporary or minor relief from symptoms.
- Progressive-relapsing MS is the rarest form of MS. It is depicted by a steady worsening of signs and symptoms from the first indication of the disease, with acute relapses that can appear over time during the course of the disease (U.S. Department of Health and Human Services, 2023c).
Early signs and symptoms of MS include visual disturbances like blurriness, diplopia , or optic neuritis (pain with eye movement and rapid vision loss); muscle weakness; muscle stiffness with muscle spasms; balance difficulties; loss of bladder control; dizziness; and tingling, pain, or numbness in the extremities, trunk, or face. Later-stage symptoms may include mental or physical fatigue; mood changes, such as difficulty controlling or expression emotion or depression; and cognitive disturbances, such as difficulties with concentration, learning, multitasking thinking, memory, or judgment (U.S. Department of Health and Human Services, 2023c).
Seizure Disorders
Seizures are sudden, abnormal, excessive electrical impulses in the brain that alter neurological functions such as motor, autonomic, behavioral, and cognitive function. A seizure can be caused by infection, trauma, brain injury, brain tumors, side effects of medications, metabolic imbalances, drug toxicities, and withdrawal from medications.
Signs and symptoms may include a starting episode; convulsive movements with a loss of consciousness; uncontrollable movements to the affected area, depending on the area of the brain it is originating from; dizziness; unusual or unpleasant sensations without a loss of consciousness; incontinence; chewing on tongue; abdominal breathing; and intense rigidity followed by muscle relaxation and contraction (Adamolekun, 2022).
Seizures may be preceded by an aura that consists of paresthesias, abnormal smells, sensation of fear or déjà vu, and epigastric sensation. Most seizures last 1 to 2 minutes and end suddenly. After the episode, a postictal state often follows. This state is characterized by deep sleep, confusion, headache, and muscle soreness. This state also varies in duration and can last from minutes to hours (Adamolekun, 2022). Individuals who experience seizures are at risk of hypoxia, vomiting, and aspiration.
Epilepsy
We define epilepsy as a chronic brain disorder characterized by recurrent (two or more) seizures that are not related to a reversible stressor and occur more than 24 hours apart. Epilepsy can have an idiopathic (primary) or secondary cause. For example, a secondary cause of a seizure can be a brain tumor.
Seizures can be triggered by a variety of factors, including stress, illness, and lightning. Some patients may experience seizures related to hormonal changes (e.g., fluctuations throughout the menstrual cycle) or due to substance use. Patients who are not able to comply with treatment, such as taking prescribed medications, may experience poorly controlled seizures.
There are several treatment options for epilepsy, including medication and lifestyle adjustments. However, patients may still have seizures and can be at risk for complications as a result. For example, a person who has a seizure while driving could get into a car accident, or a construction worker who has a seizure on the job could be seriously injured. Seizures can also cause emotional, behavioral, and mental health effects, particularly if they affect a person’s ability to function and perform in their daily life and relationships.
Name:
Jack, RN
Clinical setting:
Community health clinic
Years in practice:
3
Facility location:
Suburb outside of Des Moines, Iowa
A few months ago, Shelby, a 45-year-old female who is an established patient at the clinic, came in for a routine follow-up. She was in the waiting room, and I was walking up to the front desk just as the clerk called for help—Shelby was seizing. Since we’re a small clinic and she’s a familiar patient, I knew that Shelby had a history of epilepsy but that her seizures had been well controlled with medication.
When I got to her in the waiting room, I checked my watch quickly to note the time—just about to turn 8:45 a.m.—then started assessing. She was having a seizure and was nonresponsive. Our desk clerk was quick to call 911, but I knew the local dispatch could be slow to respond because they were understaffed. And the closest ED [emergency department] was still 30 minutes away. In the meantime, one of our other nurses came out with oxygen and we tried to get Shelby’s vitals. The provider in the office that day was new and hadn’t met Shelby yet, so I had one of the medical assistants go back and fill them in on the situation.
