Chapter 38, 44
Place child in isolation until 24 hours of antibiotic therapy has completed
A child come into the emergency department with a diagnosis of meningitis, where would you place the patient?
serum glucose leve
A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority?
oxygen gauge and tubing suction at bedside padding for side rails
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.
Loss of motor activity accompanied by a blank stare
Absence seizures are marked by what clinical manifestation?
What is Attention Deficit Hyperactivity Disorder?
Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.
meningocele has no ?
No spinal nerve involvement
- Irritability - Lethargy - Vomiting - Change in Appetite
Signs and symptoms of viral meningitis in infants and toddlers?
Gather appropriate equipment and signage for respiratory isolation precautions
The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?
-Unknown -Linked to inadequate consumption of the B vitamin folic acid before conception and during the first trimester
What is the etiology of spina bifida?
Change of level of consciousness
What is the initial finding in the client who is experiencing an increase in intracranial pressure?
Gabapentin is used in the treatment of seizure disorders. It is rapidly absorbed It cannot be taken within 2 hours of the administration of antacid medications.
What medication is used for the treatment of seizures disorder?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
Which nursing observations suggest an absence seizure?
Protect the child from hitting the arms against the bed.
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority?
What is autism spectrum disorder?
a developmental disorder that affects communication and behavior
Developmental Dysplasia of the Hip (DDH)
assymetrical gulteal and thigh folds. limited abduction of hips.
Forefoot
curls toward heel and upward in partial spination
two distinct posturing that may occur with motor function
decorticate decerebrate
•Damage to the vertebrae
what Is structural scoliosis?
assessment of DDH
•The diagnosis should be made in the newborn period
a child brain is
•highly vascular: increased risk for hemorrhage
Hindfoot
•turns inward (varus)
A private room near the nurses' station
A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room?
Did you use any medications, like aspirin, for the fever?"
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?
Assess the level of consciousness (LOC).
A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?
never to discontinue the drug abruptly.
Any individual taking phenobarbital for a seizure disorder should be taught:
noncommunicating hydrocephalus
CSF flow obstruction
what is clubfoot?
Deformity of the foot; twisted out of normal shape/position
treatment of DDH infants older than 3 months
Skin traction (Bryant's Traction) followed by spica cast
•Most common form of MD •X-linked recessive •Occurs only on males (1 out of every 3,500) live births
What is Duchenne Muscular Dystrophy?
alterations in motor function may indicate
certain neurologic problems such as increased ICP, head injury, and cerebral infections
administer antibiotics 7-14 days
how long should patient with meningitis adhere to treatment?
Semicomatose
partially in a coma - deep sleep 30 minutes 2 hours
meningitis
what is the most common infection of the CNS?
treatment of DDH Child older than 18 months
•Traction, operative reduction, rehabilitation
Diagnosis of hydrocephalus
•With infants, based on clinical manifestations •Daily head circumference is critical in infant at risk •Older children signs of increase ICP •CT/MRI •Infant with open fontanels U/S and EEG
Midfoot
•directed downward (equinus)
never to discontinue the drug abruptly.
Any individual taking phenobarbital for a seizure disorder should be taught?
•abnormal muscle tone, lack of coordination
Cerebral palsy is characterized by?
Dramatic increase in head circumference
During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?
based on clinical findings
How is cerebral palsy diagnosed?
- Headache, - malaise, - muscle aches, -nausea/vomiting, - photophobia, - nuchal/spinal rigidity
Signs and symptoms of viral meningitis in older children?
The child is in status epilepticus
The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:
Irritability, fever, and vomiting
The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?
Risk for injury
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 highestpriority?
Cerebral edema
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?
decerebrate
extension away from body, pronation of arms/legs -Damage at the level of the brain stem
- increased intracranial pressure - Cushing triad
hydrocephalus patient have?
-Surgery
if scoliosis is curve >40 degrees, what treatment would be given?
simple partial seizure
no loss of consciousness -•Occurs in specific parts of the brain •Symptoms correlate with which part of the brain - •Usually persists for 10-20 seconds •No postictal state
•Displaced fractures -Manual traction then casting •Severe -Traction followed by casting •Complex -Open reduction and internal fixation
therapeutic management of fractures?
treatment of DDH in Infants-under 3 mos. age
•Pavlik harness •Worn for 3-6 months-ensures hip flexion and abduction but doesn't allow hip extension or adduction
Autism Spectrum Disorder
•Pervasive developmental disorder •Impaired social interaction Ritualism •Intellectually disabled
what is the clinical therapy of hydrocephalus?
•Remove the obstruction (remove tumor) •Create a new CSF pathway to divert excess CSF
signs and symptoms of shunt infection
Elevated vital signs, Poor feeding, Vomiting, Decreased responsiveness, Seizure activity , Signs of local inflammation along the shunt tract
Lasts less than 30 seconds
How long does absence seizures last?
