1. Chapter 35 The Child with a Sensory/Neurologic Disorder

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

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

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

5. 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

6. Otitis Media
Clinical manifestations
Diagnosis
Treatment
Nursing care

7. 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

8. 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

9. 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.

10. Reye Syndrome
Clinical manifestations
Diagnosis
Treatment
Nursing care

11. 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

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

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

14. 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

15. Seizure Disorders (cont.)
Diagnosis
Treatment
Nursing care

16. 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

17. 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.

18. Haemophilus Influenzae Meningitis
Clinical manifestations
Diagnosis
Treatment

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

20. 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

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

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

23. Intellectual Disability
Causes
Clinical manifestations
Diagnosis
Treatment
Education

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

25. 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

26. 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

27. 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

28. 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

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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.