I checked my watch again, and it had been about 5 minutes since Shelby started seizing. She hadn’t regained consciousness so I knew it was a more protracted seizure. The other nurse, who was a recent graduate, asked if it’s normal for a seizure to last so long. I explained that a prolonged seizure like this style or having multiple back-to-back seizures without regaining consciousness in between them is called status epilepticus and it is serious.
Fortunately, the ambulance crew had been on a nearby call and came in right as I was explaining all this. They were able to transport Shelby to the ED, where they got her seizure under control. It turned out she hadn’t been taking her medication because she lost her insurance and couldn’t pay for it. She’d been planning to talk to her provider about it at the visit that day.
Cerebral Vascular Accidents (Strokes)
Stroke, also called a cerebrovascular accident, is the sudden loss of brain function due to a disruption of blood supply of the arteries in the brain. Strokes can either be ischemic, due to thrombosis or embolism, or hemorrhagic, due to vascular rupture resulting in bleeding. Stroke symptoms that last less than 1 hour without evidence of cerebral infarction are called transient ischemic attacks (TIAs) (Alexandrov & Krishnaiah, 2023).
Contributing factors to the cause of strokes include diabetes, smoking, hypertension, dyslipidemia, obesity, obstructive sleep apnea, sedentary lifestyle, excess alcohol consumption, anticoagulant use, drug use, vasculitis, a high-fat diet, and heart disorders that predispose an individual to emboli, such as atrial fibrillation or myocardial infarction. Other factors include genetics, race, age, and prior strokes (Alexandrov & Krishnaiah, 2023).
Signs and symptoms may come on suddenly and vary depending on the affected area of the brain. Symptoms may include numbness, weakness of face or limbs, confusion, visual disturbances, diplopia , aphasia , loss of balance and coordination, nausea, coma, and headache. Complications can occur in those with history of a stroke and include dysphagia , dysphasia , incontinence, atelectasis, pneumonia, confusion, sleep disturbances, depression, and a decreased ability to perform ADLs (Alexandrov & Krishnaiah, 2023). Bell palsy (Figure 26.13) can often be confused with a stroke.
A stroke must be treated as soon as possible, because the longer it goes unchecked, the more damage that can take place in the brain. Depending on the cause and location of the stroke, a patient may need medications to break up clots or prevent clotting, or procedures to remove clots. Medications to lower blood pressure may also be needed. If a patient has a bleed, they may need to discontinue any blood thinners and receive vitamin K. Transfusions may be necessary if the bleeding is severe or occurs during a procedure to remove a clot. Supportive treatment, such as fluids and breathing support, may also be needed depending on the functional status of the patient. For many patients, the period of recovery and rehabilitation after a stroke is intense and can last weeks, if not months.
The National Institute of Neurological Disorders and Stroke provides a variety of tools and education for healthcare professionals involved in diagnosis and treatment of a stroke. The full stroke scale can be accessed from this site.
The nurse must be able to quickly recognize the signs of a stroke and understand the steps they need to take if they suspect a patient is having a stroke. The acronym BEFAST can be a quick way to assess a patient for the red flag signs and symptoms and key factors of a stroke (Table 26.6):
B: Balance (Is there a sudden loss of balance?)
E: Eyes (Any loss of vision in one or both eyes?)
F: Face (Does the face appear uneven, is there any drooping?)
A: Arm (Any weakness or numbness in either arm?)
S: Speech test (Any slurred speech or trouble speaking? Does patient appear confused?)
T: Time to call for immediate assistance
The nurse also must know their workplace protocol for responding to a patient having or who has had a stroke and be empowered to put this plan into action.
Name:
Zoe, RN
Clinical setting:
Emergency department
Years in practice:
Less than 1 year
Geographic location:
Ohio
One day I was triaging patients in the ED and a patient presented with facial drooping on one side of his face. Even though I was a new nurse, I knew this was a red flag sign and was concerned the patient could be having a stroke. So, I activated stroke protocol to initiate diagnostic testing and proper assessments. During the assessment, I noted the patient did not have arm drifts or unequal pupils. They were alert and oriented to person, place, and time.
