Pediatric Nursing: Communicable Diseases and Assessments PDF

Three party communication Influenced by growth and development, sociodemographic, culture, language, education and personal variables Establish rapport: based on trust and respect - Open body language - Environment that preserves privacy and autonomy - Age-appropriate language - Eye-le...

Three party communication Influenced by growth and development, sociodemographic, culture, language, education and personal variables Establish rapport: based on trust and respect - Open body language - Environment that preserves privacy and autonomy - Age-appropriate language - Eye-level - Open ended questions - "How often is baby eating?" Health history Expected vs unexpected findings: why are these happening? - Vital signs Complete health history includes: - Birth history - Traumatic? Hypoxia? - Developmental; delay in bonding? - Behavioral/emotional problems - Fourth child or first? - Environmental factors - Passive exposure to smoke - Access to adequate nutrition. - Family medical history - Illness, hospitalizations, surgeries - Medications and immunization - Allergies - Nutritional status - Current or recent manifestations: What brought them in? - Nutrition assessment: - Collect data to review: - Eating habits: what are they eating, meals instead of just snacks? Cultural norms and allergies. - Dietary restriction - 6 months introducing foods. - Cultural norms - Food allergies - Stunting - Look at growth charts. - Wasting - Height/length per their weight (BMI) - Weight by age (over or under) - Physical assessment (well child check) - Weight in kilograms. - Naked weight or fresh diaper weights up - Height in cm until 2 years old. - Head circumference in cm. Above eyebrow and above ear. - Vital signs - Developmental milestones check - ASQ-3, Denver, CDC milestones - Health promotions and disease prevention - Appropriate to the child's developmental level - Safety - Immunizations - Provider examination - Pain: - Premature infant pain scale - Age: preterm and term infants - Five items combined with gestational age for a total of 21 points (three behavioral and two physiological) - Face, Legs, Activity, Cry, Consolability (FLACC): 2 months to 7 years old or non-verbal;/cognitively impaired at any age - Five behavior items scored from 0 to 2 for total of 10 points - Pain word scale: 3 to 7 years old. Can be used for clients older than 7 years old if they are unable to use numerical rating scale - Ask the client to quantify severity with words such as "none", "a little", "medium", "a lot" - Faces pain scale: 5 to 12 years old - Picture-based scale that uses on a scale of 1 to 5 to represent pain - Numeric Rating scale: 7 years and older - Ask client to rank their pain using a number (0 being no pain to 10 being the worst pain ever) - Age groups - Newborn: Birth to 28 days - Infant: 1 month to 1 year - Toddler: 1 to 3 years - Preschool: 3 to 6 years - School age: 6 to 12 years - Adolescent: 12 to 20 years Unit 5: Communicable diseases: Chickenpox: - Causing Agent: varicella-zoster virus - Spread: respiratory droplets or contact with open vesicle - Manifestations: Small, itchy blisters that form scabs - Diagnostics: manifestations or test the fluid from vesicle - Treatment: Supportive, calamine lotion, oatmeal baths, and antihistamines, if fever give antipyretic - Put mitts on hands and cut nails short - Stay home until all blisters have scabbed over, typically in a week. - Prevention: Varicella vaccine---live vaccine. Starts at 12 mo. Diphtheria: - Spread: airborne particles or contact depending on the bacteria - Manifestations: Flu-like symptoms followed by thick, gray colored throat and tonsils - At risk for airway obstruction/respiratory distress - Most likely be hospitalized for close monitoring - Diagnostics: throat swab - Tx: abx and diphtheria antitoxin; immunoglobin---LPNs cannot administer IV - Prevention: Dtap vaccine starts at 2mo. Mom get Tdap while pregnant at 28 weeks. Mumps: - Spread: virus through respiratory droplets or direct contact with infected saliva - Manifestations: swelling of one or more salivary glands (commonly parotid) Swelling of unilateral cheek on face - Diagnostics: buccal