Seizure Disorders
Baby Doe was delivered vaginally in the emergency department (ED) after a homeless pregnant woman arrived on foot, hemorrhaging heavily, and obviously impaired with drugs and/or alcohol. Unfortunately, the mother did not survive and no history was obtained before her death. After delivery, Baby Doe was transferred to the intensive care nursery and placed under your care. Shortly after admission, he became apneic and bradycardic, and he began chewing and smacking his lips. You recognize this as:
Complex partial seizure activity, most likely due to drug and alcohol withdrawal
Roscoe Sinter, who is 8 years old, is entering public school for the first time. Previously, he was home-schooled because of his generalized seizure disorder. As his seizures have been fully controlled and he has been seizure free for 12 months, his health care providers have given him permission to attend public school. As his school nurse, what are your priorities?
Formulating an individualized health plan for Roscoe and educating school personnel about how to respond to a seizure
A nurse is called to an examining room where a young child is having a seizure. When the nurse arrives, the parent says the child has been in the seizure for about 2 min. As the seizure continues, the nurse suspects possible status epilepticus. While waiting for the health care provider to arrive, what emergency actions should the nurse implement? Select all that apply. Monitor vital signs. Manage thermoregulation. Maintain a patent airway. Give supplemental oxygen. Insert a nasogastric (NG) tube.
Monitor vital signs maintain patent airway give supplemental oxygen
Harvey Baker, who is 15 years old, has been living with generalized seizure disorder since age 6 years as a result of traumatic brain injury (TBI). His family has tried treatment with anticonvulsants, the ketogenic diet, and a surgically implanted vagus nerve stimulator. Harvey still experiences multiple generalized seizures daily as well as several episodes of status epilepticus monthly. Each episode has resulted in further brain damage. He is currently your client in the pediatric intensive care unit (PICU) after such an episode. He is stable and resting comfortably at this time. Your next focus of treatment is:
Providing support to Harvey's family, including listening to their concerns and connecting them with community resources
An important part of preoperative care for the newborn with a neural tube defect is:
Providing tactile stimulation to the child
The nurse is caring for a pediatric client with a history of seizure activity. The child is being treated with gabapentin. The nurse knows that gabapentin should not be given within 2 hrs of which class of medication?
antacids
Important items in the assessment of a newborn with a neural tube defect are:
assessing the extremities for deformity, monitoring the integrity of the sac, and being alert for cerebrospinal fluid (CSF) leakage and sings of infection
A 5-year-old with a seizure disorder has been on a ketogenic diet for the last 6 months, with a decrease in seizure activity. This child is now admitted to the pediatric unit with left-sided back pain. The nurse tells the parents about what possible complication of the ketogenic diet?
kidney stones
A child with a history of seizures arrives in the emergency department (ED) in status epilepticus. What is the nurse's initial response?
maintain a patent airway
Non-communicating hydrocephalus results from:
obstruction
A 2-year-old child arrives on the pediatric floor after being referred by a local pediatric health care provider. Upon arrival, the child has a seizure. How should the nurse administer the ordered anticonvulsants without an accessible intravenous (IV) line?
rectally
The nurse is caring for a 3-year-old child who was previously diagnosed with febrile seizures. The nurse is teaching the mother how to calculate a proper acetaminophen dose for the child. The child's weight is 32 pounds (14.5 kg). The safe dose of acetaminophen is 10 to 15 mg/kg/dose. The nurse knows the mother has understood the teaching when she states the safe dose range as (round to the nearest whole number): 145 to 216 mg 200 to 250 mg 166 to 224 mg 120 to 200 mg
145 to 216
Parents and family of a child with hydrocephalus must show understanding of and proficiency with:
Avoidance of latex and latex-containing products Your answer is correct. Signs and symptoms of shunt failure How to recognize and respond to the child's seizure
A 6 year old child has been having seizures. The child's mother asks the nurse what she should do when a seizure occurs. Which responses by the nurse are appropriate?
Call 911 if the seizure lasts more than 5 minutes. Turn your child on his side. Check your watch or clock when you see signs of a seizure starting.
