The Child with a Neurologic Alteration Increased Intracranial Pressure (1 of 2) Infant Poor feeding or vomiting Irritability, restlessness, or lethargy Often see increased sleeping, and eventually go into a coma Bulging fontanel High-pitched cry Increased head circumference Separation of cranial sutures Distended scalp veins Eyes deviated downward (“setting sun” sign) Increased or decreased response to pain 2 Increased Intracranial Pressure (2 of 2) Child Headache Diplopia Mood swings Slurred speech Papilledema (after 48 hours) Altered level of consciousness Nausea and vomiting, especially in the morning 3 Neurologic Examination Level of consciousness (LOC) Glasgow Coma Scale Behavior Alterations in normal pattern of behavior Pupil evaluation Motor function Flexion and extension Vital signs Cushing’s response 4 Spina Bifida Congenital neural tube defects (NTD) classified by incomplete closure of the vertebrae Spina bifida occulta Spina bifida cystica Clinical manifestation Small tuft of hair or dimple in the lower lumbar sacral area Myelomeningocele is a severe form of spina bifida The nurse should avoid performing range of motion on the infant's hips Drying of the fluid-filled sac should be prevented with the application of sterile, moist non-adhesive dressings until surgical repair can be performed. Rectal temperatures should be avoided The nurse should move the infant into a prone position 5 Cerebral Palsy Chronic, nonprogressive disorder of posture and movement Difficulty controlling muscles May sit with pillow props, infants who have CP require support when sitting upright Comorbidities include Cognitive impairment Hearing and speech impairment Visual impairment An infant who has cerebral palsy does not track objects with the eyes and shows little interest in her surroundings Seizures The nurse should modify the environment Using the safety and risk reduction priority-setting framework, maintaining safety is the highest priority for this client 6 Head Injury Skull fractures Contusion Concussion Intracranial hemorrhage Epidural hematoma Subdural hematoma Pupillary reaction will get progressively slower and sluggish with increased intracranial pressure Intense, bulging fontanels, separated cranial sutures, and distended scalp veins from edema Level of consciousness can deteriorate, show signs of excessive sleeping, and eventually go into a coma Bradycardia is a late sign 7 Classification of Severity of Head Injuries Glasgow Coma Scale (GCS) Minor (mild) head injury: GCS score = 13-15 Moderate head injury: GCS score = 9-12 Severe head injury: GCS score = 3-8 8 Spinal Cord Injury Can result from any trauma or injury to the spinal cord and its vascular supply or venous drainage Motor vehicle or diving accidents Falls Sport injuries Tumors Gunshot or knife wound Sports injuries Congenital anomalies Attempted suicide 9 CNS Tumor Manifestations include irritability, decreased appetite, emesis upon waking, positive Romberg and finger/nose test, unsteady gait, bradycardia, hyporeflexia and hyperreflexia, and a positive Babinski reflex Place the child in a quiet, softly lit room, and prepare the child for an MRI Monitor the child's neurologic status and paint rating because they will determine any worsening intracranial pressure or growth of the tumor. 10 Seizure Disorders Consists of brief paroxysmal behaviour caused by excessive discharge of neurons Classification of seizures Generalized Tonic, clonic, tonic-clonic Atonic Myoclonic Absence Focal Unknown 11 Therapeutic Management Initiate seizure precautions to ensure safety Antiepileptic medications Numerous side effects Complete blood count, liver enzymes, and medication levels must be closely monitored Vagus nerve stimulation Ketogenic diet Priority nursing action during a seizure: the nurse should place the child in a side-lying position to prevent aspiration Monitor for any changes in the infant's level of consciousness and assess their motor ability Keep patient NPO until they are fully awake and alert 12 Nursing Care During A Seizure The nurse should continually assess the client's airway during a seizure Do not place anything in the child's mouth, doing so can cause injury The nurse should remove objects from the patient’s bed that can cause injury Place the client in a side-lying position to prevent aspiration of secretions or vomit Do not restrain the patient 13 Meningitis Most common infectious process affecting the CNS Primary disease process Complication of neurosurgery, systemic infection, sinus or ear infection Manifestations associated with a CNS infection includes increased intracranial pressure and a positive Brudzinski sig Early diagnosis and prompt antibiotic therapy reduce morbidity and mortality. 