Chapter 23: The Child with a Sensory or Neurological Condition.

paralytic strabismus

Paralysis/weakness of the extraocular muscle; produces double vision/diplopia. Head tilt/squint present when focusing on an object. Also called nonconcomitant. Tx: patching of the unaffected eye; glasses.

atonic/myoclonic seizure

Seizure that occurs more frequently in the AM; jerking motions on awakening. Suddenly collapses after 10 seconds-1 minute. Also called drop attacks, infantile spasms.

nonparalytic strabismus

Constant deviation of the gaze due to faulty insertion of extraocular muscles. Muscle function is normal. Also referred to as concomitant. Tx: patching, surgical repair of extraocular muscles.

nystagmus

Constant jerky movements of the eyeball.

otitis externa

Acute infection of the external ear canal; also called swimmer's ear. Ear canal is erythematous but tympanic membrane is normal. Tx: irrigation, topical ABX.

Reye's syndrome

Acute noninflammatory encephalopathy and hepatopathy that follows viral infection in children. May be caused by aspirin use during viral infections. S/S: effortless vomiting, altered LOC, lethargy, combativeness, diarrhea, hypoglycemia, tachypnea, seizures, increased ICP. Labs: increased serum ammonia. Tx: reduce ICP, maintain patent airway, maintain fluid/electrolyte balance.

tonic-clonic seizure

Also called grand mal seizure. S/S: sudden cry, aura, fall, rigidity followed by muscle jerking. Shallow, irregular breathing. Possible loss of bowel/bladder control. Usually lasts seconds/minutes. Followed by postictal lethargy.

absence seizure

Also called petit mal. Blank stare; begins/ends suddenly; lasts a few seconds. Most common in children. S/S: rapid blinking, chewing movements of the mouth. Person is unaware of what occurs during seizure; returns to full awareness after. May lead to learning disabilities if not treated.

clonic movement

Alternating contraction/relaxation of muscles.

cognitive/intellectual impairment

Below-average mental functioning (IQ < 70) and deficit in adaptive behavior, conceptual or social skills before 18 years of age. 4 levels of support for ADLs: intermittent; limited; extensive; pervasive/total. Cognition may be classified as educable, educable-mildly impaired, or trainable moderately impaired. Correlate growth/development with mental functioning.

skull fracture

Broken/depressed skull bone.

athetoid/dyskinetic cerebral palsy

CP that involves damage to basal nuclei ganglions. Continuous involuntary, purposeless, writhing movements. Related to hyperbilirubinemia. May have speech, sight, and hearing defects.

spastic cerebral palsy

CP that involves damage to the brain cortex. Spasms occur with movement. Related to cerebral asphyxia.

ataxic cerebral palsy

CP that involves uncoordinated movements and ataxia. Related to cerebellum lesions.

barotrauma

Change in atmospheric pressure between internal body systems and surrounding environment. Ex: ear popping. Tx: yawning, chewing gum, sucking on a bottle/pacifier during altitude changes.

disruptive mood regulation disorders

Characterized by disruptive irritability with outbursts occurring more than 3 times/week for 1 year. Replaces bipolar disorder.

decerebrate/extensor posturing

Condition where body is rigid, all four limbs are pronated. Indicates a brainstem injury.

decorticate/flexor posturing

Condition where body is rigid; arms, wrists, fingers are flexed. Plantar flexion occurs in the feed. Indicates damage to brain cortex.

papilledema

Edema of the optic nerve.

CP feeding techniques

Ensure proper positioning. Place small amounts of food on spoon to prevent choking. Do not touch tip of child's tongue with the spoon; activates extrusion reflex. Use rubber coated spoons to protect teeth from injury. Stroke angle of the jaw below the ears to relax bite. Stoke area under chin in circular motion to stimulate chewing. Press upward under chin to stimulate swallowing. Plan time to prevent rushing.

strabismus s/s

Eye squinting/frowning to focus. Reaching for objects and missing them. Covering one eye to see. Tilting head to see. Dizziness or HA.

hyperopia

Farsightedness

epicanthal folds

Folds of skin that extend on either side of the bridge of the nose; cover the inner eye canthus.

cerebral palsy

Group of motor disorders caused by motor center dysfunction. Causes: existing prenatal brain abnormalities; chorioamnionitis in utero; prematurity; severe hypoglycemia; shaken baby syndrome; meningitis, encephalitis. Not fatal; no cure. S/S: normal intelligence; feeding problems; seizures not related with high fever; developmental delays.

ear functions

Hearing and balance.

ketogenic diet

High fat, low carbohydrate diet. May be used to treat children with seizures who do not respond to anticonvulsants. Produces ketoacidosis in the body; reduces convulsive episodes.

myringotomy

Incision of the tympanic membrane; relieves pressure and prevents spontaneous rupture.

