Chapter 15: have powerpoint

Key Points from book:

Middle childhood aka the school years a period of life that extends from 6-12
years of age
Although growth is slower than in previous years, there is a steady gain in height
and weight, with maturation of body systems;between the ages of 6 and 12 years,
children grow 2 inches per year; primary teeth are lost and replaced by permanent teeth
A major task during the middle years is developing a sense of industry or
accomplishment. (Erikson)
Piagets period of concrete operations refers to the school age period when
children are able to use their thought processes to experience events and actions and
make judgements based on reasoning.
Piagets period of concrete operations, children have the ability to group and sort
and make conceptual decisions
The child develops a conscience and is able to understand and adhere to rules
and standards set by others
Entertaining different points of view, becoming sensitive to social norms, and
forming peer friendships are important features of social development during the school
years
Cooperative play, team activities, and the acquisition of skills are prime elements
of play during the school years; rules and rituals assume greater importance
Parental concerns during middle childhood include lying, cheating, stealing and
school achievement. Lying is often a result of not meeting peer expectations set up by
others to which they have been unable to measure up.
Peer-group identification is an important factor in gaining independence from
parents
Teasing in this age group is common and can have long-lasting effects
Stress in the school age child may present as stomach pains, HA, sleep
problems, bed-wetting, changes in eating habits, stubbornness or aggression, reluctance
to participate or regression to earlier behaviors.
The availability of junk foods, irregular family meals, and schedules of working
parents often interfere with optimal nutrition
Dental care is important during this time; potential dental problems include
caries, periodontal disease, malocclusion, and dental injury. NCLEX wants us to put
childs knocked out tooth in cold milk or saliva.
Increased socialization and media exposure make the school years an ideal time
for sex education. Sex should be treated as a normal part of growth and development
Puberty signals the beginning of the development of secondary sex
characteristics. Puberty usually begins 2 years earlier in girls than in boys
School health programs ideally include health appraisal, emergency care, safety
education, communicable disease control, counseling, guidance, and health education
with adjustment to individual student needs
injury prevention is directed toward safety education, provision of safe play areas
and equipment, and well-supervised sport activities.

Chapter 17: have powerpoint, paige presented and said to just read the book chapters and
cross reference their notes.
Key Points from book:
Alterations in growth and maturation may be manifested as short or tall stature,
precocious puberty, or delayed sexual development
The most frequent health problems related to the female reproductive system
involve menstrual dysfunction. Treatment is with NSAIDS
Health problems related to sexuality include pregnancy, sexual assault, and
STIs; prevention includes sex education and contraceptive counseling
Eating disorders observed in middle and late childhood include obesity, AN and
BN
Lactose intolerance is a developmental disorder in which there is reduced lactase
activity in the intestine, which causes bloating, abd. distention, and flatulence shortly
after the ingestion of lactose. Most persons with lactose malabsorption are able to
consume approx. 1C milk/day without having these s/s
Behavior problems in middle childhood can result from ADHD, enuresis,
encopresis, school phobia, childhood depression, conversion reaction, and childhood
schizophrenia
Signs of depression in children and adolescents are often subtle and require
astute observation by parents and health professionals
The substances abused by children and adolescents include alcohol, marijuana,
narcotics, opioids, CNS depressants or stimulants, inhalants, and mind-altering drugs
Tobacco smoking is a significant problem among teenagers; reasons for smoking
inc.: social pressures, mass media, a need to develop a self-concept, cigarettes are
considered a gateway drug. Smokeless tobacco is considered to be a substitute for
cigarettes but pose serious health hazards and is associated with cancer of the mouth
and jaw.
Suicide, the deliberate act of self-injury with intent to kill, is often associated with
depression, substance abuse, difficulties in coping with stress, an affective disorder, or a
disturbed family environment. Social isolation is a major factor in determining who may
kill themselves.
Chapter 18
I.

II.

Perspectives in the Care of Children with Special Needs

A. Scope of the Problem
drive to define the children with special needs situation so federal
and state programs can plan more comprehensive solutions
decrease in mortality has led to an increase in special needs
children and adults
most common: respiratory diseases, impairments in speech and
sensory function, and mental and nervous system disorders
Trends in Care
A. Developmental Focus
focusing on developmental stages versus
chronological aging
emphasis on the child versus their disability
B. Family Development

Development of the family along with the individual

is emphasized

III.

