PEDS EXAM #3

Febrile seizures

the most common type of childhood seizure. Long-term antiepileptic therapy is usually not required for children with simple febrile seizures

Level of consciousness

the most important indicator of neurologic health. Various levels include full consciousness, confusion, disorientation, lethargy, obtundation, stupor, coma, and persistent vegetative state.

Duchenne muscular dystrophy

the most severe and the most common muscular dystrophy of childhood. It is inherited as an X-linked recessive trait, and the single-gene defect is located on the short arm of the X chromosome

postictal state

the period after a seizure

goal of treatment of seizure disorders

to control the seizures or to reduce their frequency and severity, discover and correct the cause when possible, and help the child live as normal a life as possible. Long-term care of the child with recurrent seizure disorders includes physical care and education on the importance of drug therapy and problems related to emotional aspects of the disorder.

The purpose of the neurologic examination

to establish an accurate, objective baseline of neurologic information. Complete neurologic examination includes level of consciousness; posture; motor, sensory, cranial nerve, and reflex testing; and vital signs.

Clinical manifestations of CP

delayed gross motor development, altered motor performance, alterations of muscle tone and subsequent muscle contractures, abnormal posture, and associated disabilities such as seizures and sensory impairment

Care of the infant and child with myelomeningocele

directed toward protecting the meningeal sac, preventing infection and skin breakdown, observing for signs of urologic and bowel complications, promoting early parent-infant interaction, and planning appropriate interventions to optimize the child's development

goals of therapy for children with CP

early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction

Nursing care of the unconscious child focuses on :

ensuring respiratory management; performing neurologic assessment; monitoring ICP; supplying adequate nutrition and hydration; providing drug therapy; promoting elimination, hygienic care, proper positioning, exercise, and stimulation; and providing family support.

cerebral edema

expected after craniocerebral trauma ; Cerebral edema peaks at 24 to 72 hours after injury and may account for changes in a child's neurologic status. Cerebral edema associated with traumatic brain injury may be a result of two different mechanisms: cytotoxic edema or vasogenic edema.

Absence seizures

formerly called petit mal or lapses, are generalized seizures. They have a sudden onset and are characterized by a brief loss of consciousness, a blank stare, and automatisms.

Major complications of Duchenne muscular dystrophy

include joint contractures, disuse atrophy, obesity, cardiomyopathy, sleep disordered breathing, and respiratory failure as the condition progresses

Primary head injury

involves features that occur at the time of trauma, including fractured skull, contusions, intracranial hematoma, and diffuse injury. Secondary complications include hypoxic brain damage, increased ICP, infection, cerebral edema, and posttraumatic syndromes.

• Myelomeningocele

involves the protrusion of a sac in the lumbar or lumbosacral area that contains meninges, spinal fluid, and nerves. Associated problems include infection, neurologic damage, impaired renal function, musculoskeletal impairment, and latex allergy.

Muscular dystrophies

the greatest and most important cause of neuromuscular dysfunction of childhood.

The process of diagnosis in a child suspected of having epilepsy includes

(1) determining whether epilepsy or seizures exist and not an alternative diagnosis; and (2) defining the underlying cause, if possible.

The broad aims of therapy for children with CP

(1) establish locomotion, communication, and self-help; (2) gain optimum appearance and integration of motor functions; (3) correct associated defects as early and effectively as possible; (4) provide educational opportunities adapted to the individual child's needs and capabilities; and (5) promote socialization experiences with other affected and unaffected children

The young child's response to head injury is different from older children and adults because:

: larger head size; expandable skull; larger blood volume to the brain; small subdural spaces; and thinner, softer brain tissue.

The nurse is caring for a child with a Wilms' tumor. What is the most important nursing intervention preoperatively? A. Avoid abdominal palpation. B. Closely monitor the arterial blood gases. C. Prepare the child and family for long-term dialysis. D. Prepare the child and family for renal transplantation.

A. Avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted. Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery. Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

The nurse is planning care for a school-age child with bacterial meningitis. Which nursing intervention should be included? A. Keep environmental stimuli to a minimum. B. Avoid giving pain medications that could dull the sensorium. C. Measure the head circumference to assess developing complications. D. Have the child move the head side to side at least every 2 hours.

A. Keep environmental stimuli to a minimum Children with meningitis are sensitive to noise, bright lights, and other external stimuli because of the irritation on the meningeal nerves. The nurse should keep the room as quiet as possible with a minimum of external stimuli, including lighting. After consultation with the practitioner, pain medications can be used on an as-needed basis. A school-age child will have closed sutures; therefore, the head circumference cannot change. The head circumference is not relevant to a child of this age. The child is placed in a side-lying position, with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that increase discomfort and put tension on the neck.

A 3-year-old child is status post shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) A. Personality change B. Bulging anterior fontanel C. Vomiting D. Dizziness E. Fever

A. Personality change, C. Vomiting, E. Fever <div>Personality change can be a sign of shunt malformation related to increased intracranial pressure.<br>Vomiting can be a sign of shunt malformation related to increased intracranial pressure.<br>Fever can be a sign of shunt malformation and is a very serious complication.<br>The anterior fontanel closes between 12-18 months of age.<br>Dizziness is difficult to assess in a 3-year-old and is not necessarily a sign of shunt malformation.</div>

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the priority assessment for this child? A. Reactivity of pupils B. Doll's head maneuver C. Oculovestibular response D. Funduscopic examination to identify papilledema

A. Reactivity of pupils Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. Assessing for an oculovestibular response is a painful test that should not be done for a child who is having variable levels of consciousness. Papilledema does not develop for 24 to 48 hours in the course of unconsciousness.

What is a clinical manifestation of increased intracranial pressure (ICP) in infants? A. Shrill, high-pitched cry B. Photophobia C. Pulsating anterior fontanel D. Vomiting and diarrhea

A. Shrill, high-pitched cry A shrill, high-pitched cry is a common clinical manifestation of increased ICP in infants. The characteristic cry occurs secondary to the pressure being placed on the meningeal nerves, causing pain. Photophobia is not indicative of increased ICP in infants. A pulsating anterior fontanel is normal in infants. The infant with increased ICP would be seen with a bulging anterior fontanel. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is more indicative of a gastrointestinal disturbance.

• A 6-year-old child born with a myelomeningocele has a neurogenic bladder. The parents have been performing clean intermittent catheterization. What should the nurse recommend? A. Teach the child to do self-catheterization. B. Teach the child appropriate bladder control. C. Continue having the parents do the catheterization. D. Encourage the family to consider urinary diversion

A. Teach the child to do self-catheterization. At 6 years of age, this child should have the dexterity to perform the intermittent catheterization. This will give the child more control and mastery over the disability. Bladder control cannot be taught in a child with a neurogenic bladder. School-age children, even as young as 6 years, should be able to begin self-catheterization. A urinary diversion is not necessary for a neurogenic bladder.

In a non-potty-trained child with nephrotic syndrome, what is the best way to detect fluid retention? A. Weigh the child daily. B. Test the urine for hematuria. C. Measure the abdominal girth weekly. D. Count the number of wet diapers.

A. Weigh the child daily. A daily weight taken at the same time every day, with the child wearing the same clothing, is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. The abdominal girth will reflect edema, but weekly measurements are too infrequent. The number of wet diapers reflects how often the diapers have been changed. The diapers should be weighed to reflect the fluid balance.

• A 15 year-old is admitted to the intensive care unit (ICU) with a spinal cord injury. The most appropriate nursing interventions for this adolescent are (select all that apply) A. monitoring neurologic status. B. administering corticosteroids. C. monitoring for respiratory complications. D. discussing long-term care issues with the family. E. monitoring and maintaining hemodynamic status.