-Immobilize -Cold therapy for 48 hours -Elevation -Frequent neurovascular checks -Pain management -Tetanus vaccine if an open fracture or he or she has not received a tetanus booster in the past 5 years
Nursing management of patients after injury with fracture?
use of anticonvulsant medications
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client?
A neural tube defect that develop during the first trimester of fetal development
What is spina bifida?
Avoid making noise when in the child's room.
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis?
Signs of increased intracranial pressure (ICP)
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?
a child spinal cord is
is mobile: high risk for cervical spine injury
- Viral - Bacterial
two primary classifications of meningitis?
•Supportive (physiotherapy, wheelchair, braces) •Prevent obesity •Surgical (scoliosis) Steroids (experimental
what are key treatments for patient with muscular dystrophy?
•ROM •Log rolling Q 2 h. •Encourage deep breathing & cough •Incentive spirometry •NPO •Nasogastric tube •Frequent VS & neurological checks •Monitor H & H •Blood transfusions •Pain management •Antibiotics •Antiembolism stockings
what are post-operative care of patients with scoliosis?
Developmental Dysplasia of the Hip (DDH) higher in incidence in
•Family history (higher incidence in 1st degree relative) •Frank breech births •Identical twins •Navajo and Eskimo populations (swaddling) •Cause unknown-genetic factors play a role
communicating hydrocephalus
•Flow is not obstructed, but CSF is inadequately reabsorbed in the subarachnoid space
what is Ventriculoperitoneal (VP) Shunt?
•Insertion of a flexible tube into the lateral ventricle of the brain
therapeutic management of ADHD
•Medication •Behavior modification •Classroom management
preoperative care of hydrocephalus
•Monitor head circumference •Monitor for signs of ICP •Small frequent feedings •Assess respiratory status •Good skin care Position child carefully
post operative care of hydrocephalus
•Place child in flat position •Elevate HOB gradually •Avoid sedation •Monitor for signs of ICP and monitor VS •Educate parents concerning signs and symptoms of shunt infection or shunt malfunction
nursing intervention for meningitis?
•Place child in isolation until 24 hours of antibiotic therapy has completed •Administer antibiotics (7-14 days) •Fever control •Monitor for signs of ICP •Monitor for fluid overload •Viral meningitis is treated symptomatically
reyes syndrome signs and symptoms
•Severe and continual vomiting •Changes in mental status •Lethargy •Irritability •Confusion •Hyperreflexia
- Hypertonicity (gaining water) _ hypotonia (decreased muscle tone) - Scissoring legs - absence of reflexes - failure to meet developmental milestones altered speech
Signs and symptoms of cerebral palsy?
tubes to drain excess cerebrospinal fluid on brain.
What are shunts used for?
- increased caloric intake - special feeding devices
nutrition approach for children with cerebral palsy?
Postical phase of seizure
period directly after the seizure is over. It is especially important to describe the seizure episode including behavior after the seizure and document drug therapy.
- Elevated vital signs - Poor feeding - Vomiting - Decreased responsiveness - Seizure activity
signs and symptoms of shunt infections?
•Compensatory mechanism in children with unequal leg lengths, poor posture
what is functional scoliosis?
inflammation of the meninges (three membranes that envelop the brain and spinal cord)
what is meningitis?
Sacral pocket w/ meninges in it
what is meningocele?
Symptomatically. Not treated with medicine. Rest, plenty of fluids, and medication to reduce fever
How is viral meningitis treated?
Placing the infant in an infant car seat after feeding the patient to help reduce cerebral edema and pressure.
How should the mother place their child with intracranial pressure after feeding?
Does your child take phenytoin?"
The nurse is assessing a child and notes horizontal nystagmus. Which question would the nurse ask the parent first?
a neural tube defect
The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history?
Use a doll with electrodes attached to the head.
The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child?
Initiate droplet isolation. Identify close contacts of the child who will require post-exposure prophylactic medication. Administer antibiotics as ordered. Initiate seizure precautions.
The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply.
Bulging fontanel (fontanelle)
What finding is consistent with increased intracranial pressure (ICP) in an infant?
A build-up of fluid in the cavities deep within the brain.
What is hydrocephalus?
more severe than meningocele because the sac contains spinal fluid, meninges and nerves
What is myelomeningocele?
Decorticate
flexion into body -damages of cerebral cortex
- Daily head circumference is critical in infant at risk
for patients with hydrocephalus, what should you do daily?
•Brace worn 23 hours a day •Brace is off to shower, bathe and swim •T-shirt to be worn under the brace •Consistent use of brace will provide maximum benefit
how often should the Milwaukee brace be worn?
-Monitor every 3-6 months -Exercises to improve posture and muscle tone
if scoliosis is curve <15-20 degrees, what treatment would be given?