14 Headache International Headache Society has published criteria for classifying headaches Migraine Mild to incapacitating Depression and anxiety may co-exist. Aura may precede headache onset. Tension-type headaches Pain is more generalized. Band-like tightness or pressure Tight neck muscles Sore scalp 15 The Child with a Respiratory Alteration Allergic Rhinitis Inflammatory disorder of the nasal mucosa Seasonal, recurrent, and triggered by specific allergies Some children have symptoms year round. Manifestations include clear runny nose, afebrile, no cough, repeatedly sneezing, and itchy eyes and ears Inquiring about the client's personal/familial history and performing a venipuncture to check WBC can help to confirm allergic rhinitis versus an infection. It is important to teach client and parent to identify and avoid triggers to prevent reoccurrences of allergic rhinitis. Educate parents to follow up with an allergist 17 Implementing Environmental Modifications (1 of 3) Pollen and dust Wash sheets weekly in hot water No wool or down blankets Dust-proof covers on pillows and mattresses Replace carpet with wood or tile No drapes or blinds; use curtains or shades Air filters and cleaners, use air conditioner Household humidity at 40-50% Multilayer vacuum bags Clean with dust-attracting rags/towels 18 Implementing Environmental Modifications (2 of 3) Mold Clean with mold inhibitor Dry shoes thoroughly Moisture remover in closets Avoid basements No rubber or inner-spring mattresses Use air conditioner Humidity below 35%, use a dehumidifier House ventilation Limit number of indoor plants 19 Implementing Environmental Modifications (3 of 3) Dander Keep pets outside, if possible House ventilation Air cleaners Dust covers on mattresses and pillow cases Frequent vacuuming Air purifier 20 Sinusitis Inflammation and infection of the sinuses Can be chronic or acute Although not serious may lead to life-threatening complications if left untreated Often follows an upper respiratory tract infection May also have allergic rhinitis or otitis media Diagnosed by signs and symptoms of a cold with no improvement after 10 days Low-grade fever, cough, congestion with purulent nasal discharge, halitosis, feeling of fullness over sinus area Treatment includes analgesics (Tylenol), hydration, and the application of moist heat. When a prescription is required, amoxicillin is used most frequently. The nurse assesses the location of pain or fullness. Inspect and palpate the face for edema, document any fever, and inspect the nose and throat for purulent discharge. The nasal mucous membranes are 21 inspected for erythema and edema Viral Pharyngitis Gradual onset (1 week) with sore throat Erythema, inflammation of pharynx and tonsils Vesicles or ulcers on tonsils Fever (usually low grade, may be high) Hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia (early) Cervical lymph nodes may be enlarged, tender Usually lasts 3 to 4 days Diagnose using a throat culture. 22 Bacterial Pharyngitis Abrupt onset (may be gradual in children younger than 2 years) Sore throat (usually severe) Erythema, inflammation of pharynx and tonsils Fever usually high (39.4 to 40 degrees C) Abdominal pain, headache, vomiting Cervical lymph nodes may be enlarged, tender Usually lasts 3 to 5 days Educate the parents that children who have positive throat cultures for streptococcal pharyngitis should replace their toothbrush after they have been taking antibiotics for 24 hr. Using a contaminated toothbrush can reintroduce the bacteria and spread it to others if others handle the toothbrush. 23 Pharyngitis and Tonsillitis Tonsillitis Adenoiditis Inflammation and infection of the two palatine tonsils Infection and inflammation of the pharyngeal tonsils or adenoids Incidence peaks during middle childhood 24 Caring for the Child who Has Had a Tonsillectomy Assess the child for postoperative bleeding Elevated pulse; decreasing blood pressure Signs of fresh bleeding in back of throat Vomiting bright red blood Excessive swallowing Frequent swallowing and throat clearing are signs of hemorrhage after a tonsillectomy. Restlessness not associated with pain To prevent aspiration, the gag reflex must be present before the client is allowed have fluids. 