PEDs ch 22
The nurse is assessing a 4-year-old child whose mother reports that the child is more irritable lately. Which of the following questions would the nurse ask to elicit information suggesting possible increased intracranial pressure (ICP)?
"Does she have headaches when she gets out of bed?" ex: Headache is a common symptom of increased intracranial pressure at all ages. Increased intracranial pressure is frequently accompanied by morning headaches caused by the child moving from the bed to a standing position. Although increased ICP can cause vomiting, frequent vomiting might indicate Chiari malformation. Immunization status provides information about infection and meningitis. A change in the level of hearing is not associated with most conditions that cause increased ICP.
The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education
"I will use Visine drops in his infected eye to help reduce redness." Ex: Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.
A new parent asks the nurse, "I know that I need to put my baby to sleep on the back. I also heard that I should give my baby some "tummy time." But how much tummy time should I do every day?" Which response by the nurse would be most appropriate?
"Shoot for about 30 to 60 minutes each day." Ex: Caregivers should place an infant prone ("tummy time") for a total of 30 to 60 minutes per day to reduce skull pressure and promote motor development. Tummy time can be broken down into 10-minute increments to acclimate those infants who do not prefer this position.
The nurse is caring for a child diagnosed with aseptic meningitis. When explaining the treatment plan to the parents, which information would the nurse likely include?
"We will monitor your child closely and keep your child comfortable." ex: Aseptic meningitis is not as severe as bacterial meningitis and is usually self-limiting, requiring only supportive care. It is caused by a virus so antibiotics would not be needed. Antibiotics would be used to bacterial meningitis. Food would be withheld (NPO) if nausea and vomiting were prominent. Intensive care would be likely if the child had bacterial meningitis leading to sepsis.
An infant is diagnosed with nasolacrimal duct obstruction. The nurse is instructing the parents on how to perform lacrimal massage. The nurse determines the need for additional teaching based on which statement by the parents?
"We will press on the outer corner of the eye for several seconds." ex: Caregivers can perform lacrimal massage at home in conjunction with applying warm compresses to open the membrane. Caregivers should place the index finger between the inner corner of the child's eye and the side of the nose and press in and down over the lacrimal sac for a few seconds. The recommended frequency of the massage technique is 10 strokes to each eye once in the morning and once in the evening.
The nurse is monitoring the cerebral perfusion pressure (CPP) of a 14-year-old admitted to the unit with a traumatic brain injury. Which CPP reading would lead the nurse to notify the practitioner immediately?
42 mm Hg Ex: CPP is the difference between the mean arterial pressure (MAP) and the ICP (CPP = MAP − ICP) and represents the normal pressure gradient required to deliver blood to the brain. CPP should be greater than 40 to 50 mm Hg for infants and toddlers and greater than 50 to 60 mm Hg for older children. The nurse would notify the practitioner of a CPP of 42 mm Hg. A CPP of less than 40 mm Hg is a significant predictor of mortality in children with TBI.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?
Decrease environmental stimulation Ex: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation
T/F? Bad posture and carrying heavy backpacks can contribute to the development of scoliosis
False
T/F? Nurses should teach parents of children with osteogenesis imperfecta to lift by the legs when changing the diaper.
False
T/F? Vision loss from amblyopia can be regained with corrective lenses and occlusion therapy
False
In what culture is spina bifida more common in?
Hispanic
The most common type of scoliosis, ___________ scoliosis, is the diagnosis given when all other causes have been ruled out and thus indicates a lateral curvature resulting from no known cause.
Idiopathic
Extra digits on the hands and/or feet is a genetic condition known as ___________.
Polydactyly
Posturing
Posturing
Cisternogram
Procedure of choice for CSF leak
Nursing considerations for spina bifida
Prone, monitor CSF, extremities, another congenital anomaly, meningitis, Feedings: smaller/more often, diaper down and away from the wound ,I/O, daily HC, gentle ROM
To give eardrops to a 4-year-old child, what would be the best technique to use?
Pull the pinna of the ear up and back
A child has been diagnosed with strabismus. After further examination, the client is told that the resting position of the right eye is convergent. The nurse further explains that this means which of the following?
The resting position of the eye is turned in. Ex: In strabismus, the resting position of one eye may be divergent (turned out) or convergent (turned in). One pupil may be higher than the other (vertical strabismus). Strabismus may be monocular, in which the same eye deviates constantly.
T/F ? The cardinal sign of compartment syndrome is pain that is out of proportion to the injury and that is unrelieved by opioids.
