Unit 3 NUR 221
Decorticate posturing
-"flexor posturing" -adduction of arms (arms fold to chest); flexion of elbows and wrists
AST levels
0 to 35 Elevation occurs with hepatitis or cirrhosis
Immunizations Schedule: Tdap :
11-12 years
Autism Ch 37 p 1041 Communication impairments are signs in children with ASD that may range from absent to delayed speech. any child who does not display language skills such as babbling or gesturing by ____ months of age, single words by _____ months, and two word phrases by ____ months are recommended for immediate hearing and language evaluation.
12 months of age, 16 months, and by 24 months
Immunizations Schedule: Hep A:
12- 23 months
Immunizations Schedule: MMR and Varicella:
1st dose 12-15 months , and 2nd dose 4-6 years
Immunizations Schedule Rotavirus:
1st dose 2 months, 2nd dose at 4 months, and third dose at 6 months
Immunizations Schedule: Hematopoietic stem cell transplant (HSCT):
3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
· GCS - Glasgow coma scale -
3-part assessment - eye opening, verbal response, and motor response - 1-5 in each category - 15 highest score - <8 coma - 3 is deep coma - decrease in GCS indicates decline in condition
o Paco2 - ICP:
30 mmHg - to produce vasoconstriction - decreases CBF - decreases ICP
ALT levels
4 to 36 Elevation occurs with hepatitis or cirrhosis
adhd ch 34 p 957 predominantly hyperactive-impulsive type
6 or more symptoms of hyperactivity impulsivity but fewer than six symptoms of an attention that persist for least 6 months and attention might often still be a significant clinical feature in such cases.
adhd ch 34 p 957 combined type
6 or more symptoms of inattention and six or more symptoms of hyperactivity impulsivity that persist for at least 6 months
adhd ch 34 p 957 predominantly inattentive type
6 or more symptoms of inattention but fewer than six of hyperactivity impulsivity that persist for 6 months
status epilepticus
A condition in which seizures recur every few minutes or last more than 30 minutes.
Autism Ch 37 p 1041 Family support imperative to help parents understand that they are not the cause of child's condition parents need extra counseling early in the course of the disorder and should be referred to the :
Autism Society website that will provide information about education treatment programs and techniques and Facilities such as camps in group homes. Other resources : local and State Department of Mental Health and developmental disabilities
Autism Ch 37 p 1041 may have significant GI symptoms.
Constipation can be associated with acquired megarectum.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Recognize early signs of reduce fluid intake, such as decreased urinary output , less wet diapers, and increased thirst advise parents to be particular to situations in which dehydration may be a possibility such as hot weather or playing Outdoors or Sports What are the most important signs and symptoms of dehydration in a child with SCD?
Dry mucous membranes, loss of skin turgor, sunken eyes, no or diminished tears, sunken fontanelle, dark urine, rapid thready pulse, rapid breathing. Emphasize the importance of adequate hydration. need specific instructions on how many daily glasses or bottles of fluid are required. Foods can be a source of fluids . Increase fluids combined with impaired kidney function result in problem of enuresis.
Ch.49 pp. 1455-1461 (Cerebral Palsy) hip surveillance maybe routine care because:
Hip dislocation is common in children with CP
ICP Monitoring o 4 types of monitors:
Intraventricular catheter,Subarachnoid bolt,Epidural sensor, Anterior fontanel pressure monitor
box 33.5 clinical manifestations of potential child maltreatment physical neglect physical findings and behaviors
Suggestive physical ftt, undernutrition (in extremities, abdominal distention, lack of Sub-Q fat), poor hygiene, unclean or inappropriate dress, poor health care, frequent injuries suggestive behaviors Dull affect, excessively Passover sleepy, self stimulatory behaviors such as finger sucking a rocking, begging or stealing food, absenteeism from school, substance abuse, vandalism or shoplifting.
Immunizations : Chemotherapy or radiation treatment: 12-59 months
Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose Doses administered within 14 days of starting therapy or during therapy should be repeated at least 3 months after therapy completion.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Hydroxyurea increases the production of hbf, reduces endothelial adhesion of Sickle cells, improves the sickle-cell hydration and cell size, increases nitric oxide production (a vasodilator) and lowers leukocyte and reticulocyte counts. 40% reduction in mortality and decreased frequency of
VOC, ACS, Hospital admissions, and need for transfusions. Crisis milder. Pediatric Studies have shown that hydroxyurea can safely be used in children.
CH 44 pp. 1321-1322 Wilm's Tumor Arises from a malignant undifferentiated Metanephrogenic blastoma (a cluster of pyramidal cells capable of initiating the Regeneration of abnormal structure). Slightly favors left kidney. Unfavorable histology UH 10% of Wilms tumors demonstrate UH, which is associated with:
a poor prognosis and demands of more aggressive treatment. Survival rates for Wilms tumors or one of the highest among childhood cancers. Children with localized tumor have 90% chance of cure with multimodal therapy. Surgery and chemotherapy, with or without irradiation, is based on the clinical staging histologic pattern.
Down Syndrome CH 37 p 1029 Protruding tongue also interferes with feeding (especially if solid foods.) Parents need to know that tongue thrust is not an indication of refusal to feed but a physiological response. Use
a small but long straight handled spoon to push the food toward the back and side of the mouth. If food is pushed out, it should be refed.
o Oral airway can be used for children who have :
a temporary LOC such as a contusion, seizure, or anesthesia
1. When preparing to administer Hepatitis B vaccine to a newborn, the nurse should: (Select all that apply.) a. initiate an immunization record. b. confirm the hepatitis B status of the newborn's mother. c. obtain a syringe with a 25-gauge, 5/8-inch needle. d. assess the dorsogluteal muscle as the preferred site for injection. e. confirm that the newborn's mother has signed the informed consent.
abce
child pronography:
arranging in photography in any media, sexual acts involving children, alone or with adults are animals, regardless of consent by child's legal guardian; made a note distribution of such material in any form with or without profit
Diagnostic ADHD a description of the child's behavior in the home school and social situations are obtained from
as many of the caregivers of the child as possible especially the parents and teachers involved in the child care.
o Light coma may be able to cough and swallow; deep coma may not be able to manage secretions putting child at risk for :
aspiration and cardiac arrest § Position child head and body to prevent aspiration, empty stomach to reduce chance of vomiting § Blockages of airway from secretions can happen in seconds
Ch.49 pp. 1455-1461 (Cerebral Palsy) Comorbidities associated with CP
constipation caused by neurological deficits and lack of exercise poor bladder control and urinary retention osteopenia (related to decreased bone density from e-mobility) chronic RTI common problems with Airway clearance and aspiration pneumonia, which may be a consequence of GERD, abnormal muscle tone, immobility and, Altered positioning. Skin problems From pressure areas, malalignment, poor Bracing, nutrition, and Immobility. Latex allergies also been reported in children with CP.
nursing alert: stress to caregivers danger of shaking infants, education must include
coping mechanisms for caring for infants with inconsolable crying.
Which is a late sign of increased ICP? a. Nausea b. Irritability c. Headache d. Bradycardia
d
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification of cerebral palsy box 49.1 ataxic (non spastic, extra pyramidal)
damage to cerebellum wide-based gait, rapid repetitive movements performed poorly, disintegration of movement of the upper extremities when the child reaches for objects
Down Syndrome CH 37 p 1029 Respiratory tract infections are prevalent and when combined with cardiac anomalies, are the chief causes of :
death, particularly during the first year of life.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Abnormal Motor Performance includes :
early preferential unilateral hand preference, abnormal and isometric crawl, standing or walking on toes, uncoordinated or involuntary movements, poor sucking, feeding difficulties, persistent tongue thrust.