The nurse is caring for a child who has a history of generalized seizures. Which clinical manifestations will the nurse be alert for when providing care for this child? Select all that apply. Lip chewing Clonic phase Crying or grunting Drooling or foaming at the mouth Tonic phase
Clonic phase Crying or grunting Drooling or foaming at the mouth Tonic phase
A 16-year-old female with a seizure is being treated with valproic acid. The client tells you that she is sexually active. What is the most important teaching point the nurse will emphasize when she comes to the clinic for a routine exam?
Discussing the need for contraception
A 10-year-old female with epilepsy is being treated with valproic acid. The child has lost weight recently. What is the most important nursing intervention when she comes to the clinic for a routine exam? Asking if she is interested in getting a driver's license Encouraging her to take the medication with food Encouraging exercise and physical activity Encouraging her to keep a change of clothes in her backpack during school hours
Encouraging her to take the medication with food
The nurse is caring for a child who has been diagnosed with complex partial seizures. Which clinical manifestations would the nurse expect to assess during the child's seizure activity? Select all that apply. Lip smacking Posturing Motor responses in one extremity Twitching Impaired consciousness
Lip smacking Posturing Twitching Impaired consciousness
Nathan Hollister, age 4 years, is being seen in the neurologist's office where you are employed. Nathan has been on a ketogenic diet for 6 months. His parents tell you they cannot continue on the diet because of the side effects. He is to enter kindergarten in 6 months, and they are desperate for another treatment for the 50 to 100 absence seizures Nathan experiences each day. Your best response to the parents is to:
Offer additional treatments for the constipation and other side effects, and encourage the parents to continue with the diet for another 6 months for the greatest benefit to Nathan
Preoperative care for the child with hydrocephalus includes:
Use of soft covering under the head to protect skin
The nurse is caring for a 7-year-old child who has been having intractable seizures. The nurse educates the family and the child a potential treatment option could include what? Surgery A second antiepileptic medication Taking medium chain triglyceride (MCT) oil A ketogenic diet
a ketogenic diet
Types of neural tube defects include:
defect in the skull with protruding meningeal tissue or meningeal-covered brain; the protrusion of a cerebrospinal fluid (CSF)-filled meningeal sac through a vertebral defect, no brain development above the brainstem, a defect of the vertebral column in which the posterior arches fail to fuse, and a protrusion of a meningeal sac containing CSF, a portion of the spinal cord, and nerves through a vertebral defect
Parents bring their 2-year-old child to the emergency department (ED), stating that the child "Just had her first seizure." They say that the seizure lasted less than 5 min and involved jerking movements over the entire body. Prior to the seizure, the child had been sick and was running a fever. Based on the description, the nurse suspects that the child experienced which type of seizure?
febrile
Comprehensive care for the child with myelomeningocele includes all of the following except:
gradual elimination of latex allergy
The nurse is caring for a child who has recently been placed on a ketogenic diet. What does this diet include? Meals based on a 1,500-calorie diabetic diet High amounts of carbohydrates Low amounts of protein High amounts of fat
high amounts of fat
The nurse is caring for an infant who is experiencing seizures. The nurse correctly states that infantile seizures are caused by what?
infection, congenital disease, perinatal hypoxia
Assessment findings in toddlers and older children with hydrocephalus include all of the following except:
split cranial sutures
Ventriculoperitoneal (VP) shunts used to treat communicating hydrocephalus:
terminate in the peritoneal cavity, the atrium of the heart, or the pleural space. This shunt can become blocked or infected
Surgery to close the defect associated with myelomeningocele (spina bifida) should occur:
within 24 to 48 hours
Surgery to close the defect associated with myelomeningocele (spina bifida) should occur:
within 24-48 hours after birth
Prior to discharge from the hospital, the nurse provides a teaching session for parents of a child who recently had a tonicdash-clonic seizure. Which statement by the parent indicates a need for further teaching?
"A tonicdash-clonic seizure causes a loss of consciousness for 30 min."
The nurse is teaching a mother of a young child with a newly diagnosed seizure disorder. The child has been put on valproic acid for control of seizures. The nurse knows that the mother does not understand the side effects of valproic acid when she states: "I will bring him to the health care provider's office for regular blood work to check bleeding times." "So that he will absorb it better, I will give his medicine on an empty stomach." "I will not let him chew his tablet." "I will not use carbonated beverages to dilute his medication."
"So that he will absorb it better, I will give his medicine on an empty stomach."
