Ped's Safety (11)
1. antidote: n-acetylcysteine within 1-2 hours of ingestion
2. encourage a high protein, high calorie diet following OD
3. monitor for hepatic damage long term
Increased intercranial pressure from a brain bleed (more blood, not enough room). RN responsibilities: HOB 30 degrees, calm environment, monitor respiratory status, mannitol, and interventricular cath to allow fluid to drain out of brain
A child has been diagnosed with epilepsy. Give instructions to the family and child regarding the new diagnosis. Specifically on medication teaching.
1. adherence- never abruptly stop meds
2. don't hold down pt. or put anything in the mouth
3. understand daily med vs. active seizure medications
4. Keto diet (reduce seizures if meds dont work)
5. safety- environment, never swim or bathe alone, no baths, no driving, school communication, no contact sports, drugs/alc should be avoided, lowers the seizure threshold
characterized by scissor gait, missed milestones, toe walking, communication difficulties. DR with MRI.
Cerebral Palsy.
Supportive treatment, PT, OT, splints, braces, monitor function, drooling, anti seizure medications, body alignment
list some ways to care for a patient with visual impairments
adequate room lighting
keep objects in the same place
introduce yourself
orient them to the room
provide verbal instructions
familiar words
identify noises
A child ingests Aspirin (salicylate) and currently is in respiratory acidosis, has a potassium of 3.2, ketones in urine, tinnitus, and mild confusion. What is the antidote to Aspirin? what are some interventions?
1. Activated charcoal to decrease absorption
2. Give this through an NG tube due to risk for vomit and aspiration
3. Gastric lavage within 1 hour of ingestion
4. risk for bleeding
5. IV fluids sodium bicarb (for kidney acidosis) and potassium replacement if needed
Child has a rapidly increasing temperature over past hour. Leads to jerking movements.
Febrile seizure, give Tylenol and fluid replacement, commonly an isolated event
Seizure that lasts over 5 mins with no return to normal LOC between seizures
Status Epilepticus, can lead to brain damage, maintain respiratory status.
meds:
1. Valium, Ativan, versed (normal anti-epileptic med)
2. Benzo or phenobarbital
3. keppra or depakote
neurodevelopment disorder, affects social communication, symptoms can be sudden or gradually before age 3, primarily symptoms are social related: eye contact, social interaction, verbal, etc. parent may feel like child is not attached to parent
Autism spectrum disorder. It is a spectrum so symptoms can greatly vary. Early intervention before the age of 3 for best outcomes. teach about wandering, communication, therapies, ABA, drowning safety, etc.
A child reports after ingesting bleach 20 minuets ago. List priority nursing interventions.
1. Avoid vomiting (double burn in oral cavity)
2. LOC
3. Analgesics, steroids for swelling, antibioitcs for pneumonia and infection
4. NG tube feeds if unable to eat orally
Patient has jerking of left hand and left foot. They lose consciousness for just a few seconds.
Focal or "partial" seizure
A 3-year-old child, has neck rigidity, vomiting, has pale blotchy spots around body, is very tired. A lumbar puncture is preformed, CSF fluid is cloudy with WBC, protein, and neutophils in it. What is the suspected dx? Interventions?
Meningitis
- bacterial: antibiotics, IV steroids for inflammation, Hydration to help with BP
nursing interventions: seizure and droplet precautions, neuro check (IPC) , cluster care, respiratory status
unaligned eyes and lack of coordination in one eye. can impair visual acuity
amblyopia. or lazy eye. use a patch over good eye to strength the lazy eye and make it move where it needs to. child needs to be compliant with eye patch for the correction to work
A child ingests gas (hydrocarbon) and presents with gaging, coughing, mild cyanosis, and petroleum breath. He is confused. What are some priority interventions?
1. poison control
2. prevent vomiting
3. symptoms management (oxygen, vent if needed, IV antibiotics)
Child has a total body shaking and jerking, rigid muscles, they bite their tongue and leads to bleeding, they loose consciousness
Generalized seizure. Administer PRN medication if they have one.
A abnormal herniation of the meninges and the spinal cord into a cyst. Diagnosed with alpha fetoprotein in utero. Surgery can be done to reduce CSF leak.
myelmeningocele (spina bifida)
surgery in 24 hours, prone position, IV fluids, urinary catheter placed, soak with sterile gauze, monitor for infection, monitor for hydrocephalus
congenital cataracts- teat with surgical removal of the opaque lens
A parent reports to their PCP Their child complains of lethargy, motor delays, GI pain, decreased bone health, and renal complicaitons. They identify lead poisoning. what are some interventions?
Administer chelating agents to remove lead from the tissues (succimer)
Screen child early (all children)
Supplement any vitamins (c, d, calcium, phosphorus, iron)
2 or more seizures that are separated by 24 hours. Risk factors: family history, history of TBI, brain tumor
Epilepsy
rapid head growth, bulging anterior fontanelle, unsteady gait, separated sutures, seizures, blindness, rigid posturing, sun setting eyes, vomiting. risk factors- male, family history. upon examination, optic nerve is swollen, and cranial ultrasound is done
hydrocephaly- leads to ICP because all 4 ventricles in the brain will swell can be (obstructive or obstructive cause).
treatment- drain the fluid: place a shunt. monitor for infection and malfunction, many need to be replaced
increase in intraoccular pressure of the eye. leads to atrophy of the optic disc and blindness. symptoms include: tearing, light sensitivity, enlarged cornea, cornea hazing
congenital glaucoma
treatment- surgery to prevent blindness