Nursing of Children

Nursing of Children Neurologic & Musculoskeletal Conditions Unit 2

Ear Infections • Otitis externa • External ear canal • Pain, tenderness on pinna, ear canal red • Irrigation & topical antibiotics • Otitis Media • Middle ear • Pain in ear, irritable, ↓ hearing, T. 104F, rubbing or pulling @ ear, rolling head side to side, febrile convulsions, purulent drainage; some asymptomatic • Recognition & treat URI, broad spectrum antibiotics • Myringotomy, tympanoplasty

Otitis Media Nursing Interventions • ↓ T.; antipyretics, remove clothing • Relieve pain • Limit chewing • Local heat or cool compresses • Facilitate drainage • Prevent skin breakdown • Assess hearing loss • Administer meds

Hearing Impaired Child • Conductive hearing loss • Interference of middle ear hearing • Sensorineural hearing loss • Damage to inner ear structures or auditory nerve • Mixed conductive-sensorineural hearing loss

Hearing Impaired ChildNursing Interventions • Promote communication • Facilitate lip reading • Maximize residual hearing • Prevent further loss • Provide play • Encourage independent development • Promote parent child attachment

Amblyopia • Favoring of 1 eye = reduction in or loss of vision (lazy eye) • Early detection & prompt treatment • Obtain normal & equal vision • Eyeglasses to correct refractive errors • Patching of good eye

Strabismus • Lack of coordination between eye muscles that direct movement • Nonparalytic – faulty insertion • glasses • Paralytic – paralysis or weakness • Patch unaffected eye, glasses, eye exercises, surgery POST OP NURSING INTERVENTIONS: • Eye drsgs. @ minimum • Elbow restraints prn • Activity as tol. • Prevent eyestrain

Cranial & Spinal Nerves

Neurological Checks

Reye’s Syndrome • Multisystem disease that’s damaging to liver & brain • Liver fails to convert ammonia to urea = toxic uremia • Liver bx. = hepatic fatty degeneration • Possible link between salicylate use & Reye’s Syndrome; not use < 18 yr old • Ill with flu-like s/s 1 wk., healthy few days then has prolonged vomiting 2-3 days • ↓ LOC, listlessness, disorientation, coma ***Control cerebral edema, reverse metabolic injury, prevent resp. compromise

Sepsis • Bacteria in the bloodstream causing severe systemic reaction • Fever, ↑ P & resp., ↓ BP, lethargy • + blood cultures, immature WBC’s & neutropenia

Meningitis • Inflammation of the meninges • Bacterial (purulent): thick exudates surrounds meninges • Meningococcal menigitis: readily transmitted to others • Haemophilusinfluenzae most common causative agent; vaccine now available • Symptoms result mainly from intracranial irritation • Severe HA, drowsiness, irritable, restless, fever, nuchal rigidity, seizures, high pitch cry - infants • Petechia suggestive to meningococcal • Irregular resp report immediately • Diagnosis: • Lumbar puncture reveals cloudy or purulent CSF • Treatment: • Isolation x 24 hrs, IV antibiotics, IV flds., tx. of symptoms

Decreased LOC Care Plan • Ineffective airway clearance • Ineffective breathing pattern • Impaired skin integrity, risk for • Compromised family coping

Increased Intracranial PressureCLINICAL MANIFESTIONS • Irritability • Restlessness • Tense, bulging ant. fontanel < 18 months • High pitch cry • Change in feeding habits • ↑ occipital frontal circumference • Crying • Seizures • ↓ motor responses & sensation to painful stimuli, altered pupils size & reaction

Increased Intracranial PressureNURSING INTERVENTIONS • Assist in reducing intra abdominal & intra thoracic pressure • Assess for early changes in ICP • Supportive measures • Prevent over & under hydration • Avoid positions/activities that ↑ ICP • Help reduce child’s anxiety & fear • Prevent wt. loss • Promote normal G & D • Prevent skin breakdown • Prepare child for surgery prn • Administer meds; teachings