25 Croup Often begins at night; may be preceded by several days of symptoms of upper respiratory tract infection Sudden onset of harsh, metallic, barky cough; sore throat; inspiratory stridor; hoarseness Use of accessory muscles to breathe Frightened appearance Agitation Cyanosis 26 Croup The major types of croup are acute spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and epiglottitis. Laryngotracheobronchitis, the most common form of croup, usually affects infants and toddlers; it is one cause of airway obstruction in children ages 6 months to 6 years. Treatment includes: Humidified/cool mist oxygen and intravenous (IV) fluids Administer nebulized epinephrine Place the child on NPO status Ensure intubation equipment is accessible Encouraging the guardians to hold the toddler in an upright position will provide reassurance and help to calm the toddler. 27 Epiglottitis (Supraglottitis) Cardinal signs and symptoms Drooling Lethargy No cough High fever Dysphagia (difficulty swallowing) Dysphonia (difficulty talking) Distressed respiratory efforts This is a respiratory emergency. The greatest risk to the client's safety at, so the priority action is to prepare for intubation to maintain airway patency. DO NOT Leave child unattended if epiglottitis is suspected Examine or attempt to obtain culture; any stimulation by tongue depressor or culture swab could trigger complete airway obstruction 28 Evaluating croup treatment Decreased stridor Respiratory rate and heart rate within normal limits for age Oxygen saturation greater than 95% 29 Bronchitis Acute bronchitis Viral in origin Rhinoviruses most common agent Inflammation of the trachea and bronchi Chronic bronchitis May indicate underlying respiratory dysfunction 30 Bronchiolitis Respiratory syncytial virus (RSV) Inflammation of the bronchioles Manifestations include cyanosis, sneezing, coughing, nasal congestion, intermittent fever, and in severe cases, apneic spells Grayish skin and mucosal membranes with low body temperature are indicative of cyanosis. RSV is the causative agent in 50% of cases of bronchiolitis. RSV is a significant cause of hospitalization in children under 1 year of age. Highly communicable Contact isolation and scrupulous hand hygiene 31 Treatment for Bronchiolitis Administer antipyretics Keep patient NPO Initiate IV fluids Performing routine chest percussion is not helpful for infants who have bronchiolitis. Infants benefit from routine nasal suctioning (aspiration) to help clear secretions Supplemental oxygen is only necessary for infants whose oxygen saturation is below 90% 32 Pneumonia Inflammation of the lung parenchyma Primary or secondary disease Viral or bacterial Community acquired Marked decrease since the introduction of routine vaccination 33 Indicators of Pneumothorax New onset of chest pain Worsening dyspnea Increased shortness of breath Decreased oxygen saturation Labored respirations Tachycardia Hypotension These findings should be reported to the provider 34 Foreign Body Aspiration Seen most frequently in children age 6 months to 5 years Children’s curiosity, oral needs, and lack of supervision all contribute to FBA. Latex balloons contribute to a significant number of deaths. Most foreign bodies become lodged in the bronchi (right). Can be removed mechanically 35 Common Items of Aspiration Nuts Small toys Pins Parts of toys Seeds Chunks of food Screws Hard candy Coins Latex balloons Grapes Popcorn Bones Hotdogs Earrings Carrots 36 Pulmonary Noninfectious Irritations Acute respiratory distress syndrome (ARDS) Severe diffuse lung injury Precipitated by a variety of illnesses Breakdown in the alveolar-capillary barrier Passive smoking Children exposed to cigarette smoke have more frequent upper and lower respiratory complications. Smoke inhalation 50% of all fire-related deaths are due to smoke. 