Care of Mother and Child At-Risk or with

Problems (Acute and Chronic)-Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 34

LESSON TITLE: NURSING CARE OF A FAMILY WHEN A

CHILD HAS A NEUROLOGICAL ALTERATIONS
LEARNING OUTCOMES:
At the end of the lesson, the student nurse can:
1. Define the common types of disorders in the gastrointestinal
system and nervous system that occur in children.
2. Integrate the knowledge of the common types of disorders in
the gastrointestinal system and nervous system that occur in
children and describe these disorders that occur in these
classifications of children in formulating nursing care plan in
giving quality maternal and child health nursing care
Materials:
Book, pen and notebook, index card/class list,
speaker and LCD projector
Reference:
Pilliteri, Adele and Silbert-Flagg, JoAnne (2018)
Maternal and Child Health Nursing, 8th Edition.
USA: Lippincott Williams and Wilkins

LESSON REVIEW/PREVIEW (5 minutes)

MAIN LESSON (50 minutes)

Please refer to Chapter 52: Nursing Care of A Family When a Child Has an Unintentional Injury -Poisoning p. 1478 and
Chapter 49: Nursing Care of A Family When a Child Has a Neurological Disorder-Increased Intracranial Pressure p. 1383

POISONING
 The substances most frequently ingested in children 5 years and younger include cosmetics/personal care
products, household cleaning products, analgesics, foreign bodies such as toys, and topical preparations.
Children younger than 6 years of age are at high risk for ingesting pharmaceutical agents.
 Nearly 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medications.
 The most commonly ingested medications include opioids and benzodiazepines, acetaminophen, cough and
cold remedies, ibuprofen, and diphenhydramine.
EMERGENCY MANAGEMENT OF POISONING AT HOME
The parent should be prepared to provide the following information to the poison control center:
 What was swallowed; if the name of a medicine is not known, what it was prescribed for and a description of it
(color, size, shape of pills)
 The child’s weight and age and how long ago the poisoning occurred
 The route of poisoning (oral, inhaled, sprayed on skin)
 An estimation of how much of the poison the child took (a bottle of cleaner or medicine should say how many
pills or how much liquid it originally contained)
 The child’s present condition (sleepy, hyperactive, comatose)
 If the poison was in pill form, parents should check whether there are pills scattered under a chair before they
assume they were swallowed.
 If one child in a family has swallowed a poison, parents should investigate whether other children have also
poisoned themselves because a preschooler often shares “candy” with a younger sibling.
 If the poison control center advises parents to make the child vomit, the best way to do this is to place a finger at
the back of the child’s throat.
 Old remedies such as giving mustard or salty water are not that effective and waste time that could be spent
telephoning an emergency service (911) for help or transporting the child to the hospital.

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 EMERGENCY MANAGEMENT OF POISONING AT THE HEALTH CARE FACILITY
 In the emergency department, the best method to deactivate a swallowed poison is the administration of
activated charcoal either orally or by way of an NG tube to halt the action of the poison.
 Activated charcoal is supplied as a fine black powder that is mixed with water for administration.
 Adding a sweet syrup to the mixture can make it more palatable.
 Caution parents that, as the charcoal is excreted through the bowel over the next 3 days, stools will appear black
so they do not mistake the color for blood
INCREASED INTRACRANIAL PRESSURE
 Increased ICP occurs because of an increase in the CSF volume, blood entering the CSF, cerebral edema, head
trauma or infection, space-occupying lesions such as brain tumors, or the development of hydrocephalus or
Guillain-Barré syndrome.
 Sign and Symptoms of Increased Intracranial Pressure is on table 43.1
Sign or Symptom Indication of Increased Intracranial Pressure
Increased head An increase >2 cm per month in first 3 months of life, >1
circumference cm per month in the second 3 months, and >0.5 cm per
month for the next 6 months
Fontanelle changes Anterior fontanelle tense and bulging; closing late
Vomiting Occurring in the absence of nausea, on awakening in
morning or after nap; possibly projectile
Eye changes Diplopia (double vision) from pressure on abducens
nerves; white of sclera evident over pupil (setting sun
sign); limited visual fields, papilledema
Vital sign changes Elevated temperature and blood pressure; decreased
pulse and respiration rates
Pain Headache, often present on awakening and standing;
increasing with straining at stool (Valsalva maneuver)
or holding breath
Mentation Irritability, altered consciousness such as sleepiness
Table 43.1
ASSESSMENT INTRACRANIAL PRESSURE MONITORING
 the initial signs children may show are headache,  Intraventricular catheters are threaded into the
irritability, or restlessness. lateral ventricle, filled with normal saline, and then
 Growing pressure on the brainstem, which controls connected to an external pressure monitor.
respiration and cardiac activity, soon causes pulse  As pressure in the ventricle fluctuates, it registers
and respiration rates to slow. through the filled catheter onto an oscilloscope
 Compression of cranial vessels leads to a screen plus a written printout.
compensatory increase in blood pressure (or pulse  ICP in children normally ranges from 1 to 10
pressure, the gap between the systolic and mmHg; a level greater than 15 mmHg needs
diastolic blood pressures). Pressure on the further assessment.
hypothalamus, the temperature-regulating center  As blood pressure rises and falls with the influx of
of the body, causes an increase in body blood through vessels, so does ICP.
temperature.  On a monitor, this appears as A waves (plateau
 diplopia (double vision). waves), B waves (short-duration waves), or C
 On funduscopic examination, papilledema may be waves (small, rhythmic bursts).
detected.  If brain ischemia is present, wave patterns change
 Compare a new assessment against all recordings even before there is a deviation in blood pressure
taken in the last 24 hours so a progressive change or pulse rate
can be detected.  insertion of intraventricular catheters or
 decorticate posturing: the child’s arms are screws.it enables early detection should problems
adducted and flexed on the chest with wrists arise but also because it helps to reduce the risk of
flexed, hands fisted; the lower extremities are further injury or complications.
extended and internally rotated; the feet are
plantar flexed
 Decerebrate posturing, which occurs when the

