Chapter 16: Nursing care of the child with an alteration in intracranial regulation/ Neurologic disorder

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? (Select all that apply.) "It is so scary to think that our child will likely develop epilepsy now." "I am afraid that our 10-year-old will start having febrile seizures." "I am thankful that our child won't have to be on anti-seizure medication." "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened." "It's important to manage fevers in the future in order to decrease the risk of febrile seizures."

"It is so scary to think that our child will likely develop epilepsy now." "I am afraid that our 10-year-old will start having febrile seizures." Rationale: It is very unlikely that the parents' 10-year-old child will develop febrile seizures. Febrile seizures usually affect children who are younger than 5 years of age, with the peak incidence occurring in children between 12 and 18 months old; it is rare to see febrile seizures in children younger than 6 months and older than 5 years of age. Children who experience one or more simple febrile seizures have a slightly greater risk of developing epilepsy than the general population, so it is not "likely" that the child will develop epilepsy.

The nurse is providing education to the parents of a 2-year-old child with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught? "Call the healthcare provider if your child gets a headache." "Always keep your child's head raised 30 degrees." "Limit the amount of television your child watches." "Watch for changes in your child's behavior or eating patterns."

"Watch for changes in your child's behavior or eating patterns." Rationale: Changes in behavior or in eating patterns can suggest a problem with the shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression. Obtundation Disorientation Coma Oriented to person, place, and time Stupor

1) Oriented to person, place, and time 2) Disorientation 3) Obtundation 4) Stupor 5) Coma Rationale: Levels of consciousness in order from most alert to least alert are orientated to person, place, and time (full consciousness); confusion (disorientation); obtundation; stupor; and finally coma.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke? Meningitis Arteriovenous malformations (AVMs) Sickle cell disease Congenital heart defect

Arteriovenous malformations (AVMs) Rationale: Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

The nurse determines that a child is experiencing late signs of increased intracranial pressure based on which assessment findings? (Select all that apply.) Increased blood pressure Bradycardia Sunset eyes Irregular respirations Fixed dilated pupils

Bradycardia Irregular respirations Fixed dilated pupils Rationale: Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate to give in this situation? (Select all that apply.) Diazepam Lorazepam Gabapentin Carbamazepine Fosphenytoin

Diazepam Lorazepam Fosphenytoin Rationale: Commonly used medications for treating status epilepticus include lorazepam, diazepam, and fosphenytoin. Gabapentin and carbamazepine are anticonvulsants used to treat and prevent seizures in general.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? Congenital hydrocephalus Head trauma Intracranial hemorrhaging Positional plagiocephaly

Head trauma Rationale: A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

A 6-month-old infant is admitted with suspected bacterial meningitis. The infant is crying, irritable, and lying in the opisthotonic position. Which priority intervention the nurse should take? Educate the family about preventing bacterial meningitis. Palpate the child's fontanels. Encourage the parent to hold and comfort the infant. Institute droplet precautions in addition to standard precautions.

Institute droplet precautions in addition to standard precautions. Rationale: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the parent to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. The nurse suspects caput succedaneum based on what evidence? The infant had low-set ears and facial abnormalities. The swelling is limited to one small area without crossing the sagittal suture. The infant had a low birthweight when born at term. The swelling crosses the midline of the infant's scalp.

The swelling crosses the midline of the infant's scalp. Rationale: The fact that the swelling crosses the midline of the infant's scalp indicates caput succedaneum. If the swelling is limited and does not cross the midline or suture lines, it would suggest cephalohematoma. Low birthweight does not suggest caput succedaneum. Low-set ears may be seen in infants with chromosomal abnormalities. Facial abnormalities may accompany encephalocele.

A child is diagnosed with aseptic meningitis. The child's parent states, "I don't know where my child would have picked this up." The nurse prepares to respond to the parent based on the understanding that this disorder is most likely caused by: enterovirus. Escherichia coli. Streptococcus group B. Haemophilus influenza type B.

enterovirus. Rationale: Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. The nurse interprets this as indicating damage to the: midbrain. cranial nerves. cerebral cortex. meninges.

midbrain. Rationale: The observations indicate decerebrate posturing, which occurs with damage to the midbrain. Decorticate posturing as evidenced by arm adduction, elbow flexion with arms over the chest, and wrist flexion with fisted hands indicates damage to the cerebral cortex. Damage to the cranial nerves would be manifested by defects in motor and/or sensory function depending on the cranial nerves affected. Meningeal irritation, as with bacterial meningitis, is manifested by opisthotonus in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? "Did you use any medications like aspirin for the fever?" "Did you give your child any acetaminophen, such as Tylenol?" "How high did his temperature rise when he was ill?" "What type of fluids did your child take when he had a fever?"

