Pediatric Nursing, Day 2: Newborn at Risk and Sensory/Neurologic Disorders PDF

PEDIATRIC NURSING DAY 2 The Newborn at Risk: Congenital Disorders The Child with a Sensory/Neurologic Disorder Marian College Vocational Nursing Program Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 21: The Newborn at...

PEDIATRIC NURSING DAY 2 The Newborn at Risk: Congenital Disorders The Child with a Sensory/Neurologic Disorder Marian College Vocational Nursing Program Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 21: The Newborn at Risk: Congenital Disorders Congenital Disorders ❖Malformations or anomalies ❖Inborn errors of metabolism ❖Hereditary disorders or chromosomal abnormalities ❖Crisis for parents and family, experience grief ❖Immediate or early surgery may be required ❖Early, continuous, skilled observation and nursing care required Copyright © 2022 Wolters Kluwer · All Rights Reserved Congenital Malformations ❖Caused by genetic or environmental factors ❖Include defects of central nervous, cardiovascular, gastrointestinal, genitourinary, and skeletal systems ❖Some apparent at birth, others only after complete physical examination ❖Large percentage of health problems seen in newborns and children Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #1 ❖Spina bifida Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #2 ❖ Spina bifida (cont.) o Clinical manifestations ▪ Depending on type may be asymptomatic with no problems or be serious and with paralysis ▪ May not be able to make clear-cut diagnosis based only on symptoms o Diagnosis ▪ Elevated maternal alpha-fetoprotein (AFP) levels followed by ultrasound may show incomplete neural tube ▪ Elevated AFP in maternal serum or amniotic fluid indicates probability of CNS abnormalities Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #3 ❖ Spina bifida (cont.) o Diagnosis (cont.) ▪ Perform tests between 13 and 15 weeks gestation ▪ Diagnosis made from clinical observation and examination; MRI, ultrasonography, CT, myelography o Treatment ▪ Depends on extent, surgical repair, therapy, highly skilled nursing care ▪ Specialists: neurologists, neurosurgeons, orthopedic specialists, pediatricians, urologists, physical therapists Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 What is one of the major nursing interventions with a newborn who has a myelomeningocele? a. Family teaching b. Preventing hydrocephalus c. Preventing contractures of the upper extremities d. Family interactions Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 a. Family teaching Rationale: Give family members information about the defect and encourage them to discuss their concerns and ask questions. Provide information about the newborn’s present state, the proposed surgery, and follow-up care. Remember that anxiety may block understanding and processing knowledge, so information may need to be repeated. Provide information in small segments to facilitate learning. Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #4 ❖Hydrocephalus Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #5 ❖ Hydrocephalus (cont.) o Noncommunicating hydrocephalus: obstruction prevents CSF to pass between ventricles and spinal cord o Communicating hydrocephalus: absorption of CSF is defective o Clinical manifestations: ▪ Rapid head growth with widening cranial sutures ▪ Anterior fontanelle becomes tense and bulging, skull enlarges in all diameters, scalp becomes shiny and veins dilate Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #6 ❖Hydrocephalus (cont.) o Clinical manifestations: (cont.) ▪ Eyes appear to be pushed downward slightly, sclera visible above iris ▪ Head becomes heavy ▪ Neck muscles fail to develop sufficiently, newborn has difficulty raising or turning head ▪ Increasingly helpless, increased intracranial pressure Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #7 ❖Hydrocephalus (cont.) o Diagnosis ▪ CT and MRI, echoencephalography and ventriculography may also be performed o Treatment ▪ Surgical intervention ▪ Ventriculoperitoneal shunting Copyright © 2022 Wolters Kluwer · All Rights Reserved Central Nervous System Defects #8 ❖Ventriculoperitoneal shunting Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #1 ❖ Development of the Heart o Begins beating early in third to eighth week gestation o Circulation unique, bypasses lungs; circulated through placenta o Ductus arteriosus, foramen ovale, ductus venosus no longer necessary after birth, close during first several weeks after birth o Pressure changes in heart from right side to left side o Various abnormalities can occur resulting in different levels of complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #2 ❖Common types of congenital heart defects o Traditionally, defects were described as cyanotic or acyanotic conditions o Current classifications based on blood flow characteristics ▪ Increased pulmonary blood flow ▪ Obstruction of blood flow out of heart ▪ Decreased pulmonary blood flow ▪ Mixed blood flow (saturated and desaturated blood mix in heart, aorta, pulmonary vessels) Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #3 ❖Common types of congenital heart defects (cont.) o Ventricular septal defect Most common intracardiac defect; abnormal opening in septum between two ventricles allowing blood to pass directly between left and right ventricle Corrected by surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #4 ❖Common types of congenital heart defects (cont.) o Atrial septal defect Abnormal opening between right and left atria Corrected with surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #5 ❖Common types of congenital heart defects (cont.) o Patent ductus arteriosus Ductus arteriosus allows blood to bypass lungs After birth, duct closes, and allows blood to enter lungs If remains open, shunts blood from aorta to pulmonary artery Corrected by medication, surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #6 ❖Common types of congenital heart defects (cont.) o Coarctation of the aorta Constriction or narrowing of aortic arch Can lead to hypertension, congestive heart failure Surgical correction necessary Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #7 ❖Common types of congenital heart defects (cont.) o Tetralogy of Fallot Consists of pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy Causes cyanosis Severity depends on degree of defect Surgical correction of defects Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #8 ❖Common types of congenital heart defects (cont.) o Transposition of the great arteries ▪ Aorta arises from right ventricle instead of left ▪ Pulmonary artery arises from left ventricle instead of right ▪ Newborns usually cyanotic from birth ▪ Was once always fatal, now advancements in diagnosis and treatment have increased survival