IV.

children with chronic illness can

cause developmental struggles within the family, especially
newlyweds
C. Family-Centered Care
An emphasis on getting the family involved (public
policy extended age to 5 years)
the health care system for the child needs to be
integrated with family care
D. Normalization
Normalization: establishing a normal pattern of
living
Ex: daily routine, encouragement of
participating in age appropriate activities
E. Home Care
Goals: 1. Normalize, 2. Minimize disruption to the
family, 3. Promote maximum growth and development
F. Mainstreaming
Mainstreaming: process of integrating children
with special needs into regular classrooms and child care centers
increased in funding to get help kids be integrated
G. Early Interventions
Early Intervention: any systematic and sustained
effort to assist young, disabled, and developmentally vulnerable children
from birth to 3 years of age
Individualized family service plan: outcomes, childs
current developmental level, family needs, services required, goals for the
future
H. Managed Care
most prominent health care now
differs with kids than adults because they you have
to account for developmental changes
Cultural Issues
for some minorities, cultural understanding of
illness and disability is different
Promoting Normal Development
Look at a table in your book (for me its 22-1 so its prob 18-1 for
you, everythings broken down by age)
A. Infant
Biggest concern is child parental attachment
developmentally: if there illness is painful, it limits
the amount of exploration they can do (which is difficult because they
primarily learn through sensorimotor)
B. Toddler
The goal is autonomy, which can be difficult with
limitations imposed by chronic illness

 emphasis on language and locomotor skills (the

child needs to learn to walk and talk to become autonomous
C. Preschooler
start to feel guilty, like they caused the illness
initiative: development of social relationships,
learning about the environment, and developing a sense of purpose and
self-confidence
D. School-Aged Child
prepare the class theyre going into for the details
of the childs disability
more kids with disabilities are going back to the
classroom than before
art, music, poetry, and drama, especially help kids
with disabilities
E. Adolescent
PROMOTE INDEPENDENCE BY ENCOURAGING
ADOLESCENT INVOLVEMENT IN THEIR TREATMENT
V.
Helping the Child Cope
A. Coping Mechanisms (theres a table, 22-2 in mine so probably 182 on yours)
1. Normalization
focus on developing the adolescents
self image, normalize his/her life as much as possible
as a nurse: acknowledge strengths
and weaknesses of both the child and the family unit
2. Hopefulness
basically worthless section,
encourage hopefulness as a nurse
3. Health Education and Self-Care
teach the child about changes in the
body, especially with an illness, and how that affects the body (like
in puberty)
educate them on different risk
factors (especially girls who have menstruated and can get
pregnant
4. Realistic Future Goals
acknowledge the level of
independence they can attain
help them take part in their own care
work on coping mechanisms
VI.
Assessing Family Strengths and Adjustment
continuous assessment is important, evaluate how well the family
is coping and adjusting
VII.
Accepting the Childs Condition and Receiving Support at the Time of the
Diagnosis
manage parents emotional reactions to the
diagnosis with acceptance
BE NONJUDGEMENTAL

 maintain privacy and help set up a plan of care

Managing the Condition on an Ongoing Basis
model appropriate interventions with the children
focus on the strengths the child has along with
continuing education on how to take care of their child
A. Special Information Needs
technical information (how to minister injections, how to deal with different medications, how to
manage side effects)
info on how the condition interferes with ADLs
CAR SAFETY
being able to communicate how to deal with the
childs condition in the event of an emergency
B. Family Management Styles
Thriving & Accommodating- perceive their condition
as normal, they feel they can manage their childs illness,
(accommodating only differ as having a slightly more negative view of
their childs condition
Enduring- feel their illness is more of a burden,
focusing on the long term consequences and effects on their life, they
describe illness management as a burden
IX.
Meeting the Childs Normal Developmental Needs)
emphasize abilities, deemphasize limitations
focus on knowledge of the condition (child and
siblings)
effort towards re integrating and normalizing
(especially more in the school setting)
X.
Meeting Developmental Needs of Other Family Members
A. Parents
1. Roles
Emphasis of teaching on
Home care with the
burden assumed primarily by one parent, the financial
burden, fear of the childs dying, pressure from relatives,
the hereditary nature of the illness, fear of pregnancy
2. Mother Father Differences
recognize and support differences in
coping behaviors
3. Father's
fathers have different challenges
than mothers with the need to strengthen care-taking abilities
have more difficulty with sons with
chronic illness than daughters
change in time and scheduling
feelings of guilt and failure
4. Single-Parent Families
special efforts need to be taken to
help them gain more support from other outlets
5. Foster or Adoptive Families
VIII.

support may promote long term

placement for kids

B. Siblings

XI.

