VN 34 Test 10 Neuro Flashcards
- Reye’s syndrome risk (pp slide 8)
Aspirin use
Affects liver & brain
Priority: prevent increased intracranial pressure
- Cerebral Palsy manifestations: pp slide18
Spastic: tense, contracted muscles, standing on toes (most common)
Athetoid: constant, uncontrolled motion of limbs, head & eyes
Ataxic: poor sense of balance (often causing falls & stumbles)
Rigidity: tight muscles that resist effort to make them move
Tremor: uncontrollable shaking, interfering w/coordination
- Cerebral palsy nursing management pp slide 19
Teach parent appropriate strategies when they have a child w/special need (most important)
Physical therapist
Orthopedic
Technologic aids
Speech therapist
Position to prevent contractures
Maintain skin integrity
- Seizures assessment & document pp slide 13
Oxygenation
Vitals
Time
Aura
Eye positioning & movement
Bowel/bladder incontinence
- Manifestations of simple & complex seizures (PP slide 9):
Partial Simple:
Localized motor activity
Shaking of leg or other body (focal seizures)
Partial Complex:
Non-purposeful movements
Lip smacking or rubbing of hands
- Carbamazepine
Uses: bipolar, seizures, neuropathic pain
-CNS effects/sedation (avoid tasks that require mental alertness)
-blood dyscrasias: leukopenia: anemia; Thrombocytopenia: report fever, sore throat/bleeding/bruising (monitor labs routinely)
sleep disturbances, anorexia, bone marrow suppression
-don’t stop abruptly, tapper off, take meds @ the same time daily (bedtime)
Toxicity: nystagmus, ataxia, vertigo, staggering gait
Dizziness should subside w/in 3-4 days or weeks
- Meningitis Manifestations (pp slide 14):
High- pitched cry
Irritability
Generalized convulsions are common
Headache
Fever
Bulging fontanel
Projective vomiting
Nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back)
Photophobia
Delirium
- Meningitis Interventions (pp slide 15):
IV antibiotics
Positioning, avoid straining, coughing & bright lights
Prevention w/vaccines
Prophylactic abx. w/close contact
- Otitis media: manifestations & treatment (PP slide 7)
Manifestations:
Usually restless, shakes the head, and rubs or pulls at the ear
Irritability, decreased activity, lack of appetite & hearing impairment
Treatment: pg.716
Antibiotics(10 day course) or myringotomy (incision of eardrum w/tiny tubes placed in the tympanic membrane)
Spontaneous rupture usually relieves symptoms
- Objective data (ch.28 pp slide 14)
Information observed directly
Height, weight, VS, examination of body system
- Subjective data (ch.28 pp slide 2)
Information spoken by child or family
Interviewing family & child allows collection of info which can be used to develop plan of care
Requires knowledge of growth & development & understanding of communication techniques
Chief complaint
- Vision impairment (PP slide 3)
Vision impairment includes myopia (nearsightedness), hyperopia (farsightedness), astigmatism, partial sight or blindness
Adequate vision & normal development are more likely w/early treatment
Specialized equipment helps prevent isolation
- Manifestations of ICP in infants pp slide 16
Distended scalp veins
Bulging fontanels
Change in feeding
High pitched cry
Irritability, restlessness
Lethargy, indifference
Inconsolability
Separated sutures
- Manifestations of ICP in children pp slide 16
Diplopia (double vision)
N/V
Lethargy or irritability
Increased sleep
Change in LOC
Headache
Inability to follow commands
Seizures
10a. Measuring temperature
Oral =97.6f -99.3f (4-6yrs)
Rectal = usually 0.5f -1f higher than oral
Axillary =usually 0.5f-1f lower than oral (newborn/ infants)
Tympanic: usually 0.5f-1f lower than oral (noninvasive, used on sleeping child)
10b. measuring apical pulse pg. 602
Family caregiver can hold the child on their lap for security for the full minute, Place the stethoscope between the child’s left nipple & sternum
Newborn: 100-180
Adolescent: 55-95
10c. Safety when assessing infants in outpatient settings
Don’t walk away from child
Have hands within inch or two of child
10d. Visual Acuity
Visual acuity of children gradually increases from birth until about 7yrs of age, when most children have 20/20 vision.
Babies will be able to follow things w/their eyes at 2 months of age.
10e. Head and chest circumference (ch.28 pp slide 19):
Measured routinely up to age 3 or on any child w/neurologic or developmental concern
Chest should exceed head circumference by 2-3 inches
- Post op on child priority and nursing considerations:
Monitor VS
Monitor for hemorrhage
Check I & O (should have some output w/in 6hrs)
- Pain assessment of the child (pg.598):
Grimacing
Crying or protests when handled (wants to be left alone)
Turns head frequently from side to side
Turns & rolls constantly, seemingly to try to get away from pain
Pulls ear or rubs head
- Nursing considerations for the administration of rectal medications?
Child is placed in a side-lying position & the nurse must wear gloves or a finger cot.
The suppository is lubricated, then inserted into the rectum, followed by a finger, which is inserted up to the first knuckle joint. (The little finger should be used for insertion in infants.
After the insertion of the suppository, the buttocks must be held tightly together for 1 to 2 minutes until the child’s urge to expel the suppository passes. (don’t warm up suppository)
- IM injections for infants/contraindicated areas for IM injections
Appropriate IM site: vastus lateralis
Avoid dorsal gluteal
- Interviewing a child NTK (Ch. 28 pp slide 5)
When interviewing a child, the child can agree or disagree to have the parent present
When admitting child always assess where they are developmentally
Use age-appropriate questions
Be honest answering child’s questions
Use stories & books as appropriate
Listen attentively to child’s comments, make feel important
- Insertion of foreign bodies in the ear or nose nursing considerations (Ch. 35 pp slide 6)
Should be evaluated by provider
Teach to bring child in if parent suspects something is stuck (risk for injury)
Irrigation, forceps
Risk of infection
