FINAL PED CHAPTER 22

The nurse is teaching the parents of a preschool-age child with cerebral palsy about the upcoming surgery that is planned for the child to help control their spasticity. The nurse tells the parents that the surgeon will be inserting which item in their child during this procedure? baclofen pump vagal nerve stimulator central venous catheter botulinum toxin

baclofen pump Explanation: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? a. Skeletal traction b. Physical therapy c. Orthotics d. Occupational therapy

ANS: A Feedback: Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? Tremulous movements at rest and with activity Sudden jerking movement caused by stimuli Writhing, uncontrolled, involuntary movements Clumsy, uncoordinated movements

ANS: B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The childs muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? Apply Denis Browne splints to the infant each night. Perform passive foot exercises. Check the infant's toes for coldness or blueness. Change the infant's diapers frequently.

Check the infant's toes for coldness or blueness.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment? Quietly observe the child at play while interviewing the parent. Ask the parent to describe the child's development. Get down to the child's level and interact with the child. Review the child's health history to determine if the child is on track developmentally.

Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities. Asking the parent to describe the child's motor development may be appropriate in some cases such as the ability to feed. Getting down to the child's level may help assess the child's social development but observing the child play at a distance is best to assess a child's fine and gross motor development. Reviewing the child's history will give the nurse a sense of the child's past developmental level but will not give information about the child's current status.

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal? development of gross motor movement development of fine motor skills promote optimal self-care ability enhance feeding capabilities

development of gross motor movement Explanation: Physical therapy focuses on assisting in the development of gross motor movements, such as walking and positioning, and helps the child develop independent movement. Occupational therapy assists in the development of fine motor skills and fashioning orthotics and splints. Occupational therapy assists the child in performing optimal self-care ability by working on skills such as activities of daily living. Speech therapy assists with feeding techniques for the child who has swallowing problems.

A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands; however, she will not voluntarily grasp it. The nurse should interpret this as: a. Normal development. b. Significant developmental lag. c. Slightly delayed development caused by prematurity. d. Suggestive of a neurologic disorder such as cerebral palsy.

ANS: A This indicates normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary. No evidence of developmental lag, delayed development, or neurologic dysfunction is present.

A parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse? spastic movements of the extremities suspected failure to thrive babbling speech sits with assistance

suspected failure to thrive Explanation: The finding that requires the nurse's immediate attention is the suspicion of failure to thrive (FTT). FTT refers to inadequate growth in infants and children. Children diagnosed with cerebral palsy (CP) often have difficulty maintaining adequate nutrition due to muscle spasticity and difficulty chewing and swallowing. The nurse who suspects FTT in a child with CP should refer the child to a dietitian and/or speech therapist. Parents should also be taught the most effective way to feed their child. Spastic movements are common findings in CP and in this case do not require immediate intervention by the nurse. Babbling speech may also be found in the infant diagnosed with CP. The infant should be referred to a speech therapist but in this case does not require immediate intervention. A 12-month-old child with CP may need assistance to sit related to muscle spasticity.

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. exaggerated deep tendon reflexes hemiplegia poor control of balance hypertonicity drooling dysarthria

exaggerated deep tendon reflexes hemiplegia poor control of balance hypertonicity Explanation: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.