XII.

educate siblings to their

developmental and intelligence level, especially with adolescents
(access to the internet)
prepare siblings for the physical
changes of their brother/sister
siblings (older females or younger
males) may act out
educate them on catching the
illness, and help deal with their emotions of unbalanced allocation
of time and money to the sick child
C. Extended Family Members and Friends
grandparents are a primary source of help with
care, focus on educating them
grandparents can go through stages of grief
parents need to decide how much to tell and who to
tell about their childs illness
use resources like friends or family, be aware that
some might feel worried about befriending a child with a chronic illness
(he/she might die, he/she might be contagious)
Coping with Ongoing Stress and Periodic Crises
A. Concurrent Stresses Within the Family
financial stressors are the primary stressors
B. Coping Mechanisms
Approach Behaviors: coping mechanisms
resulting in movement toward adjustment and resolution of the crisis
Avoidance Behaviors: maladaptation of the crisis
1st long term coping strategy- finding meaning
within an existing medical- scientific belief
2nd- learn to share burdens in the family network
and outside of the family network
C. Parental Empowerment
Empowerment: can be viewed as a personal
process through which individuals develop and use the necessary
knowledge, confidence, and competence to make there voices heard
Assisting Family Members in Managing Their Feelings
A. Shock and Denial
manifestations include: 1. physician shopping, 2.
attributing symptoms of the actual illness to a minor condition, 3. refusing
to believe diagnosis, 4. delayed in agreement to treat, 5. acting happy
and optimistic despite diagnosis, 6. refusing to talk about it, 7. insisting
that no one is telling the truth, 8. denying the reason for hospital
admission, 9. asking no questions
denial can be protective for the child to develop
normally (as normally as possible) for as long as possible

 can become maladaptive when it impedes

recognition of treatment
B. Adjustment
open admission= first sign of adjustment
anger and bitterness, feelings of unfairness, watch
for siblings passive anger
C. Reintegration and Acknowledgement
establishment of new goals and reintegration into
social situations
XIII.
Establishing a Support System
A. Intrafamilial Resources
marital relationship represents primary support
cohesion, adaptability, sense of coherence, and
hardiness are key
B. Social Support Systems
ASSESS TYPE OF SUPPORT NEEDED BEFORE
DECIDING ON INTERVENTIONS
C. Parent-to-Parent Support
parent-parent self help groups are extremely helpful
so people can see theyre not alone and get other help
D. Parent- Professional Partnerships
working with nurses and doctors to develop a list of
explicit and implicit responsibilities
E. Community Resources
local and national disease oriented organizations
can help
Chapter 19- Impact of cognitive or sensory impairment on the child and family
Nursing care
educate child and family
teach child self-care skills
promote childs optimal development and self
esteem
encourage play and exercise
provide means of communication
establish discipline
encourage socialization
provide information on sexuality
help family adjust to future care
care for child during hospitalization
nurses need to be able to assist in measures to
prevent CI (cognitive impairment)-Evolve says The child with CI needs to
be referred for stimulation and educational programs as young as
possible. Evidence exists that early intervention programs for children
with disabilities are valuable for cognitively impaired children.
ASD-Autism Spectrum Disorders (review from Psych/MH)
do not confuse autism spectrum disorder (ASD)
with atrial septal defect (ASD)

