VN 34 Test 10 Neuro

Question 1

1. Reye’s syndrome risk (pp slide 8)

Answer 1

 Aspirin use
 Affects liver & brain
 Priority: prevent increased intracranial pressure

Question 2

2. Cerebral Palsy manifestations: pp slide18

Answer 2

 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

Question 3

2. Cerebral palsy nursing management pp slide 19

Answer 3

 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

Question 4

3. Seizures assessment & document pp slide 13

Answer 4

 Oxygenation
 Vitals
 Time
 Aura
 Eye positioning & movement
 Bowel/bladder incontinence

Question 5

3. Manifestations of simple & complex seizures (PP slide 9):

Answer 5

Partial Simple:
 Localized motor activity
 Shaking of leg or other body (focal seizures)
Partial Complex:
 Non-purposeful movements
 Lip smacking or rubbing of hands

Question 6

3. Carbamazepine

Answer 6

 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

Question 7

4. Meningitis Manifestations (pp slide 14):

Answer 7

 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

Question 8

4. Meningitis Interventions (pp slide 15):

Answer 8

 IV antibiotics
 Positioning, avoid straining, coughing & bright lights
 Prevention w/vaccines
 Prophylactic abx. w/close contact

Question 9

5. Otitis media: manifestations & treatment (PP slide 7)

Answer 9

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

Question 10

6. Objective data (ch.28 pp slide 14)

Answer 10

 Information observed directly
 Height, weight, VS, examination of body system

Question 11

7. Subjective data (ch.28 pp slide 2)

Answer 11

 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

Question 12

8. Vision impairment (PP slide 3)

Answer 12

 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

Question 13

9. Manifestations of ICP in infants pp slide 16

Answer 13

 Distended scalp veins
 Bulging fontanels
 Change in feeding
 High pitched cry
 Irritability, restlessness
 Lethargy, indifference
 Inconsolability
 Separated sutures

Question 14

9. Manifestations of ICP in children pp slide 16

Answer 14

 Diplopia (double vision)
 N/V
 Lethargy or irritability
 Increased sleep
 Change in LOC
 Headache
 Inability to follow commands
 Seizures

Question 15

10a. Measuring temperature

Answer 15

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)

Question 16

10b. measuring apical pulse pg. 602

Answer 16

 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

Question 17

10c. Safety when assessing infants in outpatient settings

Answer 17

 Don’t walk away from child
 Have hands within inch or two of child

Question 18

10d. Visual Acuity

Answer 18

 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.

Question 19

10e. Head and chest circumference (ch.28 pp slide 19):

Answer 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

Question 20

11. Post op on child priority and nursing considerations:

Answer 20

 Monitor VS
 Monitor for hemorrhage
 Check I & O (should have some output w/in 6hrs)

Question 21

12. Pain assessment of the child (pg.598):

Answer 21

 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

Question 22

13. Nursing considerations for the administration of rectal medications?

Answer 22

 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)

Question 23

14. IM injections for infants/contraindicated areas for IM injections

Answer 23

 Appropriate IM site: vastus lateralis
 Avoid dorsal gluteal

Question 24

15. Interviewing a child NTK (Ch. 28 pp slide 5)

Answer 24

 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

Question 25

16. Insertion of foreign bodies in the ear or nose nursing considerations (Ch. 35 pp slide 6)

Answer 25

 Should be evaluated by provider
 Teach to bring child in if parent suspects something is stuck (risk for injury)
 Irrigation, forceps
 Risk of infection