A. monitoring neurologic status. B. administering corticosteroids. C. monitoring for respiratory complications. E. monitoring and maintaining hemodynamic status. <div>Close monitoring of sensory and motor function is important to prevent further deterioration of neurologic status as a result of spinal cord edema.<br> Corticosteroids are administered to minimize the inflammation associated with the injury.<br> Close monitoring of respiratory status for possible need of ventilator support. Remember A-B-Cs, airway, breathing, circulation.<br> Monitoring and maintaining hemodynamic status may require immediate attention related to increased intracranial pressure resulting in hypotension and bradycardia.<br> The discussion of long-term care issues with the family is not appropriate in the acute phase of spinal cord injury.</div>

The nurse is performing a neurologic assessment of a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest A. neurologic health B. severe brain damage C. decorticate posturing D. decerebrate posturing

A. neurologic health The Moro, tonic neck, and withdrawal reflexes are usually present in infants under 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. The presence of the Moro, tonic neck, and withdrawal reflexes does not indicate severe brain damage. Decorticate posturing is indicative of severe dysfunction of the cerebral cortex and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes. Decerebrate posturing is indicative of dysfunction at the level of the midbrain and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. The most appropriate nursing action is to A. notify the practitioner immediately. B. assess for level of consciousness (LOC). C. observe closely for signs of increased intracranial pressure (ICP). D. administer pain medication and assess for response.

A. notify the practitioner immediately. The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately because this is considered a medical emergency. Assessing for the LOC should be done as part of the assessment. The nurse is noting signs of potentially increased ICP as described; therefore, this has already been completed. Pain medication should not be given, because it can often mask the signs of increasing ICP. The priority nursing intervention is to consult with the practitioner immediately.

the basic mechanism of a seizure

Abnormal electrical discharges (1) may arise from central areas in the brain that affect consciousness; (2) may be restricted to one area of the cerebral cortex, producing manifestations characteristic of that particular anatomic focus; or (3) may begin in a localized area of the cortex and spread to other portions of the brain; if sufficiently extensive, this produces generalized seizure activity.

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? A. Suction the child frequently. B. Provide environmental stimulation. C. Turn the head side to side every hour. D. Avoid activities that cause pain or crying.

Avoid activities that cause pain or crying. Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause the ICP to increase. Suctioning is a distressing procedure. In addition, the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized because it can increase ICP. The child's head should not be turned side to side. If the jugular vein is compressed, the ICP can rise.

• A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? A. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. B. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. C. Place the child in a well-supported, semireclining position to make use of gravity flow. D. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

B. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw controls assist with head control, correction of neck and trunk hyperextension, and jaw stabilization. The child is too old to be bottle-fed. The neuromuscular compromise of the jaw interferes with the child's ability to eat. The child should be sitting up for meals to prevent aspiration. For swallowing, the neck should not be hyperextended.

The postoperative care of a preschool child who has had a brain tumor removed should include A. recording of colorless drainage as normal on the nurse's notes. B. close supervision of the child while he or she is regaining consciousness. C. positioning the child on the right side in the Trendelenburg position. D. no administration of analgesics.

B. close supervision of the child while he or she is regaining consciousness The child needs to be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain as needed.

• A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A priority nursing intervention is to A. recommend allergy testing. B. provide a latex-free environment. C. use only powder-free latex gloves. D. limit the use of latex products as much as possible.

B. provide a latex-free environment. The most important nursing intervention is to provide a latex-free environment. From birth on, limitation of exposure to latex is essential in an attempt to minimize sensitization. Latex-free catheters for self-catheterization are available. Allergy testing may expose the child to the allergen and, therefore, is not recommended. The gloves contain latex and will contribute to sensitization. No latex products should be used with children who have latex allergies. Latex products should be avoided at all times.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the major priority of nursing care? A. Initiate isolation precautions as soon as the diagnosis is confirmed. B. Initiate isolation precautions as soon as the causative agent is identified. C. Administer antibiotic therapy as soon as it is ordered. D. Administer sedatives and analgesics on a preventive schedule to manage pain

C. Administer antibiotic therapy as soon as it is ordered. Initiation of antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and to avoid resultant disabilities. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Initiation of antibiotics is the priority nursing intervention. Pain should be managed on an as-needed basis.

• Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)? A. DMD is inherited as an autosomal dominant disorder. B. DMD is characterized by weakness of the proximal muscles of both the pelvic and shoulder girdles. C. DMD is characterized by muscle weakness, usually beginning at about age 3 years. D. The onset of DMD occurs in later childhood and adolescence.

C. DMD is characterized by muscle weakness, usually beginning at about age 3 years. Usually, children with DMD reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life. DMD is inherited as an X-linked recessive disorder. Weakness in a child with DMD is usually first noted in walking. Progressive muscle weakness in other muscle groups then follows. DMD usually develops in the third year of life.

The nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. What is an appropriate nursing intervention? A. Suggest that the parents go home until the child is alert enough to know they are present. B. Use ointment on the lips but do not attempt to cleanse the teeth until swallowing returns. C. Encourage the parents to hold, talk to, and sing to the child as they usually would. D. Position the child with proper body alignment and the head of the bed lowered 15 degrees.

C. Encourage the parents to hold, talk to, and sing to the child as they usually would. The parents should be encouraged to interact with the child. Senses of hearing and tactile perception may be intact, and stimulation is important in the child's recovery. Suggesting that the parents go home until the child is awake is not recommended. The child may be able to hear that they are present, and this stimulation may assist in recovery. Oral care is essential in the unconscious child. Mouth care should be done at least twice daily to prevent oral infections. The head of the bed should be elevated, not lowered, in a child with neurologic involvement.

• What most accurately describes bowel function in children born with a myelomeningocele? A. Incontinence cannot be prevented. B. Enemas and laxatives are contraindicated. C. Some degree of fecal continence can usually be achieved. D. A colostomy is usually required by the time the child reaches adolescence.

C. Some degree of fecal continence can usually be achieved. With diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, and/or enemas. Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort, although they may be used in some instances. A colostomy is not indicated for the child with myelomeningocele.

The temperature of an unconscious adolescent is 105º F (40.5º C). The priority nursing intervention is to A. continue to monitor temperature. B. initiate a pain assessment. C. apply a hypothermia blanket. D. administer aspirin stat.

C. apply a hypothermia blanket. Brain damage can occur at temperatures as high as 105º F (40.5º C). It is extremely important to institute temperature-lowering interventions such as hypothermia blankets. DO NOT GIVE TEPID BATHS! The temperature needs to be monitored, but lowering the temperature is the priority. Pain assessments should be ongoing, but this is not the priority at this time. Lowering the body temperature is the priority. Aspirin should never be administered to a child, because of the risk of Reye syndrome. Antipyretics, such as acetaminophen or ibuprofen, usually are not effective with temperatures as high as 105º F (40. 5ºC).

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that A. no additional treatments are usually necessary. B. chemotherapy is usually not necessary. C. chemotherapy with or without radiotherapy is indicated. D. kidney transplant will be indicated within the year.

C. chemotherapy with or without radiotherapy is indicated. The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention. Most children with Wilms' tumor do not require renal transplants.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain A. cannot occur if the child is comatose. B. may occur if the child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. An important part of the discussion with the parents is that A. parental protection is essential until the child reaches adulthood. B. mental retardation is to be expected with hydrocephalus. C. shunt malfunction or infection requires immediate treatment. D. most usual childhood activities must be restricted.

C. shunt malfunction or infection requires immediate treatment. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. The development of mental retardation depends on the extent of damage before the shunt was placed. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. Based on the nurse's knowledge of seizures, the nurse recognizes this as A. absence seizure. B. generalized seizure. C. status epilepticus. D. simple partial seizure.