SCA and SCD teach the family to seek early intervention for problems such as:
fever 101.3 degrees Fahrenheit or 38.5 degrees Celsius or higher. give penicillin as ordered, recognize signs and symptoms of stroke, splenic sequestration, as well as respiratory problems that can lead to hypoxia. treat the child normally. the nurse tells the family that the child is normal but can get sick in ways that other children cannot.
Immunizations Schedule: Meningococcal:
first dose 11-12 years, second dose 16 years
Ch.49 pp. 1455-1461 (Cerebral Palsy)
hemiplegia: motor dysfunction on one side of the body; upper extremity more affected than lower extremity (20 to 30% of spastic CP)
Ch.49 pp. 1455-1461 (Cerebral Palsy)
monoplegia only one limb involved
Immunizations Schedule Annual Flu Vaccine :
start at 6 months
sexual abuse one out of three girls, one out of six boys, by 18 years old. 95% of perpetrators know the child 5% are strangers. defined as:
the employment, used, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, sexually explicit conduct or any stimulation of such conduct; or right, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. Incest: physical sexual activity between family members; blood relationship is not required.
CH 44 pp. 1321-1322 Wilm's Tumor Other effects of malignancy include weight loss and fever. If metastasis has occurred, symptoms of lung involvement (dyspnea, cough, SOB, and CP) may be evident. signs of malignancy :
weight loss, enlarged liver and spleen, indications of anemia, and lymphadenopathy.
treatment adhd ch 34 p 957 Appropriate classroom placement Computers are helpful for children who have difficulty with :
writing dysgraphia, and fine motor skills, in such children handwriting will not improve.
· Consciousness - ability to respond to sensory stimuli and have subjective experiences o 2 components of consciousness
§ Alertness - arousal-waking state, ability to respond to stimuli § Cognitive power - ability to process stimuli and produce verbal and motor responses
ICP Monitoring § Anterior fontanel pressure monitor
· Infants · Noninvasive · If not correctly placed may have inaccurate results
Immunizations Schedule: HIB and PCV13 :
1st dose 2 months, 2nd dose at 4 months, and third dose at 6 months , 4th 12-15 months
Immunizations Schedule: Dtap
1st dose 2 months, 2nd dose at 4 months, and third dose at 6 months, 15-18 months 4th dose, 5th dose 4-6 years
Immunizations Schedule: Inactivated Polio Virus IPV:
1st dose 2 months, 2nd dose at 4 months, and third dose at 6-18 months, 4th dose 4-6 years
Immunizations Schedule Hep B :
1st dose at birth, 2nd dose at 1-2 mo , 3rd dose 6-18 months
SCA and SCD Oxygen is unable to reach the in mesh sickled erythrocytes in clogged vessels. Prolonged administration of oxygen can depress bone marrow, further aggravating the anemia. This may indicate need for:
Blood transfusions. Exchange RBC transfusion (erythrocytapheresis) is a replacement of sickle cell with normal rbc's.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) transcranial Doppler identifies the child who is at risk for developing a:
CVA by monitoring in a cranial vascular flow
treatment adhd ch 34 p 957 Environmental manipulation. Modify the environment to allow a child to be more successful. Consistency between families and teachers in terms of reinforcing the same goal is essential. Fostering and prove organization and a highly structured environment. .
Encouraged to make more appropriate choices and take responsibility for actions. teaching parents how to make organizational charts and decrease distractions while the child is completing hmwk. Consistent study area. Parents should model behavior positively and problem-solving. Strategies to help the child succeed and cope with deficits while emphasizing strengths
Autism Ch 37 p 1041 scientific evidence to date shows no link between MMR and thimerosal containing vaccines and ASDs. has been reported in association with conditions such as :
FXS, tuberous sclerosis, Prader Willi syndrome, metabolic disorders, fetal rubella syndrome, haemophilus influenzae meningitis, structural brain anomalies. prenatal and perinatal events such as maternal and paternal ages over 40 years of age, uterine bleeding during pregnancy, low apgar score, fetal distress, neonatal hyperbilirubinemia. use caution in interpreting these findings.
Autism Ch 37 p 1041 one of the Hallmarks of ASD
Failure of social interaction and communication development may show less interest in social interaction (abnormal eye contact, decrease response to their own name, decreased imitation, unusual repetitive Behavior) and have verbal and motor delay. Majority of children with autism have some degree of CI, with scores typically in the moderate to severe range. Some children with autism (known as savants) excel in particular areas.
treatment adhd ch 34 p 957 Appropriate classroom placement homework and classroom assignments may need to be reduced and more time I need to be a lot of protest. Verbal instructions should be in Company by visual references such as written instructions on the Blackboard. Schedules arrange to the academic subjects taught in the morning. Regular and frequent breaks.
First grade programs in which high-risk children receive special attention to prevent or reduce the need for services as they progressed. A system toward more successful achievement personal adjustment and retention in regular classrooms.
prevent abuse Prevention of child maltreatment goal
Foster attachment process by encouraging parents to hold and look at their infant and teaching coping mechanisms for Pro on crying. Minimize the effects of Separation by encouraging parents to visit and help parents become comfortable caring for the child. Teach parents appropriate method of bathing feeding toileting disciplining and preventing injuries while stressing the normal needs and developmental characteristics of children. Refer parents to community services and self-help groups.
CH 44 pp. 1321-1322 Wilm's Tumor Other clinical manifestations are the result of compression from the tumor Mass, metabolic alteration secondary to the tumor, or metastasis. They are:
Hematuria occurs in less than 1/4 of children. Anemia usually secondary to Hemorrhage within the tumor results in pallor, anorexia, and lethargy. Hypertension, caused by secretion of excess amounts renin by the tumor.
Down Syndrome CH 37 p 1029 Dietary intake needs supervision, decreased muscle tone affect gastric motility, predisposing child to constipation.
Increase fiber and fluid, promote evacuation. Prevent obesity. Height and weight measurement should be obtained on a Serial basis.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Chronic nature this pain can greatly affect a child's development. Nonpharmacologic and complementary treatment (prayer spiritual healing, massage, heating pads, herb, relaxation, breathing exercises, distraction call my music, got an imagery, self-motivation, acupuncture, and biofeedback) when mild to moderate voc, tx with :
NSAIDs such as ibuprofen or ketorolac toradol or non-opioid such as acetaminophen are usually initially used. Drugs are titrated adjusted to a therapeutic level. Opioids IV or orally for severe pain around the clock. IV ketorolac for a Max of five day course. Patient-controlled analgesia PCA. May give meds around the clock.
Ch.49 pp. 1455-1461 (Cerebral Palsy) primary modalities for diagnosis.
Neurologic examination and history. Neuroimaging. MRI. General movements assessment (GMA) strong predictive value in children older than 2 and younger than 5. Metabolic and genetic testing is recommended. Nurses should monitor infants with known etiologic risk factors and evaluate them closely the first two years. Motor impairment not apparent until after 2 to 4 months of age at the earliest. Diagnosis cannot be confirmed until 2 years of age.
pediatric Glucose (Serum)
Newborn, 1 day --> 40 to 60 Newborn, > 1 day --> 50 to 90 Child --> 60 to 100
treatment adhd ch 34 p 957 Pharmacologic therapy stimulants such as Methylphenidate hydrochloride and dextroamphetamine. Non-stimulant medications including norepi reuptake Inhibitors and adrenergic Agonist have fewer side effects in children.