Later, I learned that the imaging for the patient come back clear. I spoke with my charge nurse about the concerns I had and wondered why the patient would be experiencing stroke symptoms and have these negative tests. The charge nurse explained to me that there are other conditions that can present with stroke-like symptoms.
I felt really silly and like I had jumped to conclusions by initiating the stroke protocol, but my charge nurse reassured me that I had done the right thing because it was very important to rule out a stroke. Early intervention is critical for patients who are having strokes, because the longer the brain is deprived of the oxygen and blood supply it needs, the more brain cells will die.
Neurological Infections
Infectious neurological disorders include meningitis, encephalitis, and Creutzfeldt-Jakob disease. Meningitis is the inflammation of the meninges, the protective covering of the brain and spinal cord . This disorder either originates in the bloodstream from other infections or by direct spread. For example, the direct spread may be a result of a traumatic injury to the facial bones. Symptoms include nuchal rigidity (stiff, painful neck), a positive Kernig and Brudzinski signs, photophobia (light sensitivity), and a rash that ranges from petechiae to large areas of ecchymosis. A positive Kernig sign is when the patient’s leg is unable to be fully extended from flexion in a supine position. A positive Brudzinski sign is that when the patient’s neck is flexed, the hips and knees flex. Other symptoms may include seizures due to increased intracranial pressure, which can also lead to a decreased level of consciousness.
Encephalitis is inflammation of the brain’s active tissues caused by an infection or autoimmune response . A wide range of symptoms may result and can even lead to brain damage, stroke , or death, in extreme cases. Affected individuals may display flu-like signs and symptoms such as fever, fatigue, and headache, as well as seizures, difficulties with movement, anxiety, sensitivity to light and sound, neck stiffness, irritability, hallucinations, loss of consciousness or disorientation, psychosis, memory loss, diplopia , speech or hearing impairments, partial weakness or paralysis in the extremities, impaired judgment, personality changes, and coma (U.S. Department of Health and Human Services, 2023b).
Creutzfeldt-Jakob disease is a rare brain disorder characterized by its rapid progression. This disorder causes rare changes in brain tissue that affects muscle coordination, memory, and thinking. The main signs and symptoms include severe mental deterioration, dementia , myoclonus (involuntary muscle jerks), or involuntary muscle movements. Early symptoms in the disease may include vision changes; insomnia or sleep disturbances; confusion; depression; mood swings; impaired thinking, judgment, and memory; walking and balancing difficulties; and lack of coordination. Later-stage signs and symptoms may include weakness in the extremities, loss of ability to speak or move, pneumonia, blindness, and coma (U.S. Department of Health and Human Services, 2023a).
Common Spinal Cord Disorders
Spinal cord injuries include any injury to the vertebral column, supporting soft tissue, intervertebral discs, or the spinal cord itself. Damage may occur due to laceration, transient concussion, laceration, compression of the tissues, or complete transection (severing) of the spinal cord. Clinical manifestations vary depending on the area of the spinal cord that is damaged, as shown in Figure 26.14. Spinal cord injuries may lead to paraplegia , lower body paralysis, or tetraplegia , paralysis of all extremities. Sensory and motor functions that may be affected range from paralysis (partial or total), loss of bladder or bowel control, pain, loss of sweating and vasomotor tone, blood pressure reduction, and respiratory dysfunction. Types of spinal cord injuries include Brown-Séquard syndrome, central cord syndrome, anterior cord syndrome, and posterior cord syndrome.
Brown-Séquard syndrome
Central cord syndrome, also called Brown-Séquard syndrome, is caused by a lesion resulting from a transverse hemisection of the spinal cord. This means the spinal cord is transected from north to south. This may be a result of an injury caused by a knife, fracture, or dislocation of a unilateral articular process, or an acute ruptured disc. Characteristics of this disorder include ipsilateral (occurring on same side of body) paralysis or paresis; contralateral (occurring on opposite side of body) loss of pain and sense of temperature; and ipsilateral loss of pressure, touch, and vibration.
