Chapter 23 The child with a sensory or neurological condition.

Enucleation

removal of the eye

Hyperopia

farsighted

Myringotomy

incision of the tympanic membrane

Nystagmus

involuntary continual jerking movements of the eyeball

Papilledema

edema and inflammation of the optic nerve

Postictal lethargy

short period of sleep following a seizure

Strabismus

crossed eyes

Concussion

temporary disturbance of the brain usually followed by a period of unconsciousness

Decerebrate

rigid extension and pronation of the arms and legs

Decorticate

adduction of arms, flexed on chest with wrist flexed, hands fisted, and feet are in plantar flexion

An acute infection of the external ear canal is called?

otitis externa, swimmer's ear

True or false? when a child has otitis externa, the tympanic membrane is erythematous.

false

True or false? Prolonged exposure to moisture is a precipitating factor for otitis externa.

true

True or false? Otitis media frequently occurs after a child has an upper respiratory infection.

true

Explain why infants are more prone to ear infections than older children.

Answers should note that the eustachian tube
has not matured and lies horizontally instead
of at a 45-degree angle. It is shorter, wider,
and straighter, and that the infant's humoral
(humor, "body fluid") defense mechanisms are
immature. Some answers may

List the main symptoms of otitis media.

Fever, headache, vomiting, severe pain in ear,
rubbing or pulling ears, diarrhea, irritability,
diminished hearing

List two possible complications of recurrent episodes of otitis media.

Hearing loss
Cholesteatoma

Describe the treatment of otitis media.

Antibiotics to combat the organism and analgesics for pain

What teaching should be done when antibiotics are prescribed for children with acute otitis media?

Antibiotics should be given for the prescribed
time. Parents should be instructed to give the
entire dosage even if the child appears to have
improved.

Complete bilateral deafness is usually discovered during ________________ but partial deafness may be unrecognized until _____________.

Infancy, school-age

Identify findings that might indicate a hearing problem in an infant?

Lack of response to environmental sounds
No verbal attempts at speech by 18 months of age
Persistence of the Moro reflex beyond 4 months of age

Identify findings that might indicate a hearing problem in an older child.

Poor school performance
Behavior problems
Indifference to sound

Describe three or more strategies the nurse can use when caring for a hospitalized school-aged child who has a hearing impairment.

Smile when approaching.
Face the child when speaking.
Ensure being seen by the child before touching
to avoid startling.
Speak in short sentences.
Use sign language.
Write or draw to enhance communication.

Identify one strategy to relieve a childs discomfort resulting from a change in altitude or barometric pressure during airplane diescent.

Have child yawn or chew gum during airplane
descent.
Offer infants juice or water through a bottle.
Take systemic decongestants before air travel,
timed for peak effectiveness during airplane
descent.

During a visual assessment, the nurse should observe the eyes for:

Equal distance from nose
Symmetry

Visual acuity can be tested by _________ to _____________ years of age.

2 1/2 - 3

For amblyopia, describe goal of treatment?

The goal of treating amblyopia is to obtain
normal and equal vision in each eye.

For amblyopia describe treatment?

The treatment for amblyopia is glasses for
significant refractive errors and patching
of the good eye. The patching may be only
daytime or part-time.

Why might a child be embarrassed when being treated for amblyopia?

The child wearing a patch is often subjected to
teasing by peers.

Untreated strabismus can result in ______________ of one eye.

Blindness

Describe the procedure for wiping secretions from the eye in the child with conjunctivitis.

Wipe from the inner canthus downward and
away from the opposite eye, use separate
wipes for each eye, and perform frequent hand
hygiene.

How would the nurse position a child who has a hyphema?

Keep the head of the bed elevated 30 to 45 degrees to decrease intraocular pressure.

List the clinical manifestations of retinoblastoma.

A yellowish-white reflex is seen in the pupil.
This is referred to as the cat's eye reflex
or leukokoria . There may be a loss of vision, strabismus, or hyphema. In advanced tumors, the child may have pain.

Neural tube development occurs about the __________ to ___________ week of fetal life.

Third, fourth

What medication, when used during a viral illness, has been linked to Reye's syndrome?

Aspirin (acetylsalicylic acid)

Which two immunizations are recommended to prevent sepsis for all children between 2 months and 4 years of age?

H. influenzae type B
Pneumococcal conjugate vaccine (PCV)

List five signs and symptoms of meningitis.

Severe headache
Drowsiness
Restlessness
Fever
Stiff neck (nuchal rigidity)
Delirium
Irritability
Vomiting
High-pitched cry (infants)
Opisthotonos
Seizures
Coma (older child)
Petechiae

List two measures the nurse should take to decrease stimuli when caring for a child with meningitis.

Frequent neurologic checks; vital signs; intake
and output. Organize care so that the child is
disturbed as little as possible�light and noise
kept to a minimum; avoid jarring or startling.
Use soft voice and gentle touch. Explain these
precautions to par

List treatment measures for the child with meningitis.

Isolation until 24 hours after antibiotic therapy
has been initiated. IV line for antibiotics and
fluid and electrolyte balance. Antibiotics are
usually administered for a minimum of 10-
days. Possible sedative to reduce restlessness.
An anticonvulsant ma

The majority of brain tumors in children are located in the ______________.

Lower part of the brain (cerebellum or brain
stem)

The manifestations of a brain tumor are directly related to the ____________ and ___________ of the tumor.

Location, size

Most brain tumors create increased ___________________ ____________________ producing symptoms such as ____________, ________________, _________, and ___________.

Intracranial pressure, headache, vomiting,
drowsiness, seizures

Preoperative care of a child with a brain tumor should address what body image issue?

Appearance

Febrile seizures occur in response to a(n)

rapid rise in temperature (above 38.8� C [102�
F])

What should the nurse observe and record after a seizure?

Child's activity immediately before the seizure
Body movements
Changes in color, respiration, and muscle
tone
Length of seizure
Level of consciousness and behavior
Incontinence
Parts of the body involved

Generalized tonic-clonic seizure

Has three phases: aura, seizures, and postictal period

Absence seizure

temporary loss of awareness

Partial seizure

can be manifested by motor activities, sensory signs, or psychomotor activity

Myoclonic seizure

repetitive muscle contractions

What is the term meaning a prolonged seizure that does not respond to treatment for 30 minutes or more?

Status epilepticus

One of the most common causes of status epilepticus is?

abrupt withdrawal of anticonvulsant medication

List four or more common causes of cerebral palsy.

It is now believed that CP results most often
from existing prenatal brain abnormalities, exposure to maternal chorioamnionitis in utero,
prematurity, or severe hypoglycemia. CP can
be acquired as a result of shaken baby syn-
drome, meningitis, or encepha

List three clinical manifestations that might indicate a child has cerebral palsy.

Feeding problems during infancy
Convulsions not associated with high fever
Developmental delays
Persistence of primitive reflexes such as the
Moro and tonic neck reflexes may be seen.

List three precautions that should be taken when the nurse is feeding a toddler with cerebral palsy.

...