complex neurodevelopmental disorders of unknown

etiology
Language (in social communication), imaginative
play and social interaction may show delay before 3 years of age in order
for diagnosis to be made.
behavioral patterns that are repetitive, restricted,
and stereotype are commonly seen
impairments range from mild to severe
GI problems exist in these little kids
savant autism is rare but really cool and does exist
(Rainman)
no cure for ASD but highly structured and intensive
behavior modification programs have proven highly effective.
Hearing Impairment
a general term indicating disability that may range
in severity from slight to profound hearing loss.
slight to moderate= person has
residual hearing and can speak words
profound= person needs hearing
aids, and has trouble speaking words
hearing defect are classified by etiology, pathology,
or symptomatology. The nurse should be concerned if child isnt babbling
by 7 months, failure to localize sound by 6 months. lack of startle or blink
at loud sounds.
conductive or middle ear hearing loss- interference
with middle ear sound transmission. Tx:abx, tubes, and if hearing is
completely lost d/t chronic infnx, hearing aids are good.
sensorineural= perceptive or nerve deafness
involves damage to inner ear structures or auditory nerve. resulting in
distortion of sound and problem with word discrimination. Tx: cochlear
implants
Mixed- results from recurrent otitis media infections,
interferes with transmission of sound in middle ear and along neural
pathways.
Central auditory imperception- includes all hearing
losses that are not linked to defects in the conductive or sensorineural
structures.
organic-defect involves reception of
auditory stimuli and expression of message into meaningful
communication
aphasia (inability to
express)
agnosia (inability to
interpret sound)
dysacusis (difficulty
processing/discriminating sounds)

 functional-no lesion occurs, often

seen in conversion hysteria (unconscious ability to tune someone
out during traumatic event), infantile autism, and childhood
schizophrenia.
A Decibel (dB) is the unit of loudness measured on
a scale beginning with 0 (the softest sound the normal ear can hear) up to
2000.
Lip reading, cued speech, sign language and other
methods of communication are helpful to the child with hearing problems.
with lip reading, speak at an even rate, do not use a surgical mask with a
patient who lip reads!!! make sure there is an interpreter present for those
who sign. cued speech is an adjunct to lip reading and uses hand signals
when words that look alike are used. (Olive juice, I Love You)
Immunizations are important when preventing
acquired hearing loss via unimmunized children exposed to MMR.
Down's Syndrome- most common chromosomal abnormality.
trisomy 21-extra chromosome on chromosome 21,
common for children to have congenital heart disease such as septal
defects of the heart, respiratory tract infections(use cool mist vaporizer for
moisture), thyroid dysfunction, increased incidences of leukemia,
hypotonic musculature.
**have child checked for atlantoaxial instability
before participating in sports!!!!! X ray is done.
These children should have peer experiences
similar to those of other children, such as group outings, Discovery Club,
Cub Scouts, and Special Olympics.
good prognosis-may live 60 years or longer with
Downs.
Fragile- X syndrome
most common inherited cause of CI or intellectual
disability
Prevalence: 1 in 2000 to 5000 births
Clinical Manifestations
long face with a prominent jaw, large
protruding ears, large testes
developmental delay and language
delay are common
autism like behavior
in carrier females, clinical
manifestations are minor, mostly anxiety, withdrawal, and
depression
Therapeutic Management
no cure
use of serotonin agents ( tegretol,
Prozac to control violent tempers
CNS stimulants to improve attention
span

Medical Treatment: musculoskeletal

concerns, mitral valve prolapse, recurrent OM, and seizures
speech and language therapy
Prognosis
expected to live a normal life span
Nursing Care Management
Genetic counseling, chromosomal
analysis
Visual Impairment
Definition and Classification
Legal Blindness: 20/200 or lower
Partial Sight: better than 20/200 but
worse that 20/70
Visual Impairment: encompasses
both these terms
Etiology
Perinatal infections like STDs,
Retinopathy of prematurity, trauma, postnatal infections
Refractive errors are most common
Refraction: bending
of light rays as they pass through the lens of the eye
Trauma is the most common cause
of visual impairment
Conjunctivitis is the most common
infection in kids
Nursing Care Management
assessment, prevention, and
rehabilitation of the child are important
Assess for visual concerns
infancy: observe
infant following light or object, test for strabismus
childhood: educate
family on appropriate interventions
Encourage motor
development and assist with recognition tasks
help normalize child
as much as possible
EMPHASIS ON
PARENT CHILD ATTACHMENT
Appropriate Play
materials
in the hospital:
reorient child, reassure parents, encourage independence,
provide a safe environment

Chapter 28
I.
There is a review of the physiology of the brain that weve gone over a
bunch so if you want to review you can, its all the meninges and stuff

II.

Intracranial Pressure
A. early signs
1. headache, vomiting, personality changes, irritability
and fatigue

III.

IV.