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 midbrain is not functional, is characterized by rigid
extension and adduction of the arms and pronation
of the wrists with the fingers flexed; the legs are
held extended with the feet plantar flexed.
THERAPEUTIC MANAGEMENT
 Actions such as coughing, vomiting, and sneezing and rapid administration of intravenous (IV) fluid increase
ICP. When a parent is burping an infant after a feeding, caution them to be careful not to put pressure on the
jugular veins because this is another action that increases ICP.
 Placing a child in a semi-Fowler’s position (use an infant seat for babies) or administering a corticosteroid such
as dexamethasone (Decadron) can effectively reduce cerebral edema and its accompanying pressure.
 An osmotic diuretic, such as mannitol, given IV, causes a shift of fluid from extravascular compartments into the
vascular stream (from brain tissue into blood vessels), so it also reduces pressure.
 Children usually have an indwelling urinary catheter inserted before beginning an osmotic diuretic to ensure that
the child’s kidneys are able to successfully excrete the intravessel fluid and prevent back pressure on the heart.
 If the ICP is caused by excessive fluid accumulating in the brain’s ventricles, a ventricular tap may be necessary
for immediate reduction of pressure.
 Because increased ICP is a sign of an underlying disorder, after the pressure is reduced, the underlying cause
must then be identified and rectified or the pressure will rise again from the original disorder.

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by pair. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Multiple Choice

1. Nurses should begin screening for lead poisoning when a child reaches which age?
A. 12 months
B. 6 months
C. 18 months
D. 24 months
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

2. Which therapeutic agent is called the universal antidote?

A. Glucose
B. Activated Charcoal
C. Protamine Sulfate
D. Pysostigmine
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

3. The drug Deferoxamine is administered in which drug overdose?

A. Iron
B. Beta blockers
C. Calcium gluconate
D. Digoxin
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

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 4. Which drug is used in acetaminophen overdose?
A. Acetylcysteine
B. Physostigmine
C. Flumazenil
D. Acetylsalicylic Acid
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

5. In which poisoning the Digibind is used as an effective antidote?

A. Cholinergics
B. Benzodiazepine
C. Digoxin
D. Atropine
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

6. Which of the following is a part of the main structures that play a role with altering intracranial pressure:
A. Neurons
B. Cerebrospinal fluid
C. Periosteum
D. Dura mater
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

7. A nurse is collecting data about a child who has been admitted to the hospital with a diagnosis of
seizures. The nurse checks for causes of the seizure activity by:
A. Testing the child's urine for specific gravity
B. Asking the child what happens during a seizure
C. Obtaining a family history of psychiatric illness
D. Obtaining a history regarding factors that may occur before the seizure activity
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

8. A nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If
the infant's level of consciousness diminishes, a priority intervention is:
A. Taking the apical pulse
B. Taking the blood pressure
C. Testing the urine for protein
D. Palpating the anterior fontanel
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

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 9. A mother arrives at the emergency department with her 4-year-old child and states that the child fell off a
bunk bed. A head injury is suspected, and a nurse is monitoring the child continuously for signs of
increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child?
A. Nausea
B. Bradycardia
C. Bulging fontanel
D. Dilated scalp veins
ANSWER: ________
RATIO:_______________________________________________________________________________________ ____
_________________________________________________________________________________________________
_____________________________________________________________

10. Which of the following is contraindicated in a patient with increased ICP?

A. Lumbar puncture
B. Midline position of the head
C. Hyperosmotic diuretics
D. Barbiturates medications
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
______________________________________________________________________________ _______________
_____________________________________________________________________
9. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
10. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.
PERIOD 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PERIOD 2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PERIOD 3
32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

AL STRATEGY: CAT 3-2-1

3-2-1
Three things you learned:
1. __________________________________________________
2. __________________________________________________
3. __________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________
2. __________________________________________________

One question you still have:

1. __________________________________________________

(For next session, review Chapter 49: Nursing Care of a Family When a Child Has a Neurological Disorder-
Neurocutaneous Syndromes p. 1386, Cerebral Palsy p. 1388 and Infection P.1391)

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