True
spina bifida
congenital defects in the lumbar spinal column caused by imperfect union of vertebral parts
___________ is a condition of premature closure of one or more of the cranial sutures and leads to an abnormal head shape and can cause increased intracranial pressure
craniosynostosis
The ultimate goal of treatment for Legg-Calvé-Perthes disease is to relieve pain, protect the shape of the femoral head, and restore ___________ movement
hip
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?
hypertension ex: 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.
Encephalitis
inflammation of the brain usually caused by a virus
Meningitis
inflammation of the meninges of the brain and spinal cord
Focal seizure
localized seizure often affecting one limb
A child is brought to the emergency department and is experiencing status epilepticus. The nurse would expect to administer which treatment as first-line therapy?
lorazepam Ex: In the acute care setting, first-line therapy is a benzodiazepine (lorazepam as first choice) given intravenously, followed by phenytoin or fosphenytoin, then phenobarbital, valproate, or levetiracetam. If the seizures persist, an infusion of midazolam, pentobarbital, or propofol may be started.
The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?
obtunded ex: Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Fully conscious describes a child who has no neurologic changes. Stupor exists when the child only responds to vigorous stimulation. Decreased level of consciousness is a vague term that does not describe the assessment findings.
A nurse is caring for a baby admitted to the hospital with suspected abusive head trauma (shaken baby syndrome). Which assessment finding would confirm this suspicion?
retinal hemorrhages Ex: Abusive head trauma (shaken baby syndrome) is the repetitive, violent shaking of a small infant by the arms or shoulders, causing a whiplash injury to the neck, edema to the brainstem, possibly subdural hemorrhage, and distinctive hemorrhages to the retinas. Periorbital edema might occur with a blow to the eye. Bruising on the face might relate to slapping. Drainage from the ear might be a ruptured tympanic membrane or cerebrospinal fluid.
The nurse is providing care to a child diagnosed with encephalitis and suspects that the child may be developing syndrome of inappropriate antidiuretic hormone (SIADH). The child's most recent laboratory test results have come back. Which result(s) would the nurse interpret as supporting this suspicion? Select all that apply. serum sodium level serum potassium serum magnesium serum osmolality urine osmolality
serum sodium level serum osmolality urine osmolality ex: Children with encephalitis may demonstrate signs and symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). This syndrome affects water and electrolyte balance. Water intoxication and hyponatremia are acute signs of SIADH. Findings consistent with SIADH include decreased serum sodium levels, high urine osmolality, and low serum osmolality, all of which are evidenced by this child's laboratory results. The child's serum potassium and magnesium levels are within age-appropriate limits.
What are the main differences between the MS of children and Adults
the growth of bone, the nature/characteristics of bone, and alignment of bones
The nurse is conducting a class at a local community center for parents of preschool-aged and school-aged children. One of the topics is Reye syndrome. The nurse emphasizes the need to avoid the use of aspirin in children with a viral illness. Which virus(es) would the nurse address as commonly associated with this syndrome? varicella influenza hepatitis cytomegalovirus Epstein-Barr virus
varicella influenza ex: Reye syndrome occurs when aspirin is administered to a child during a viral illness. Influenza A and B and varicella are the viruses most commonly associated with Reye syndrome. Parainfluenza, measles, adenoviruses, Coxsackie viruses, cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus (HIV), hepatitis A and B, and rotavirus have been implicated as well, but these viruses are less common
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?
"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Ex: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures
A toddler is prescribed amoxicillin for bilateral otitis media. The parent reports that the toddler refuses to take the oral medication. The nurse knows that more education is needed when the parent makes which statement?
"I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddler down and force the medication down his throat." ex: The objective of administering oral medications is to administer the entire dose to the toddler while creating the least aversion to the medication as possible. No force should be used. Allowing the toddler to take the medication slowly from a medicine spoon or syringe is one way to reduce aversion.
A 1-year-old has just undergone surgery to correct craniosynostosis. When talking with the parents, which of the following would be most appropriate
"Now that the surgery was successful, do you have any questions?" ex: Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance. The nurse needs to adapt the teaching to the parents' questions, comments, and knowledge level.
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?
"She has been irritable for the last hour....seems like she is just upset for some reason." Ex: Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.
Postoperative care following placement of a ventriculoperitoneal shunt includes positioning the child on the nonoperative side and keeping the elevation of the bed below _______ degrees.
30
Interventions for muscular dystrophy
Glucocorticoids can slow progression (but increase risk for osteoporosis/fractures); physical therapy; monitor respiratory fuction with pulmonary function tests (PFTs) and therapies to increase lung volume, assisted coughing, venitlatory support; home pulse ox; vaccinations to avoid infections; dystrophin deficiency results in weak myocardium that cannot keep up with physiological demands of the heart so annual cardiac exam, ECG, and CV MRI
Managment of Spina Bifida
Protect the Sac, Fetal surgery: before 26 weeks gestation, Diet, laxatives, catheter, exercises
The nurse is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse?