Not Prescribe based on child's weight but on the resolution of the symptoms instead. Follow the child and evaluate for therapeutic effects and potential side effects. Scheduled re-evaluation to determine medication Effectiveness, detecting available any side effects call my monitor development and health status especially growth and blood pressure, and assess family interaction.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Reflex abnormalities include :
Persistence of primitive infantile reflexes, obligatory tonic neck reflex at any age, non persistence Beyond 6 months, persistent or hyperactivity of the moro , plantar, and Palmar grasp reflex is, hyperreflexia, ankle clonus, and stretch reflexes elicited in many muscle groups on Fast Passive movements.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Universal screening of newborns for SCD has become standard. Early diagnosis (before three months of age) enables initiation of appropriate interventions to minimize complications. Testing:
Sickle turbidity test sickledex, used on blood from finger or heel stick and yields accurate results in 3 minutes. If positive, HGB electrophoresis is necessary to distinguish between children with the tray and those with the disease. Hemoglobin electrophoresis (referred to as fingerprinting of the protein) blood test separates various hemoglobins by high-voltage the blood test is for detecting percentages of the various types of HGB, traits and diseases.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) The most common severe , painful episode ; considered clinical Hallmark of SCD and is usually accompanied by increasing health care costs because of prolonged hospitalization.
The vaso-occlusive crisis (VOC), painful episode, is characterized by ischemia causing mild to severe pain that may last for minutes to days are longer.
Immunizations : Immunoglobulin deficiency, early component complement deficiency: 12-59 months
Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Clinical features are primarily the result of obstruction caused by the sickle-cell rbc's with other cells, vascular inflammation, and increased RBC destruction. The abnormal adhesion entanglement and imaging of rigid sickle-shaped sales accompanied by the inflammatory process intermittently blocks the microcirculation causing:
Vaso Occlusion. The resultant absence of blood flow to adjacent tissues causes local hypoxia, leading to tissue ischemia and infarction (cellular death). Most of the complications seen in SCA can be traced to this process and its impact on various organs of the body.
2. Several types of long-term central venous access devices are used. A benefit of using an implanted port (e.g., Port-a-cath) is that it: a. is easy to use for self-administered infusions. b. does not need to pierce the skin for access. c. does not need to limit regular physical activity, including swimming. d. cannot dislodge from the port, even if child plays with port site.
a
4. The MOST important nursing consideration when caring for a child with sickle cell anemia is to: a. teach parents and child how to minimize crises. b. refer parents and child for genetic counseling. c. help the child and family to adjust to a short-term disease. d. observe for complications of multiple blood transfusions.
a
5. The nurse who is concerned about increased intracranial pressure in an infant should assess for: a. irritability. b. photophobia. c. pulsating anterior fontanel. d. vomiting and diarrhea.
a
The nurse observes erythema, pain, and edema at a child's intravenous (IV) site with streaking along the vein. What should the nurse do FIRST? a. Immediately stop the infusion. b. Check for a good blood return. c. Ask another nurse to check the IV site. d. Increase the intravenous (IV) drip for 1 minute and recheck.
a
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Delayed gross motor development includes:
a delay in all motor accomplishments, increases as growth advances, delays are more obvious as growth advances.
3. When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to: (Select all that apply.) a. use an infusion pump with a micro dropper to ensure the prescribed infusion rate. b. check IV fluids and infusion rate with another licensed professional. c. avoid restraining the child to prevent undue emotional stress. d. observe the insertion site frequently for signs of infiltration. e. change the insertion site every 24 hours.
abd
Autism Ch 37 p 1041 Occurs in 1 in 68 children in the US, is about 4 times more common in boys and girls, and is not related to socioeconomic level, right, or parenting Style. high risk for recurrence of ASD in families with one affected child. individuals may have :
abnormal electroencephalograms, epileptic seizures, delayed development of hand dominance, Persistence of primitive reflexes, metabolic abnormalities (elevated blood serotonin), cerebellar vermis hypoplasia (part of the brain involved in regulating emotion and some aspects of memory), and infantile abnormal head enlargement.
Caregiver child interaction
abusive parents might have difficulty showing concern for their child. Unable or unwilling to comfort child. Blame child for their injuries or belittle them for being clumsy or stupid. Parent may become hostile or uncooperative. May not participate in care or so little concern for Progress, discharge, or follow-up care. Children might be unresponsive to parent or excessively clinging and intolerant of Separation. Maybe overly attached to the abusive parent, possibly in Hope of preventing any upset that may precipitate anger and another attack. May avoid eye contact. Some shy from strangers and some are unusually affectionate and outgoing.
2. The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. a. Time the seizure b. Restrain the child c. Stay with the child d. Place the child in a prone position e. Move furniture away from the child f. Insert a padded tongue blade in the child's mouth
ace
ICP nursing care o Nurses must be :
acquainted with the devices, assist with insertion, interpret monitor readings, be able to distinguish between danger signals and mechanical dysfunction.
adhd ch 34 p 957 Nursing Care Sleeplessness is reduced by :
administering the medication early in the day.
CH 44 pp. 1321-1322 Wilm's Tumor Post-op radiotherapy is indicated for children with metastatic disease. Chemotherapy is indicated for :
all children. Duration of therapy ranges from 6 to 15 months.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Associated disabilities include:
altered learning and reasoning, seizures, impaired behavioral and interpersonal relationships, sensory impairment such as Vision or hearing.
adhd ch 34 p 957 Nursing Care Nurses in any setting Provide support and guidance to the children and families during the difficult period of the child's growing up with a disabling condition. Management begins with :
an explanation to the parents of the child about the diagnosis, including the nature of the problem in the practitioner's concept of the underlined CNS basis for the disorder.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification anatomic and radiologic findings:
anatomic distribution or parts of the body affected by motor impairments or limitations; radiologic finding sometimes including white matter lesions or brain anomaly noted on the CT or MRI
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Hyperhemolytic crisis is accelerated rate of RBC destruction characterized by:
anemia, jaundice, and reticulocytosis.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Medication alert meperidine Demerol is not recommended. Normeperidine, metabolite of meperidine is a CNS stimulant that produces:
anxiety, Tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with SCD are particularly at risk for Normeperidine induced seizures.
treatment adhd ch 34 p 957 Pharmalogic Small dosage initially dose gradually increase for desired response, monitored carefully for side effects such as :
appetite loss abdominal pain headache sleep disturbances and growth velocity. Stimulants should be avoided in children who have history of tick like behaviors or a history of Tourette Syndrome or ADHD combined with tics because these medications May exaggerate ticks. Other medications such as tricyclic antidepressant and extended-release clonidine may be used as adjunct therapy for ADHD primarily for children with co-existing conditions such a sleep disturbances.
o Adrenocorticosteroids for ICP:
are not recommended for cerebral edema secondary to head trauma
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) most common forms of SCD in the United States
are sca, sickle cell disease, Sickle thalassemia disease. SCA is the most common form in African Americans followed by sickle cell disease and sickle thalassemia disease. The incidence of the disease varies in different Geographic locations. Among African-Americans, the incidence of sickle cell trait is about 8% whereas among the inhabitants of West Africa the incident is reported to be as high as 40%. The high incidence of sickle cell trait in West Africa is believed by some to be the result of selective protection afforded trait carriers against one type of malaria.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification of cerebral palsy box 49.1 dyskinetic (non spastic, extra pyramidal)
athetoid : chorea (involuntary, and irregular, jerking movements), characterized by slow worm like writhing movements that usually involve extremities, trunk, Neck, facial muscles, and tongue dystonic: slow, twisting movements of the trunk or extremities; abnormal posture involvement of the pharyngeal, laryngeal, and oral muscles causing drooling and dysarthria (imperfect speech articulation)
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Heterozygous-sickle cell trait. Homozygous individuals have predominantly HBS and have sca. The Inheritance pattern is that of an :
autosomal recessive disorder. both parents have sickle cell trait, there is a 25% chance with of producing an offspring with SCA. Newborns with SCA are generally asymptomatic.
