Chapter 28: Caring for a Child with a Neurological or Sensory Condition

Question 1

What is the Nervous System Made up of?

Answer 1

-The central nervous system (CNS): contains brain and spinal cord
-The peripheral nervous system (PNS): consists of cranial nerves, the spinal nerves, and peripheral nerves
>PNS subdivided into sensory-somatic nervous system and autonomic nervous system

Question 2

Brain

Answer 2

a network of nerve cells called neurons, which consists of axons and dendrites
>Axons: take information away from the cell body
>Dendrites: bring information to the cell body

Question 3

Bain Tissue

Answer 3

may be white or gray
>White matter: consists of axons that are coated with myelin, which allow nerve impulses to travel rapidly
>Gray matter: made of neuronal cell bodies and surrounds the cerebral hemispheres, forming the cerebral cortex; also found deep in the brain and include the:
-basal ganglia (affect movement)
-hypothalamus (maintains homeostasis and regulates BP, heart rate, and temperature)
-thalamus (processes sensory impulses and sends them to the cerebral cortex)

Question 4

The Spinal Cord

Answer 4

mass of nerve tissue encased in a vertebral column, and the cord contains sensory and motor pathways
-does not extend the length of the vertebral canal

Question 5

What Happens when there is a disruption in the pathway from the brain to the PNS and spinal cord?

Answer 5

results i altered neurological function

Question 6

Growth and Development

Answer 6

a child with a neurological condition (e.g. cerebral palsy) is at greater risk for limited intellectual development than typically developing children b/c of impaired physical mobility and altered sensory and perceptual changes
-intellectual capacity impacts daily-life functioning: verbal, memory, and literacy skills; functional mobility: self-care; and social functioning

Question 7

Nursing Care of A Child with a Neurological Condition

Answer 7

focus on maximizing the child’s intellectual, cognitive, and motor abilities through comprehensive rehabilitation services
-impaired physical mobility is associated with decreased muscle control and strength; physical therapy is required to assess and treat motor dysfunctions
-nurse should implement range of motion exercises and position the child to promote tendon stretching to encourage mobility, increase circulation, and prevent contractures
>activities of daily living and play promote motor growth and development; encourage the child to use fine and gross motor skills while completing these tasks such as eating with a utensil and getting dressed; allow time for the child to complete the task
-position toys that encourage rolling and teaching
-education about keeping physical therapy appointments and wearing proper brace wear and adaptive equipment is important

Question 8

Nurse Should Understand That Sensory and Perceptual Changes are Caused by Cerebral Damage

Answer 8

• provide assistance with accepting or learning alternate methods for living with diminished vision or hearing
• technologies such as tablet devices and personal computers have provided new ways for children with sensory changes to communicate and interact
• encourage use of these adaptive devices to enhance sensory input
• educate the family about maximizing the usage of the child’s intact senses when possible

Question 9

Level of Consciousness (LOC)

Answer 9

or arousal

• is awareness of the environment by which the child is alert and responsive to the environmental stimuli
• controlled by the reticular activating system and the cerebral hemispheres of the brain

Question 10

An Alteration in content of thought may be caused by Structural Factors:

Answer 10

abnormalities of the anatomy of the brain

Question 11

An Alteration in content of thought may be caused by Metabolic factors:

Answer 11

infections, trauma, congenital anomalies, vascular anomalies, and toxins

Question 12

An Alteration in content of thought may be caused by Psychogenic factors:

Answer 12

influenced by psychological disturbances within a child

Question 13

Altered Level of Consciousness (LOC)

Answer 13

significant indicator of neurological dysfunction
-most common cause of altered LOC in children: infection of the brain and meninges
>when determining the etiology of an altered state of consciousness, organic and functional causes are evaluated

Question 14

Unconsciousness

Answer 14

state in which a child’s cerebral function is depressed

• ranges from stupor to a coma
• requires astute and continuous monitoring
• nurse carefully monitors vital signs, LOC, reflexes, and pupil reaction
• nurse carefully and meticulously documents the objective data obtained to determine any deterioration that may alter therapy
• assess the child for any seizure activity that may occur as a result of cerebral ischemia and edema

Question 15

Stupor

Answer 15

aroused only with vigorous or unpleasant stimulation

Question 16

Coma

Answer 16

state of unconsciousness when the child cannot be aroused even by painful stimuli

Question 17

Persistent Vegetative State

Answer 17

complete unawareness of the environment accompanied by sleep-wake cycles

Question 18

States of Consciousness Technique and Patient Response: Alertness

Answer 18

• Technique: speak in a normal tone of voce

- Response: an alert patient answers appropriately while opening his eyes and responding fully

Question 19

States of Consciousness Technique and Patient Response: Lethargy

Answer 19

• Technique: speak in a loud voice
• Response: a lethargic patient opens his eyes but appears drowsy; answers questions appropriately but falls asleep easily

Question 20

States of Consciousness Technique and Patient Response: Obtundation

Answer 20

• Technique: shake gently to arouse
• Response: an obtunded patient opens his eyes and looks at the stimuli; appears slightly confused; alertness and interest in surroundings are decreased

Question 21

States of Consciousness Technique and Patient Response: Stupor

Answer 21

• Technique: use a painful stimuli
• Response: a stuporous patient only responds to painful stimuli; verbal responses are absent or slow; responsiveness to a painful stimuli ceases

Question 22

States of Consciousness Technique and Patient Response: Coma

Answer 22

• Technique: apply repeated painful stimuli
• Response: a comatose patient does not respond to internal or external stimuli; he remains in an unarousal state with eyes closed