Remove any blankets or heavy clothing and replace with a thin sheet ex: The child should not have any blankets or clothing that would elevate the temperature further. Removing them is helpful in allowing the heat to dissipate. The child should not be placed in a bathtub because he or she may suffer another seizure and slip underwater. Using ice packs or alcohol can be a shock to an immature nervous system. Antipyretics should be administered as a suppository rather than PO to reduce the risk of aspiration while the child is in the postictal or drowsy state following the seizure
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?
Risk for injury Ex: A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to an inability to swallow. All of these symptoms would make Risk for injury the highest priority.
In cases of suspected shaken baby syndrome, the nurse is a mandated reporter and is legally and ethically responsible to report any suspected abuse to the proper child welfare and law enforcement agencies.
True
T/F: Headaches that awaken a child from sleep are a red flag that require immediate follow-up with the pediatrician.
True
T/F? A smaller diaper should be used inside a larger diaper for more absorption in infants with a spica cast
True
T/F? Interventions for a child diagnosed with meningitis include isolation, seizure precautions, frequent neurological assessments, and fever management.
True
___________ injuries in nonambulating children should raise a red flag indicating potential abuse.
Twisting
How is Spina bifida diagnosed?
Ultrasound, Prenatal increased maternal serum, AFP, CT , MRI
The nurse is caring for a child with hearing loss due to damage from chronic inner ear infections. The nurse knows that the child most likely has which type of hearing loss?
conductive ex: Otitis media, middle ear infection, can cause damage to the structures of the middle ear, which can result in conductive hearing loss. Sensorineural hearing loss involves the dysfunction of the nerves and central auditory dysfunction involves dysfunction within the central nervous system.
The nurse is providing care to an infant with microcephaly. When reviewing the prenatal and birth history, the nurse would identify the mother's exposure to which infection as a potential contributing factor?
cytomegalovirus ex: Microcephaly is diagnosed as either primary, in which a genetic, chromosomal, or hereditary cause is implicated, or secondary, in which the defect occurs as a result of exposure to irradiation, maternal infection with toxoplasmosis, rubella, or cytomegalovirus, or maternal use of alcohol or tobacco. Candida, gonorrhea, or chlamydia are not associated with microcephaly.
conjuctivitis
inflammation of the conjunctiva (pink eye)
A 17-year-old is brought to the emergency department with a fever, headache, and stiff neck. Bacterial meningitis is suspected. The nurse would anticipate preparing the adolescent for which test to confirm the diagnosis?
lumbar puncture ex: Although a complete blood count may be done to evaluate for an elevated white blood cell count and clotting deficiencies, bacterial meningitis is diagnosed with a lumbar puncture to analyze the cerebrospinal fluid and identify the organism. Computed tomography or magnetic resonance imaging are not used to confirm the diagnosis.
The nurse is caring for an infant with increased intracranial pressure. The mother is preparing to feed the child. What action by the mother indicates an understanding of the proper care of this infant?
placing the infant in an infant car seat after feeding the infant ex: Placing a child or infant in the semi-Fowler position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed. In the supine position, the client is completely flat on his or her spine. Prone is face down and flat. Sims is a side-lying position with one leg flexed. All of the described positions place the client flat, not with the head raised; that would be in the semi-Fowler position.
The nurse will help parents of a child with amblyopia understand that occluding vision in the unaffected eye is therapeutic because
use of the affected eye promotes vision development ex: When lack of convergence of an image creates unclear vision in a child, vision is suppressed in one eye, resulting in disuse and lack of visual development. Occluding the unaffected eye forces use of the affected eye and development of vision. Occlusion does not impact eye strain, pain, or pupil size.
The nurse is performing a neurologic assessment on a 5-month-old infant. Which task should the nurse perform first?
Palpate the cranium. ex: Palpating the cranium is the least invasive assessment activity and should be performed first. Blowing on the face, running a cotton swab over the extremities, and whispering a word in the infant's ears are all part of the neurologic assessment, but are more invasive and should be performed later in the assessment.
A nurse is preparing a presentation on neurologic development in children. What information should the nurse include in the presentation?
Poverty and caregiver mental illness are shown to contribute to developmental delays in children. Ex: Poverty, child abuse, and caregiver mental illness have been shown to contribute to development delays in a child's development. An embryo's nervous system develops early in pregnancy, so it is highly susceptible to genetic alterations, maternal exposure to environmental insults, and teratogens such as infections and certain medications. Cerebral metabolism in infants and young children requires a larger, not smaller, portion of the body's blood to maintain its rapid growth and development. The ratio of body surface area to body weight in infants and very young children is much greater than, not less than, that of adults.
