Chapter 35 The Child with a Sensory/Neurologic Disorder

Growth and Development of the Eyes, Ears, and Nervous System The nervous system Sensory organs Eyes Ears

Vision Impairment Types of vision impairment Refractive errors Myopia; hyperopia; astigmatism Partial sight Blindness Clinical manifestations and diagnosis Treatment and education Nursing care

Eye Conditions Cataracts Glaucoma Strabismus Eye injury and foreign objects in the eye Eye infections Nursing care of the child undergoing eye surgery

Hearing Impairment Types of hearing impairment Conductive hearing loss Sensorineural (perceptive) hearing loss Mixed hearing loss Central auditory dysfunction Clinical manifestations Diagnosis Treatment and education Nursing care

Otitis Media Clinical manifestations Diagnosis Treatment Nursing care

Insertion of Foreign Bodies into the Ear or Nose Children, especially toddlers and preschool-aged children, may insert small objects into their ears or noses Irrigation Forceps Infection may occur

Question 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

Answer 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.

Reye Syndrome Clinical manifestations Diagnosis Treatment Nursing care

Acute or Nonrecurrent Seizures Clinical manifestations and diagnosis Treatment Nursing process for the child at risk for seizures Assessment Selected nursing diagnoses Outcome identification and planning

Acute or Nonrecurrent Seizures (cont.) Nursing process (cont.) Implementation Preventing aspiration Promoting safety Promoting family coping Providing family teaching Evaluation: Goals and expected outcomes

Seizure Disorders Clinical manifestations Partial seizures Simple partial seizures Complex partial seizures

Seizure Disorders (cont.) Clinical manifestations (cont.) Generalized seizures Tonic–clonic seizures (formerly grand mal) Absence seizures (formerly petit mal) Atonic or akinetic seizures (formerly drop attacks) Myoclonic seizures Infantile spasms Status epilepticus

Seizure Disorders (cont.) Diagnosis Treatment Nursing care

Question You are the emergency department nurse admitting a 6- year-old male patient 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 physician to order? a. IV Dilantin b. IV Solumedrol c. IV Morphine d. IV Diazepam

Answer d. IV Diazepam Rationale: Status epilepticus is an emergency situation and requires immediate treatment. The drugs diazepam, given rectally or IV, and lorazepam are used to treat the condition.

Haemophilus Influenzae Meningitis Clinical manifestations Diagnosis Treatment

Nursing Process for the Child with Meningitis Assessment Selected nursing diagnoses Outcome identification and planning

Nursing Process for the Child with Meningitis (cont.) Implementation Monitoring for complications Preventing aspiration Promoting safety Monitoring fluid balance Providing family teaching regarding spread of infection Promoting family coping Evaluation: Goals and expected outcomes

Cerebral Palsy Causes Prevention Clinical manifestations and types Spastic type; athetoid type Ataxic type; rigidity type Mixed type Diagnosis

Cerebral Palsy (cont.) Treatment and special aids Physical therapy Orthopedic management Technologic aids for daily living Nursing care

Intellectual Disability Causes Clinical manifestations Diagnosis Treatment Education

Intellectual Disability (cont.) Nursing process for the child with cognitive impairment Assessment Selected nursing diagnoses Outcome identification and planning

Intellectual Disability (cont.) Nursing process for the child with cognitive impairment (cont.) Implementation Promoting growth and development Promoting self-care Fostering communication skills Preventing injury Promoting family coping Preventing social isolation Evaluation: Goals and expected outcomes

Head Injuries Significant cause of serious injury or death in children of all ages Toddlers, young children: May receive a head injury from a fall or child abuse School-aged children and adolescents Usually experience injury as a result of bicycling, inline skating, or motor vehicle accident

Head Injuries (cont.) Treatment If bleeding: Apply an ice pack and pressure until bleeding is controlled Without bleeding: Apply ice for an hour or so to decrease swelling Open wound: Cleaned with soap and water, sterile dressing applied Observe the child for at least six hours for vomiting or change in level of consciousness

Head Injuries (cont.) Treatment (cont.) If child falls asleep: Awaken every one to two hours to assess if change in level of consciousness No analgesics or sedatives administration during observation period Check pupils for reaction to light every four hours for 48 hours

Head Injuries (cont.) Notify the health care provider immediately if Child vomits > three times Pupillary changes Double or blurred vision Change in level of consciousness Acts strange or confused Trouble walking Headache (increasing severity or awakens from sleep)

Head Injuries (cont.) Complications of head injuries with or without skull fractures can include: Cerebral hemorrhage Cerebral edema Increased intracranial pressure Shaken baby syndrome Form of child abuse Can cause head injury without external signs of head trauma

Drowning Second leading cause of accidental death in children Toddlers and older adolescents: Highest rate of death from drowning Infants more commonly drown in a bathtub Swimming in undesignated swimming areas, such as creeks, quarries, and rivers, is especially hazardous for older children and adolescents

Drowning (cont.) Treatment When discovered, cardiopulmonary resuscitation (CPR) should be started immediately and continued until the victim can be transported to a medical facility for additional care Intensive care is carried out according to the patient’s needs

Question Which age group is most likely to receive a head injury from child abuse? a. Toddlers b. Preschoolers c. School-aged kids d. Adolescents

Answer 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.