seizure triggers

Includes flashing dark/light patterns; startling movements; overhydration; photosensitivity.

purulent meningitis

Inflammation of meninges caused by intracranial irritation/bacterial infection. Forms thick exudate around the meninges and adjacent structures. Increases risk of subdural effusion and hydrocephalus. Occurs: 6-12 months old. Cause: H. influenzae.

encephalomyelitis

Inflammation of the brain and spinal cord.

encephalitis

Inflammation of the brain. Causes: togaviruses/RNA viruses and herpes virus type 1 and 2. May also follow URI, rubella, or measles/rubeola, DTaP vaccine, and lead poisoning. S/S: HA followed by drowsiness; sometimes called "sleeping sickness". Tx: sedatives, antipyretics, quiet environment, O2 as needed. May cause permanent brain damage, intellectual/development disabilities.

conjunctivitis

Inflammation of the conjunctiva. Causes: bacteria, viruses, allergens, irritants, toxins, systemic diseases. Tx: ABX if bacterial; warm compresses.

meningitis

Inflammation of the meninges; may be bacterial or viral. S/S: severe HA, drowsiness, delirium, irritability, poor feeding, nuchal rigidity, high-pitched cry, seizures, opisthotonos, petechiae. Dx: examine CSF. Tx: ABX treatment for 10-14 days.

otitis media

Inflammation of the middle ear. Occurs most often after URI; affects children 6-24 months and early childhood. Cause: streptococcus, Haemophilus influenzae. Passive smoking environments increase risk of URIs. Tx: ABX, myringotomy, analgesics.

opisthotonos

Involuntary arching of the back; caused by muscle contractions.

retinoblastoma

Malignant tumor of the eye retina. May be bilateral or unilateral. S/S: leukocoria, loss of vision, strabismus, hyphema, pain. Tx: enucleation, laser photocoagulation.

meningitis nursing interventions

Monitor VS for slowed pulse, irregular RR, and increased BP. Keep lights and noise to a mimimum; use soft voice and gentle touch. Antipyretics, sponge baths, cooling mattress. Monitor for signs of ICP.

myopia

Nearsightedness

strabismus

Occurs when eyes are not able to focus in the same direction. Lack of coordination between extraocular eye muscles. Brain ignores the image from one eye.

intellectual impairment causes

Phenylketonuria, hypothyroidism, fetal alcohol syndrome, Down syndrome, brain malformations, hypoxia, CMV, meningitis, lead poisoning, neoplasms, encephalitis.

hyphema

Presence of blood in the anterior chamber of the eye; appears as a bright red/dark red spot in front of the iris. Occurs from blunt trauma or perforating injury. Tx: rest, topical medication, elevate HOB 30 degrees.

status epilepticus

Prolonged seizure that does not respond to treatment for 30 minutes or more. Can result in brain hypoxia. Causes: sudden d/c of anticonvulsants, generalized infection. Tx: manage airway, provide O2, IV diazepam, lorazepam, phenytoin, phenobarbital.

dyslexia

Reading disability that involves a defect in the brain cortex that processes graphic symbols.

amblyopia

Reduction/loss of vision that occurs in children who strongly favor one eye. May be refractive or caused by strabismus. At risk until visual stability occurs usually by 9 years of age. Also known as lazy eye.

enucleation

Removal of the eye.

ear infection s/s

Rubbing/pulling at the ear. Rolling head from side to side. Hearing loss. Loud speech. Inattentive behavior. Articulation problems. Speech development problems.

partial/Jacksonian seizure

Seizure that begins in one area of the body; cannot be stopped. Person is aware and awake during the seizure. May progress to involve other areas of the body.

complex partial/psychomotor seizure

Seizure that begins with a blank stare, followed by chewing motions, then random activity. Person is unaware of surroundings; may mumble or appear dazed. May pick at clothing, appear afraid, run or struggle. Lasts 1-2 minutes; patient has no memory of actions. Also called temporal lobe seizure.

tonic movement

Stiffening/contraction of muscles.

sepsis

Systemic response to infection; may be caused by bacteria, fungus, and viruses. Risks: immune-compromised, neutropenia. S/S: fever, chills, tachypnea, tachycardia, neurological signs, lethargy. Hypotension and neutropenia are ominous signs. Tx: IV ABX, monitor for s/s of shock. Prevention: HiB and pneumococcal vaccinations at 2 months and 4 years of age.

concussion

Temporary brain disturbance usually followed by a period of unconsciousness. Jars the brainstem; accompanied by loss of memory for events occurring immediately before, during, and after the accident. S/S: HA, drowsiness, blurred vision, vomiting, dyspnea.

mixed cerebral palsy

Usually a combination of spastic and athetoid CP.