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					                                     Learning Guide

                  Nursing Care of the Pediatric Individual with a
                             Neurological Disorder
                                    Chapter 52

Increased Intracranial pressure:
 1. What is increased intracranial pressure and causes in a pediatric patient?

2. Compare the clinical manifestations of increased intracranial pressure (may see
   abbreviated as IICP or ICP) between an infant and child including:
      Levels of consciousness
      Behavior
      Pupil Evaluation
      Motor Function
      Vital Signs

3. What diagnostic tests will the healthcare provider order? How will the nurse prepare the
   client/family for these procedures?

4. Discuss the medications typically used in treating ICP:
      a. What assessment findings and lab values should the nurse monitor in relation to
         these medications?
      b. What priority instructions does the nurse provide for the client/family related to
         discharge and home care of a client taking these medications?
      c. What implications are there for using research to improve practice with the child
         experiencing IICP?

5. What priority interventions does the nurse include when caring for the client/ family
   with IICP?

Spina Bifida/ Meningocele/ Meningomyelocele:

6. What is the difference between spina bifida, meningocele, and meningomyelocele.

7. What common nutritional supplement do healthcare providers encourage for all women
   of childbearing age? Why?

8. What are important nursing interventions when providing pre-operative care?

9. What are post-operative expected outcomes and related nursing interventions?

10. Post operative care is consider from a multidisciplinary approach. Who are these teams
    that are included in the long-term-care?

 11. What are the early and late manifestations of hydrocephalus in an infant and child.

12. What diagnostic measures confirm the diagnosis of hydrocephaly? What are the nursing
    responsibilities when preparing the child/family for these procedures?
13. What is the purpose of a shunt?

14. Differintiate between the two types of shunts:
       a. Atrioventricular-
       b. Ventricular peritoneal-

15. What are the priority nursing interventions for pre-operative care of a newborn or child
    with hydrocephaly?

16. Post-operative care includes monitoring the child's vital signs and neurological status.
    What additional assessment areas should receive high priority? Please list specific
    interventions/ assessments
       a. Shunt function and failure
       b. Position of the client
       c. Activity
       d. Incision site
       e. I & O
       f. Nutrition
       g. Family teaching


17. What are the clinical manifestations general and physical, related to cerebral palsy?

18. What assessment findings would the nurse expect to find on the child's prenatal and
    current health history?

19. Why do these children experience failure to thrive?

20. What is the primary psychosocial goal for the client with cerebral palsy?

21. What significant findings would a metabolic work up indicate about a child with CP?
   Why is this level elevated?

22. What is the priority complication of cerebral palsy? What nursing interventions and
    teaching will the nurse include to prevent this complication?

23. What additional long-term complications/ needs does this child/family experience?

24. What members of the healthcare team are included in the care of this child? What
    additional support do the parents/caregivers require?


25. Why pre-disposes the infant/young child to head injury?

26. What is the Pathophysiology involved in shaken baby syndrome?

27. What immediate treatment does the nurse initiate?

28. What are the legal implications for the nurse when assessment findings indicate
    possible abuse of an infant or child?
29. Why is it not prudent for the nurse to discuss suspicions of abuse with the parents or
    primary caregivers?

 30. Differentiate between the types of seizures:
        a. Generalized
        b. Absence
        c. Partial
        d. Febrile

31. How does a nurse distinguish between altered mental status, jitteriness, and seizure

32. What   is the primary nursing goal when caring for the individual experiencing a seizure?
      a.    What preventive measures does the nurse provide?
      b.    How does the nurse maintain the airway of an individual experiencing a seizure?
      c.    What is the priority nursing intervention following a seizure?

33. What is the long-term goal or focus of treatment when caring for a child experiencing
    seizure activity?

34. What information does the nurse include when teaching the child/ family about the
    action, side effects, contraindications and necessary interventions required with seizure
       a. Phenobarbital
       b. Carbanazepine (Tegretol)
       c. Dilantin (Phenytoin)

35. What is the rationale for continuing the medications until the health care provider
    decreases the dosage gradually? Why is it important to stress this teaching with the
    parents/ care givers?

36. Why is status epilepticus a pediatric emergency?


37. Why does bacterial meningitis present more of a risk than viral meningitis?

38. Compare the clinical manifestations of meningitis for the infant and the young child.

39. What procedure will the health care provider order to determine the type of meningitis?
      a. What findings differentiate between bacterial and viral meningitis?
      b. What additional laboratory values must the nurse monitor?

40. What are the nursing interventions specific to lumbar puncture?

41. Discuss the action, side effects, contraindications and necessary interventions required
    for medications used to treat meningitis.
       a. Antibiotics
       b. Dexamethasone
       c. Antipyretics
42. What isolation precautions are indicated? What precautions are necessary to prevent
    spread of bacterial meningitis in an exposed population?

                                      Chapter 54

43. The chromosomal anomaly associated with Down's syndrome is

44. What are the physical assessment findings that a nurse identifies in the initial
    assessment of a newborn that indicate Down's syndrome or another chromosomal
      a. Facial-
              i. eyes-
             ii. mouth-
      b. Ears-
      c. Neck-
      d. Hands-
      e. Abdomen-
      f. Cardiac

45. If the nurse visualizes any of the outward signs of Down's syndrome what is the
    immediate priority nursing assessment to perform next?

46. What are nursing measures used in promoting health of the child with Down's

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