T/F? Postoperative care for pectus excavatum includes teaching the child how to splint the chest with a pillow to minimize pain when coughing and with deep breathing
True
T/F? To prevent deformational plagiocephaly, parents should be taught to place infants in a prone position for 30 to 60 minutes per day to reduce skull pressure.
True
A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication?
Use a soft toothbrush ex: Phenytoin is an anticonvulsant medication. It can be used in the management of seizure disorders. This medication is associated with gingival hyperplasia. This may result in tender and bleeding gums. The use of a soft toothbrush will reduce pain, bleeding and discomfort. There is no need to take this medication on an empty stomach or with citrus foods and beverages. The medication does not make an individual photosensitive
The nurse is reviewing discharge planning instructions with the parents of a child who had a ventriculoperitoneal (VP) shunt placed. Which statement by the parents requires further follow-up by the nurse?
"Our child may have occasional lethargy." ex: Lethargy, changes in behavior, poor feeding, and nausea and vomiting may indicate that the shunt has become infected, clogged, or kinked or has developed a blood clot. The statement "Our child may have occasional lethargy," requires further follow-up by the nurse, because this is not an expected symptom during recovery from VP shunt placement. The statement by the parents may indicate that they will not take action if the child becomes lethargic, and the nurse should clarify that lethargy may indicate that a complication with the shunt has occurred.
The nurse is performing discharge teaching with the parents of a 3-month-old infant with deformational plagiocephaly (DP). Which statement by the parents requires further follow-up by the nurse?
"We do not have a bassinet, so we will use a car seat." ex: "We do not have a bassinet, so will we use a car seat," requires further follow-up by the nurse, because it is recommended to only use car seats while traveling in a car. Car seats can inhibit mobility and contribute to DP. Thirty to 60 minutes of tummy time per day, switching the client's position frequently, and playing on the floor with toys during tummy time are all recommended. Therefore, the statements, "We will limit tummy time to about 30 to 60 minutes," "We will switch our infant's position frequently," and "We will play on the floor with toys during tummy time" are all appropriate and require no further follow-up by the nurse.
The child has conjunctivitis with much mattering of the eyes. What instruction should the nurse give the family? All family members should use frequent and proper hand hygiene. Use measures (such as distraction) to keep the child from rubbing the eyes. Wipe mattering from the eyes from the outer canthus inward (temple to nose). Consider the child contagious until treated with prescribed medication for 24 hours. Avoid sharing towels, clothing, pillow cases and other personal items with others.
All family members should use frequent and proper hand hygiene. Use measures (such as distraction) to keep the child from rubbing the eyes Consider the child contagious until treated with prescribed medication for 24 hours. Avoid sharing towels, clothing, pillow cases and other personal items with others. ex: Proper hand washing, avoiding sharing personal items within the family, and considering the child contagious until 24 hours after treatment will reduce the likelihood of transmitting the conjunctivitis. Keeping the child from rubbing the eyes as much as possible will reduce eye irritation and also help to prevent spreading the infection. The eyes should be wiped from the inner canthus outward (nose to temple) to avoid contaminating the second eye.
A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?
Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours Ex: A black eye is caused by a simple contusion to the eye. It affects the surrounding tissue of the eye but does not affect the eye itself. It produces swelling and bruising. It also causes scleral hemorrhage due to rupture of the blood vessels. The best treatment for the contusion is to place ice on for 20 minutes then off for 20 minutes for a 24-hour period. This helps reduce the swelling and pain. The bruising (the "black" eye) occurs from the vessels broken and leaking into the tissue. This may take about 3 weeks to go away. The nurse should assure the parent that scleral hemorrhages are benign but may take several weeks to resolve. The child would not need to be referred to an ophthalmologist unless the vision is impaired. Acetaminophen can be given for pain, but it is not the most important form of treatment for the problem
The nurse is planning care for a preschool-age child diagnosed with bacterial meningitis. What should the nurse identify as a priority goal for this client's care?
Reduce the pain related to nuchal rigidity. Ex: Meningitis is an infection of the cerebral meninges. Pathologic organisms spread to the meninges. Once organisms enter the meningeal space, they multiply rapidly and then spread throughout the CSF to invade brain tissue through the meningeal folds, which extend down into the brain itself. A child with meningitis usually has an upper respiratory tract infection prior to the development of meningitis. Then the child will become increasingly irritable because of an intense headache with sharp pain when bending the head forward. Reducing the pain caused by neck pain would be the priority goal for this client's care. Inspecting the teeth, providing opportunities for play, and increasing stimulation would not be priority goals for this client.