The nurse is caring for a client with increased ICP as a result of a head injury. The nurse would note which trend in vital signs if the ICP was rising? a. Increasing temp, HR, RR; Decreasing BP b. Increasing temp, BP; Decreasing HR, RR c. Increasing RR; Decreasing HR, BP, temp d. Increasing HR, BP; Decreasing temp, RR
b
Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age?
b. Social interaction d. Inability to maintain eye contact e. Language as used in social communication
Ch.49 pp. 1455-1461 (Cerebral Palsy) commonly, CNS depression, hypotension, diaphoresis, and constipation may be seen with what PO medication given to treat spaciscity ?
baclofen (lioresal) PO
5. The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? (select all that apply) a. The child has symptoms of a cold b. The child had a previous anaphylactic reaction to the vaccine c. The mother reports that the child is having intermittent episodes of diarrhea d. The mother reports that the child has not had an appetite and has been fussy e. The child has a disorder that caused a severely deficient immune system f. The mother reports that the child has recently been exposed to an infectious disease
be
CH 44 pp. 1321-1322 Wilm's Tumor Risk for intestinal obstruction or s/e from chemo and radiation, the nurse monitors GI activity such as:
bowel movements, bowel sounds, distension and vomiting. Other considerations are frequent evaluation of BP and observation for signs of infection, especially during chemo.
3. A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is: a. absence seizure. b. generalized seizure. c. status epilepticus. d. simple partial seizure.
c
The nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? a. Flaccid paralysis of all extremities b. Adduction of the arms at the shoulders c. Rigid extension and pronation of the arms and legs d. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities
c
4. The MOST appropriate nursing interventions when caring for a child experiencing a seizure include: (Select all that apply.) a. restraining the child when a seizure occurs to prevent bodily harm. b. placing a padded tongue between the teeth if they become clenched. c. avoid suctioning the child during the seizure. d. describing and documenting the seizure activity observed. e. applying supplemental oxygen after inserting an artificial oral airway.
cd
o CO2 has a vasodilating effect and increases :
cerebral blood flow (CBF) and ICP.
Early signs and symptoms of increased ICP include:
changes in mental status, such as disorientation, restlessness, and mental confusion. purposeless movements. increased respiratory effort.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification of cerebral palsy box 49.1 spastic (pyramidal) (impairment gamma; scissor gait)
characterized by persistent primitive reflexes, positive Babinski reflex, ankle clonus, exaggerated stretch reflexes, eventual development of contractures. most common 70 to 80% of all cases of CP. diplegia, tetraplegia, triplegia, monoplegia, hemiplegia hypertonicity with poor control posture, balance, and coordinated motion and impairment of fine and gross motor skills
characteristics of the abused child:
children from birth to 1 year of age are at highest risk for being abused. Children that require constant attention Children with disabilities, cannot tell others or defend themselves. Premature infants because of failure of parent-child bonding during infancy, increased physical care needs, or irritability. Removing a child from a home places other siblings at risk for abuse, no child is safe if left in an abusive environment
environmental characteristics of abuse
chronic stress, divorce, poverty, unemployment, poor housing, frequent relocation, alcoholism, and drug addiction. Crowded living conditions. a concealed crisis may also be present in upper class families. Substitute caregivers such as daycare providers and babysitters.
Down Syndrome CH 37 p 1029 Constant stuffy nose forces child to Breathe by mouth which dries The oropharyngeal membranes increasing the Susceptibility to upper respiratory tract infections. Lessen these problems by:
clearing the nose with a bulb type syringe, rinsing mouth with water after feedings, increasing fluid intake, and using a cool mist vaporizer to keep the mucous membranes moist and the secretions liquefied. Change the child's position frequently practicing good hand washing and properly disposing of soiled articles such as tissues.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification of cerebral palsy box 49.1 mix type
combination of spastic CP and dyskinetic CP may be labeled mixed with no specific motor pattern is dominant this term is losing favor to more precise descriptions of motor function and affected area of brain involvement
Abusive head trauma (AHT)
commonly used terms include shaken baby syndrome, inflicted head injury, or neuro inflicted brain injury. often a result of inconsolable infant crying. 6 to 36% of victims died as a result of their injuries, Many have life-long complications including neurologic visual, cognitive, behavioral, and sleep abnormalities. Violent shaking causes the brain to rotate within the skull, resulting in shearing forces that tear blood vessels and neurons. Characteristic injuries are intracranial bleeding (subdural hematoma) and in 80% of cases retinal hemorrhages, which are classic result of repetitive acceleration-deceleration head trauma. P r e d a h t, a prediction tool, of 6 clinical features. has high sensitivity and specificity in estimating the probability of aht when three or more of the six features are present. Prevent AHT by teaching caregivers about care for infant and techniques to cope with inconsolable crying.
· Brain death is pronounced by
complete cessation of clinical evidence of brain function and irreversibility of condition
If antibiotics are ordered the nurse stresses the importance of :
completing full course.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Allogeneic hematopoietic stem cell transfusion transplantation (hsct) offer :
curative treatment for children with SCD with overall survival of 92% to 95% episode free survival of 80% to 86%.
1. The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? a. Emergency cart b. Tracheostomy set c. Padded tongue blade d. Suctioning equipment and oxygen
d
2. A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance? a. Eggs b. Penicillin c. Sulfonamides d. A previous dose of hepatitis B vaccine or component
d
3. An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? a. Monitor the infant for a fever b. Bring the infant back to the clinic c. Apply a hot pack to the injection site d. Apply a cold pack to the injection site
d
4. A parent brings her 4 month old infant to a well baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to the infant? a. Varicella; hepatitis B vaccine (HepB) b. Diphtheria tetanus acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus (IPV) c. MMR, Hib, DTaP d. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)
d
5. The nurse suspects that a child is having an adverse reaction to a blood transfusion. The FIRST action by the nurse should be to: a. notify the physician. b. take vital signs and blood pressure and compare them with baseline. c. dilute infusing blood with equal amounts of normal saline. d. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.
d
Ch.49 pp. 1455-1461 (Cerebral Palsy) Intense pain may occur with these muscle spasms pharmacological agents given orally include:
dantrolene sodium, Baclofen (lioresal), and diazepam (Valium) They are effective in decreasing overall spasticity the most common side effects of these agents include hepatotoxicity (dantrolene) ,drowsiness , fatigue , and muscle weakness
CH 44 pp. 1321-1322 Wilm's Tumor From surgery the stage and pathology of tumor determined. Physician discusses info with parents. Nurse is present during conversation to provide additional support and access understanding. Older children need an opportunity to:
deal with their feelings considering the many procedures they have been through. Therapeutic play may be beneficial and children of any age understand what they have undergone Express their feelings.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2
delayed gross motor development, abnormal Motor Performance, alterations of muscle tone, abnormal postures, reflex abnormalities, and Associated disabilities.
· Unconsciousness -
depressed cerebral function, inability to respond to sensory stimuli and have subjective experiences
Neglect from deprivation of Necessities is easier to identify than emotional neglect or psychological maltreatment because physical signs are usually evident.
depression to acting-out behavior to help identify possible emotional abuse. Any persistent unexplained change in child's behavior is an important clue to possible emotional abuse.
Autism Ch 37 p 1041 Autism regression is when the child seems to:
develop normally than regresses suddenly this is a red flag event that has been frequently displayed in expressive language.
Autism Ch 37 p 1041 Autism spectrum disorders definition for ASD based on 2 Behavior domains that include :
difficulties in social communication and social interaction, and unusually restricted, repetitive Behavior, interest, or activities.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Aplastic crisis is:
diminished RBC production triggered by viral infection that may result in profound anemia.