C. status epilepticus. Status epilepticus is a generalized seizure that lasts more than 30 minutes. This is considered a medical emergency and requires immediate treatment. Absence seizures are generalized seizures that are characterized by brief losses of consciousness, blank staring, and fluttering of the eyelids. Generalized seizures are the most common form of seizures. They include tonic-clonic (grand mal) seizures and absence (petit mal) seizures. Tonic-clonic seizures have tonic-clonic activity and loss of consciousness and involve both hemispheres of the brain. Simple partial seizures are characterized by varying sensations and motor behaviors.

A child is admitted to the pediatric intensive care unit for a submersion injury. The child's parents express guilt over the submersion injury to the nurse. The most appropriate response by the nurse is A. "You will need to watch your child more closely in the future." B. "Why did you let your child almost drown?" C. "Your child will be fine, so don't worry." D. "Tell me more about your feelings."

D. "Tell me more about your feelings." The nurse needs to be nonjudgmental and provide the parents an opportunity to express their feelings. You will need to watch your child more closely in the future is a judgmental statement. Why did you let your child almost drown? is a judgmental question. Saying the child will be fine may not be true.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? A. Restrain the child as necessary. B. Discourage the parents from holding the child. C. Do passive range-of-motion exercises once a day. D. Adjust activities to the child's tolerance level.

D. Adjust activities to the child's tolerance level. The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

• What is important when caring for a child with myelomeningocele in the preoperative stage? A. Place the child on one side to decrease pressure on the spinal cord. B. Apply a heat lamp to facilitate drying and toughening of the sac. C. Keep the skin clean and dry to prevent irritation from diarrheal stools. D. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus.

D. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure. Preoperatively, the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the physician. Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.

Which of the following phrases describes a characteristic of most neonatal seizures? A. Generalized seizure B. Tonic-clonic seizure C. Well-organized seizure D. Subtle and barely discernible seizure

D. Subtle and barely discernible seizure Signs of seizures in newborns are subtle. They include symptoms such as lip smacking, tongue thrusting, eye rolling, and arching of the back. The newborn's central nervous system is not sufficiently developed to maintain a generalized seizure. The newborn's central nervous system is not sufficiently developed to maintain a tonic-clonic (generalized) seizure. The newborn's central nervous system is not sufficiently developed to maintain a well-organized seizure.

The nurse is caring for an immobilized preschool child. What is helpful during this period of immobilization? A. Encourage the child to wear pajamas. B. Let the child have few behavioral limitations. C. Keep the child away from other immobilized children if possible. D. Take the child for a "walk" by wagon outside the room.

D. Take the child for a "walk" by wagon outside the room. It is important for children to have activities outside of the room if possible. This can give them opportunities to meet their normal growth and developmental needs. The child should be encouraged to wear street clothes during the day. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

• An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child's mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that A. most activities such as Scouts cannot be adapted for children with CP. B. after-school activities usually result in extreme fatigue for children with CP. C. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP. D. after-school activities often provide children with CP with opportunities for socialization and recreation.

D. after-school activities often provide children with CP with opportunities for socialization and recreation. Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs in order to promote socialization opportunities. Most activities can be adapted for children with CP. The child, family, and activity director should assess the degree of activity to ensure it matches the child's capabilities. A supportive environment associated with after-school activities will add to the child's self-esteem.

The most appropriate nursing intervention when caring for a child experiencing a seizure is to A. restrain the child when a seizure occurs to prevent bodily harm. B. place a padded tongue between the teeth if they become clenched. C. suction the child during the seizure to prevent aspiration. D. described and document the seizure activity observed.

D. described and document the seizure activity observed. The priority nursing intervention is to observe the child and seizure and document the activity observed. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.

External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure A. prevention of urinary tract complications. B. prevention of separation anxiety. C. acceptance of hospitalization. D. development of normal body image.