The nurse is assessing the vision of 9-year-old boy. His vision appears normal on a vision screening test, although the nurse notices that he has to tilt his head occasionally as he is reading the chart. His mother tells the nurse that he has trouble reading and reports having a headache after doing his homework. Which condition should the nurse suspect in this boy?
astigmatism ex: Astigmatism is an irregular curvature of the cornea, causing light to focus incorrectly on the retina resulting in an uneven quality of vision. On any given page of print, therefore, the child may see only half the letters or can have great difficulty reading or following written instructions. The child may report headache and vertigo after doing close work. Even though their vision appears deceptively normal on vision screening tests (they are able to see all of the numbers on a chart by tilting their head), these children need to be referred to an ophthalmologist on the basis of other problems such as vertigo, headaches, and difficulty with reading.
Many children with neurological conditions experience ___________, which is hypersensitivity to light.
Photophobia
The nurse receives a call from the parent of a 4-month-old infant who underwent endoscopic surgery for craniosynostosis 2 months earlier. The parent reports that the infant's skin appears red on the both temples. How should the nurse respond?
"Your infant should be evaluated in person, because a new helmet may be needed." Ex: "Your infant should be evaluated in person, because a new helmet may be needed."
The parents of a toddler have just learned that their child has profound hearing loss. The parents are very upset and state to the nurse, "It just isn't fair. We did everything right during our pregnancy all the way to this point." How should the nurse respond?
"I can't imagine how difficult this must be. When you're ready I would be happy to arrange a meeting with a support group of other parents with children who have hearing loss." ex: This comment is the most empathic and supportive. Encouraging a support group, when the parents are ready, is very helpful. Those in a support group know how these parents feel and can also offer helpful options for dealing with a hearing-impaired child. Telling the parents to "think positively" or that "things could be much worse" disregards the concern the parents have voiced to the nurse. The nurse generalizes the parents' feelings by telling them "many children who have a profound hearing loss function very well....."
A 1-year-old has just undergone surgery to correct craniosynostosis. When talking with the parents, which of the following would be most appropriate?
"Now that the surgery was successful, do you have any questions?" ex: Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance. The nurse needs to adapt the teaching to the parents' questions, comments, and knowledge level.
A nurse is providing care for a 6-year-old child admitted to the hospital for meningitis. The child's past medical history shows recent mild-to-moderate hearing loss secondary to recurrent ear infections. Which intervention is most important for the nurse to implement?
Determine an effective method of communicating with the child ex: The nurse's priority is to determine an effective method of communicating with the child. Educating the parents about antibiotics to treat infection, coordinating hearing rehabilitation and speech therapy services, and providing the family with information on support groups are all appropriate interventions for the child's plan of care. However, the ability to communicate effectively with the child is the most important.
The parents of a 2-week-old neonate bring the neonate to the office for an evaluation. While reviewing the neonate's history, the nurse determines that the neonate is at risk for deformational plagiocephaly and institutes a teaching plan for the parents about prevention. Which factor in the neonate's history would lead the nurse to this action Neonate was in the breech position in utero. Neonate was born at 34 weeks' gestation. Mother's length of labor was 22 hours.
Neonate was in the breech position in utero. Neonate was born at 34 weeks' gestation. Mother's length of labor was 22 hours. ex: Although deformational plagiocephaly (DP) may occur as a result of supine positioning for long periods of time, other conditions may contribute to its increased incidence, including premature birth, prolonged intubation, male gender, multiple-gestation pregnancies, breech position in utero, primiparous mothers, maternal age greater than 35 years, birth trauma, congenital anomalies, low activity level, developmental milestone delay, inadequate time spent in the prone position, bottle feeding, and prolonged labor. Based on the information provided, the infant was in the breech position in utero and was considered premature (born at 34 weeks' gestation), and the mother's labor was prolonged (22 hours). The mother is multiparous and younger than age 35 years.
The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?
brain stem ex: Decerebrate posturing is seen with injuries occurring at the level of the brain stem. Decorticate posturing occurs with damage of the cerebral cortex. Both types of posturing are characterized by extremely rigid muscle tone. Injuries to the frontal lobe of the brain and the mid-cervical spine would not cause these types of posturing.
A nurse is providing discharge teaching to the parents of a child hospitalized with hydrocephalus, who had a ventriculoperitoneal (VP) shunt placed. The nurse should intervene if the parents make which statement?