The signs and symptoms of Brown-Séquard syndrome may be evident on a neurological exam and can also be assessed with imaging. There is no cure for the condition, but treatments, including surgery, medication, and physical and/or occupational therapy, can improve a patient’s function. The nurse may be involved in assessment of and care for patients with Brown-Séquard syndrome, which can include monitoring, implementing safety protocols (e.g., fall prevention), and providing patient education on medications and self-care.
Central Cord Syndrome
Central cord syndrome is caused by injury or edema of the central cord. This is most commonly found in the cervical region and can be caused by injuries related to hyperextension. This disorder is characterized by sensory loss in the upper extremities, motor deficits in the upper extremities, and dysfunction of bladder or bowel control also may be affected.
Assessment and exam findings paired with imaging to look at specific structures can diagnose central cord syndrome, and the treatment will typically depend on whether the condition responds to conservative care or requires surgery. The nurse’s role in care for patients can range from providing support and education to more involved measures like maintaining a patient’s airway and taking steps to prevent complications like pneumonia.
Anterior Cord Syndrome
Anterior central cord syndrome may be caused by hyperflexion injuries associated with vertebral fracture or dislocation or acute disc herniation. Characteristics of this disorder include loss of sensations like pain and temperature and loss of motor function below the level of the lesion, whereas the sensations of light touch, vibration, and position remain intact.
Magnetic resonance imaging is typically used to diagnose anterior cord syndrome, and the diagnosis is supported by assessment and clinical exam findings. The nurse may encounter patients with anterior cord syndrome after surgery and provide postoperative care. Specific treatments are related to the cause of the syndrome but can include treating underlying inflammation or surgery to address a structural cause.
Posterior Cord Syndrome
Posterior cord syndrome is a type of incomplete spinal cord injury caused by demyelination disorders, external compression (e.g., from tumors), blockage in a posterior spinal artery, or any lesion to the posterior portion of the spinal cord. This area of the spinal cord is responsible for proprioception as well as sensations of light touch and vibration. Characteristics include sensory ataxia and impaired voluntary movement and coordination.
Clinical assessment and exam findings that the nurse may contribute to can often be used to diagnose posterior cord syndrome. Specific findings, such as sensory deficits, can be important diagnostic clues. The treatment will depend on the cause but can range from supplemental vitamin B12 to correct a deficiency or antibiotics to treat an infection. The nurse’s role in management will also depend on the cause and will involve supporting the patient’s treatment plan and providing education about the condition.
Developmental Disorders
Developmental disorders vary but include conditions that result in impairment in learning, language, behavior, and movement. These conditions may develop at or during conception or shortly after birth. Many developmental disabilities are caught while the affected individual is young. Developmental and behavioral screenings are performed at well-child visits to assess developmental areas like movement, language, behavior, and thinking skills to identify children at risk for a developmental disorder. These disorders affect the individual throughout their life span. Types of disorders include cerebral palsy, intellectual disability, and prenatal injuries.
The nurse may have the opportunity be involved in early detection of developmental disorders, depending on the patient population they work with. Nurses who treat infants and young children are well positioned to identify developmental disorders, though they can and should assess older patients for them as well. Whatever the age of the patient, the nurse’s role in management will involve being part of coordinated, collaborative care that provides treatment and support for the patient based on their needs.
Cerebral Palsy
Cerebral palsy refers to a group of conditions that involve movement difficulties and muscle stiffness. Any muscle malfunction as a result of brain damage after the age of 2 years is not considered cerebral palsy (Victorio, 2023). This disorder often is the result of brain damage from oxygen deprivation, infections, or brain malformations at conception, during pregnancy, or shortly after birth. Characteristics of this disorder range from clumsiness, difficulty moving one or more extremities, ataxia, walking on the toes, paralysis, stiff joints, intellectual disability, failure to thrive, teeth grinding, tremors, speech delays, overactive reflexes, seizures, and visual or hearing disturbances.