D. development of normal body image. Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

The nurse is instructing a group of parents about head injuries in children. The nurse should explain that infants are particularly vulnerable to acceleration-deceleration head injuries because the A. anterior fontanel is not yet closed. B. nervous tissue is not well developed. C. scalp of head has extensive vascularity. D. musculoskeletal support of head is insufficient.

D. musculoskeletal support of head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants of acceleration-deceleration head injuries. The lack of closure of the anterior fontanel is not relevant to the development of acceleration-deceleration head injuries in infants. The lack of well-developed nervous tissue is not relevant to the development of acceleration-deceleration head injuries in infants. The vascularity of the scalp is not relevant to the development of acceleration-deceleration injuries in infants.

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is A. birth asphyxia B. neonatal diseases C. cerebral trauma D. prenatal brain abnormalities

D. prenatal brain abnormalities The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period. Birth asphyxia had previously been thought of as a factor in the development of CP. Neonatal diseases have previously been thought of as factors in the development of CP. Cerebral trauma has previously been thought of as a factor in the development of CP.

• The major goal of therapy for children with cerebral palsy (CP) is A. reversing degenerative processes that have occurred. B. curing the underlying defect causing the disorder. C. preventing spread to individuals in close contact with the children. D. recognizing the disorder early and promoting optimal development.

D. recognizing the disorder early and promoting optimal development. Because CP is currently a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy. It is difficult to reverse the degenerative processes associated with CP. The underlying defect(s) associated with the development of CP cannot be cured. CP is not contagious.

• A neural tube defect that is not visible externally in the lumbosacral area would be called A. meningocele. B. myelomeningocele. C. spina bifida cystica. D. spina bifida occulta.

D. spina bifida occulta. Spina bifida occulta is completely enclosed. Often, this disorder will not be noticed. A clue to the presence of this internal disorder will be a dimple or tuft of hair on the lumbosacral area. A meningocele contains meninges and spinal fluid but no neural tissue and is evident at birth as a sac in the lumbosacral area. Transillumination of light will be present. A myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves and is evident at birth as a sac in the lumbosacral area. Transillumination of light will not be present. Spina bifida cystica is a cystic formation with an external saclike protrusion

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? A. Increased metabolism B. Increased venous return C. Increased cardiac output D. Decreased exercise tolerance

Decreased exercise tolerance Muscle disuse leads to tissue breakdown and loss of muscle mass or muscle atrophy. It may take weeks or months to recover. Metabolism decreases during periods of immobility. There is decreased venous return due to decreased muscle activity secondary to immobility. There is decreased cardiac output secondary to immobility.

Identify five clinical signs or symptoms that are seen in children with spastic CP

Increased muscle tone Increased deep tendon reflexes and clonus (sudden dorsiflexion of the ankle or rapid distal movement of the patella resulting in alternating spasm and relaxation of the muscles being stretched) Flexor, adductor, and internal rotator muscles more involved than extensor, abductor, and external rotator muscles Difficulty with fine and gross motor skills Most common contracture is that of the heel cord. Hip adductor contractures leading to progressive subluxation and dislocation Knee contractures Scoliosis common Typical gait is crouched, in-toeing, and scissoring. Elbow, wrist, and fingers in flexed position with thumb adducted Motor weakness of antagonist muscle groups

Identify at least six warning signs associated with CP

Physical Signs Poor head control after 3 months of age Stiff or rigid arms or legs Pushing away or arching back Floppy or limp body posture Inability to sit up without support by 8 months Use of only one side of the body, or only the arms to crawl Behavioral Signs Extreme irritability or crying Failure to smile by 3 months Feeding difficulties Persistent gagging or choking when fed After 6 months of age, tongue pushing soft food out of the mouth

vaccines that reduce the incidence of bacterial meningitis

Routine immunization of infants with Haemophilus influenzae type b and pneumococcal conjugate

Epilepsy

a condition characterized by two or more unprovoked seizures and can be caused by a variety of pathologic processes in the brain. Seizures are a symptom of an underlying disease process. A single seizure event should not be classified as epilepsy and is generally not treated with long-term antiepileptic drugs

Status epilepticus

a continuous seizure that lasts more than 30 minutes or a series of seizures from which the child does not regain a premorbid level of consciousness.

