Chain of Survival and EMSC

Chapter 23 The Child with a Sensory or Neurological Condition Copyright 2019, Elsevier Inc. All rights reserved. Ears Newborn Tympanic membrane almost horizontal More vascular Inconsistent light reflex Eustachian tube is shorter and straighter than in adult

Eustachian tube functions Ventilation Protection Drainage Copyright 2019, Elsevier Inc. All rights reserved. 2 Otitis Externa An acute infection of the external canal Signs

Often referred to as swimmers ear Pain and tenderness on manipulating the pinna or tragus Tympanic membrane is normal Rule out the presence of a foreign body, cellulitis, diabetes mellitus, or herpes zoster Treatment Irrigation and topical antibiotics or antivirals Copyright 2019, Elsevier Inc. All rights reserved. 3 Acute Otitis Media Pathophysiology

Inflammation of the middle ear Structures lined by mucous membranes Mastoid sinuses Middle ear Eustachian tube Protects middle ear Provides drainage Equalizes air pressure Infection of the throat can easily spread to the middle ear and mastoid. Copyright 2019, Elsevier Inc. All rights reserved.

4 Hearing Impairment Hearing loss can result from Defects in the transmission of sound to the middle ear Damage to the auditory nerve or ear structures A mixed loss involving both a defect in nerve pathways and interference with sound transmission Behavior problems may arise because these children do not understand verbal directions.

Copyright 2019, Elsevier Inc. All rights reserved. 5 Barotrauma An injury that occurs when the pressure in the atmosphere between a closed space and the surrounding area changes Airplane descent Underwater diving Copyright 2019, Elsevier Inc. All rights reserved. 6 The Eyes

Begin to develop in a 4-week-old embryo Newborn sight is not mature. Shape of eye is less spherical in a newborn. Tears are not present until 1 to 3 months of age. Depth perception does not begin to develop until about 9 months of age. Copyright 2019, Elsevier Inc. All rights reserved. 7 Dyslexia

Reading disability Involves a defect in the cortex of the brain that processes graphic symbols Treatment involves remedial instruction Copyright 2019, Elsevier Inc. All rights reserved. 8 Amblyopia Reduction or loss of vision that usually occurs in children who strongly favor one eye Treatment Glasses, opaque contact lens, or patching the good eye Forces the weaker eye to be used

Copyright 2019, Elsevier Inc. All rights reserved. 9 Strabismus Also known as cross-eye Child is not able to direct both eyes in same direction Lack of coordination between the eye muscles that direct movement of the eyes When coordination does not occur, the brain will

disable one eye to provide a clear image. The disabled eye can develop permanent visual impairment because of sensory deprivation. Several types: nonparalytic and paralytic Copyright 2019, Elsevier Inc. All rights reserved. 10 Eye Strain (1 of 2) Symptoms Inflammation Aching or burning

Squinting Short attention span Frequent headaches Difficulties with schoolwork Inability to see the board at the front of the class Copyright 2019, Elsevier Inc. All rights reserved. 11 Eye Strain (2 of 2) Nursing interventions Observe Teach Prevent

Refer Rehabilitate Copyright 2019, Elsevier Inc. All rights reserved. 12 Conjunctivitis (1 of 2) Inflammation of the conjunctiva or mucous membrane that lines the eyelids Caused by a variety of bacterial and viral organisms or from a blocked lacrimal duct Acute form is commonly called pink eye Common forms respond to warm

compresses, topical antibiotic eye drops, or eye ointments. Copyright 2019, Elsevier Inc. All rights reserved. 13 Conjunctivitis (2 of 2) Symptoms include Itching Tearing of one or both eyes Edema of the eyelids and periorbital tissues Child may appear distracted or irritable Copyright 2019, Elsevier Inc. All rights reserved.