2. older children: headache, nausea and vomiting

3. seizures may occur
B. Assessment
1. Watch for elimination or reappearance of reflexes
2. history is very important (animal encounters, fevers,
past illness, ingestion of harmful substances
C. Physical Exam
1. size and shape of head
2. spontaneous activity and postural reflexes
3. Older children: use same methods as adults
4. OCULAR MOVEMENTS, PUPILLARY
RESPONSES, FACIAL MOVEMENTS, and MOUTH FUNCTIONS
Altered States of Consciousness
A. Altered States of Consciousness: usually refers to varying
states of unconsciousness that may be momentary or may last for hours, days,
or indefinitely
B. Etiology
1. direct or indirect cause
a) direct: encephalitis, indirect:
hypoglycemia
C. Level of Consciousness
1. earliest indicator of improvement or deterioration
D. Coma Assessment
1. Glasgow Coma Scale: (eye opening, verbal
response, motor response)
a) pediatric version recognizes
developmental expectations of the child
b) numeric values of 1-5 are assigned
to the levels of response in each category. the sum of these three
numeric values provide an objective measure of the patient's LOC.
a person with an unaltered LOC would score the highest, 15. the
child who opens eyes spontaneously, obeys commands, and is
oriented is scored at a 15.
2. Irreversible coma- Brain death is the total cessation
of brainstem and cortical brain function that results from any condition
that causes irreversible widespread brain injury
Neurologic Examination
A. Vital signs
1. elevated body temp, pulse is variable, BP could be
normal, elevated, or low (increase is uncommon in children), respirations
are slow deep and irregular
B. Skin
1. examine for injury, needle marks, bites, petechia,
evidence of toxic substances

C. Eyes

V.

1. pupil size and reactivity, (Pinpoint pupils in

poisoning, widely dilated and fixed suggest paralysis of CNIII(3))
2. Unilateral fixed suggest same side lesion
3. bilateral fixed imply brainstem damage
4. dilated nonreactive: Hypothermia, anoxia, ischemia,
poisoning with atropine like substances
5. REVIEW DOLL'S EYES REFLEX: eyes move in
opposite direction of head (absence suggests CN III)
D. Motor Function
1. watching the kid walk will help provide clues to the
location and extent of cerebral dysfunction.
2. asymmetric movements of the limbs or absence of
of movements suggest paralysis
E. Posturing
1. Flexion-Decorticate-severe dysfunction of cerebral
cortex or lesions above the brainstem
2. Extension-Decerebrate-dysfunction at level of
midbrain or lesions to brain stem.
F. Reflexes
1. three key reflexes that demonstrate neuro health in
young infants are the Moro, tonic neck and withdrawal reflexes.
Head Injury
A. Etiology
1. falls, motor vehicle injuries, and bicycle injuries
2. boys 2x as often as girls
3. highest rate of mortality
4. physical characteristics (being placed on a high
chair, large head size of infants, etc.)
B. Pathophysiology
1. acceleration-deceleration causes the most brain
damage (a head striking a stationary surface)
2. inadequate perfusion when ICP exceeds arterial
pressure
3. shearing forces are caused by unequal movement,
tearing small arteries
4. Mild: GCS of 13-15, Moderate: GCS 9-12, Severe:
GCS of 8 or less
5. Concussion: alteration of mental status with or
without loss of consciousness
a) hallmark symptoms confusion
and amnesia
6. Contusion and Laceration
a) bruising and tearing of cerebral
tissue
(1) most commonly in
occipital, frontal and temporal lobes

VI.

(2) SHAKEN BABY

SYNDROME CAN YIELD INTRACRANIAL
SUBARACHNOID OR SUBDURAL HEMORRHAGES
7. Fractures
a) linear: most common, associated
with an overlying scalp hematoma,
b) comminuted: associated linear
fractures
c) Depressed: broken and pushed
inwards
d) Open: risk of CNS infection
e) Basilar: leakage of CSF from the
nose or ear, blood behind tympanic membrane, subq bleeding
over the mastoid process (behind the ear) and subq bleeding
around the eye
C. Complications
1. hemorrhage, infection, edema, herniation
2. EPIDURAL= ARTERIAL (lucid interval then normal
period then loss of consciousness of lethargy)
a) Cushing Triad (Systemic HTN,
bradycardia, respiratory depression)
3. Subdural hemorrhage
a) venous bleed
b) presenting signs: Irritability,
vomiting, increased head circumference, bulging anterior
fontanelle, lethargy, coma, or seizures
c) in infants, accumulation of blood
may cause shock or fever before any other alterations
4. Subarachnoid are rare in children
5. Cerebral Edema
a) peaks 24-72 hours after trauma
b) well known/ expected complication
c) yields increase in ICP
D. Postconcussion syndrome
1. sequelae to brain injury with or without loss of
consciousness
2. S/S: headaches, dizziness, fatigue, irritability,
anxiety, insomnia, loss of concentration, and memory impairment
3. Headaches can occur 1-3 months after mild TBI,
occurring in 25-75% of individuals
4. structural complications possible (hydrocephalus)
Diagnostic Evaluation
A. EMPHASIS ON HEALTH HISTORY
B. initial assessment
1. ABCs, neuro exam, papillary responses, motor
responses, assessment for spinal cord injury, and vital signs
C. Labs
1. H&H, serum electrolytes and glucose, MRI

