38 neuro

The nurse instructs the parents of a child with Guillain-Barré syndrome on care that will be needed once the child is discharged home. Which statement made by the parents indicates that teaching has been effective?

"Our child might experience weakness even after recovering from the illness." Explanation: Most children recover completely, without any residual effects of the syndrome; although, some may continue to have minor problems such as residual weakness. To prevent muscle contractures and effects of immobility, turning and repositioning every 2 hours is important in addition to passive range-of-motion exercises about every 4 hours. It will take longer than 10 days for the child to recover and return to school.

The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate?

"Take your time feeding your baby." Explanation: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is preparing a care plan for a toddler diagnosed with cerebral palsy (CP). Which intervention would be appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups? Select all that apply.

Administer carbidopa/levodopa as prescribed. Administer benzodiazepines as prescribed. Teach parents exercises and games to help prevent contractures.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?

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

A preadolescent child with ataxia-telangiectasia is demonstrating an exacerbation of choreoathetosis. What should the nurse do to help this patient?

Ataxia-telangiectasia is a primary immunodeficiency disorder that results in progressive cerebellar degeneration. Telangiectasia or red vascular markings appear on the conjunctiva and skin at the flexor creases. Neurologic symptoms caused by the degeneration process can usually be detected in early infancy when developmental milestones are not met. Children develop an awkward gait when they begin to walk. Choreoathetosis or rapid, purposeless movements may develop. Unfortunately, there is no effective treatment, and children with this disorder often die in late adolescence of infection, respiratory failure, or a malignant brain tumor. The nurse should provide comfort measures when caring for this child. The patient may not be able to walk. It is an unrealistic expectation for this child to increase independence.

late signs of increased intracranial pressure

Bradycardia Fixed dilated pupils Irregular respirations

Guillain-Barré syndrome

Despite the length of this disorder, most children recover completely without any residual effects. A small number may have some residual weakness but not necessarily paralysis. The paralysis peaks at about 3 weeks and then slowly reverses. Supportive care such as mechanical ventilation, nutritional support, passive ROM, and every 2 hour turning and repositioning are the focus of care for children with this syndrome. There is no medication specific for this syndrome.

LP

During the procedure, typically 3 tubes of cerebral spinal fluid (CSF) are removed for testing. After the procedure, the child is encouraged to lay flat for at least 30 minutes. During that time, the child is also encouraged to drink a glass of fluid to help prevent cerebral irritation. Even when all proper procedures are followed, some children develop a headache following the test. An analgesic may be given for pain relief.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

Moving the infant's head every 2 hours Explanation: Positional plagiocephaly can occur because the infant's head is allowed to stay in one position for too long. Because the bones of the skull are soft and moldable, they can become flattened if the head is allowed to remain in the same position for a long period of time. Massaging the scalp will not affect the skull. Measuring the intake and output is important but has no effect on the skull bones. Small feedings are indicated whenever an infant has increased intracranial pressure, but feeding an infant each time he fusses is inappropriate care.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.

Oriented to person, place, and time Disorientation Obtundation Stupor Coma

A 10-year-old boy has been experiencing complex partial seizures and has not responded well to medication. Surgery is planned to remove brain tissue at the seizure foci. Which diagnostic test would be the most accurate in identifying the seizure foci?

Positron emission tomography (PET)

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected?

The child is not responding or eating well.

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. The nurse suspects caput succedaneum based on what evidence?

The swelling crosses the midline of the infant's scalp.

A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication?

Use a soft toothbrush. Explanation: Phenytoin is an anticonvulsant medication. It can be used in the management of seizure disorders. This medication is associated with gingival hyperplasia. This may result in tender and bleeding gums. The use of a soft toothbrush will reduce pain, bleeding and discomfort. There is no need to take this medication on an empty stomach or with citrus foods and beverages. The medication does not make an individual photosensitive.

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.

Verbal response Motor response Eye opening

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply.

You Selected: Tachycardia Elevated blood pressure Jitteriness Ocular deviation

The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?

hypothermia Explanation: Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia. All of these symptoms result from the increased ICP putting pressure on the cranial vessels and the hypothalamus. Double vision, or diplopia, also occurs as a result of increasing ICP.

Carbamazepine

is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

The nurse is caring for a 4-year-old with meningitis. A primary nursing goal would be to:

reduce the pain related to nuchal rigidity.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?

semi-Fowler's position with a parent at the bedside

The nurse is talking with a teen and her parents about triggers for her frequent headaches. Which statements indicate an understanding? Select all that apply

"I may experience headaches during certain periods in my menstrual cycle." "Giving up cola may be beneficial to helping me avoid headaches." "Chocolate may trigger my headaches."

Athetoid cerebral palsy is marked by involuntary, uncoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion; the whole body is in a state of slow, writhing muscle contractions whenever voluntary movement is attempted.

Ataxic cerebral palsy is essentially a lack of coordination caused by disturbances in the kinesthetic and balance senses; it is characterized by an awkward and wide-based gait. Rigidity cerebral palsy is uncommon and is characterized by rigid postures and lack of active movement. Spastic cerebral palsy is characterized by scissoring caused by severe hip adduction. When scissoring is present, the child's legs are crossed and the toes are pointed down. When standing, the child is on her or his toes. It is difficult for this child to walk on the heels or run.

The nurse is caring for an 8-month-old baby diagnosed with spastic cerebral palsy. Which assessment finding supports this medical diagnosis?

The child has a strong Moro reflex when startled. Explanation: Spasticity is excessive tone in the voluntary muscles that results in loss of upper motor neurons. A child with spastic cerebral palsy has hypertonic muscles, abnormal clonus, exaggeration of deep tendon reflexes, abnormal reflexes such as a positive Babinski reflex, and continuation of neonatal reflexes, such as the tonic neck reflex, well past the age at which these usually disappear. If infants with this disorder are held in a ventral suspension position, they arch their backs and extend their arms and legs abnormally. They tend to assume a "scissors gait" because tight adductor thigh muscles cause their legs to cross when held upright. This involvement may be so severe it leads to a subluxated hip. Posture when in a sitting position is not remarkable for this health problem.