rate Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #9 ❖Risk factors o Preterm newborn; maternal alcoholism, smoking, ingestion of certain drugs during pregnancy, maternal diabetes mellitus, advanced maternal age; rubella in first trimester; maternal malnutrition and heredity; offspring of mothers with congenital heart anomalies; previous siblings with congenital heart abnormality increases risk in later siblings ❖Clinical manifestations o Varies depending on defect; cyanosis, murmur, feeding difficulties, tires easily with feeding, failure to thrive or grow Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #10 ❖Treatment and nursing care o Advances in treatment have improved techniques and outcomes; improved diagnostic techniques and sophisticated monitoring techniques o Perform surgery as early as possible to improve outcome and prevent further possible complications such as CHF ❖Care at home before surgery o Allow child to lead as normal a life as possible o Various responses from family o Routine clinic visits Copyright © 2022 Wolters Kluwer · All Rights Reserved Cardiovascular System Defects: Congenital Heart Disease #11 ❖ Treatment and nursing care (cont.) o Cardiac catheterization: may be performed to gain more accurate information; close observation and treatment essential after procedure o Preoperative preparation: teaching essential; describe equipment to be used; tour of facility; appropriate teaching for postoperative tasks and allow time to practice o Cardiac surgery: type depends on situation; induced hypothermia o Postoperative care: PICU; tasks depend on procedure; education, goals and plans Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 What is the most common cardiac defect causing cyanosis? a. Coarctation of the aorta b. Transposition of the great vessels c. Patent ductous arteriosus d. Tetralogy of Fallot Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 d. Tetralogy of Fallot Rationale: Tetralogy of Fallot is a fairly common congenital heart defect involved in 50% to 70% of all cyanotic congenital heart diseases. Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #1 ❖Most are apparent at birth or shortly thereafter ❖Often result of interruption of embryonic growth at crucial stage ❖Many interfere with normal nutrition and digestion ❖Many require immediate surgical intervention Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #2 ❖ Cleft lip and cleft palate o Clinical manifestations Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #3 ❖Cleft lip and cleft palate (cont.) o Diagnosis ▪ Physical appearance confirms o Treatment ▪ Surgery, timing of surgery varies among surgeons and extent of deformity ▪ Repair needed to ensure intelligible and pleasant speech, proper nutrition ▪ May require several surgeries to complete correct depending on extent of deformity Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Is the following statement true or false? The optimal time for repairing a cleft palate is between 6 months and 5 years of age. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 True Rationale: The optimal time for surgical repair of the cleft palate is considered to be between 6 months and 5 years of age. Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #4 ❖Esophageal atresia (EA) and tracheoesophageal fistula o Clinical manifestations Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #5 ❖Esophageal atresia (EA) and tracheoesophageal fistula (cont.) o Treatment and nursing care ▪ Surgery, may be done in stages ▪ Prevention of mucus aspiration and respiratory distress ▪ IV fluids for hydration, TPN for nutrition ▪ May need gastrostomy tube and drainage of proximal esophageal pouch Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #6 ❖ Imperforate anus o Clinical manifestations Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #7 ❖Imperforate anus (cont.) o Treatment ▪ Surgery, extent and type depends on defect; may need colostomy o Nursing care ▪ Family education for colostomy care Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #8 ❖Hernias o Diaphragmatic hernia ▪ Hernia of diaphragm, with displacement of abdominal organs into left chest ▪ Pushes heart to right and compresses left lung ▪ Requires surgery to repair ▪ Outcome of surgery depends on degree of pulmonary development Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #9 ❖Hernias (cont.) o Omphalocele ▪ Rare; usually detected on ultrasound ▪ At birth, cover with moistened gauze and plastic wrap ▪ Surgical repair necessary Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #10 ❖Hernias (cont.) o Umbilical hernia ▪ Incomplete closure of umbilical cord ▪ Largely cosmetic problem ▪ Bowel strangulation possible but rare ▪ Surgery necessary if does not close Copyright © 2022 Wolters Kluwer · All Rights Reserved Gastrointestinal System Defects #11 ❖Hernias (cont.) o Inguinal hernia ▪ Primarily in males ▪ Intestine slips into scrotal sac ▪ Surgery required to prevent strangulation of intestine Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 When a newborn is born with an omphalocele, what nursing care should be prioritized? a. Contents gently replaced in abdominal cavity b. Covered with gauze moistened in sterile saline c. Plastic wrap is placed directly over defect to conserve heat d. Infant swaddled in blankets so mother can hold newborn Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 b. Covered with gauze moistened in sterile saline Rationale: At birth, the defect should be covered immediately with gauze moistened in sterile saline, which then may be covered with plastic wrap to prevent heat loss. Copyright © 2022 Wolters Kluwer · All Rights Reserved Genitourinary Tract Defects #1 ❖ Hypospadias o Urethra terminates on the ventral (underside) surface of the penis, instead of at the tip ❖ Epispadias o Urethra is on the dorsal (top) surface of the penis ❖ Treatment o Surgical repair, may be done as outpatient o Circumcision should be avoided as foreskin is used in repair o May need repair of other defects Copyright © 2022 Wolters Kluwer · All Rights Reserved Skeletal System Defects #1 ❖Congenital talipes equinovarus (clubfoot) o Can be noted in utero on ultrasound o Most common congenital foot deformity o Clinical manifestation Copyright © 2022 Wolters Kluwer · All Rights Reserved Skeletal System Defects #2 ❖ Congenital talipes equinovarus (clubfoot) (cont.) o Treatment Nonsurgical: (Ponseti method)use of plastic splint or cast; casts changed frequently until radiographic evidence of correction Surgical: used if no response to nonsurgical treatment Denis-Brown method Copyright © 2022 Wolters Kluwer · All Rights Reserved Skeletal System Defects #3 ❖Developmental dysplasia of the hip o Clinical manifestations ❖ Barlow test: upon adduction and