swab or serum blood test. - Tx: supportive (rest, hydration, pain relief) - Prevention: MMR vaccine Measles (Rubeola): - Spread: virus through respiratory droplets or direct contact with infected saliva. Can live in the air for 2HRS - Manifestations: fever, rash, and kolpik spots; white spots on inside of cheek, appear 1-2 days before they get rash. After rash on body these spots fade. - Tx: supportive (adequate nutrition and hydration) - Prevention: MMR vaccine Poliomyelitis: - Spread: viral spread through fecal-oral route or respiratory tract - Manifestations: mild flu to central nervous system (muscle weakness or paralysis, respiratory depression) - Diagnostics: throat swabs, stool specimens, or CSF - Treatment: no cure---supportive measures. Respiratory support like the iron lung. - Prevention: IPV vaccine. Eradicated in the US Meningitis: inflammation of the meninges (covering of the spinal cord and brain) - Viral: not as severe. More prevalent during summer and fall when enteral viruses are more common. - Younger child: lethargy, fever, irritability, poor eating, vomiting, full or bulging anterior fontanel; soft spot on head. - Older child: fever, N/V, photophobia, headache, nuchal rigidity, irritability, lethargy, blurred or double vision - Bacterial: like viral but more severe and can cause sepsis - Brudzinski sign, when neck is flexed their knees involuntarily flex up when patient is supine. - Kernig sign, knee at 90-degree angle, painful when straightened - Petechial rash (meningococcus infection: can lead to necrosis) Diagnostics: lumbar puncture, testing for CSF. (increased WBC, culture it) Treatment: antibiotics are stopped if viral and corticosteroids for bacterial infection Nursing interventions for meningitis: - Droplet precautions: viral if patient is incontinent. Bacterial: 24 hours after antibiotics are started, they stop precautions. - Neuro checks: confusion, lethargy, high-pitched cry can indicate increased intracranial pressure, bulging anterior fontanels increases risk for seizures - Fluids - Antipyretics, monitor temperature, children at risk for febrile seizures - Prevention: Meningococcal, pneumococcal (PCV), Hib - Hepatitis: inflammation of the liver - Spread: - Hep A\-\-- contaminated food and water. - Hep B & C---bloodborne through infected body fluids - Manifestations: - A---GI upset: N/V and diarrhea - B \-\-- malaise, decreased appetite, RUQ pain---jaundice and hepatomegaly = chronic hep B - C -- mostly asymptomatic, malaise and poor appetite - Treatment: supportive antivirals, interferon - Prevention: Hep B vaccine at birth. Hep A vaccine at 12 mo. Hep C use precautions and using sterile needles - Fifths disease: - Spread: viral through respiratory droplets, direct contact or blood - Manifestations: "slapped check" rash (once present no longer contagious) followed by non-pruritic rash - Treatment: supportive - Hand, Food & Mouth: - Spread: viral through respiratory tract, oral secretions or fluid from a vesicle of a human host to another individual - Manifestations: rash, ulcer sores with red boards and white or gray-yellow bases - Treatment: supportive if painful/itchy Benadryl cream - Impetigo: - Spread: bacteria that enters through broken skin. Common in wrestlers. - Manifestations: honey-crusted lesions, if severe enough large bullae (blisters): in severe cases so oral abx are prescribed - Tx: abx topically or orally - Conjunctivitis (pink eye) - Inflammation of the conjunctiva - Bacterial vs viral - Viral: watery clear discharge - Bacteria: crusty, yellowish discharge - Treatment: - Topical abx eye drops - Parent education: - Proper hand hygiene - Avoid eye rubbing - Cool rag to help with pain - Allergic - Response to allergen - Antihistamine - Antibody, a substance our body makes to fight against foreign substances vs Antigen, a substance that provokes an immune response in the body. - Types of Immunity - Natural immunity: born with it. Skin and mucus membranes - Acquired immunity develops during lifetime. Active or Passive - Active immunity: body is actively fighting it. To an infection or vaccine. Through getting sick or artificially through a vaccine - Natural active immunity: Antibodies developed in response