Cerebral palsy (CP)

a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. One of the major risk factors for development of CP is preterm birth.

Epidural (extradural) hematoma

a hemorrhage into the space between the dura and the skull. As the hematoma enlarges, the dura is stripped from the skull; this accumulation of blood results in a mass effect on the brain, forcing the underlying brain contents downward and inward as it expands.

Submersion injury

a major cause of unintentional injury-related death in children ages 1 to 14 years. The term near-drowning is no longer used; instead, the term submersion injury should be used up until the time of drowning-related death• All children who have a submersion injury should be admitted to the hospital for observation. Although many patients do not appear to have suffered adverse effects from the event, complications (e.g., respiratory compromise, cerebral edema) may occur 24 hours after the incident.

Acute bacterial meningitis

a medical emergency that requires early recognition and immediate therapy to prevent death and avoid residual disabilities. The child is isolated from other children, usually in an intensive care unit for close observation. An IV infusion is started to facilitate administration of antimicrobial agents, fluids, antiepileptic drugs, and blood, if needed. The child is placed on a cardiac monitor and in respiratory isolation.

Head injury

a pathologic process involving the scalp, skull, meninges, or brain as a result of mechanical force. Fractures resulting from head injuries may be classified as depressed, compound, basilar, and diastatic

seizure

a symptom of an underlying pathologic condition and may be manifested by sensory-hallucinatory phenomena, motor effects, sensorimotor effects, or loss of consciousness. The manifestation of seizures depends on the region of the brain in which they originate and may include unconsciousness or altered consciousness; involuntary movements; and changes in perception, behaviors, sensations, and posture.

neural tube defects

constitute the largest group of congenital anomalies with multifactorial inheritance. The most common are spina bifida and myelomeningocele.

Nursing care of the child with meningitis includes

administering antibiotics, taking isolation precautions, removing environmental stimuli, ensuring correct positioning, monitoring vital signs, administering intravenous (IV) therapy, promoting adequate fluid and nutritional status, and providing supportive care to the family.

• Management of nephrotic syndrome

aimed at reducing excretion of protein, reducing or preventing fluid retention by tissues, and preventing infection and other complications

Bacterial meningitis

an acute inflammation of the meninges and cerebrospinal fluid

subdural hemorrhage

bleeding between the dura and the arachnoid membrane, which overlies the brain and the subarachnoid space. The hemorrhage may be from two sources: (1) tearing of the veins that bridge the subdural space and (2) hemorrhage from the cortex of the brain caused by direct brain trauma. Subdural hematomas are much more common than epidural hematomas and occur most often in infancy, with a peak incidence at 6 months.

Partial seizures

categorized as simple (meaning without associated impairment of consciousness) or complex (with impaired consciousness); both types may become generalized. Partial seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most often affected and are characterized by localized motor symptoms; somatosensory, psychic, or autonomic symptoms; or a combination of these.

Generalized seizures

categorized as tonic-clonic, absence, atonic and akinetic, myoclonic, and infantile spasms. The generalized tonic-clonic seizure, formerly known as grand mal, is the most dramatic of all seizure manifestations of childhood

Nephrotic syndrome

characterized by increased glomerular permeability to protein, with massive urinary loss of protein resulting in hypoproteinemia and edema. A previously well child begins to gain weight, which progresses insidiously over a period of days or weeks. Puffiness of the face, especially around the eyes, is apparent on arising in the morning but subsides during the day, when swelling of the abdomen and lower extremities is more prominent. The generalized edema may develop so slowly that parents consider it a sign of healthy growth. The disorder can occur as a primary disease, known as idiopathic nephrosis, childhood nephrosis, or minimal-change nephrotic syndrome