extension of the hips (with health care provider providing stabilization to the pelvis), may “feel” the dislocation actually occur ❖ Ortolani sign (or click): health care provider can actually feel and hear the femoral head slip back into the acetabulum under gentle pressure Copyright © 2022 Wolters Kluwer · All Rights Reserved Skeletal System Defects #4 ❖ Developmental dysplasia of the hip (cont.) o Treatment Use of 2 or 3 diapers to maintain constant flexion/abduction 4-8 weeks Use of brace, traction (if severe), or cast (spica cast – change every 6 wks) Long term – Pavlik harness (age 1-6 months) May need surgery (18 months & older if not responsive to treatment)followed with hip spica cast, followed by brace Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #5 Ortolani maneuver is used to aid in the diagnosis of what? a. Talipes equinovarus b. Pavlik disease c. Congenital hip dysplasia d. Barlow disease Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #5 c. Congenital hip dysplasia Rationale: Experienced examiners may detect an audible click when examining the newborn using the Barlow sign and Ortolani maneuver. Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #1 ❖Hereditary disorders that affect metabolism ❖Nursing care involves accurate observation of manifestations to aid prompt diagnosis and initiation of treatment ❖Reinforcing family teaching vitally important o Dietary guideline o Information about disorder o Genetic counseling o Support and information for long-term care of chronically ill child Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #2 ❖Phenylketonuria (PKU) o Recessive hereditary defect of metabolism, if untreated, causes severe intellectual disability o Clinical manifestations: frequent vomiting, aggressive and hyperactive traits, severe, progressive mental disability, convulsions, eczema, musty smell to urine o Diagnosis: Guthrie inhibition assay test after ingestion of protein (48-72 hrs after life), if positive, further testing required to confirm o Normal – 2-10 m/dL, >20 in PKU Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #3 ❖ Phenylketonuria (PKU) (cont.) o Treatment: formula low in phenylalanine; continue with diet low in phenylalanine (most grains, meat, fish, dairy products, eggs, nuts, legumes) o Sapropterin dihydrochloride (Kuvan) – drug to breakdown excess phenylalanine in blood o Nursing care: ▪ Refer to nutritionist to assist family; avoid aspartame sweetener (NutraSweet/ Equal) ▪ Family and child will need support as child gets older ▪ If woman wants to get pregnant, will need to follow diet at least 3 months before getting pregnant; routine blood testing required Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #4 ❖Galactosemia o Recessive hereditary metabolic disorder; enzyme necessary to convert galactose into glucose is missing o Clinical manifestations: early feeding difficulties with vomiting and diarrhea, producing dehydration, weight loss, jaundice o Treatment and nursing care: galactose omitted from diet; must substitute milk for special formula; must maintain lactose-free diet as child gets older Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #5 ❖Congenital hypothyroidism o Associated with either congenital absence of thyroid gland or inability of thyroid gland to secrete thyroid hormone o Clinical manifestations ▪ Signs and symptoms begin to appear at about 6 weeks; depressed nasal bridge, large tongue, puffy eyes, short and thick neck, hoarse cry, skin dry and cold, slow bone development, chronic constipation and enlarged abdomen Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #6 ❖Congenital hypothyroidism (cont.) Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #7 ❖Congenital hypothyroidism (cont.) o Diagnosis ▪ Routine test for triiodothyronine (T3) and thyroxine (T4) levels o Treatment and nursing care ▪ Replacement of thyroid hormone; monitor blood levels ▪ If treatment not begun in early infancy, intellectual disability and slow growth occur ▪ Therapy must be continued for life Copyright © 2022 Wolters Kluwer · All Rights Reserved Inborn Errors of Metabolism #8 ❖Maple syrup urine disease (MSUD) o Inborn error of metabolism of branched-chain amino acids, autosomal recessive in inheritance, rapidly progressive and often fatal o Clinical manifestations: onset very early in infancy; feeding problems, seizures, spasticity, opisthotonos; urine with distinct maple syrup odor; blood test o Treatment and nursing care: dietary, must be initiated within 12 days of birth, diet low in branched-chain amino acids, must be continued indefinitely Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #1 ❖Often evident at birth ❖Frequently cause physical and cognitive challenges throughout life ❖Most common: nondisjunction abnormalities (chromosomal division is uneven, may have one extra or missing one) Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #2 ❖ Down syndrome o May also have trisomy 21 o Higher risk for women older than 35 years; but can be born to women of all ages o Various screening during pregnancy with blood test and ultrasound can detect possibility of Down syndrome before delivery o 2nd trimester screening – “quad test” - AFP (low), unconjugated estriol (UE) (low), inhibin-A (a placental hormone) (high), hCG (high) – high risk for Down syndrome Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #3 ❖Down syndrome (cont.) o Clinical manifestations: brachycephaly; short stature; upward and outward slanted eyes with epicanthic fold at inner angle; short, flattened bridge of nose; thick, fissured, protruding tongue; dry, cracked, fissured skin that may be mottled; small hands with short broad fingers and curved fifth finger; single deep crease on palm of hand; wide space between first and second toes; lax muscle tone; heart and eye anomalies; greater susceptibility to leukemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #4 ❖Down syndrome (cont.) o Treatment and nursing care ▪ Physical characteristics determines medical and nursing management; respiratory difficulties, late motor development, GI tract issues, congenital heart defects, vision or hearing problems, difficulty eating, ▪ Family needs strong support and education ▪ Intervention programs available ▪ Difficult decisions may be necessary Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #5 ❖Turner syndrome o Having one less X chromosome o Characteristics: Short stature; low-set ears; broad-based, short neck; low-set hairline on neck; broad chest; increased angle of the arms; hand/feet edema; frequently have congenital heart defects; females do not develop secondary sex characteristics o Normal intelligence, but may have visual-spatial concerns, learning disabilities, problems with social interaction, lack physical coordination o Treatment: growth hormones Copyright © 2022 Wolters Kluwer · All Rights Reserved Chromosomal Abnormalities #6 ❖Klinefelter syndrome o Extra X chromosome present (characteristics not evident until puberty); most common in males o Characteristics: Atypical physical sexual development; behavioral issues; difficulty with memory and processing; often of normal intelligence o Treatment: Testosterone hormone replacement in early teens Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process ❖Assessment o Data collection ❖Nursing care focus o Goal o Implementations o Evaluation of goal/desired outcome Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #6 Is the following statement true or false? A chromosomal abnormality is always due to a lack of chromosomes in the infant’s genetic structure. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #6 False Down syndrome is the result of an extra chromosome, usually attached in the 21st position. Turner syndrome and Klinefelter syndrome are related to a lack of a chromosome which results in a defect. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 35: The Child With a Sensory/Neurologic Disorder The Nervous System ❖Communication network of body ❖Central nervous system: brain, spinal cord ❖Peripheral nervous system: nerves throughout body ❖Cerebrospinal fluid: in brain and spinal cord, cushion and protective mechanism ❖Nerve impulses activate, coordinate, integrate, control all bodily functions ❖Autonomic nervous system regulates involuntary functions ❖System immature at birth, growth and development occurs, gross and fine motor skills develop Copyright © 2022 Wolters Kluwer · All Rights Reserved Sensory Organs #1 ❖Eyes o Detect light, stimuli from environment o Produce and transmit nerve impulse to brain, brain interprets information results in “seeing” o By 2 months: can focus and follow object with eyes o By 7 months: depth perception has matured o Visual acuity: usually between 20/100 and 20/400 until 5 years of age; most have 20/20 by then Copyright © 2022 Wolters Kluwer · All Rights Reserved Sensory Organs #2 ❖Ears o Organ of hearing, equilibrium and balance o External, middle, inner ear o Tympanic membrane o Eustachian tube o First hearing screening completed before newborn discharged Copyright © 2022 Wolters Kluwer · All Rights Reserved Sensory Organs #3 ❖ Eustachian tube: infant/young child vs. adult Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #1 ❖Vision affects learning process, social development, coordination, and safety ❖Vision impairment classifications o Sighted with eye problems o Partially sighted o Legally blind ❖Types o Refractive errors o Partial sight o Blindness Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #2 ❖Refractive errors o Refraction: the way light rays bend as they pass through lens to retina o Myopia: nearsightedness o Hyperopia: farsightedness o Astigmatism: unequal curvature in cornea that bend light rays in different directions Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #3 ❖Partial sight o Visual acuity between 20/20 and 20/200 in better eye after all necessary medical or surgical correction o High incidence of refractive errors o Eye injuries, cataracts Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #4 ❖Blindness o Legally defined as corrected vision of 20/200 or less, or peripheral vision of less than 20 degrees in better eye o Causes: maternal infections o Can seriously hamper ability to form human attachments; learn coordination, balance, and locomotion; distinguish fantasy from reality, interpret the surrounding world Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #5 ❖Clinical manifestations and diagnosis o Possible signs: squinting and frowning while trying to read something at distance, tearing, red-rimmed eyes, holding work too close to eyes while reading or writing, rubbing eyes o Snellen eye chart o Picture charts not considered as accurate o Simple chart for home use available (See Tips for Reinforcing Family Teaching: Home Eye Test for Children) Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #6 ❖Treatment and education o Medical and surgical advances now available o Earlier treatment given, better the results o Errors of refraction usually correctable o Children with partially sighted or blind do better among normally sighted children o Specialized equipment and devices available Copyright © 2022 Wolters Kluwer · All Rights Reserved Vision Impairment #7 ❖Nursing care o Have same needs as other children o Blind: needs emotional comfort and sensory stimulation which is communicated via touch, sound, and smell o Allow child to touch items o Identify self when enter the room o Encourage child to be as independent as possible Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #1 ❖Cataracts o Development of opacity in crystalline lens that prevents light rays from entering eye o Congenital cataracts may be hereditary or result of injury, metabolic disturbance (galactosemia and diabetes), long-term use of systemic corticosteroids o Treatment: surgical extraction of cataract and lens implantation, will need lens changes as grows Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #2 ❖Glaucoma o Types: congenital infantile, juvenile type, secondary type o Increased intraocular pressure caused by overproduction of aqueous fluid o Slowly advances to blindness if not treated o Treatment: goniotomy Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #3 ❖Strabismus o Failure of two eyes to direct gaze at same object simultaneously o Also called “squint” or “crossed eyes” o Can result in diplopia (double vision) o CNS suppresses vision in deviant eye causing amblyopia (lazy eye) o Wide variation: monocular strabismus, esotropia, exotropia Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #4 ❖ Strabismus (cont.) Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #5 ❖Strabismus (cont.) o Treatment depends on type o Patching, glasses, orthoptics, surgery o Early detection and treatment essential for successful outcome Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #6 ❖Eye injury and foreign objects in the eye o Ecchymosis of the eye (black eye): most concerning if eyeball involved in injury o Penetrating wound: potentially serious o Sympathetic ophthalmia; often includes photophobia, lacrimation, pain, some dimness of vision, detached retina, atrophy of eyeball o Small foreign objects ▪ Avoid the use of cotton-tipped applicators to remove object Copyright © 2022 Wolters Kluwer · All Rights Reserved Eye Conditions #7 ❖ Eye infections o Hordeolum (stye): purulent infection of follicle of eyelash, generally caused by Staphylococcus aureus, localized swelling, tenderness, pain, reddened lid edge; treat with warm saline compresses, ophthalmic antibiotic ointment, never squeeze stye o Conjunctivitis: acute inflammation of conjunctiva; caused by virus, bacteria, allergy, or foreign body; most commonly caused by bacteria; culture will identify organism; treated with ophthalmic antibacterial agents; precautions to prevent spread o Use eye drops during day, ointments at night Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Care for Child Undergoing Eye Surgery ❖Sensory deprivation is possible ❖Waking up to total darkness—panic and anxiety ❖Needs to be well prepared for surgery; however, younger child unable to comprehend or understand ❖Use of play to teach can be helpful; play with blindfold before surgery to help become accustomed ❖Restraints should not be used indiscriminately, but may be necessary ❖Speak to child as you approach them, provide tactile stimulation Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 ❖Is the following statement true or false? ❖A child who is blind from birth has difficulty relating to the environment and may have difficulty meeting growth and development milestones. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 ❖True ❖Being able to see is vitally important for an infant to meet the growth and development milestones as vision is an important factor for relating to the environment around us. Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #1 ❖Hearing loss one of most common disabilities in the United States ❖Development can be moderately to severely impaired ❖Development of speech, human relationships, and understanding of environment all depend on hearing ❖Hearing loss range from mild (hard of hearing) to profound (deaf) ❖Hard of hearing: can learn speech and language by imitating sounds ❖Deaf: no hearing ability Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #2 ❖Conductive hearing loss o Middle ear structures fail to carry sound waves to inner ear o Often result of chronic serous otitis media or other infection o Hearing levels can fluctuate o Chronic middle ear infection can destroy part of eardrum or ossicles o Seldom complete, responds well to treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #3 ❖Sensorineural hearing loss o Result of damage, disease, or disorder affecting inner ear (nerve endings in cochlea or nerve pathways leading to brain) o Causes: Hereditary or congenital factors, toxic reactions to certain drugs o Generally severe o Unresponsive to medical treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #4 ❖Mixed hearing loss o Combines both conductive and sensorineural hearing impairments o Conduction level determines how well child hears ❖Central auditory processing disorder o Damage to or faulty development of proper brain centers make child unable to use auditory information received o May have normal hearing Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #5 ❖ Clinical manifestations o May have difficulty with normal conversation, especially if not looking an individual talking o Mild to moderate hearing loss may go undetected o May be gradual o Certain reactions and mannerism common: locate a sound and turn head to one side when listening, fails to comprehend when spoken to, gives inappropriate answers to questions, consistently turns up volume on television or radio, cannot whisper or talk softly Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #6 ❖ Diagnosis o Profoundly deaf more likely to be diagnosed before age 1 o If hearing difficulties suspected, should be referred for complete audiologic assessment o Tested in soundproof room o Speech reception and speech discrimination tests o In very young infants: noisemakers of varying intensity and pitch o Deafness, intellectual disability, autism sometimes incorrectly diagnosed due to similar symptoms Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #7 ❖Treatment and education o After type and degree of hearing loss established, treat underlying cause o Surgery, hearing aid, cochlear implants o Teach to communicate with lip reading, sign language, oral speech o Ensure vision is normal; if not, correct problem o Special preschools available for deaf children o Federal law requires free and appropriate education for all disabled children Copyright © 2022 Wolters Kluwer · All Rights Reserved Hearing Impairment #8 ❖ Nursing care o When in healthcare facility, encourage primary caregiver to be present to help with communication o Stand or sit face to face on child’s level when speaking to child o Be certain child can see you before you touch the child o Demonstrate each procedure before it is performed o Keep a night light in the child’s room o Proper care of hearing aid o Learn sign language Copyright © 2022 Wolters Kluwer · All Rights Reserved Otitis Media #1 ❖One of most common infectious disease ❖Related to eustachian tube ❖Haemophilus influenzae and streptococcus pneumoniae common causative agents ❖Infant immunizations have decreased incidence of otitis media ❖Clinical manifestations: infant who is restless, repeatedly shakes head, rubs or pulls at one ear; older children complain of pain, fever, irritability, decreased activity, lack of appetite, hearing impairment, possible vomiting or diarrhea Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Otitis Media #2 ❖Diagnosis: o Otoscopic exam shows bright red, bulging eardrum; spontaneous rupture may occur followed by purulent drainage and relieved pain ❖Treatment and nursing care: o Acute cases: antibiotics, analgesics, antipyretics o Chronic cases: prophylactic course of antibiotic, myringotomy with tubes o Possible complications: mastoiditis o Teaching about prevention and care of child if infected Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Chronic serous otitis media can destroy part of the eardrum or the ossicles. What does this lead to? a. Mixed hearing loss b. Sensorineural hearing Loss c. Conductive hearing loss d. Central auditory dysfunction Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 c. Conductive hearing loss Rationale: In conductive hearing loss, middle ear structures fail to carry sound waves to the inner ear. This type of impairment most often results from chronic serous otitis media or other infection, and it can make hearing levels fluctuate. Chronic middle ear infection can destroy part of the eardrum or the ossicles, which leads to conductive deafness. Copyright © 2022 Wolters Kluwer · All Rights Reserved Insertion of Foreign Bodies Into the Ear or Nose ❖Toddlers and preschool-aged children may insert small objects into their ears or noses ❖Ears: o To remove: irrigation, use of forceps ❖Nose: o Risk of infection if object remains inside nose o To remove: healthcare professional uses speculum to inspect and remove Copyright © 2022 Wolters Kluwer · All Rights Reserved Reye Syndrome #1 ❖Usually occurs