"We expect our child to continue engaging in normal activities, including sports." Ex: The nurse should intervene if the parents expect the child to engage in sports. The nurse will need to determine which type of sports the child will engage in. A child with a VP shunt should avoid contact sports such as football because of the risk of shunt damage. The parents should report any changes in behavior or signs of infection immediately so that treatment can begin promptly. VP shunts are typically needed for life and have the potential to become displaced as the child grows
The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? increased head circumference pulse rate of 60 beats/min and regular vomiting blood pressure decreased from baseline parent states, "My infant does not act right."
increased head circumference pulse rate of 60 beats/min and regular vomiting parent states, "My infant does not act right." ex: Signs of increased intracranial pressure include bulging fontanel ([fontanelle] increased head circumference), decreased pulse, vomiting, increased blood pressure and behavior changes. The nurse must listen to the parents if concerns about behavior are mentioned. The blood pressure would increase, not decrease. The nurse would alert the health care provider immediately of these signs so intervention can be started if needed.
The nurse in the clinic is providing discharge instructions to the parent of a toddler with conjunctivitis. Which comments by the parents require further instruction? "Cold packs will be most helpful in treating this infection." "I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected." "I didn't know that conjunctivitis could be related to allergies." "I bet my child's eye infection is related to her upper respiratory infection."
"Cold packs will be most helpful in treating this infection." "I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected." ex: Inflammation of the bulbar or palpebral conjunctiva is referred to as conjunctivitis, and it can be infectious, allergic, or chemical in nature. Warm compresses are best for treating conjunctivitis, along with medications. Conjunctivitis is very contagious and is often transferred from one eye to the other in this age group because children often touch one eye then the other without washing their hands.
The nurse is caring for a 4-year-old child who is unconscious. Which action by the nurse is priority?
Position on the side with the chin extended. ex: Maintaining the child's airway and breathing is the priority; therefore, the nurse should position an unconscious child to maintain the airway, such as on the side with the chin extended, which will prevent the tongue from obstructing the airway if the child is not receiving artificial ventilation. Maintaining adequate hydration, seizure precautions such as keeping side rails up and padded, and cushioning the bony prominences and protecting the limbs to promote skin integrity are interventions that should be included in the plan of care but they are not the priority.
Antibiotic therapy to treat meningitis should be instituted immediately after which event?
Collection of cerebrospinal fluid (CSF) and blood for culture ex: Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy
___________ hearing loss involves dysfunction in the ear structures responsible for transmitting sound from outside of the ear to the inner ear, including the outer ear, tympanic membrane, and ossicles.
Conductive
Pectus Excavatum (sunken/funnel chest)
Congenital deformity that causes ribs and sternum to grow abnormally such that the breastbone (sternum) goes inward, producing a depression/concave appearance
Generalized seizure
a seizure that affects both sides of the brain
Hydrocephalus
abnormal accumulation of fluid (CSF) in the brain
Microcephaly
abnormally small head
Teratogen
agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. The nurse should first ____________ followed by _____________.
1. ensure proper oxygenation 2. administer intravenous (IV) or intramuscular (IM) benzodiazepine. Ex: 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.
A child comes to the clinic with a report of having trouble seeing. The nurse inspects the eyes and obtains a history from the child about the vision. Which question(s) will help the nurse determine if the child may have a refractive error? "Do you see the ball in the outfield when playing baseball?" "How far away do you have to hold a book to read?" "Do images look blurry when you play video games?" "Have you had a vision screening test?" "Have you had an injury to your eye recently?
"Do you see the ball in the outfield when playing baseball?" "How far away do you have to hold a book to read?" "Do images look blurry when you play video games?" Ex: The most common cause of visual difficulties in children are refractive errors. These occur when light entering the lens does not bend appropriately to fall directly on the retina. A child reporting blurriness when holding an item close is said to have hyperopia (farsightedness). This is because the light does not fall on the retina. This child may have trouble seeing the words on a book close up or playing video games. Myopia (nearsightedness) occurs when the light falls in front of the retina. Children with this problem can see well at close range but have trouble seeing things at a distance. An example would be playing outfield in baseball and not being able to see the ball. An eye test is to test visual acuity, not refractive errors. An eye injury is not associated with a refractive error.
Which of the following would a nurse assess in a child with pneumococcal meningitis?
nuchal rigidity Ex: Pneumococcal meningitis is manifested by fever, irritability, and nuchal rigidity. Pneumococcal pneumonia is manifested by a temperature of 102 °F (38.9 °C) to 103 °F (39.4 °C), chills, productive cough, and otitis media
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Ex: Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.
The mother of a 10-day-old infant reports her baby has been having "lots of eye discharge." What is the best initial response by the nurse?