to an infection - Artificial immunity: Antibodies developed in response to a vaccination - Passive immunity: Develops after you receive antibodies from someone or somewhere else. - Artificial passive, getting help from a medication like immunoglobulins. - Natural passive immunity like breastmilk. Hep B vaccine at birth Dtap vaccine at 2 months Rotavirus vaccine at 2 months Hib vaccine at 2 months IPV vaccine at 2 months PCV vaccine at 2 months Dtap vaccine at 4 months Rotavirus vaccine at 4 months Hib vaccine at 4 months IPV vaccine at 4 months (2 Be DR. HIP. 4 DR.HIP) Hep B vaccine at 6 months Dtap vaccine at 6 months Rotavirus vaccine at 6 months HIB vaccine at 6 months IPV vaccine at 6 months PCV vaccine at 6 months Influenza vaccine at 6 months (Be DR.HIP in 6 months) Varicella-zoster vaccine at 1 MMR vaccine at 1 Hep A at 1 Dtap at 1 HIB at 1 IPV at 1 PCV at 1 (1 Very MAD HIP-ster) Varicella-zoster at 4-6 years Dtap at 4-6 years IPV at 4-6 years MMR at 4-6 years (Very DIM BETWEEN 4-6 years) - Parasitic infestations and parasitic infections - Scabies - Causing agent: sarcotpes scabiei mite - Spread: burrows under skin and lay eggs. Mites can survive under the skin for 2-3 months, eggs hatch in 2-3 weeks. - Manifestations: intense itching on wrists, genitals and fingers (worse at night) - Treatment: topical medication (permethrin cream) - Caring for patient: cool baths or compress, trimming fingernails, washing bedding and clothing in hot water - All household members in close contact may need to be treated. - Lice (pediculosis) - Causing agent: pediculus humanus capitis - Spread: close contact or sharing personal items - Manifestations: pruritic, visible nits - Treatment: medicated shampoos, lotions or creams - Caring for patient: combing hair to remove lice, treating bedding, clothing and personal items by washing in hot water. - Koplik spots are a sign of measles - Lumbar punctures are utilized to diagnose meningitis - Children of different age ranges present with varying manifestations for meningitis - Sensory nervous system - Ears - Outer ear: Ear lobe and ear canal - Middle ear: tympanic membrane and ossicles: malleus, incus and stypsis. - Inner ear: semicircular canals, cochlear, and vestibular nerve - Main function: Sound enters and goes through external acoustic meatus and into that ear canal which hits the eardrum/tympanic membrane and cause vibrations, these cause the ossicles to hit each other and transfer that sound into the cochlear stimulating the vestibular nerve which sends those signals to the brain. - Balance: The semicircular canals play a role on balance. - Peds clients have their eustachian tube that has a part to help with drainage but since theirs is more horizontal it hinders the movement of the tube allowing organisms to grow and inflammation to continue. - Otitis media: Middle ear infection in eustachian tubes. - Risk factors: smoke exposure, allergies, daycare, respiratory infection, pacifiers: these put pressure on the ears. Not up to date on immunizations - Clinical presentation: - Inflammation and ear pain - Difficulty hearing - Fever - Poor appetite - Vomiting - Rolling head side to side/tugging at ear - Irritable - Otorrhea (drainage) - Perforation \-\-- abrupt ear pain, vertigo, tinnitus, hearing loss or bloody otorrhea. - Diagnostics: otoscope exam - Treatment: Can heal on its own. Avoid having fluid go in the ear. - Abx -- oral - Myringotomy with tympanoplasty tube placement to equalize pressure in the ear drum (4 or more ear infections in a year) - Strabismus: normal in newborns. 6 muscles in the eye. - One or more eye muscle not working properly - Visual screening helps identify - Treatment: - Patch therapy: force the bad eye to work more and strengthen the muscle. Patch the good eye. - Glasses to allow for better focus and align the eyes. - Eye exercise - Eye drops to use as indicated - Strabismus surgery - Considerations of peds patient - May affect reading, seeing board, alter self-image - Cognitive system - Lead poisoning (plumbism) - Ingestion or environmental exposure - Screening - Medicaid patients should get the 12-24 month test - Not enrolled in Medicaid: risk assessment - Diagnostics: Serum lead level - Treatment: - Remove source of lead in house - Chelating agents to reduce blood and tissue levels - Will not correct any injury that has already occurred. Irreversible, no cure. - Brain: Hyperactivity, developmental and cognitive delays, impaired balance, hearing loss, seizures, coma or death. - Heart: Low iron and hemoglobin levels, anemia and hypertension - Stomach: abdominal pain, constipation, anorexia, vomiting - Kidneys: Kidney damage - Bones: impaired vitamin D and calcium absorption, blood dyscrasias, delayed growth. - ADHD: Most common neurodevelopmental disorders of childhood. - Anatomical differences in brain and disruptions in neurotransmitter imbalances that cause disruptions with attention, self-regulation and impulse control - Risk factors: low birth weight, premature, exposed to toxins or stress in utero - Clinical presentation: inattentive, hyperactive and impulsive - Diagnostics: - Thorough hx and assessment of behaviors to rule out other disorders - Manifestations should have been present for at least 6 months - Treatment: varies by the child - 4-6 yo -- Parent training and behavioral management and educational support - 6-12 yo \-\-- PTBM, educational support and medication - 12-18 yo -- Medication, educational support and behavioral interventions - Children who have ADHD are at higher risk for engaging in risky behaviors putting them at risk for injury and accidents including: - Participating in high-risk sexual behaviors and substance use - Increased risk for dental injuries and dental caries in children who have ADHD - Adolescents may be at risk for challenges in driving due to inattention and impulsivity - Autism spectrum disorder - Screening: through milestone checks during well child visits - 18 + 24 months all children recommended to be screened - Clinical presentation: - Decreased interest in things that others like to want or talk about - Finding it challenging to care about how others feel - Avoiding looking into other's eyes - Difficulty using body language appropriately - Use of unnatural speech - Takes everything in literal sense w/o appreciation for jokes - Difficulty with social relationships - Difficulty adjusting to change - Focusing on certain topics all the time - Being very sensitive to loud sounds - Demonstrating repetitive movements such as rocking back and forth - Prefers to arrange things without tolerance for others moving items - Treatment: varies by child - Individualized education plan - Parent training and behavioral management - ST/OT - Medication (aripiprazole or risperidone) often more with patients that have irritability - Down Syndrome - Extra copy of Chromosome 21 - Results in mental and physical changes that affect a child's cognitive abilities and physical appearance - Screening---prenatally and NB - Clinical manifestations: - Almond eyes that slant up - Short neck - Small ears - Protruding tongue - Small white spots on colored part of eye - Small hands and feet - Single palmar crease - Poor muscle tone or loose joints - Treatment and therapies: - Depend on cognitive concerns and medical diagnosis - Impact on overall health - Heart defects, vision and hearing disorders, OSA, GI issues - Developmental (sensory processing challenges) - Overstimulated or under stimulated, Intellectual delays, speech deficits, memory impairment, behavioral issues, higher incidence of ASD. - Respiratory system: - Obligatory nose breathers first 6 months - Trachea---short narrow and less supported by surrounding structures - Respiratory distress - Nasal flaring - Head bobbing - Retractions - Cyanosis - Croup: group of disorders causing swelling and restricted airflow, most caused by virus - Clinical manifestations - Nasal discharge, congestion, fever, barking cough - As swelling increases---SOB, stridor retractions and anxious - Treatment: Neb or steroids - Client education: worse at night, steam can help, cold air: to relax airways and help with movement - Epiglottitis: Medical emergency and does not have a cough! - Stridor - Tripod position - Drool - Do not inspect throat\-\--can cause laryngeal spasm and obstruct airway even further - Treatment: - Airway management tool - Abx - Prevention \-- Hib vaccine - Bronchitis - Commonly caused by RSV, flu, and COVID - Clinical manifestations: cough, fever, tachypnea, wheezing or crackles in lungs = respiratory distress - Treatment: - Hydration - Antipyretics - Nasal drops and bulb suctioning before eating - RSV - Peak of infection is first 2 months of the year - Most common under 1 year of age they are hospitalized - Symptoms depend on client age, primary or secondary infection, underlying health conditions - Older adults: cough, nasal congestion with drainage and conjunctivitis - Younger patients: wheezing and crackles, apnea, tachypnea, severe coughing, hypoxia. Most common reason children are hospitalized under the age of 1. - Diagnostics: nasal swab - Treatment: similar to bronchitis - Prevention - Palivizumab: for individuals that are high risk with underlying health conditions, multiple injections. Nirsevimab: RSV vaccine - Abryso (pregnancy) - Streptococcal Pharyngitis: - Clinical manifestations - Sore throat with no cough or nasal drainage - Throat- red, petechiae and white exudate - Most common is Group A strep - Diagnostics - Throat swab - Treatment - Antibiotics. - For non-adherence given Penicillin one time dose IM - Tonsillitis: responsible for trapping organisms, clearing infection from the body and regulates body fluid. - Clinical manifestations - Difficulty and pain with swallowing - Exudate - Diagnostics - Throat swab for bacterial. Can be viral - Treatment: - Supportive - OTC pain medication - Cold liquids - Abx if bacterial - Surgery - Tonsillectomy and/or adenoidectomy - Post-op cares - Monitor for bleeding -- frequent swallowing, clearing the throat, restlessness, bright red emesis, tachycardia, or pallor - Monitor for difficulty breathing - Offer ice chips or sips of water - Administer pain medications on a regular schedule - Encourage clear liquids initially then soft diet - Avoid red-colored liquids, citrus juice and milk-based food initially: sticks to your throat at risk of scabs falling off. - Avoid straws at risk for scabs falling off - Pertussis - Communicable disease that is mandated to be reported - Causing agent: Bordetella pertussis - Spread: respiratory droplets or contact - Manifestations: stages --cough and fever to thick mucus in airway causing coughing spells that are violent with whoop sound at the end, vomiting -- decrease in coughing spells but can last up to a month - Treatment: abx even the whole family. Babies get Dtap at 2, 4, and 6 mo - Prevention: Dtap vaccine - Asthma: - Chronic lung disease characterized by inflammation, mucus formation and narrowing of airways - Risk factors: Puerto Rican and African American - Males (early childhood) and female (adolescence) - Exposure to allergens (smoke, workplace chemicals, dust) - Obesity - Triggers: Pet dander, dust mites, weeds, tobacco smoke, cold air, chemicals, scents and medications like NSAIDS that block COX 1 decreasing prostaglandins and increasing leukotrienes that cause inflammation - Clinical presentation: - Trouble breathing - Short, persistent cough - Chest tightness - Irritability - Wheezing - Retractions - Tripod position - Diagnostic: - Pulmonary Function Testing - Peak Expiratory Flow Rate: how much patient can exhale - Chest x-ray - Bronchoprovocation testing: exposes to common allergies and evaluates reaction. Stimulate exercise to assess exercise-induced asthma. - Will be called reactive airway disease under the age of 5. - Treatment: - Metered dose inhaler or nebulizer - Rescue medications - Control medications - Caring for the client - Zones of manifestations - Green : asthma well controlled. - Yellow : some manifestations - Red - CDC asthma action plan - Self-care - Play - Cystic fibrosis - Anomaly in protein responsible for making mucus in organs - Causes mucus to be syrupy and thick - Genetics - Clinical manifestations - Clubbing -- prolonged hypoxia - Barrel-shaped chest - Wheezing or rhonchi - Nasal congestion w/ sinus infections - Constipation or meconium ileus (tarry black stool blockage if not done at birth) - Foul-smelling, bulky, greasy stool (effects the way they break down food unable to excrete fat) - Low BMI : not efficiently metabolizing food. - Delayed puberty that may cause fertility issues g - Elevated salt content in sweat. - Diagnostics: - Sweat chloride test. Chloride level of \>60 - Autosomal recessive: Both parents have to carriers. 