37 Apnea Cessation of breathing for 20 seconds or longer During an episode of apnea it is important to note the following: Time and duration of the episode Color change Bradycardia O2 saturation Action that stimulated breathing 38 Asthma A reversible obstructive airway disease characterized by Increased airway responsiveness to a variety of stimuli Bronchospasm resulting from constriction of bronchial smooth muscle Inflammation and edema of the mucous membranes that line the small airways and the subsequent accumulation of thick secretions in the airways 39 Emergency Asthma Management Worsening wheeze, cough, or shortness of breath No improvement after bronchodilator use Difficulty breathing Trouble with walking or talking Discontinuation of play Listlessness or weak cry Gray or blue lips or fingernails 40 Therapeutic Management of Asthma Administer medications and treatments Albuterol is considered a "rescue" medication due to its rapid onset of action Education for the child and family Avoidance of triggers Recognize early signs of an asthma episode Measures to prevent an asthma attack 41 Cystic Fibrosis Inherited multisystem disorder characterized by widespread dysfunction of the exocrine glands Abnormal secretions of thick, tenacious mucus Obstruction and dysfunction of the pancreas, lungs, salivary glands, sweat glands, and reproductive organs Transmitted as an autosomal recessive trait 42 Therapeutic Management of Cystic Fibrosis Maintain a patent airway Administer bronchodilators Perform or supervise respiratory treatments Administer antibiotics and pancreatic enzymes Increased exercise tolerances Teach the child and family about cystic fibrosis and its treatment 43 The Child with a Cardiovascular Alteration Congenital Heart Disease (1 of 2) Left-to-right shunting lesions Patent ductus arteriosus Atrial septal defect Ventricular septal defect Atrioventricular septal defect Obstructive or stenotic lesions Pulmonary stenosis Aortic stenosis Coarctation of the aorta 45 Congenital Heart Disease (2 of 2) Cyanotic lesions with decreased pulmonary blood flow Tetralogy of Fallot Calming the crying infant is the primary response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness. Tricuspid atresia Pulmonary atresia with intact ventricular septum Cyanotic lesions with increased pulmonary blood flow Truncus arteriosus Patent ductus arteriosus Hypoplastic left heart syndrome Transposition of the great arteries 46 Heart Failure Manifestations Difficulty feeding, poor weight gain Weigh the infant every day on the same scale at the same time. Mild tachypnea, tachycardia Cardiomegaly Galloping rhythm Poor perfusion, edema Liver and spleen enlargement Mottling, cyanosis, pallor 47 Feeding the Infant with Congestive Heart Failure (1 of 2) Feed the infant or child in a relaxed environment; frequent, small feedings may be less tiring. Hold the infant in an upright position. This may provide less stomach compression and improve respiratory effort. 48 Feeding the Infant with Congestive Heart Failure (2 of 2) If the child is unable to consume appropriate amount during 30-minute feeding every 3 hours, consider nasogastric feeding. Monitor for increased tachypnea, diaphoresis, or feeding intolerance (vomiting). Concentrating formula to 30 kcal/oz may increase caloric intake without increasing infant’s work. 49 Educating Parents Signs and symptoms of heart failure Increased cyanosis Dehydration Infection Dysrhythmias Decreased nutritional intake 50 The Child Undergoing Cardiac Surgery Preoperative preparation Postoperative management Monitoring cardiac output Supporting respiratory function Monitoring fluid and electrolyte balance Promoting comfort Healing and recovery 51 Acquired Heart Diseases Infective endocarditis Dysrhythmias Rheumatic fever Kawasaki disease Hypertension Cardiomyopathies High cholesterol levels 52 Infective Endocarditis IE occurs most commonly in the presence of CHD Inflammation resulting from infection of the cardiac valves and endocardium Manifestations include fever, chills, night sweats, palpitations, a dry cough, and achy joints Bacteria, fungus, or viral agent Infection can result from poor hygiene or an invasive procedure. Most common organisms are Streptococcus and Staphylococcus aureus. Diagnosis includes an echocardiogram and blood cultures Treatment with antibiotic therapy 53 Prophylaxis for Infective Endocarditis Dental procedures, including cleaning, that may induce gingival or mucosal bleeding Tonsillectomy and/or adenoidectomy Surgery and/or biopsy involving respiratory or intestinal mucosa Amoxicillin given orally 1 hour prior to the procedure is the recommended prophylaxis. Clindamycin or azithromycin is the antibiotic of choice in children allergic to penicillin or amoxicillin. 