14 Conjunctivitis Copyright 2019, Elsevier Inc. All rights reserved. 15 Hyphema Presence of blood in the anterior chamber of the eye One of the most common ocular injuries Appears as a bright-red or dark-red spot in front of the lower portion of the iris Treatment

Bedrest with HOB elevated 30 to 45 degrees decreases intraocular pressure and intracranial pressure if there is an associated head injury. Topical medications may also be prescribed. Copyright 2019, Elsevier Inc. All rights reserved. 16 Retinoblastoma A malignant tumor of the retina Manifestations Yellowish white reflex is seen in the pupil because

of a tumor behind the lens Called the cats eye reflex or leukokoria May be accompanied by loss of vision, strabismus, hyphema, and in advanced tumors, pain Copyright 2019, Elsevier Inc. All rights reserved. 17 The Nervous System The bodys communication center Transmits messages to all parts of the body Records experiences Integrates certain stimuli

Most neurologic disabilities in childhood result from congenital malformation, brain injury, or infection. Copyright 2019, Elsevier Inc. All rights reserved. 18 Causes of Altered Level of Consciousness (ALOC) A fall to 60 mm Hg, or below, of PaO2 A rise above 45 mm Hg of PaCO2

Low blood pressure causing cerebral hypoxia Fever (1 F rise in fever increases oxygen need by 10%) Drugs (sedatives, antiepileptics) Seizures (postictal state) Increased intracranial pressure (ICP) Copyright 2019, Elsevier Inc. All rights reserved. 19 Reyes Syndrome Acute noninflammatory encephalopathy and hepatopathy that follows a viral infection in children

May be a relationship between the use of aspirin during a viral flu or illness Some studies show that a genetic metabolic defect triggers Reye syndrome when the stress of a viral illness produces vomiting and hypoglycemia. Copyright 2019, Elsevier Inc. All rights reserved. 20 Sepsis Systemic response to infection with bacteria; also results from viral or fungal infections Causes a systemic inflammatory response syndrome (SIRS) due to the endotoxin of the bacteria that causes tissue damage Untreated can lead to septic shock,

multiorgan dysfunction syndrome (MODS), and death Copyright 2019, Elsevier Inc. All rights reserved. 21 Meningitis Manifestations If bacterial, symptoms are a result of intracranial irritation from the purulent toxins released by the bacteria The presence of petechiae suggests meningococcal infection.

Expected findings Photophobia Nausea, irritability headache Copyright 2019, Elsevier Inc. All rights reserved. 22 Assessment Check for nuchal rigidity; may not be diagnostic in children younger then toddler age Seizures with a high-pitched cry

Poor feeding, vomiting 2 years thru adolescence: Brudzinskis sign (flexion of extremities upon flexion of the neck) and Kernigs sign ( resistance to extension of the childs leg from a flexed position) Copyright 2019, Elsevier Inc. All rights reserved. 23 Laboratory tests Blood cultures are sometimes positive CSF analysis will indicate meningitis Lumbar puncture CT scan or MRI-performed to assess ICP or any abscesses

Child may also show a petechiae-like rash Copyright 2019, Elsevier Inc. All rights reserved. 24 Lumbar puncture positioning Copyright 2019, Elsevier Inc. All rights reserved. 25 Meningitis- nursing care Place child in droplet isolation until after they

have been on antibiotics for 24 hours Frequent neuro checks Accurate monitoring and recording of vital signs Minimize stimuli-child may be overly sensitive to light and noise; also will prevent seizures Carefully monitor childs I&O Copyright 2019, Elsevier Inc. All rights reserved. 26 Encephalitis Inflammation of the brain Also known as encephalomyelitis when the spinal cord is also infected

Symptoms result from the CNSs response to irritation Headache followed by drowsiness May proceed to coma Convulsions are seen, especially in infants Fever, cramps, abdominal pain, vomiting, nuchal rigidity, delirium, muscle twitching, abnormal eye movements Copyright 2019, Elsevier Inc. All rights reserved. 27 Encephalitis- treatment and nursing care

Treatment is supportive and aimed at relieving symptoms Seizure precautions are necessary Adequate nutrition and hydration Provide a quiet environment and good hygiene Closely observe for any neuro changes Copyright 2019, Elsevier Inc. All rights reserved. 28 Brain Tumors

Second most common type of neoplasm in children Most occur in lower part of the brain and commonly in school-age children Signs and symptoms directly related to location and size of tumor Diagnosis is made by clinical presentation, laboratory tests, head CT or MRI, EEG Surgical intervention in some cases; chemotherapy and/or radiation therapy in others Copyright 2019, Elsevier Inc. All rights reserved. 29 Types of Seizures Febrile