25% chance of passing onto child. - Airway clearance therapy - Chest physiotherapy - Manual percussion w/postural drainage - Bronchodilator - Diet high in protein and vitamin supplements that can help with absorption of food. - Pancreatic enzymes -- taken with meals and snacks. - Vitamin supplements- taken with meals and snacks - Immune system - Juvenile idiopathic arthritis - Systemic autoimmune inflammatory disease-causing inflammation in joints under the age of 16 - Immune and inflammatory cells infiltrate the joints: exact trigger of this imbalance is unknown. - Clinical presentation - Joint pain and swelling - Osteopenia - Alterations in fusion of epiphyseal areas of the bones - Rash - High fever - Lymphadenopathy: enlarged lymph nodes - Diagnostics - MRI and Ultrasound - Labs, CBC, ESR---to look at inflammation, rheumatoid factor - Manifestations: - Faltering growth - Low physical activity - Obesity - Low vitamin D levels - Low levels of zinc, selenium, and iron - Inadequate dietary intake - Dyslipidemia - Bone health problems - GI distress - Dysbiosis - Underweight from malnutrition - Treatment - Non-pharmacological - PT and OT : to decrease joint pain, maintain joint function - ROM exercises - Nutritional support - Pharmacologic - Disease modifying antirheumatic drugs-methotrexate: to suppress immune system and prevent joint damage - Biologic response modifiers-infliximab: In severe cases to target specific molecules involved in inflammatory process. - Corticosteroids: short term use. - Surgical Management - Joint replacement or fusion : alleviate pain but may not improve function - Impact on overall health - Joint deformities like Swan Neck deformity. Boutonniere deformity---abnormal flexion of fingers. - Chronic pain lead to absences - Neuromuscular and musculoskeletal system - More porous makes bones more flexible - Physis is the weakest part of the bone that allows for bone expansion (growth plate) - Fractures - Complete - Incomplete or Greenstick: part of bone is broken. Most often seen under 10 years - Plastic deformity: bent bone that does not result in a fracture. Requires surgical intervention to straighten the bone. - Buckle: Fracture under 12 years. No surgery. Excessive pressure that causes a bulge instead of a break within the bone. Common forearm injury - Simple (closed) - Compound (open) - Complicated: Small fragments broken - Fracture treatment options - Immobilization - Traction to pull the bones together using weights or pulleys. Halo. Brians traction is the 90 degree angle. - Casts. Internal, has pins. - Surgical intervention - Internal or external fixation - Complications - Impaired circulation and nerve compression - Compartment syndrome: muscles swell causing increased pressure to the area. - Physeal involvement - Nonunion: fractured bone does not heal d/t lack of circulation - Malunion: fracture does not heal properly causing the bone to be shorter. - Infection - Pulmonary embolism caused from possible fat being broken off typically from femur fracture---clot from leg traveling to the lungs. - Osteomyelitis - Bone infection caused by bacteria and fungi. Can happen after a fracture. - Most caused by Staphylococcus aureus - Clinical presentation - Fever, nausea, leathery, limping, discomfort, redness on skin and swelling above site of infection - Diagnostic studies - CBC - X-ray, bone scan, biopsy, or MRI - Treatment - IV antibiotics, most of the time its long-term, patient will have PICC line - Surgery (necrotic tissue or when bone is no longer visible) - Spinal curvatures - Lordosis: lumbar spine - Kyphosis: thoracic and cervical spine, hunchback appearance. - Scoliosis: S curvature in the spine. Severe enough to have uneven shoulders54Wear - Screening - Clinical manifestations - Uneven hips or shoulders asymmetrical rib cage or body leaning toward one side or more than the other. - Adam's forward bend test: Helps identify spine curvature or change in the trunk outside of what is expected - Back should be exposed, stand with feet together, bend forward 90 degrees at the