Ch.49 pp. 1455-1461 (Cerebral Palsy)
diplegia: all extremities affected, lower more than upper, occurs in 30 to 40% of spastic CP
CH 44 pp. 1321-1322 Wilm's Tumor Important not to palpate the tumor unless absolutely necessary because manipulation of the mass may cause :
dissemination of cancer cells two adjacent and distant sites. Nursing alert: to reinforce the need for caution it may be necessary to post a sign on the bed that reads do not palpate abdomen; careful bathing and handling in preventing trauma to the tumor
ADHD refers to developmentally inappropriate degrees of inattention impulsiveness and hyperactivity their behavior evokes negative responses from others and repeated exposure to negative feedback adversely affects their self-concept. Manifestations may be numerous and few mild or severe for child's developmental level. Mild manifestations appear in education and family environments. Learning disability may not become evident until child in her school. Major clinical manifestation is :
distractibility. Children often demonstrate immaturity relative to chronological age. Selective attention is often seen in which the child had difficulty attending to non-preferred tasks such as completing chores or finishing homework.ADHD demonstrate one of the three subtypes
· LOC -
earliest indicator of improvement or decline in neuro status; determined by observations of responses to the environment; may be better to assess with the parent present, sometimes children are shy or scared in an unfamiliar setting with unfamiliar people.
SCA SCD Quality patient outcomes :
early recognition of signs and symptoms, tissue deoxygenation minimized, Sickle Cell crisis prevented or quickly managed , pain appropriately manage, stroke prevented, prophylactic penicillin regimen followed, hypoxia preventing when surgery is necessary, pneumococcal, H influenzae type B, and meningococcal vaccines administered.
treatment adhd ch 34 p 957 Tx with behavioral and pharmacologic therapy, environmental manipulation, and appropriate classroom placement. Behavioral therapy:
effective parenting skills such as delivering positive reinforcement , rewarding small increments of desired behaviors, and providing age appropriate consequences . Use of organizational charts for completing self-care activities and use of word processor instead of manually writing assignments are emphasized
Support family
encourage the child's relationship with non-offending parents. Nurse does not become a substitute parent but rather acts as a role model for parents and helping them relate positively and constructively to their child. Parental ignorance, nurse can educate the parent regarding children's physical and emotional needs. parents on child rearing maybe calls for them to not be aware of nonviolent methods of discipline. May need help in dealing with their frustration. May be sensitive to criticism or resistance to authority figures teaching is implemented through demonstration in example rather rather than through lecturing. Praise any competent parenting Abilities by demonstrate to promote their sense of parental adequacy.
Sexual abuse Collecting Evidence medical records should include verbatim statements made by the child and interviewer that reflect appropriate non-leading questions and statements, child may not be emotionally ready to discuss abuse, Nurses connect with child by:
establishing Rapport, engage and play activities while encouraging conversation, psychological counseling for child to be forthcoming. Children who have been sexually abused within the past 72 to 96 hours should be considered for forensic testing. record the location in detail description of all injuries, no color size and location of bruising, burn documentation include the location pattern demarcation lines, and presence of eschar or blisters. Obtain photographs of possible with a measurement tool. Nurses should consider intra-abdominal injury in infants and children who have any other signs of abuse. Chain of custody must be appropriately maintained with local law enforcement personnel. Documentation of the chain of custody form should include the names of people collecting and receiving evidence such as photographs and DNA samples, type of evidence collected and received. Forensic evidence obtained from the body diminishes greatly after 24 hours the best chance for evidence Collection comes from bed linens or the child's underwear. Female genital exam should include a description of the vulva, Hammond, and surrounding tissue. Exam to be done by practitioner. Unless the child is seen within a few days of injury the genital tissue may appear normal.
o Chest physiotherapy is carried out on a regular basis and the child's position is changed at least :
every 2 hours to prevent pulmonary complications
Ch.49 pp. 1455-1461 (Cerebral Palsy) Box 49.3 early signs of cerebral palsy
failure to meet any developmental milestone such as rolling over raising head sitting up or crawling. Persistent primitive reflexes such as Morrow, a tonic neck. Poor head control (head lag) and clenched fist after 3 months of age. Stiff or rigid arms or legs, scissoring legs. Pushing away or arching back, stiff posture. Floppy or limp body posture, especially while sleeping. Inability to sit up without support by 8 months of age. Using only one side of the body or only the arms to crawl. Feeding difficulties. Persistent gagging or choking when fed. After 6 months of age, tongue pushing soft food out of the mouths. Extreme irritability or crying. Failure to smile about three months of age. Lack of interest in surroundings.
· RESPIRATORY MANAGEMENT ICP: o Respiratory effectiveness is the primary concern in the care of the unconscious child, and establishing an adequate airway is always the:
first priority.
Autism Ch 37 p 1041 Eating habits of ASD children may be particularly problematic for families and may involve:
food refusal accompanied by mineral deficiencies, mouthing objects, eating on Edibles, and smelling and throwing food. Children have difficulty organizing their behavior and redirecting their energy, they need to be told directly what to do. Communication should be at the child's developmental level, brief, and concrete.
o Cerebral hypoxia at a normal body temperature that lasts longer than _____ minutes nearly always causes irreversible brain damage
four
Ch.49 pp. 1455-1461 (Cerebral Palsy) Early neurologic manifestations are usually :
generalized hypotonia or decrease tone that last for a few weeks or may extend for months or even as long as one year.
adhd ch 34 p 957 Nursing Care Parents need to be informed of the possible side effects of medications. If decreased appetite is a concern, parents can : (3)
give the psychostimulants with or after meals rather than before encourage consumption of nutritious snacks in the evening when the effects of the medication are decreasing and serve frequent small meals with healthy on-the-go snacks.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Dental hygiene is important regular visits to the dental and prophylaxis including brushing, fluoride, and flossing should be started as soon as teeth erupt. Dental Care is especially important for children given phenytoin because they often develop:
gum hyperplasia.
Down Syndrome CH 37 p 1029 hypotonicity of muscles and hyperextensibility of joints complicate positioning. The limp flaccid extremities resemble the posture of a ragdoll holding the infant is difficult and cumbersome. The extended body position promotes :
heat loss, because more surface area is exposed to the environment. Encourage parents to a swaddle or wrap infant Snuggly in a blanket before picking up the child to provide security and warmth. Child's lack of clinging or molding is a physical characteristic and not a sign of Detachment or rejection.
adhd ch 34 p 957 Nursing Care Nurses and therapists in the community work with families and school personnel on a long-term basis to :
help plan and Implement therapeutic regimen and evaluate the effectiveness of therapy. They coordinate services and serve as a liaison between health and education professionals directly involved in child's Therapy Program.
Autism Ch 37 p 1041 Care Management therapeutic intervention, no cure for ASD the most promising results have been through:
highly structured and intensive behavior modification programs in general the objective and treatment is to promote positive reinforcement, increase social awareness of others, teach verbal communication skills, and decrease unacceptable Behavior. Providing a structured routine for the child to follow is key in the management of ASD.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Medication includes levodopa for treating dystonia, trihexyphenidyl (artane) for treating dystonia and for increasing the use of upper extremities and vocalization and reserpine for:
hyperkinetic movement disorders such as chorea or athetosis. Gabapentin (Neurontin) used for decreasing specificity pain in children with CP successfully.
CH 44 pp. 1321-1322 Wilm's Tumor Surgery scheduled within 24 to 48 hours of admission. Keep explanation simple and repeat them often, with attention to what child will experience. Monitor blood pressure, because :
hypertension from excess renin and production of poietin.