Epilepsy Classified as Generalized Tonic-clonic or grand mal Three distinct phases: aura, seizure, postictal period Partial Account for 40% Consciousness may be intact or slightly impaired Can have simple or complex seizures Copyright 2019, Elsevier Inc. All rights reserved. 30 Seizure Diagnosis and Treatment

Determine type, site, or cause Multiple diagnostic techniques can be used CT/MRI, EEG Laboratory tests to rule out poisoning or electrolyte abnormalities Drug of choice depends on the type of seizure; give at same time each day Diet changes may be needed for patients who do not respond well to anticonvulsants. Copyright 2019, Elsevier Inc. All rights reserved. 31 Cerebral Palsy (CP)

Manifestations Vary with each child May range from mild to severe Intellectual and developmental disabilities sometimes seen Suspected during infancy if There are feeding problems. Convulsions not associated with high fevers Developmental milestones are not being achieved at expected age level. Copyright 2019, Elsevier Inc. All rights reserved.

32 The physically disabled child Need to have their basic needs and human requirements met, just as any other child Must participate in family and social activities to the fullest extent possible Educational programs are integrating the disabled more fully into the community Copyright 2019, Elsevier Inc. All rights reserved. 33 Cognitive Impairment

Elements involved in mental functioning Level of consciousness Thought processes Expressive language Copyright 2019, Elsevier Inc. All rights reserved. 34 Intellectual Impairment Limitations in at least two of the following

Communication Self-care Home living Social skills Community use Self-direction Health and safety Functional academics Leisure Work Copyright 2019, Elsevier Inc. All rights reserved. 35 Approach to the Intellectually Impaired Child

Teach parents to provide experiences that the child can be successful in. Concentrate on strengths, not weaknesses. Constant failure can cause child to become angry, which can cloud the problem and interfere with successful therapy. Copyright 2019, Elsevier Inc. All rights reserved. 36 Head Injuries Major cause of death in children older than 1

year of age A concussion is a temporary disturbance of the brain that is usually followed by a period of unconsciousness. A childs response to a head injury may differ from that of an adult. Copyright 2019, Elsevier Inc. All rights reserved. 37 Pathophysiology Brain injury occurs at the time of impact Children are more susceptible to injury because their muscles surrounding the CNS

are not fully developed Increased bleeding or hypoxia may occur Increased blood flow increases cerebral edema Which may lead to increased ICP Copyright 2019, Elsevier Inc. All rights reserved. 38 Shaken Baby Syndrome Infants who are roughly shaken can sustain retinal, subarachnoid, and subdural hemorrhages in the brain, as well as high-level cervical spine injuries. Can result in permanent brain injury or death Symptoms can include:

Headache (manifested as fussiness in a toddler) Drowsiness Blurred vision Vomiting Dyspnea In severe cases, child may be completely unconscious. Copyright 2019, Elsevier Inc. All rights reserved. 39 Nursing Care of a Brain-Injured Child

Subtle clues to change can be missed unless the nurse performs aggressive assessment in looking for them. The lack of the childs ability to communicate and cooperate poses a challenge in the neurologic assessment of infants, but knowledge of normal growth and development aids the nurse in evaluating the status of the patient. Copyright 2019, Elsevier Inc. All rights reserved. 40 Neurological Monitoring of Infants and Children

Pain stimuli response LOC Arousal awareness Cranial nerve response Motor response Posturing Pupil response of the eyes Bulging fontanels Scalp vein distention

Ataxia; spasticity of lower extremities Moro or tonic neck with withdrawal reflexes Copyright 2019, Elsevier Inc. All rights reserved. 41 Neuro check 4 components: Level of consciousness Pupil and eye movement

Vital signs Motor activity Nursing care: Check wound, if any Check for nuchal rigidity Observe for signs of shock Copyright 2019, Elsevier Inc. All rights reserved. 42 Near-Drowning

Accidental or near-drowning is the fourth leading cause of death in children younger than 19 years of age. Near-drowning is defined as survival beyond 24 hours after submersion. Priorities include immediate treatment of Hypoxia Aspiration Hypothermia CNS injury remains the major cause of death or longterm disability. Copyright 2019, Elsevier Inc. All rights reserved. 43

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