I need to watch for any new bruises or bleeding and let my health care provider know about it."
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?
eye opening verbal response motor response
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.
Sometimes it is hard to tell what products may contain aspirin."
The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?
-Milwaukee brace
if scoliosis is curve >24 degrees but, <40 degrees what treatment would be given?
complex partial seizure
in epilepsy, a type of seizure that doesn't involve the entire brain and therefore can cause a wide variety of symptoms - •Consciousness impaired - •Difficult to control
•Violent shaking: shaken baby syndrome (SBS) •Blows to the head •Intentional cranial impacts against the wall, furniture, or the floor
what are causes of non accidental head trauma?
- prenatal-sonogram and increased AFP - children need multiple surgeries and multidisciplinary team
what are diagnosis of spina bifida?
•Early flexion contraction •Scoliosis •Usually wheelchair bound by 12 years old •Death due to pneumonia/respiratory failure or CHF
what complications can children have with muscular dystrophy?
•Muscle biopsy •Electromyography (EMG)
what exams do nurses perform to rule of muscular dystrophy?
Increased systolic BP (increased pulse pressure), widened pulse pressure, bradycardia, irregular respirations
what is Cushing's triad?
Gower sign
what is a classic physical examination finding in muscular dystrophy?
•Spastic -Spasticity (hypertonicity of muscle groups) •Dyskinetic -Bizarre twisting movements •Ataxic -Disturbed coordination •Mixed
what is cerebral palsy characterized by
Cerebral palsy is due to abnormal brain development, often before birth.
what is cerebral palsy?
inflammation of the brain that may lead to inflammation of meninges
what is encephalitis?
a group of inherited conditions that result in progressive muscle weakness and wasting.
what is muscular dystrophy?
lateral curvature of the spine
what is scoliosis?
CBC LP MRI CT scan
what laboratory testing. would you do for a patient with encephalitis?
What is Reye's syndrome?
•A prodromal viral illness, such as chickenpox, croup, flu, or an upper respiratory infection
older child with DDH
•Affected leg shorter than the other •History of delay in walking •Limp •Lordosis or waddling gait (with bilateral dislocation)
assessment of doh in infants
•Asymmetry of gluteal and fat thigh folds •Limited abduction of the affected hip •Positive Ortoloni's maneuver (listen for clunk-8 to 12 weeks) •Barlow's maneuver (gentle downward movement, feel dislocation-8 to 12 weeks) •Difference in leg length •Difference in knee height symmetry (Allis sign)
warning signs of autism spectrum?
•Not babbling by 12 months •No gestures by 12 months •No single words by 16 months Needs IEP
factors affecting neurological disease in children?
•Prematurity •Difficult birth •Infection during pregnancy •Nausea, vomiting, headaches •Changes in gait •Falls •Visual disturbances •Recent trauma
spina bifida occulta, meningocele, myelomeningocele
what are types of spina bifida?
•Falls •Motor vehicle accidents •Pedestrian and bicycle accidents •Child abuse
what are. common head trauma in children?
Protozoan, bacterial, fungal, viral Associated with a viral illness in children Early diagnosis is essential Prognosis depends on causative agent
what causes encephalitis
ICP and fluid overload
what should you monitor closely for with patients with meningitis?
Treatment of clubfoot
•Correction is best achieved if it is begun in the newborn period •Passive range of motion once cast off •May need Denis Browne splints for up to 1 year •Surgery (3-12 mos of age)
what Is the exact cause of clubfoot?
•Exact cause is unknown •Affected foot is usually smaller and shorter
children with ADHD also have?
•Tourette Syndrome
Positive Kernig sign
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?
The child will remain free from injury during a seizure.
The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client?
"Watch for changes in his behavior or eating patterns."
The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?
Fever Flu-like symptoms Altered LOC Headache Lethargy Drowsiness Generalized weakness Seizure activity
what are signs and symptoms of encephalitis?
- monitor for leakage of spinal fluid - monitor skin integrity of sac - assess for infection - position child on side or abdomen apply wet, sterile, saline dressing
what are some nursing care for spina bifida?
- Enlarging head size - bulging - non- pulsating fontanels - downward rotations of eyes - poor feeding - vomiting - lethargy irratability - high pitched cry abnormal muscle tone
what are the signs and symptoms of hydrocephalus?
Begins in 5th grade
when does school screening for scoliosis occur?
abuse and violence is characterized by
•Child maltreatment •Munchhausen Syndrome by Proxy
•Serum creatinine levels
what should you monitor for patients with muscle dystrophy?
•Body image disturbance related to bracing •Pain related to surgery (spinal fusion) •Impaired physical mobility related to brace wear •Risk for noncompliance with treatment regimen
what are key nursing diagnosis of scoliosis?