Late signs of increased intracranial pressure that comprise Cushing triad include :
hypertension with a widening pulse pressure, bradycardia, and abnormal respiration. The presence of those signs indicates very late signs of brain stem dysfunction and that cerebral blood flow has been significantly inhibited.
Ch.49 pp. 1455-1461 (Cerebral Palsy) S/E of intrathecal Baclofen include :
hypotonia, somnolence, seizures, nausea, vomiting, headache pump is the size of a hockey puck ; is place in the Sub-Q space of the mid abdomen in an operating room by neurosurgeon.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification causation and Timing:
identification of a clearly identified cause such as postnatal event
Down Syndrome CH 37 p 1029 Decreased muscle tone compromises respiratory expansion. The underdeveloped nasal bone causes chronic problem of :
inadequate drainage mucus.
Box 33.4 Warning signs of abuse physical evidence of abuse or neglect
including previous injuries, conflicting stories, injury blamed on siblings or other party, injury inconsistent with the history, history inconsistent with developmental level, complaint other than the one associated with signs of abuse, inappropriate responsive caregivers such as exaggerated or absent emotional response, refusal to sign for additional test or refusal to seek necessary treatment, excessive delay in seeking treatment, or absent the parents for questioning. Inappropriate response of child such as little or no response to pain, fear of being touched, excessive her lack of separation anxiety, indiscriminate friendliness to strangers. Child report of physical or sexual abuse. Previous reports of abuse in the family. Repeated visits to emergency facilities with injuries. Parent or caregiver report found the child unresponsive indicating absence during the supposed event
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Alterations of muscle tone include :
increased or decreased resistance to passive movement, opisthotonic posturing (arching of back), feel stiff on handling or dressing, difficulty in diapering, rigid unbending at the hip and knee joints when pulled to sitting position is a early sign.
o Longer term airway assistance would include naso/orotracheal tube to open airway and manage secretions o Suctioning is only used as needed to clear the airway, exerting care to prevent :
increasing ICP.
Exhibitionism:
indecent exposure, usually exposure of genitalia by an adult man to children or women
molestation:
indecent liberties, such as touching, fondling, kissing, single or mutual masturbation, oral genital contact
Child prostitution:
involving children in sex acts for profit and usually with changing partners
Autism Ch 37 p 1041 Nursing alert claims of beneficial results from the use of secreton, a peptide hormone that stimulates pancreatic secretion, has been studied extensively in multiple randomized control trials, denoting clear evidence that it :
lacks any benefit.
Diagnostic ADHD psychological testing , projective test, is used to identify visual perceptual difficulties problems with special organization and other phenomena that suggests cortical or Diencephalic organization and other phenomena and it helps to identify the child's intelligence and achievement levels psychiatric disorders medical problems and traumatic experiences are ruled out including :
lead poisoning, seizures, partial hearing loss , psychosis, and witnessing of sexual activity or violence
Normal values ICP:
less than 1.5 - 6 mmHg in term infants normal adult ICP is defined as 5 to 15 mm Hg ICP values of 20 to 30 mm Hg represent mild intracranial hypertension; however, when a temporal mass lesion is present, herniation can occur with ICP values less than 20 mm Hg
pedophilia:
literally means " love of child " , does not denote a type of sexual activity but rather the preference of an adult for pre-pubertal children as the means of achieving sexual excitement
Ch.49 pp. 1455-1461 (Cerebral Palsy) Clinical manifestations of cerebral palsy at time of diagnosis box 49.2 Abnormal postures include :
maintaining hips higher than the trunk and prone position with legs and arms flexed or drawn underbody, scissoring and extension of legs with feet plantar fixed in Supine position, persistent infantile resting and sleeping position, arms abducted at shoulders, elbows Flexed, hands fisted.
CH 44 pp. 1321-1322 Wilm's Tumor radiotherapy and chemotherapy are usually begun immediately after surgery, parents an explanation of what to expect, such as :
major benefits and side effects. ideally the nurse should be present during physician parent conferences. Recovery. Is usually rapid.
Munchausen Syndrome by proxy msbp,
medical child abuse or factitious disorder by proxy. Caregivers deliberately exaggerated or fabricate histories and symptoms or induce symptoms. for the gratification of a caregiver, most cases biological mother with some degree of healthcare knowledge and training. Common symptoms presented are seizures, nausea and vomiting, diarrhea, altered mental status; usually witnessed only by perpetrator and resolution of symptoms after separation from perpetrator confirm diagnosis.
Down Syndrome CH 37 p 1029 Child skin is pliable and soft during infancy however it gradually becomes rough and dry and is prone to cracking an infection. Skin care involves the use of :
minimum soap and application of lubricants. Lip balm is applied to the lips especially when the child is outdoors to prevent excessive chapping.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification motor abnormalities:
nature and topology of the motor disorder; functional motor abilities
Plan for discharge
no matter how severe the abuse, children usually mourn the loss of their parents. Need help to understand why they must not return home and that this new home is no way of punishment. Foster parents and courage to visit in the hospital nurse should take an active role in helping new parents understand child and health needs
Ch.49 pp. 1455-1461 (Cerebral Palsy) Primitive reflexes involved in diagnosis the tonic neck reflex
normally disappears between 4 and 6 months of age. An obligatory response is considered abnormal. Elicited by turning infant's head to one side and holding it there for 20 seconds. When a crying infant is unable to move from the asymmetric posturing of the tonic neck reflex it is considered obligatory and an abnormal response.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Primitive reflexes involved in diagnosis Crossed extensor reflex
normally disappears by 4 months of age, is elicited by applying and noxious stimulus to the soul of one foot with an extended. CP suggested if these reflexes persist after 4 months of age. Normally the contralateral foot response with extensor, abduction, and then adduction movement.
Autism Ch 37 p 1041 Hospitalization: The parents are essential to planning care and ideally should stay with a child as much as possible. Nurses should recognize that:
not all children with ASD are the same and they require individual assessment and treatment. Decreasing stimulation by using a private room, avoiding a strenuous auditory and visual distractions, and encouraging parents to bring in possessions the child is attached to my lesson the destructiveness of hospitalization.
Total volume of cranium
o 80% cranium o 10% blood o 10% CSF o These volumes must compensate for each other with changes
Autism Ch 37 p 1041 Prognosis symptoms associated with autism can be greatly improved with early and intensive interventions, and reported symptoms were completely overcome in some cases. Some may achieve independence but most require lifelong supervision. Aggravation of psychiatric symptoms occur in:
one half of the children during adolescence, with girls having a tendency for continued deterioration. parent delivered interventions are associated with some improved outcomes Prognosis is most favorable for children with higher intelligence, functional speech, and less behavioral impairment.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia); Sickle cell anemia SCA: Sickle cell disease ( SCD):
one of the groups of diseases in which normal adult HGB is partly or completely replaced by abnormal sickle HGB (HBS ). refers to a group of hereditary disorders, all of which are related to the present of HBS.
CH 44 pp. 1321-1322 Wilm's Tumor Wilms tumor or nephroblastoma is the most common kidney tumor. Peak incidence between 2 and 3 years of age. 5% of Wilms tumors are familial. Most common presenting sign is:
painless swelling or mass within the abdomen characteristically firm non-tender confined to one side and deep within the flank.
Three risk factors are commonly identified in child abuse:
parental characteristics, characteristics of the child, environmental characteristics.
Significant risk factors for child sexual abuse include
parental unavailability, lack of emotional closeness and flexibility, social isolation, emotional deprivation, communication difficulties. Most sexual abuse is committed by men and people known to with the child such as family members.