VII.

VIII.

Therapeutic Management
A. majority if no loss of consciousness can be observed at home
1. warning about s/s of worsening: headaches
vomiting, change in mental status or behavior, unsteady gait, or seizures
2. bring in child after 1 or 2 days
3. monitor IV fluids very closely
4. sedating drugs usually withheld in acute phase
(give tylenol for headache)
B. Surgical Therapy
1. skull fracture depressed more than the thickness of
the skull or an intracranial hematoma that causes more than 5 mm
midline shift is indicated for surgery
C. Prognosis
1. dependent on the extent of the injury and
complications
2. generally more favorable than adults
3. more than 90% recover without symptoms
4. Concerns: cognitive, emotional, or mental problems
5. True coma does not usually last more than 2 weeks
(if coma happens, outcomes have a wide range)
D. Nursing Care Management
1. CONTINUAL ASSESSMENT (q15) MOST
IMPORTANT: LOC
E. Family Support
1. educational and emotional support, be honest
F. Rehabilitation
1. as soon as possible
2. take care of the whole child: emotional, physical,
cognitive, and social
3. PT, OT, nutrition, speech, special ed, psychiatry,
medical doctors, etc on the team for rehabilitation
G. Prevention
1. APPROPRIATE CAR RESTRAINTS AND
HELMETS
Submersion Injury
A. Major cause of injury 1-14 years of age, type of child abuse
B. Pathophysiology
1. PULMONARY, CARDIAC, and NEUROLOGIC
systems affected
2. features: hypoxia, aspiration, hypothermia
3. if any aspiration occurs: atelectasis, arterial
hypoxemia, acidosis
C. Clinical manifestations
1. R/T loss of consciousness and neurologic status
D. Therapeutic Management
1. CPR, restore oxygen delivery, watch for seizures
2. ALL CHILDREN WITH SUBMERSION INJURY
SHOULD BE HOSPITALIZED FROM 12-48 HOURS

IX.

3. watch for aspiration pneumonia and other

respiratory complications (atelectasis, ARDS, bronchospasm)
E. Nursing Care Management
1. Maintain airway
2. encourage and reassure parents
3. help parents or caretakers deal with their guilt
F. Prevention
1. SUPERVISION
2. Familiarity with CPR
Intracranial infections
A. Bacterial Meningitis
1. KNOW THE VACCINES FROM THE PPT
2. S. pneumoniae is the most common cause
between 3 mos and 10 years of age
3. HEARING IMPAIRMENT IS THE MOST COMMON
SEQUAELA
B. Prevention
1. vaccines
C. Nursing Care
1. proper precautions (isolation droplet)
2. side-lying position, pain management
3. acetaminophen with codeine is one of the most
commonly used
4. Strict Is and Os, clear liquids and then progress
5. Family support- help parents deal with the sudden
onset and condition of their child
D. Nonbacterial (aseptic) meningitis)
1. Manifestations: headaches, fever, malaise, and GI
symptoms
E. Reye Syndrome
1. FOLLOWS VIRAL INFXN
2. SXS
a) fever, profuse vomiting, neuro
impairment, disordered hepatic fxn.
b) AVOID ASA (salicylates) for a fever
with viral illness.
(1) liver shuts down and
doesnt filter toxins, hepatic encephalopathy, and cerebral
edema may occur
F. Seizure Disorders
1. most common neuro dysfunction in children (more
than half are febrile seizures)
2. SYMPTOM OF UNDERLYING DISEASE
PROCESS!!!
a) neurologic, metabolic, ingestion,
traumatic, infectious
3. SxS