Posturing

Encephalitis • Inflammation of brain • Symptoms result from irritation to CNS; seizures in infants, H/A, drowsiness, fever, stiff neck, coma • Supportive tx., relieve symptoms; sedatives, antipyretics, seizure precautions, neuro checks

Seizure Disorders • Excessive, disorderly discharge of electrical impulses by neuronal tissue causing sudden, transient alteration in CNS • Partial: local focus of abnormality • Manifested by motor activities, sensory signs or psychomotor activity • Generalized (Grand mal): multifocal, involves both hemispheres • 3 phases; aura, seizure, postictal phase • Absence (Petit mal): temporary loss of consciousness • Status epilepticus: cont. of grand mal with no recovery between attacks

Nursing Interventions • Protect from injury • Document • Prevent seizures • Minimize anxiety • Promote positive self-image • Promote normal G & D • Education • Administer meds as ordered • Maintain normal lifestyle as possible • Provide emotional support

Anticonvulsant Drugs • Tegretol (carbamazepine) • Dilantin (phenytoin) • Depakene (valproic acid) • Mysoline (primodone) • Klonopin (clonazepam) • Valium (diazepam)

Cerebral Palsy • Nonspecific neuromotor disorders caused by nonprogressive developmental defects in motor centers of brain • Intelligence usually normal but mental retardation may occur • Delay in gross motor development • Exaggerated arching of back • Spastic movements • Abnormal reflexes • Contracted muscles or uncontrolled movement

Cerebral Palsy GOALS • Normalization • Function at optimal level for his/her capabilities INTERVENTIONS • Promote comfort; provide physical care needs • Provide play situations • Help achieve normal development • Support parents • Educate parents in care & goals

Musculoskeletal System

Traction Buck’s skin or Buck’s extension Uses tape, ace wraps, or other devices attached to skin Russell traction Similar to Buck except sling under knee suspending thigh above bed 2 way pull prevents subluxation of tibia Fractures • Pain & tenderness • Edema • Discoloration • Limited movement • Numbness

Neurovascular Check • Pain • Pulse • Sensation • Color • Capillary refill • Movement

Osteomyelitis

Duchenne’ Muscular Dystrophy • Frequent falling • Clumsiness • Contractures of ankles & hips • Gower’s manuever • Death usually from cardiac failure or resp. infection

Legg-Calve’-Perthes • Blood supply is disrupted to epiphysis • Effects the head of the femur • Keep femoral head deep in hip socket & avoid direct wt. bearing • Braces, casts or traction • May develop degenerative arthritis as adult

Ewings Sarcoma Malignant growth in marrow of long bones Tumor sensitive to radiation therapy Avoid vigorous weight bearing to avoid pathological fractures Osteosarcoma • Primary malignant tumor of long bones • Pain & edema @ site in which in adolescents attribute to “growing pains” or an injury; pathological fracture • Radical resection or amputation

Juvenile Rheumatoid Arthritis • Systemic inflammatory disease involving joints, connective tissue & viscera • Drug therapy • Aspirin, corticosteroids, NSAID’s • Exercise • Reduce pain & swelling • Promote mobility • Preserve joint function • Educate • Help with adjusting to live with chronic disease

Torticollis (Wry Neck) • Shortening of sternocleidomastoid muscle • Congenital or acquired • Head is held to involved muscle side • Detection

Scoliosis • S-shaped curvature of spine • 2 types • Functional • Structural • Untreated→ back pain, fatigue, heart & lung complications • Screening • Preparation of child • Exam spine from front, side & back while child stands erect & then when child bends forward at waist • Look for body alignment & asymmetry • Curves up to 20° - no tx. • Curves 20 - 40° - daily exercise & Milwaukee Brace • Curves > 40° - spinal fusion

Nursing of Children