Down Syndrome CH 37 p 1029 nursing alert: immediately report in a child with the following signs of spinal cord compression: (4)
persistent neck pain, loss of establish motor skills, loss of bladder or bowel control, changes in sensation.
Decerebrate posturing
posturing in which the neck is "extended" with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
Cerebral palsy may result from a variety of causes. It is now known that the most common cause of cerebral palsy is:
prenatal brain abnormalities
Ch.49 pp. 1455-1461 (Cerebral Palsy) Therapy ankle foot orthosis (AFOs, braces) are worn by many of these children and are used to help :
prevent or reduce deformity, increase the Energy Efficiency of gate, and control alignment. Orthopedic surgery may be indicated . This includes tendon lengthening procedures, release of spastic muscles, and correction of hip and adductor muscle spasticity or contracture to improve locomotion.
Incompatibility between the history and the injuries
probably the most important criteria on which to base the decision to report suspected abuse.
The primary goal in caring for the child with cognitive impairment is to:
promote optimum development.
child should be treated as a child with the usual physical needs developmental tasks and play interest, not as a victim of abuse. Goal of the nurse child relationship is to
provide a role model for the parents and helping them are late positively and constructively to their child in the foster a therapeutic environment for the child in his or her reprieve from the abusing situation.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Goals of therapy are to prevent the sickling phenomena and treat the medical emergencies of crisis. Medical management main objectives are to
provide rest to minimize energy expenditure and to improve oxygen utilization, hydration through oral and IV Therapy, electrolyte replacement cause hypoxia results in metabolic acidosis, which also promotes sickling, analgesia for the severe pain from Vaso Occlusion, blood replacement to treat anemia and to reduce the viscosity of the sickle blood, and antibiotics to treat any existing infection. Vaccines, susceptibility to infection as a result of functional asplenia. Oral penicillin prophylaxis recommended by 2 months of age to reduce the chance of pneumococcal sepsis.
adhd ch 34 p 957 Nursing Care Psychostimulants and antidepressants have the potential for abuse. All children taking these drugs should be monitored closely for
psychological dependence, tolerance, depression, and other adverse Behavior changes or idiosyncratic effects. Most children with ADHD or not interested in abusing their drugs because of the effect of the drugs and these children are opposite that produced in normal individuals. However, caution parents to keep these drugs safely stored away from young children who may inadvertently ingest them and Adolescents that may abuse them.
CH 44 pp. 1321-1322 Wilm's Tumor specific tests include :
radiographic study such as abd ultrasound, CT, MRI of abd; CT of chest to evaluate for the presence of metastasis in the lung; and Doppler ultrasound of inferior vena cava. CBC (polycythemia is sometimes present if the tumor secretes excess erythropoietin). Urinalysis.
o Mannitol - ICP:
rapid reduction - generally given slowly but may be increased in emergency situations
o Osmotic diuretics - ICP -
rapid relief - emergency situation - only lasts about 6 hours
Child sexual abuse has centered on education of children to protect themselves. They need
reassurance that no matter what the other person says or does the parent wants to know about it and will not punish them. reassured that it was not their fault. Teach children safety in terms of potential risk situations. Be made aware that nice people, including friends and relatives, Can be offenders; carefully observe how others act towards the child.
The major goals of therapy for children with cerebral palsy include:
recognizing the disorder early and promoting optimal development
Ch.49 pp. 1455-1461 (Cerebral Palsy) Botulinum toxin a Botox is also used to reduce spasticity in targeted muscles The drug inhibits the release of acetylcholine into a specific muscle group, there by:
reducing spasticity.
Care Management protect child from further abuse
referrals usually come to the state welfare assigned to a case worker in agency such a CPS. After a referral has been made, a caseworker is assigned to investigate the report. Child is left in the home or move temporarily based on findings. Court proceeding may be necessary before the child can be placed outside the home or when parental rights are to be terminated. Nurses might be subpoenaed to appear in court. All states have mandatory reporting for child maltreatment. support child
o Hyperventilation often accompanies unconsciousness and may lead to :
respiratory alkalosis; or it may present to compensate for metabolic acidosis.
Down Syndrome CH 37 p 1029 Hypotonicity of the chest and abdominal muscles and its function of the immune system probably predispose the child to the development of:
respiratory tract infection. Physical problems include thyroid dysfunction, especially congenital hypothyroidism, and an increased incidence of leukemia.
adhd ch 34 p 957 Nursing Care Children taking tricyclic antidepressants display a dramatic increase in the incidence of dental caries. Marked anticholinergic action of the drugs increases saliva viscosity and produces a dry mouth. Emphasis on :
rigorous dental hygiene, home fluoride treatments, regular visits to the dentist, limited intake of refined carbs, and use of artificial saliva is an important nursing function. Child should drink plenty of fluids and be well hydrated.
Immunizations: do not give MMR to pregnant women or women planning to get pregnant in next 28 days because:
rubella can cross to the fetus
CH 44 pp. 1321-1322 Wilm's Tumor Tumor affected kidney and adjacent adrenal gland removed. Great care is taken to keep the encapsulated tumor intact because:
rupture conceive cancer cells throughout the abdomen, lymph Channel, and bloodstream. Regional lymph nodes are inspected, biopsy when indicated. Any and all structures are removed.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Carbamazepine (Tegretol ), divalproex (valproate sodium and valproic acid), Depakote) lacosamide (Vimpat), levetiracetam (Keppra) , oxcarbazepine (Trileptal) , and Lamotrigine (Lamictal) are prescribed for those who have:
seizures.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification Associated impairment:
seizures; hearing or Vision impairment; attentional, behavioral, communicative, or cognitive deficits; oral motor and speech function
Ch.49 pp. 1455-1461 (Cerebral Palsy) Cerebral palsy is defined as a group of permanent disorders of the development of movement and posture cause an activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. in addition to motor disorders the condition often involves disturbances of:
sensation, perception, communication, cognition, and behavior;secondary musculoskeletal problems, and epilepsy. It is the most common permanent physical disability of childhood and the incident is reported to be between 2.4 to 3.6 for every thousand live births in the United States
Down Syndrome CH 37 p 1029 Down syndrome can usually be diagnosed by the clinical manifestations alone but a chromosome analysis should be done to confirm the genetic abnormality. Many of these children have congenital heart malformations, most common being : _____ _______
septal defects.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) A CVA stroke is a sudden and severe complication, often with no related illnesses. Sickled cells block the major blood vessels in the brain resulting in cerebral infarction, which process variable degrees of neurologic impairment. Current treatment for STD children who have experienced a stroke is chronic transfusion therapy. Emergency signs of a CVA:
severe and relieve headaches, severe vomiting, jerking or twitching of the face legs or arms, seizures, strange abnormal behavior, inability to move an arm or leg, stagger or unsteady walk, stutter or slurred speech, weakness and a hand foot or leg, changes in vision.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) acute chest syndrome ACS is clinically similar to pneumonia; it is the presence of a new pulmonary infiltrate and may be associated with chest pain, fever, cough, tachypnea, wheezing, and hypoxia. acute chest syndrome: signs of an emergency :
severe chest, back, or abdominal pain. Fever of 38.5 degrees Celsius, 101.3 degrees Fahrenheit, or higher. Cough. Dyspnea, tachypnea. Retractions. Declining oxygen saturation oximetry.
Autism Ch 37 p 1041 clinical manifestations and diagnostic evaluation children with ASD demonstrate core deficits primarily in :
social interactions, Communications, and behavior.