after a viral illness (upper respiratory infection or varicella, commonly) ❖Administration of aspirin during viral illness has been implicated as contributing factor ❖AAP recommends aspirin or aspirin compounds NOT be given to children during viral infections ❖Characterized by acute encephalopathy and fatty degeneration of the liver and other abdominal organs Copyright © 2022 Wolters Kluwer · All Rights Reserved Reye Syndrome #2 ❖Clinical manifestations o Symptoms appear 3 to 5 days after initial illness o Child recuperates unremarkably when symptoms of severe vomiting, irritability, lethargy, confusion, and disorientation appear o Need immediate intervention to prevent seizures, coma, respiratory arrest ❖Diagnosis o History of viral illness, liver function tests, liver biopsy, lumbar puncture, coagulation studies, blood glucose, ammonia levels; hypoglycemic, delayed PTT Copyright © 2022 Wolters Kluwer · All Rights Reserved Reye Syndrome #3 ❖Treatment o Requires ICU care; medical management focuses on supportive care, osmotic diuretics ❖Nursing care o Careful observation o Accurate I&O o Monitor blood glucose level, bleeding time o Care for family, support, education, keeping well informed Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute or Nonrecurrent Seizures #1 ❖ Seizure (convulsion) may be symptom of wide variety of disorders ❖ Febrile seizures o Most common, usually occur in form of generalized seizure early in course of fever o Commonly associated: 102°F to 106°F (38.9°C to 41.1°C); some may convulse with fever of 100°F to 102°F (37.8°C to 38.9°C) o Often one of initial symptoms of acute infection o Less common causes: intracranial infections, toxic reactions to certain drugs and minerals, metabolic disorders, head trauma, various brain disorders Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute or Nonrecurrent Seizures #2 ❖Febrile seizures (cont.) o Clinical manifestations and diagnosis ▪ Occur suddenly without warning, restlessness and irritability may precede episode; body stiffens, LOC, clonic movements occur, irregular breathing, unable to swallow saliva o Treatment ▪ Protection from seizure ▪ IV diazepam or lorazepam ▪ Acetaminophen given for fever Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #1 ❖Also referred to as convulsive disorders ❖Result of variety of causes ❖Epilepsy: recurrent and chronic seizure disorder o Classifications ▪ Primary (idiopathic); most common ▪ Secondary (resulting from infection, head trauma, hemorrhage, tumor, or other organic or degenerative factors) Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #2 ❖Clinical manifestations o Focal (partial) onset: seizure begins in a particular area of the brain o Generalized onset: involves both hemispheres of brain o Unknown onset: beginning of seizure not known o International League Against Epilepsy has new terms to describe and classify seizures (Wilfong, 2020) Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #3 ❖Focal (partial) onset seizures o Focal onset aware seizures (formerly called simple partial seizures): child awake and aware during seizure ▪ Focal onset motor seizure causes localized motor activity, limited to one side of body or may spread to other parts ▪ Focal onset sensory seizure may include sensory symptoms (aura) involving sight, sound, taste, smell, touch, or emotions; child may have numbness, tingling, paresthesia, or pain Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #4 ❖Focal (partial) onset seizures (cont.) o Focal onset impaired aware seizures (formerly called complex partial seizures): child confused or awareness is affected during seizure, unable to respond normally ▪ Seizure begins in small area of brain and changes consciousness ▪ Motor and nonmotor symptoms, nonpurposeful movement; repetitive actions ▪ After seizure may be confused or sleep, often unaware of seizure Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #5 ❖Generalized onset seizures o Both sides or hemispheres of brain affected at same time o Types ▪ Tonic-clonic ▪ Absence ▪ Atonic ▪ Myoclonic ▪ Infantile spasms Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #6 ❖Generalized onset seizures (cont.) o Tonic-clonic seizures ▪ Four stages: prodromal period, tonic phase, clonic phase, postictal period o Absence seizures ▪ Interrupts conversation or physical activity, child loses awareness and stares straight ahead, may have muscle twitching ▪ After seizure immediately is alert and continues conversation, unaware of what happened Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #7 ❖Generalized onset seizures (cont.) o Atonic seizures ▪ Sudden momentary loss of consciousness, muscle tone, and postural control resulting in fall and possible injuries o Myoclonic seizures ▪ Sudden jerking of muscle or group of muscles, often in arms and legs, without loss of consciousness ▪ Occurs in early stages of falling asleep Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #8 ❖Generalized onset seizures (cont.) o Infantile spasms ▪ Most common in younger than 2 years ▪ Flexion or extension of arm, leg, or head ▪ Often preceded or followed by cry ▪ Muscle contractions are sudden, brief, symmetrical, accompanied by rolling eyes ▪ Loss of consciousness does not always occur ▪ Almost always indicate cerebral defect; poor prognosis despite treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #9 ❖Status epilepticus o Seizure that lasts longer than 30 minutes or series of seizure in which child does not return to previous normal level of consciousness o Immediate treatment decreases likelihood of permanent brain injury, respiratory failure, or even death o Emergency situation, requires immediate treatment o Treated with diazepam and lorazepam, rectally or IV Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #10 ❖Diagnosis o EEG, video and ambulatory EEG, skull radiography, CT, MRI, brain scan, physical and neurologic assessments, seizure history ❖Treatment o Anticonvulsant drug therapy: carbamazepine, ethosuximide, phenobarbital; phenytoin, valproic acid (See Table 35-1) o Surgery o Vagus nerve stimulation therapy o Ketogenic diets Copyright © 2022 Wolters Kluwer · All Rights Reserved Seizures Disorders #11 ❖Nursing care o Keep child safe during seizure o Provide child and family with complete and accurate information o Certain limits and restrictions may be necessary Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 You are the emergency department nurse admitting a 6-year-old male client who has come in by ambulance from his school. The paramedics inform you that the child has been having repeated seizures for approximately 35 minutes. What drug would you expect the health care provider to order? a. IV Dilantin b. IV Solumedrol c. IV Morphine d. IV Diazepam Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 d. IV Diazepam Rationale: Status epilepticus is an emergency situation and requires immediate treatment. The drugs diazepam and lorazepam, given rectally or IV, are used to treat the condition. Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #1 ❖Viral meningitis o Referred to as aseptic meningitis o Symptoms: similar to bacterial meningitis, not as severe o Cause: different viruses, often enter body through infection in nose or mouth o Enteroviruses most common cause Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #2 ❖Bacterial meningitis o Caused by: Streptococcus pneumoniae, group B Streptococcus, Neisseria meningitides, Haemophilus influenzae o Transmission varies: droplet, via bloodstream from infection elsewhere o Standard precautions and droplet transmission precautions necessary o Hib and pneumococcal conjugate vaccines has decreased incidents of infections Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #3 ❖Clinical manifestations o Onset gradual or abrupt o Infants: fever, bulging fontanel, poor sucking and feeding, lethargy, irritability o Children: headache, nuchal rigidity, opisthotonos, positive Kernig and Brudzinski signs, photophobia, nausea/vomiting, confusion o Generalized seizures, coma o Meningococcal meningitis: petechiae and purpuric rash Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #4 ❖ Kernig sign Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #5 ❖ Brudzinski signs Copyright © 2022 Wolters Kluwer · All Rights Reserved Meningitis #6 ❖ Diagnosis o Lumbar puncture before antibiotics are given; measure spinal pressure; check spinal fluid for WBCs, protein, glucose, clear or purulent, gram stain ❖ Treatment o Appropriate transmission precautions; IV antibiotics and steroids; antipyretics, anticonvulsants o Aspiration of subdural effusion o Prevention of complications: deafness, intellectual disability, seizure disorders, hydrocephalus, paralysis Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #1 ❖Group of disorders arising from malfunction of motor centers and neural pathways in brain ❖One of most complex of common permanent disabling conditions ❖Often can be accompanied by seizures, intellectual disability, sensory defects, behavior disorders Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #2 ❖Causes o Prenatal causes: any process interfering with oxygen supply to brain, maternal infection, nutritional deficiencies, kernicterus, teratogenic factors o Perinatal causes: prematurity because immature blood vessels predispose neonate to cerebral hemorrhage; anoxia immediately before, during, or after birth; intracranial bleeding, asphyxia, maternal analgesia that depresses respiratory center, birth trauma o Postnatal causes: head trauma, infection, neoplasms, CVA Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #3 ❖Prevention o Very important, brain damage irreversible o Prenatal care to improve nutrition, prevent infection, decrease incidence of prematurity o Perinatal monitoring to prevent trauma o Postnatal prevention of infection o Protection of trauma of MVA, child abuse, other accidents Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #4 ❖Clinical manifestations and types o Difficulty controlling voluntary muscle movements, seizures, intellectual disability, hearing and vision impairments, behavior disorders, delayed gross motor development, abnormal motor performance, abnormal postures, persistence of primitive reflexes o Diagnosis seldom occurs before 2 months of age, may be delayed until second or third year when tries to walk o Diagnosis based on observations of delayed growth and development Copyright © 2022 Wolters Kluwer · All Rights Reserved  Cerebral Palsy #5 ❖ Major types o Spastic type ▪ Hyperactive stretch reflex in associated muscle groups ▪ Increased activity of deep tendon reflexes ▪ Clonus ▪ Contractures affecting extensor muscles, scissoring ▪ When standing is on toes, difficult to walk or run Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #6 ❖Major types o Athetoid type (dyskinetic) ▪ Involuntary, uncoordinated motion with varying degrees of muscle tension ▪ Constantly in motion, whole body state of slow, writhing muscle contractions whenever voluntary movement attempted ▪ Facial grimacing, poor swallowing, tongue movements causing drooling, dysarthria ▪ Average or above average intelligence ▪ Hearing loss common Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #7 ❖Major types o Ataxic type ▪ Lack of coordination caused by disturbances in kinesthetic and balance senses ▪ Least common type ▪ May not be diagnosed until start to walk ▪ Gait is awkward and wide-based Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #8 ❖Major types o Mixed type ▪ Signs of more than one type of CP ▪ Usually severely disabled ▪ May be caused by postnatal injury Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #9 ❖Diagnosis o Birth and family history o May not be diagnosed until start to walk o May show signs of intellectual disability, attention deficit disorder, or recurrent seizures o Developmental delays and screening o MRI, cranial ultrasound may help determine cause in infants before closure of cranial sutures Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #10 ❖Treatment and special aids o Help child make the best use of residual abilities and achieve maximum satisfaction and enrichment in life o Team of healthcare professionals works with family to set realistic goals o Medications: baclofen, diazepam, dantrolene o Physical therapy: teach ADLs, various techniques used Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #11 ❖Treatment and special aids (cont.) o Orthopedic management: braces and other orthopedic devices used as supportive and control measures; surgery sometimes used to improve function and correct deformities o Technologic aids for daily living: biomedical engineering perfected number of devices: motorized wheelchairs, completely electronic cottages with voice activated computer systems; special chairs; special feeding aids, dishes, silverware; games; computer programs to help with communication Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #12 ❖Treatment and special aids (cont.) Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebral Palsy #13 ❖Nursing care o Interview and observe child and family to determine needs, level of development, stage of family acceptance and set realistic goals o Encourage child to maintain current self-care activities and set goals for attaining new ones o Provide appropriate pre- and postoperative care when surgery is needed o Provide necessary support to help child and family deal with complex situation Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 ❖Is the following statement true or false? ❖Moderate technology has greatly improved the life of a child with cerebral palsy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 ❖True ❖Moderate technology has provided many new pieces of equipment which has improved the life of many children with cerebral palsy. From better transportation means to better communication. Depending on the extent of the child’s disorder, some are now able to learn skills and find employment which wasn’t always possible. Technology also provides better forms of communication which didn’t exist. Copyright © 2022 Wolters Kluwer · All Rights Reserved Intellectual Disability #1 ❖Disorder with significant limitations in intellectual functioning (learning, reasoning, problem-solving)— an IQ of 70 or lower, concurrent deficits in adaptive behavior (American Association on Intellectual and Development Disability [AAIDD], 2020) ❖Adaptive behavior: conceptual skills, social skills, practical skills expected for age and cultural group ❖Onset occurs before 18 years ❖Often occur in combination with other physical disorders Copyright © 2022 Wolters Kluwer · All Rights Reserved Intellectual Disability #2 ❖Causes o Prenatal: inborn errors of metabolism, prenatal infection, teratogenic agents, genetic factors (Down syndrome most common) o Perinatal: birth trauma, anoxia from various causes, prematurity, difficult birth; prenatal factors may have influenced the perinatal complications o Postnatal: poisoning (lead), infections and trauma, impoverished early environment, emotional rejection Copyright © 2022 Wolters Kluwer · All Rights Reserved Intellectual Disability #3 ❖Clinical manifestations and diagnosis o Severity: mild, moderate, severe, profound; determined by adaptive impairment and level of support needed o Mild: slow learner, acquire basic skills, slower than average in learning to walk, talk, feed self; may not be obvious to casual acquaintances o Moderate: little if any ability to attain independence and academic skills, referred to as trainable, delayed motor development and speech, few become capable of assuming complete self-maintenance Copyright © 2022 Wolters Kluwer · All Rights Reserved Intellectual Disability #4 ❖Clinical manifestations and diagnosis (cont.) o Severe: markedly delayed during first year of life; cannot learn academic skills; may be able to learn some self-care skills if sensorimotor stimulation is begun early; will probably learn to walk and speak but sheltered environment and careful supervision always required o Profound: minimal capacity for functioning and needs continuing care; may learn to walk and develop primitive speech but will never be able to perform self-care activities Copyright © 2022 Wolters Kluwer · All Rights Reserved Intellectual Disability #5 ❖Treatment and education o New teaching methods available o Mild to moderate: taught tasks that help achieve some degree of independence o Family will go through grieving process with diagnosis o Early diagnosis and intervention important o Child often kept at home in supportive family environment, helps with growth and development Copyright © 2022 Wolters Kluwer · All Rights Reserved Brain Tumors #1 ❖May be benign or malignant ❖Second most common type of cancer in children and adolescents ❖Cause of most brain tumors unknown ❖Can cause neurologic effects with long term concerns ❖Prognosis depends on type, location, ability to remove tumor, and treatment done Copyright © 2022 Wolters Kluwer · All Rights Reserved Brain Tumors #2 ❖Clinical manifestations and diagnosis o Clinical manifestations may be subtle and/or nonspecific and vary with age and location o If cranial sutures not fused, large head, bulging fontanels, and irritability are common o Nausea and vomiting common in all ages o Older children: headache, impaired vision, visual disturbances (diplopia), nystagmus, papilledema, abnormal gait, poor coordination, head tilting, seizures; changes in behavior or school performance, sleep disturbances, growth impairment Copyright © 2022 Wolters Kluwer · All Rights Reserved Brain Tumors #3 ❖Clinical manifestations and diagnosis (cont.) o MRI, CT, tissue samples, lumbar puncture often done to identify tumor type ❖Treatment and nursing care o Surgery, radiation, chemotherapy may be used o Anticonvulsant therapy may be indicated o Close monitoring child for IICP, chemotherapy reaction and adverse affects o Reinforce family teaching Copyright © 2022 Wolters Kluwer · All Rights Reserved Head Trauma #1 ❖Broad term used to describe head injuries that include any kind of distress to scalp, skull, or brain, such as fractures, concussions, bleeding, bruises ❖Traumatic brain injury (TBI): serious injuries affecting the brain; can be mild, moderate or severe ❖Glasgow Coma Scale is used to classify severity ❖Primary cause varies with age: fall, child abuse, bicycling, inline skating, skiing, MVA, sports ❖Amount of bleeding if laceration can be alarming, apply ice pack and/or pressure Copyright © 2022 Wolters Kluwer · All Rights Reserved Head Trauma #2 ❖ Observe child for at least 6 hours after injury for vomiting and change in LOC; if fall asleep wake up every 1 to 2 hours check LOC, do not give analgesics or sedatives, check pupils every 4 hours for 48 hours ❖ Notify health care provider if vomiting, pupillary changes, double or blurred vision, change in LOC, acts strange or confused, has trouble walking, headache that is more severe or wakes them up from sleep ❖ Complications: hemorrhage, hypoxia, cerebral edema, IICP ❖ Abusive head trauma: retinal hemorrhage, intracranial hemorrhage; shaken baby syndrome Copyright © 2022 Wolters Kluwer · All Rights Reserved Drowning ❖Second leading cause of accidental death ❖Toddlers and older adolescents have highest rate of death ❖Infants more commonly drown in bathtubs; toddlers and preschoolers in pools or small bodies of water ❖Responsible adult must continuously supervise ❖Treatment: CPR immediately, continued until transported to medical facility o See Table 35-3 and Figure 35-12 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #5 Which age group is most likely to receive a head injury from child abuse? a. Toddlers b. Preschoolers c. School-aged kids d. Adolescents Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #5 a. Toddlers Rationale: Toddlers and young children may receive a head injury from a fall or child abuse; school-aged children and adolescents usually experience such an injury as a result of a bicycling, inline skating, or motor vehicle accident. Copyright © 2022 Wolters Kluwer · All Rights Reserved References ❖Hatfield, N.T. & Kincheloe, C.A. (2022). Introductory Maternity & Pediatric Nursing. 5th ed. Philadelphia, PA: Wolters Kluwer / Lippincott, Williams and Wilkins Copyright © 2022 Wolters Kluwer · All Rights Reserved