a) change in LOC, involuntary

movements, posturing, changes in perception, behaviors, or
sensations
4. classification/clinical manifestations
a) partial
b) generalized
c) unclassified
5. Diagnosis of seizures
a) must differentiate epilepsy from
other brief alterations in consciousness or behavior
b) HX
c) description (can i get a witness!) of
event
(1) duration, progression,
postictal behavior
d) physical exam, lab values, EEG,
video monitoring
6. EPILEPSY
a) two or more unprovoked seizures
b) seizure are an indispensable
characteristic of epilepsy
c) a single seizure is not generally
categorized as epilepsy and not treated with long term antiepileptic meds.
7. Therapeutic mgmt
a) goals of meds and therapy
(1) control seizures
(2) reduce the frequency
and severity of seizures
(3) discover and correct
the cause
(4) help the child live as
normally as possible
(5) promote normal
growth and development
b) MEDS
(1) monotherapy is tx of
choice
(2) polypharm may be
used if seizures are not controlled
(3) increase dose as kid
grows
(4) wean child when d/cwhen to d/c?
(a) when
child has been seizure free for 2 years
(b) when
eeg is normal

(c) when
they are going through puberty
(d) there
is there possibility of recurrent seizures after first
year of d/c meds.- just fyi.
c) KETOGENIC DIET- High fat, LOW
Carb
d) vagus nerve stimulation
e) surgical therapy
8. Status epilepticus
a) definition is seizure(s) lasting more
that 30 minutes or a series of seizures in which the patient does
not regain a premorbid LOC
b) therapeutic mgmt
(1) maintain airway and
monitor for apnea
(2) safety of pt
(3) establish IV access
(4) meds-diazepam or
lorazepam.fosphenytoin followed by phenobarbital
(5) support the family
9. Febrile Seizures
a) transient disorder in childhood
b) not true seizures
c) do not treat these
d) **NO POST-ICTAL BEHAVIOR****
e) usually occur with temps >101.8
f) mgmt
(1) protect child from
injury
(2) tepid baths and longterm antipyretics are ineffective
(3) call 911 if seizure
>5min.
G. Hydrocephalus
1. imbalance in the production and absorption of CSF
in the ventricular system
a) non-obstructive or communicating
b) obstructive or noncommunicating
(1) commonly associated
with spina-bifida
2. may not be apparent at birth-appears after closure
of cranial defect
3. setting sun eyes
4. mgmt

a) VP shunt-prevent infxn, can get

clogged w/protein, kid can outgrow->need for bigger shunt later in
life.
b) nurse care want to measure head
circumference daily
5. question: a neonate is brought to the ED by his
mom. you suspect hydrocephalus, which observation would indicate this
condition?
a) bulging fontanel, eyes rotated
downward Sunset eyes
Chapter 29- The Child with Endocrine Dysfunction
the endocrine system has three components: the cells,, which send chemical
message via hormones; target cells, which receive the message; and the environment
through which the chemical is transported from the site of synthesis to the sites of
cellular action.
pituitary dysfunction is manifested primarily by growth disturbance.
The main physiologic action of TH is to regulate the basal metabolic rate and
control the processes of growth and tissue differentiation
Disorders of thyroid fxn include hypothyroidism, autoimmune thyroiditis, goiter,
and hyperthyroidism.
Therapy for hyperthyroidism is directed at retarding the rate of hormone secretion
and may include drug therapy, thyroidectomy, or radioiodine therapy.
Classic forms of hypoparathyroidism is childhood are idiopathic (deficient
production of PTU) and pseudohypoparathyroidism (increased PTH production with endorgan unresponsiveness to PTH)
The adrenal cortex secretes three important groups of hormones:
glucocorticoids, mineralocorticoids, and sex steroids
Disorders of adrenal fnx include acute adrenocortical insufficiency, chronic
adrenocortical insufficiency, Cushing's syndrome, and CAH (Congenital Adrenal
hyperplasia-Symptoms in infants may include ambiguous genitalia in girls and an
enlarged penis in boys).
Five categories of Cushings syndrome are pituitary, adrenal, ectopic, iatrogenic
and food dependent (she didnt go over these but they are in the book)
Management of CAH includes assignment of a sex according to genotype; admin
of cortisone and possibly, reconstructive surgery.
DM-we know diet, exercise, insulin therapy, BS checks, promoting healthy
lifestyle, educating for sxs of hypoglycemia/hyperglycemia.
-I dont know why it is formatting this way but hopefully you guys can see what I wrote. I
can e-mail it to you if you want.