Screening and diagnostic testing for cerebral palsy may start with a child’s pediatrician or primary care provider, but a specialist referral is typically an important next step. Brain imaging and genetic testing can be instrumental in making the diagnosis.
The nurse should have a solid grasp of the spectrum of cerebral palsy signs and symptoms and understand that milder cases may not be diagnosed until a child is a few years old. The nurse may encounter patients of all ages with cerebral palsy who have different medical, psychosocial, and developmental needs and levels of support, so a patient-centered approach is key.
Patients with cerebral palsy may need surgery, devices to assist with movement, and physical therapy and speech. Many children with cerebral palsy also receive support at school.
Intellectual Disability
Intellectual disability may be the result of genetics or a disorder that interferes with brain development. Some causes may occur at or before conception, such as chromosomal abnormalities, as with Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), or Patau syndrome (trisomy 13), all of which are associated with intellectual disabilities; or inherited disorders such as Tay-Sachs disease (Sulkes, 2022). Some occur during pregnancy, such as malnutrition, drugs, alcohol, or infections; hypoxia may occur during birth. Other causes include extreme prematurity, poisons, brain infections, malnutrition, severe abuse or neglect, or brain tumors after birth.
Characteristics may vary and include a head that is too large or small; flattened nose; upward-slanting eyes; malformations on the hands (e.g., wide, short hands and fingers; single palmar crease); widely separated first and second toes with increased number of skin creases; decreased muscle tone at birth; small ears or mouth; seizures; lethargy; abnormal urine odor; failure to thrive; abnormal growth; delayed motor skills development; language development delays; behavioral disturbances such as temper tantrums or physical aggression toward themselves or others; anxiety; and depression. Other clinical manifestations may include visual, hearing, cardiovascular, or gastrointestinal problems.
As with other developmental conditions, the nurse working with young patients may be in a unique position to notice signs of potential intellectual disability early and support the appropriate treatment. For example, the nurse may take note of motor or social skills deficits, or signs of specific conditions such as Tay-Sachs disease.
Prenatal Injuries
Prenatal injuries may result in various developmental disorders. The prenatal environment, both external and internal, greatly influence the development of the fetus and later health, including into adulthood. Prenatal injuries can cause neurodevelopment disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder, and fetal alcohol syndrome (FAS) (Doi et al., 2022). Autism spectrum disorder is characterized by delays in language, movement, or learning skills; hyperactivity; seizures; constipation; unusual emotional reactions; interest in only a limited number of things; attention difficulties; apathy; and sensitivity to sounds. Attention-deficit hyperactivity disorder is characterized by constant fidgeting, excessive movement or talking, the inability to sit still, acting without thinking, aggression, impulsivity, and a short attention span. Those affected by FAS may have problems with memory, learning, communication, vision, hearing, or communication. Characteristics of FAS in infants include a flat midface, thin upper lip, short nose, microcephaly, epicanthal folds, upturned nose, and small palpebral fissures (Figure 26.15).
Nurses working with infants, in particular, must be able to recognize these conditions and assess for them. The nurse’s role is paramount to ensuring that a child and their family can access the treatment and support they need. Nurses who work with people who are or may become pregnant also need to be well-versed in the risk factors associated with prenatal injuries and be able to offer support and intervention for patients who are at risk.
Prenatal injuries also include drug use disorders, stress, toxin exposure (e.g., mercury, pesticides, herbicides, certain cleaning products, lead), malnutrition, and medication use that has not been deemed safe in pregnancy. Intrauterine growth restriction can also lead to injuries due to the placental blood-flow reduction, hypoxemia, and undernutrition. These injuries can also result in prematurity, low birth weight, and failure to thrive (Doi et al., 2022).