"Did you use any medications like aspirin for the fever?" Rationale: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

The parent of a newborn with a caput succedaneum asks the nurse how this happened to the baby. Which response by the nurse would be most appropriate? "During delivery, your vaginal wall put pressure on the baby's head." "Your baby's head became blocked inside your vagina while you were pushing." "It's normal for this to happen, but they don't really know why." "The forceps used during delivery caused this to happen."

"During delivery, your vaginal wall put pressure on the baby's head." Rationale: Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify this as a neural tube defect. Encephalocele Arnold--Chiari malformation Spina bifida occulta Anencephaly

Arnold--Chiari malformation Rationale: Arnold--Chiari malformation is a deformity of the cerebellar tonsils being displaced into the upper cervical canal. Anencephaly is a neural tube defect. Encephalocele is a neural tube defect. Spina bifida occulta is a neural tube defect.

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? Seizure activity Intracranial mass Brain stem herniation Brain stem dysfunction

Brain stem dysfunction Rationale: Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? Dramatic increase in head circumference Vertical nystagmus Pupil of one eye dilated and reactive Posterior fontanel is closed

Dramatic increase in head circumference Rationale: A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

The nurse is caring for an 8-year-old child who was in a car accident. What would lead the nurse to suspect a concussion? The child is bleeding from the ear and draining fluid from the nose. The child has vomited and has bruising behind the ear. The child is easily distracted and can't concentrate. The child is weak and has blurry vision.

The child is easily distracted and can't concentrate. Rationale: A child with a concussion will be distracted and unable to concentrate. Signs and symptoms of contusions include disturbances to vision, strength, and sensation. Vomiting and bruising behind the ear are signs of a subdural hematoma. Bleeding from the ear and otorrhea are signs of a basilar skull fracture.

A child is hospitalized diagnosed with bacterial meningitis. What can the nurse anticipate will be included in the plan of care and treatment? (Select all that apply.) Acetaminophen Antibiotic therapy Administering tepid baths as needed Antiviral medications Ice packs to the back of the neck and feet to reduce body temperature

Acetaminophen Antibiotic therapy Administering tepid baths as needed Rationale: Bacterial meningitis involves a multifaceted plan of care and treatment. Ice packs will sharply reduce temperature and should not be used. Measures that promote shivering should be avoided as they will increase the metabolic rate. Acetaminophen will be prescribed in effort to reduce the body temperature. Tepid baths can be instituted as needed to reduce body temperature. Antibiotic therapy will be initiated to eradicate the pathogens. Antiviral medications are not indicated as this is not a viral infection.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? 11 PM bedtime; 6:30 AM wake-up Swimming twice a week Drinking three cans of diet cola Use of nonscented soap

Drinking three cans of diet cola Rationale: Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? (Select all that apply.) Fontanels Eye opening Verbal response Motor response Posture

Eye opening Verbal response Motor response Rationale: The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? (Select all that apply.) This type of seizure is usually short, lasting for no more than 30 seconds. You might have mistaken this type of seizure for lack of attention. Your child will probably sleep deeply for ½ to 2 hours after the seizure. This type of seizure is more common in girls than it is in boys. The child will commonly report a strange odor or sensation before the seizure. You might see a blank facial expression after a sudden stoppage of speech.

This type of seizure is usually short, lasting for no more than 30 seconds. You might have mistaken this type of seizure for lack of attention. This type of seizure is more common in girls than it is in boys. You might see a blank facial expression after a sudden stoppage of speech. Rationale: Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

The nurse is educating the parents of a 7-year-old child with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Instructing the child's teacher how to respond to a seizure Treating the child as though the child did not have epilepsy Placing the child on the side on the floor Understanding the side effects of medications

Understanding the side effects of medications Rationale: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though the child did not have epilepsy helps improve the child's self-image and self-esteem. Placing the child on the side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

When assessing a neonate for seizures, what would the nurse expect to find? (Select all that apply.) Tonic--clonic contractions Jitteriness Elevated blood pressure Tachycardia Ocular deviation

Jitteriness Elevated blood pressure Tachycardia Ocular deviation Rationale: Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic--clonic contractions typically are more common in older children.

A 9-year-old child is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Have the child sleep without a pillow under the head. Teach the child and parents to keep a headache diary. Have the parents call the healthcare provider if the child vomits more than twice. Review the signs of increased intracranial pressure with parents.

Teach the child and parents to keep a headache diary. Rationale: A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the healthcare provider when the child has a head injury.

A parent has brought their 5-month-old child to the clinic because the child has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? The child has a high-pitched cry. The child is not responding or eating well. The child's pupil reaction time is rapid and uneven. The fontanels are bulging or tense.

The child is not responding or eating well. Rationale: Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.