Chapter 49: Nursing Care of a Family when a Child has a Neurologic Disorder
An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? "I have ibuprofen available in case it's needed." "My child will likely outgrow these seizures by age 5." "I always keep phenobarbital with me in case of a fever." "The most likely time for a seizure is when the fever is rising."
"I always keep phenobarbital with me in case of a fever." Explanation: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I will give the medication to him when I first wake him up in the morning." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "I'm glad to know he will only need this medication for a short time to stop his seizures."
"I need to watch for any new bruises or bleeding and let my health care provider know about it." Explanation: Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.
Stages of tonic clonic seizures in order
A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.
A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? Ask the boy to touch each finger on one hand with the thumb of that hand in rapid succession. Measure the circumference of the calves and thighs with a tape measure. Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched. Ask the boy who he is, where he is, and what day it is.
Ask the boy to touch each finger on one hand with the thumb of that hand in rapid succession. Explanation: Tests for cerebellar function are tests for balance and coordination, such as asking the child to touch each finger on one hand with the thumb of that hand in rapid succession. Motor function is measured by evaluating muscle size, strength, and tone. Begin by comparing the size and symmetry of extremities. If in doubt about either of these, measure the circumference of the calves and thighs or upper and lower arms with a tape measure. If children's sensory systems are intact, they should be able to distinguish light touch, pain, vibration, hot, and cold. Have a child close his eyes and then ask him to point to the spot where you touch him with an object. Orientation, which is one measure of cerebral function, refers to whether children are aware of who they are, where they are, and what day it is (person, place, and time).
A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? The child's risk for cognitive problems is greatly increased. Structural damage occurs with febrile seizure. The child's risk for epilepsy is now increased. Febrile seizures are benign in nature.
Febrile seizures are benign in nature. Explanation: Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.
What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? Bradycardia Cheyne-Stokes respirations Fixed, dilated pupils Projectile vomiting
Projectile vomiting Explanation: Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? Onset and character of fever Degree and extent of nuchal rigidity Signs of increased intracranial pressure (ICP) Occurrence of urine and fecal contamination
Signs of increased intracranial pressure (ICP) Explanation: Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.
The nurse caring for a 3-year-old child with a history of seizures observes the child having a seizure. What information should the nurse document concerning the event? Select all that apply. Time the seizure started Factors present before seizure started Persons in attendance during seizure Number of seizures child has had in the last 48 hours Eye position and movement Incontinence of urine or stool
Time the seizure started Factors present before seizure started Eye position and movement Incontinence of urine or stool Explanation: Following a seizure, the nurse documents the following: time the seizure started; what the child was doing when the seizure began; any factor present just before the seizure (bright light, noise); part of the body where seizure activity began; movement and parts of the body involved; any cyanosis; eye position and movement; incontinence of urine or stool; time seizure ended; and child's activity after the seizure. Who was with the child or the number of seizures the child has had are not relevant to document regarding observation of this seizure.
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Understanding the side effects of medications Treating the child as though she did not have epilepsy Placing the child on her side on the floor Instructing her teacher how to respond to a seizure
Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP? tachypnea hyperthermia poor handwriting hypertension
hypertension Explanation: Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia. All of these symptoms result from the increased ICP putting pressure on the cranial vessels and the hypothalamus. Double vision, or diplopia, also occurs as a result of increasing ICP.
The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse? Administer lorazepam IV as prescribed. Perform a glucose finger stick to determine the child's blood sugar level. Administer carbamazepine as prescribed. Observe and document the length of time of the seizure and type of movement observed.
Administer lorazepam IV as prescribed. Explanation: A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action.
The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question? Place in an indwelling urinary catheter. Administer dexamethasone, dosage determined by the pharmacist. Administer mannitol IV, dosage determined by the pharmacist. Initiate an IV of 0.9% NS to run at 250 ml/hr.
Initiate an IV of 0.9% NS to run at 250 ml/hr. Explanation: Rapid administration of IV fluids may increase ICP. An IV rate of 250 ml/hr of normal saline can be considered a rapid infusion. Corticosteroids such as dexamethasone can reduce cerebral edema. Osmotic diuretics, such as mannitol, can reduce pressure. Because of the administration of the osmotic diuretic, indwelling urinary catheters are typically inserted.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Sudden, momentary loss of muscle tone, with a brief loss of consciousness Muscle tone maintained and child frozen in position Brief, sudden contracture of a muscle or muscle group Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Explanation: Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.
Absence seizures are marked by what clinical manifestation? Brief, sudden onset of increased tone of the extensor muscle Loss of motor activity accompanied by a blank stare Sudden, brief jerks of a muscle group Loss of muscle tone and loss of consciousness
Loss of motor activity accompanied by a blank stare Explanation: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.
A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response? Report to the emergency room for medical evaluation. Immerse the child in a bathtub of tepid water. Administer oral acetaminophen per package directions. Remove any heavy clothing and cover with a thin sheet.
Report to the emergency room for medical evaluation. Explanation: When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response.
The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? While turning the child's head to the left, the eyes turn to the right. While stimulating the child's foot, the big toe points upward and other toes fan outward. While calling the child's name, the child stares straight ahead and does not turn to the sound. While assessing the child's pupils, there is no change in diameter in response to a light.
While assessing the child's pupils, there is no change in diameter in response to a light. Explanation: To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. Complete the following sentence(s) by choosing from the lists of options. The nurse should first ensure proper oxygenation insert an airway into the client's mouth suction the client's airway followed by administer intravenous (IV) or intramuscular (IM) benzodiazepine administer an antiepileptic by mouth (PO) do not allow the client to sleep once the seizure has ended
ensure proper oxygenation administer intravenous (IV) or intramuscular (IM) benzodiazepine The nurse first ensures a patent airway and proper oxygenation using a blow-by method.The nurse then administers an antiepileptic medication such as benzodiazepines intravenously or intramuscularly for prolonged seizure activity. Nothing should be inserted into the child's airway when the child is seizing, not even suction. The nurse can place the child in a side-lying position to prevent the tongue from occluding the airway and help with secretions that may pool up in the back of the throat.The child should not receive anything orally when the child is seizing. The nurse should administer medications via intravenous push (IVP) or intramuscular (IM) during prolonged seizure activity.It is appropriate for the nurse to allow the child to sleep once the seizure has ended. The child should be placed in the left lateral recumbent recovery position.
