- Reye’s syndrome risk
Causes by aspirin
- Affects liver and brain.
Priority- prevent increase Intracranial Pressure (ICP)
- Cerebral Palsy manifestations
Spastic-tense, contracted muscles (most common type of CP) on the toes
Ataxic-poor since of balance, often causing falls and stumbles.
Athetoid- constant, uncontrolled motion of limbs, head, and eyes
Rigidity- tight muscles that resist effort to make them move.
Tremor- uncontrollable shaking, Interfering with coordination.
- Cerebral Palsy: plan of care
Teaching care to the parent with a child with special needs.
Physical therapist
Orthopedic
Technologic aid
Speech therapist
Position to prevent contractures.
Maintain skin integrity
- Seizures: assessment
Oxygenation
Vitals
Time
Aura
Eye positioning and movement
Bowel/ bladder incontinence
- Seizures: manifestations
Partial seizures: complex or simple
Simple: Localized motor activity: shaking of leg or other body part. Now called focal seizures
Complex: Non-purposeful movement/ lip smacking or rubbing of hands
- Seizures: carbamazepine
Use
Generalized Tonic-clonic Focal.
Adverse effects:
Bone marrow suppressions and anorexia, Sleep disturbances
Nursing Implications:
Administer low doses initially, then gradually increase dosage.
Administer dose at bedtime and at the same time.
There may be dizziness and downiness with intal dose. Avoid driving and other activities that require alertness at the beginning of treatment.
This should subside within 3-4 days or weeks.
Don’t stop abruptly, taper off.
Toxicity: nystagmus, ataxia, vertigo, staggering gait
- Meningitis in infant: manifestations
High-pitch cry
Fever
Bulging fontanel
Irritability
Headache
Nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back)
Photophobia
Delirium
Projectile vomiting
Generalized convulsion.
- Meningitis in infant: nursing care
IV antibiotics
Positioning, avoid straining, coughing, bright lights.
Prevent with vaccines.
Prophylactic antibiotic with close contact
- Otitis media: manifestations
The child with acute otitis media is usually restless, shakes the head, and rubs or pulls at the ear.
The child may also have fever, irritability, decreased activity, lack of appetite and hearing impairment.
- Otitis media: treatment
Antibiotics or a myringotomy, incision of the eardrum with tiny tubes placed in the tympanic membrane, are used to treat otitis media. Or spontaneous rupture-usually relieves symptoms.
- 10 day course?
- Subjective data
Information spoken by child or family is subjective data.
Interviewing family and child allows collection of information which can be used to develop plan of care.
Requires knowledge of growth and development and understanding of communication technique
- Chief Complaint
Reason for visit
Need to get the most complete explanation for the visit.
- Objective data
Information observed directly.
Includes height, weight, V/S and examination of body.
9a. Measuring temperature
Oral: 97.6F to 99.3F (4-6 years)
Rectal: usually 0.5F to 1F higher than oral
Axillary: usually 0.5F to 1F lower than oral (infants)
Tympanic: usually 0.5F to 1F lower than oral
9b. Apical pulse
A family caregiver can hold the child on their lap for security for the full minute that the pulse is counted. Place the stethoscope between the child’s left nipple and sternum.
9c. Safety when assessing infant in outpatient settings:
Never leave child unattended. Have hand within inch or 2 of child
9d. Visual acuity:
Visual acuity of children gradually increases from birth until about 7 years of age, when most children have 20/20 vision.
2 months they can follow with their eyes.
9e. Head and chest circumference:
30-33cm of head circumference, chest should exceed head circumference by 2 to 3 inches.
9f. Pain assessment of the child
Grimacing, crying (wants to be alone), turn head to side to side frequently, pull on ears or rubs head, and turns or rolls constantly to get away from pain.
- FEEBIE: For the administration of rectal medications, the child is placed in a side-lying position and the nurse must wear gloves or a finger cot. The suppository is lubricated, then inserted into the rectum, followed by a finger, which is inserted up to the first knuckle joint. The little finger should be used for insertion in infants. After the insertion of the suppository
the buttocks must be held tightly together for 1 to 2 minutes until the child’s urge to expel the suppository passes. The suppository would begin to soften making it difficult to insert if warmed prior to insertion.
- IM injections for infants
Vascular laterals
- IM injections area that are contraindicated
Avoid the Dorsal gluten.
- Side note: when interviewing a child, the child can agree or disagree to have the parent present.
Include preschool child and older child in interview.
Use age-appropriate questions.
Be honest answering child’s question.
Use stories and book as appropriate.
Listen attentively to child’s comments, make feel important.
Admitting a child in a hospital but every child is different so always assess if they are ahead or late.
- Vision Impairment
Vision impairment includes myopia (nearsightedness), hyperopia (farsightedness), astigmatism, partial sight, or blindness.
Adequate vision and normal development are more likely with early treatment.
Specialized equipment helps prevent isolation.