waist with the arms loosely dangling down - Treatment: - 25-45 degree -- Brace - Only used for patients that are still growing. Wear for 16-23 hours a day. Wear a shirt under to prevent skin breakdown. Only take off in shower - \>40 degree -- surgery. Will see increased height d/t straighten of the spine. Help restore balance. - Physical Therapy - Developmental dysplasia of the hip-DDH, Head of the femoral bone does not fit properly in the hip joint. - Head of femoral bone does not fit properly in the acetabulum - Screening - Barlow and Ortolani maneuver: working with legs that provider does - Risk factors - Breech---ultrasound at 6 weeks after delivery - Restricted movement - Family hx of bone disorders - DDH - Diagnostics - Ultrasound - Xray - Treatment - Palvik Harness - Worn 23 hours a day - Surgery: if harness does not work or not detected earlier - Congenital Talipes Equinobvarus (Clubfoot) - Front part of foot is turned inward - Diagnose in ultrasound - Treatment - Ponseti Method begins at infancy ideally 2 weeks after birth. - Serial castings to correct the position of the feet changed every 7 days then followed by a brace initially worn 24 hours a day. - Surgery if casting is unsuccessful - Cerebral Palsy - Non-progressive motor dysfunction resulting from anomalies in muscle tone, posture and movement - Risk Factors: prematurity, LBW, prenatal hypoxia, intrauterine infection or injury, trauma during birth, genetic disposition, hypoglycemia as a newborn, meconium aspiration, or any lack of oxygen as a newborn - Categorized by motor anomalies - Spastic -- increased muscle tone, causing movements to be stiff and awkward - Dyskinetic -- impaired muscle tone and presents with slow, uncontrollable, jerky movements of the extremities - Ataxic -- poor coordination and an unsteady wide gait - Mixed -- mixed presentation - Treatment and Therapies - PT and OT to improve and maximize function - Orthotic, different braces they may need. - Anticonvulsants if at risk for seizures. - Muscular Dystrophy - Hereditary disorders that are characterized by generalize progression of muscle weakness and degeneration - Duchenne's muscular dystrophy - X-linked recessive disorder - Clinical manifestations - Developmental delays - Clumsy - Difficulty walking - Gower's sign - Contractures - Pseudohypertrophy - Treatment - Delandistrogene moxeparvovec - Treats DMD, no vaccine should be given within 4 weeks of administration - Glucocorticosteroid - Harness or surgery - Febrile seizures - Sudden rise in body temperature - Simple and complex - Simple: lasts under 15 minutes and does not reoccur within the next 24 hours - Full recovery about an hour - Complex: Lasts longer than 15 minutes in duration and occurs more than once in 24-hour period - Not as common in occurrence - Full recovery longer than an hour - Typically occur in less than 5 years - Epilepsy - 2 or more seizures that are unprovoked and greater than 24 hours apart - Types: - Generalized: jerking, weakness of limbs, rigidity, spasm, sudden loss of movement, eyelid movement or staring - Focal: aura, may have impaired or complete awareness along with symptoms above - Combined - Unknown epilepsy: Stiffness, jerking, conclusion, lack of movement, staring, loss of control of bowel and bladder, cyanosis - Diagnostic testing: - EEG - MRI and labs - Treatment: - Anticonvulsants - Diet (ketogenic or modified atkins) - Vagus nerve stimulation - Brain surgery - Client Education - Place child on side on floor - Should not restrain or put things in mouth - Keep record - Hydrocephalus - Increased amount of CSF causing ventricles to enlarge - Inflammation and can potentially cause brain tissue damage - Clinical presentation: Infants -- large head, bulging fontanels, prominent scalp vascular, downward-deviated eyes (sunset sign), fatigue, irritability, seizures, vomiting, low muscle tone - Older children -- headaches, vision problems or crossed eyes, lethargy, poor appetite, balance problems, concentration issues, developmental delays, urinary incontinence. - Diagnostic tests - Prenatal ultrasound - MRI and/or CT - Lumbar Puncture - Treatment -- SURGERY - VP shunt - Endoscopic Third Ventriculostomy - Choroid Plexus Cauterization