54 Pediatric Dysrhythmias Fast pulse rate Supraventricular tachycardia Ventricular tachycardia Slow pulse rate Bradydysrhythmias Absent rhythms Asystole Ventricular fibrillation Pulseless electrical activity 55 Rheumatic Fever Arthritis Carditis Chorea Erythema marginatum Subcutaneous nodules Auscultating heart sounds is the priority assessment because tachycardia and cardiac murmur indicate cardiac involvement, which can result in serious, life-threatening, and life-long complications. Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. It is appropriate to determine whether the child previously had a sore throat. 56 Kawasaki Disease Mucocutaneous lymph node syndrome Acute, febrile, exanthematous illness Generalized vasculitis of unknown etiology Major cause of acquired heart disease Cause remains unknown Coronary artery aneurysms are seen in 20–25% of children left untreated IVIG is given to increase platelets and aspirin helps to prevent the platelets from sticking together. 57 Primary Hypertension Average systolic or diastolic blood pressure that exceeds the 95th percentile Weight reduction Physical conditioning Dietary modification Relaxation techniques Pharmacologic treatment Management is directed toward treating the symptoms of heart failure, including treatment with digitalis, calcium channel blockers, diuretics, warfarin, and supplemental oxygen. Blood pressure screening should be initiated when a child is 3 years old or younger if at risk and should continue through adolescence. Early development of essential hypertension is linked to childhood obesity, children with diabetes mellitus, and a strong family history of hypertension. 58 Infusing Intravenous Antihypertensive Medications Infuse very slowly Maintain an arterial line for monitoring Sudden hypotension may result after initiation of antihypertensives. 59 Cardiomyopathies Diseases of the heart muscles in which the pathology is not the result of CHD, coronary artery disease, or other systemic cause Dilated and decreased contractility and dilation of the ventricles Hypertrophic: hypertrophy of the ventricles with impaired filling Restrictive: infiltration of the muscle by abnormal material A Holter monitor can help screen for asymptomatic ventricular dysrhythmias. Clients should avoid strenuous and competitive sports. Cardiomyopathy has a genetic predisposition. 60 High Cholesterol During Childhood and Adolescence Preventative cardiology Tobacco use Dyslipidemia (elevated LDLs and cholesterol and decreased HDLs) Hypertension Decreased physical activity Obesity Family history Type 1 or 2 diabetes 61 The Child with a Hematologic Alteration Iron Deficiency Anemia Etiology Decreased iron intake Increased iron or blood loss Periods of increased growth Incidence Premature infants Infants 9–24 months of age Adolescents 63 Evaluation and Management Complete history Emphasis on dietary intake The nurse should recognize fatigue, dyspnea, and elevated heart rate as manifestations Complete blood count We expect to see Low hemoglobin levels Decreased MCV levels Low reticulocyte count (Immature RBCs) The child’s CBC will be monitored routinely for several weeks to determine whether the condition is improving 64 Evaluation and Management Dietary intake of iron Iron-fortified formula or breast milk Infants younger than 12 months need iron-fortified formula or breast milk. Increase iron-rich foods Apricots, dark-green leafy vegetables, beef, black beans, and egg yolks are rich sources of iron. Avoid a diet that consists primarily of milk. A daily milk intake in toddlers of less than 24 oz will encourage the consumption of iron-rich solid foods. Iron supplementation Iron supplements should be administered through a straw or by a medicine dropper placed at the back of the mouth Iron supplements are taken between meals. Administering this medication with drinks rich in vitamin C facilitates absorption of iron. Orange Juice Tomato Juice 65 Sickle Cell Disease (SCD) Refers to a group of congenital disorders Sickled hemoglobin Chronic hemolytic anemia Ischemic tissue injury Manifestations include pain, dyspnea, anxiety, sleeplessness, depression, ulcers of the lower extremities, jaundice and elevated heart rate Treatment of pain related to SCD Opioids (morphine) Nonsteroidal anti-inflammatories 66 Complications