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification CP has four primary types of movement disorders:
spastic dyskinetic ataxic mixed
Ch.49 pp. 1455-1461 (Cerebral Palsy) clinical classification the most common type
spastic CP represents an upper motor neuron muscular weakness. The reflex arc is intact, and the characteristic physical signs are increased stretch reflexes, increased muscle tone, and often weakness.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) packed RBC transfusions for treatment of:
splenic sequestration , stroke, and used pre-op with maintenance IV hydration for surgical procedures in children with SCD.
A 3-year-old male child has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. The MOST appropriate nursing action related to feeding this child is to:
stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing.
· Coma -
state of unconsciousness from which the patient cannot be aroused even with powerful stimuli
box 33.5 clinical manifestations of potential child maltreatment Physical abuse Physical findings and behaviors
suggestive physical findings bruises and welts, patterns descriptive of object used, various stages of healing. Burns patterns descriptive of object used, absence of Splash marks and present of symmetric Burns, stun gun injury, fractures and dislocations, injury denoting type of abuse such a spiral fracture dislocation from twisting and extremity or Whiplash from shaking the child. Multiple New or Old fractures in various stages of healing. Lacerations and abrasions with unusual symptoms or placement, descriptive Mark such as from human bites or pulling out of hair. Chemical unexplained repeated poisoning especially drug overdose, unexplained sudden illness such as hypoglycemia from insulin Administration . suggestive behaviors weary of physical contact with adults, fear parents are going home, lying very still while serving environment, inappropriate reaction to injury, lack of reaction to frightening abeyance, apprehension hearing other child cry, indiscriminate friendliness and displays of affection, superficial relationships, acting-out Behavior such as aggression to seek attention, withdrawal Behavior.
box 33.5 clinical manifestations of potential child maltreatment Sexual abuse Physical findings and behaviors
suggestive physical findings bruises, bleeding, lacerations, or irritation of external genitalia, anus, mouth, or throat. Torrance and your bloody under clothing. Pain on urination or pain swelling and itching the genitalia. Penile discharge. STI, non-specific vaginitis, venereal warts. Difficulty in walking or sitting. Unusual odor in genital area recurrent UTI. Presence of sperm. Pregnancy in young adult. Suggestive behaviors emergence of sexually related problems, including excessive or public masturbation, age inappropriate sexual play, promiscuous, or overtly seductive Behavior. Withdrawn Behavior, excessive daydreaming. Preoccupation with fantasies, especially in play. Poor relationships with peers. Sudden changes such as anxiety, loss or gain of weight, clinging Behavior. An incestuous relationship success of anger at mother for not protecting daughter. Regressive Behavior such as bedwetting or thumb-sucking. Sudden onset of phobias or fears, particularly fears of Dark, Men, strangers, or particular settings or situations. Running away from home. Substance abuse, perfume and Rapid personality changes such as extreme depression hostility and aggression. Social withdrawal. Rapidly declining school performance. Suicide attempts are ideation.
box 33.5 clinical manifestations of potential child maltreatment Emotional abuse and neglect physical findings and behaviors
suggestive physical findings ftt , eating or feeding disorder, enuresis, sleep disorder. Suggestive behaviors during infancy lack of social smile in stranger anxiety, withdrawal from environment and people, unusual fearfulness, antisocial Behavior such as destructiveness, stealing, cruelty to animals or people. Extremes of behavior such as over compliant and passive or aggressive and demanding. Emotional and intellectual development, especially language. Suicide attempts or attempts to harm self.
Down Syndrome CH 37 p 1029 Therapeutic management no cure exists for Down syndrome but a number of therapies exist such as:
surgery to correct serious congenital abnormalities (such as heart defects and strabismus).
Ch.49 pp. 1455-1461 (Cerebral Palsy)
tetraplegia: all four extremities involved legs Trump mouth pharynx and tongue, occurs in ten to fifteen percent of spastic CP
nursing alert the priority is to remove the child from
the abusive situation to prevent further injury.
diagnostic adhd ch 34 p 957 Behavioral checklist and Adaptive skills should be completed by
the child caregivers and Educators and scored by the primary care provider
adhd ch 34 p 957 Nursing Care The greater the parents' understanding of the disorder and its effects the more likely they will be to carry out the recommended program of therapy. They need to understand that :
the therapy is not necessarily A panacea (solution or remedy, a cure all) and that it will extend over a long period.
Cushing's triad
three classic signs—bradycardia, hypertension, and bradypnea—seen with pressure on the medulla as a result of brain stem herniation increased ICP
Down Syndrome CH 37 p 1029 Inadequate drainage resulting in pooling of mucus in the nose interferes with feeding. Because the child Breathe by mouth, sucking for any length of time is difficult. When eating solid foods, children gag on food because of mucus in oropharynx. Parents are advised:
to clear the right before each feeding, give small frequent feedings, and allow opportunities for rest during mealtime.
Ch.49 pp. 1455-1461 (Cerebral Palsy) Therapy has five goals:
to establish Locomotion, communication, and self-help skills, to gain optimal appearance and integration of motor functions, to correct Associated defects as early and effectively as possible, to provide educational opportunities adapted to the child's needs and capabilities, to promote socialization experiences.
Ch.49 pp. 1455-1461 (Cerebral Palsy)
triplegia 3 limbs involved
· Increased ICP could be caused by:
tumors/lesions, accumulation of fluid within the ventricular system, bleeding, or edema of cerebral tissues · When compensation is exhausted, any further increase in volume of the cranium results in increased ICP
Autism Ch 37 p 1041 Early recognition, referral, diagnosis, and an intensive early intervention tends to improve outcomes. Diagnosis is often not made until:
two to three years after symptoms are first recognized. Majority of parents observed atypical development in their ASD children before 24 months of age.
Autism Ch 37 p 1041 Physical contact often :
upset these children, minimal holding and eye contact may be necessary to avoid behavioral outbursts. May be fussy eaters who willfully starve themselves in order to prevent eating, or indiscriminate hoarders who swallow any available edible or inedible items such as thermometer.
Ch. 43 pp. 1275-1283 (Sickle Cell Anemia) Most acute symptoms of the disease occur during periods of exacerbation called crisis. There are several types of episodic crisis including :
vaso-occlusive, acute splenic sequestration, aplastic, hyperhemolytic, cerebrovascular accident CVA, chest syndrome, and infection.
Diagnostic ADHD a physical examination including __________ and _________ screening and a detailed ________ exam is completed
vision and hearing screening and a detailed neurological evaluation
Parental Characteristics of Abuse
younger parents, single parent families, especially those that include an unrelated partner, the partners sometimes are abuser , although the biological parent is most commonly the perpetrator. often socially isolated, few supportive relationships, low income, little education, substance abuse problems, additional stressors of substance abuse because parents have impaired judgment and may react with violence while under the influence of drugs or alcohol. These parents are vulnerable to additional crises of any nature and may strike out at the child as a method of releasing their frustration and anxiety. Low self-esteem, little knowledge of appropriate parenting skills, parenting skills are learned behaviors and parents who grew up poor parental role models may have difficulty parenting their own children. Often, child abusers were abused or observed some types of abuse in their home.
· ICP MONITORING: o Used to guide therapy to reduce ICP and provides information on intracranial compliance, cerebrovascular status, and cerebral perfusion o Indications:
§ GCS <8 § GCS >8 with respiratory assistance § Decline in condition § Subjective judgement regarding clinical appearance and response
ICP Monitoring § Intraventricular catheter
· Gold standard · Drainage bag attached to system for CSF to relieve pressure o Monitor closely o Drains too rapidly could cause bleeding and pain · Full penetration of the brain · Risk for infection
ICP Monitoring § Epidural sensor
· Less invasive · May have inconsistent results
ICP Monitoring § Subarachnoid bolt
· Not to be adjusted by anyone but the neurosurgeon even to check the site · Stabilized with dressings, do not touch!