"Tell me more about this drainage." Ex: Tearing or discharge from one or both eyes is often first noted at the 2-week checkup. Obtain a thorough history about the eye drainage to distinguish it from neonatal conjunctivitis. Determine the onset and progression of symptoms, as well as the newborn's response to any interventions attempted so far. The best response by the nurse is an attempt to obtain additional information. Telling the child's mother this is normal in the absence of additional information is inappropriate. Asking if this looks like an infection is asking the child's mother to make a diagnosis. There is no need at this time to consult an eye specialist.
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?
"This shunt is the only surgery my baby will need." Ex: Hydrocephalus results from an imbalance in the production and absorption of CSF. In hydrocephalus, CSF accumulates within the ventricular system and causes the ventricles to enlarge, and increases in ICP subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.
The nurse is caring for a child diagnosed with aseptic meningitis. When explaining the treatment plan to the parents, which information would the nurse likely include?
"We will monitor your child closely and keep your child comfortable." ex: Aseptic meningitis is not as severe as bacterial meningitis and is usually self-limiting, requiring only supportive care. It is caused by a virus so antibiotics would not be needed. Antibiotics would be used to bacterial meningitis. Food would be withheld (NPO) if nausea and vomiting were prominent. Intensive care would be likely if the child had bacterial meningitis leading to sepsis
A 3-month-old infant is diagnosed with mild craniosynostosis. When teaching the parents about treatment, which information would the nurse likely include?
"Your infant will need to wear a helmet after the defect is corrected for most hours of the day." ex: Craniosynostosis is treated by surgery to release the fused suture(s) and to achieve cosmetic improvements for facial and head deformities. Surgery is done before the infant is 6 months of age to achieve the best outcome. Endoscopic surgery is done on infants up to 6 months old and is minimally invasive, but it still requires that the infant wear a helmet afterward. Open surgery is reserved for infants older than 6 months and is done to reshape moderate to severe malformations.
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply
- oxygen gauge and tubing - suction at bedside - padding for side rails Ex: When planning the client's environment it is imperative that both safety items and those to manage the seizure are present. The side rails should be padded to prevent injury during seizure activity. Oxygen setup should be provided. Suction may be needed. Tongue blades and smelling salts are not employed
A nurse is administering carbamazepine to a 4-year-old child diagnosed with epilepsy. The health care provider has prescribed 10 mg/kg/day by mouth. The child weighs 32 lb (14.52 kg). How many milligrams should the nurse administer? Record your answer rounded to the whole number
145
status epilepticus
A condition in which seizures recur every few minutes or last more than 30 minutes.
The nurse is caring for a toddler who was just diagnosed with a hearing impairment. What would the nurse expect to assess in the child?
A delay or lack of clear, understandable speech pattern Ex: A hearing impairment will often cause a delay or absence of normal speech and language development in a child. Toddlers typically do not vocalize the sounds of the letter 'R" and "S" until older. Purulent drainage may represent an ear infection. Oxygen at birth may be problematic for vision, but not hearing
Deceleration
A sudden stopping of movement; a type of traumatic brain injury in which the brain continues in motion within the skull because of inertia after the skull has been forcibly stopped, leading to brain injury as it hits the skull
During physical assessment of a 2-year-old child, the nurse suspects that the child may have a cataract in one eye based on assessment of which of the following?
Absence of the red reflex ex: The absence of the red reflex and a white, opaque appearance of the lens are telltale signs of a cataract. A blue tinge to the sclera and excess watering of the eyes are signs of glaucoma. Edema of the eyelids is a sign of allergic conjunctivitis.
A nurse is providing preoperative care for a newborn with hydrocephalus. What intervention(s) will the nurse include in the newborn's plan of care? Select all that apply Avoid repositioning the head. Administer antibiotic therapy. Administer furosemide therapy. Measure abdominal circumference. Measure head circumference to the nearest centimeter.
Administer antibiotic therapy. Administer furosemide therapy. Measure abdominal circumference.
A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, is vomiting, and has loss of appetite. Which of the following interventions would be most appropriate for the child at this time?
Administer intravenous antibiotics as ordered Ex: It is likely the child's VP shunt has become infected. Intravenous antibiotics are required. The symptoms of seizures and vomiting should diminish once the infection is brought under control. Eradicating the likely central nervous system infection takes precedence over poor appetite
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
Periorbital cellulitis
An infection of the eyelid; also known as preseptal cellulitis or eyelid cellulitis.
The primary treatment for osteomyelitis is ___________.
Antibiotics
Deformational plagiocephaly (DP)
Asymmetry and flattening of head from external forces
To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority?
Cerebral edema Ex: The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.
The nurse is assessing a 9-year-old child who is suspected of having meningitis. The nurse assesses the child for meningeal irritation using the Kernig sign. Which result would the nurse interpret as positive?
Child reports pain behind the knee when leg is extended ex: When testing for the Kernig sign, the nurse would lay the child supine with the hips flexed and then try to straighten a leg out. The test is positive if pain behind the knee is experienced when the leg is extended. Younger children may cry out or resist leg extension. Another test for meningeal irritation is the Brudzinski sign. With this test, the nurse lays the child flat and then attempts to raise the child's head toward the chest and place the chin on the chest. Meningeal irritation is present if the child indicates pain or resistance or the child immediately flexes the hips and knees.
Osteogenesis Imperfecta
Disorder affecting collagen that results in fragile bones that break easily
two most common types of muscular dystrophy
Duchenne's and Becker's
Assessment for Duchenne's
Elevated creatinine kinase (CK), Molecular genetic testing identifies deletions/mutations in DMD gene
Whats a big sign for Duchenne's?
Gowers sign
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention ex: 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.
What to monitor for Cerebral Palsy
Motor impairment, seizures, aspiration, Ataxic: gait,fall, stumbling, Aphratoid: rhythmic movement, Rigidity, MOST DO NOT HAVE COGNITIVE IMPAIRMENT
What to monitor during interventions for muscular dystrophy
Nutritional complications (prone to obesity from long term glucocorticoids and malnutrition/weight loss from swallowing and impaired nutrient absorption) and may need feeding tube
A nurse has received the above hand-off report for a client hospitalized with blunt head trauma following a motor vehicle accident. What is the nurse's priority in providing care for the client?
Observe for behavioral changes. Ex: The nurse's priority is to monitor the client for any changes in behavior. Even subtle changes such as sleepiness or lethargy could indicate worsening of the client's condition. Maintaining adequate hydration, rest, and pain relief should all be part of the nurse's plan of care, but they are not the priority
A nurse is providing care for a 14-year-old child hospitalized after a motor vehicle accident that resulted in blunt head trauma. The nurse notes that the client appears to be sleeping and is lying with upper limbs flexed at the elbow and wrists while lower limbs are extended. Which action should the nurse take next?
Utilize the Glasgow Coma scale (GCS). ex: The nurse should further assess the client using the GCS, which will determine level of consciousness. The client's positioning suggests decorticate posturing, which indicates brain injury to the corticospinal tracts. Performing this assessment will provide additional important information that the nurse can provide when notifying the health care provider. Allowing the client to sleep undisturbed and repositioning the client are inappropriate because the nurse is missing signs of the client's deteriorating condition.
The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the parents about the care of the eye?
Wipe the drainage away from the inner to the outer canthus of the eye Ex: Conjunctivitis is inflammation of the conjunctiva that causes pustular drainage. The eye should be cleansed from the inner to the outer canthus to prevent the spread of infection to the other eye. The child does not need to miss school for 2 weeks with this eye infection. Ophthalmic medication should be used as prescribed, which might be longer than 3 days. The eye does not need to be covered.
To prevent Reye syndrome, caregivers should be instructed not to administer ___________ to children unless instructed to do so by the pediatrician.
aspirin
Paroxysmal
beginning suddenly or abruptly
What to asses for a pt with Osteogenesis Imperfecta
bone deformity, muscle weakness, height for short stature, face for triangular shape, blue tinted sclera, hearing loss, swelling/bruising/pain
Most important thing to look for a pt with funnel chest
cardiopulmonary difficulty
The nurse is assessing a child with a suspected traumatic brain injury. The child is disoriented to place and time, but not person, and is having difficulty following commands. The nurse would use which terminology to document the child's level of consciousness?
confusion
cerebral palsy
paralysis caused by damage to the area of the brain responsible for movement, lack of o2
Photophobia
sensitivity to light
Craniosynostosis
the premature fusing of the skull bones
A 6-year-old child is brought to the urgent care clinic. After interviewing the parents and assessing the child, the nurse suspects viral conjunctivitis. After explaining the treatment plan, the parents ask the nurse, "When can our child go back to school?" Which response by the nurse would be appropriate?
"You will need to wait until the eye is completely clear." ex: Bacterial and viral forms of conjunctivitis are highly contagious, so children with these types of infection and their parents need to be informed on avoiding contact with others during the period of infectiousness, performing frequent and thorough handwashing, avoiding contact between the eyes and hands, and undertaking other methods of preventing the spread of the infection. A child with viral conjunctivitis should not return to day care or school until the eye is completely clear, with no discharge.