of SCD Vaso-occlusive crisis Blood flow to tissue is obstructed. Characterized by severe pain in the area of involvement If it is in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Nursing priorities include hydration and pain management Acute sequestration crisis Blood flow from liver, lungs, or spleen is obstructed by sickled RBCs. Results in circulatory collapse Acute anemia Respiratory failure Aplastic event 67 Parental Teaching for A Child With Sickle Cell Disease Parents should be taught to avoid cold and extreme heat Good hand hygiene is necessary to prevent infection Vaccines Avoid taking iron supplements Visit the eye doctor annually Adequate rest periods should be provided Penicillin should be administered daily as ordered The use of aspirin should be avoided; acetaminophen or ibuprofen should be used as an alternative Fluids should be encouraged, and an increase in fluid intake is encouraged in hot weather or when there are other risks for dehydration Join a support group 68 Hemophilia A lifelong hereditary blood disorder Treatment of a bleed Factor prophylaxis Rest, ice, compression, and elevation (RICE) Family education Management of bleeding Environmental safety Normal growth and development 69 Bleeding Disorders Von Willebrand disease Immune thrombocytopenic purpura (ITP) Underproduction of Von Willebrand protein Acquired thrombocytopenia Disseminated intravascular coagulation (DIC) Uncontrolled formation and deposition of fibrin thrombi Bone marrow ceases production The child with DIC is seriously ill and needs to be monitored in an intensive care unit. Disseminated intravascular coagulation is characterized by decreased platelet count, prolonged PT, and elevated D-dimer levels due to widespread activation of the clotting cascade and breakdown of fibrin clots Aplastic anemia Hemorrhage as a result of injury is the child’s greatest threat to life. Nurse must emphasize the importance of injury prevention 70 Actions to Avoid in Children with Low Platelet Counts Avoid administering intramuscular injections, aspirin, aspirincontaining products, and nonsteroidal antiinflammatory medications (e.g., ibuprofen). Avoid taking temperatures rectally, and perform invasive procedures with extreme caution. Eliminate participation in high-risk activities such as contact sports. 71 The Child With an Intellectual Disability or Developmental Disability Intellectual and Developmental Disorders These children may have limitations in both intellectual and adaptive functioning. Social interaction Use of language for self-expression Self-care abilities Lifelong challenges that require assistance from health care and educational professionals 73 Americans with Disabilities Act Developmental disability has become an umbrella term to encompass children with Intellectual disability Sensory deficits Orthopedic problems Cerebral palsy Autism spectrum disorders 74 Causes of Intellectual Disability Genetic Alterations occurring during pregnancy Neonatal alterations Acquired childhood conditions or diseases Environmental problems Unknown causes 75 Problems Related to Intellectual Disability Mild Self esteem issues related to the presence or absence of physical features, largely determined by the cause of the intellectual disability Social isolation and loneliness Depression Severe Self injury Fecal smearing Temper tantrums, tearing personal items, disrobing 76 Management General strategies Increase the time spent in a regular school setting Reading to children at least 4 days a week is important for literacy and language skills and improves behavior and overall well-being Multidisciplinary efforts Strong advocacy on the part of parents Comorbidities Safety challenges Environmental challenges Parental oversight 77 Disorders Resulting in Intellectual or Developmental Disability Disorders of intellectual impairment Disorders of known genetic cause Fragile X and Rett syndrome Disorders related to environmental alterations Down syndrome Fetal alcohol syndrome (FAS), failure to thrive Disorders with little understood genetic influence Autism spectrum disorders 78 Down Syndrome A collection of associated symptoms and disorders that tend to occur together Trisomy 21 Moderate to severe intellectual impairment Distinct facial features Heart defects Risk factors include increased maternal age and genetic predisposition Individuals who have Down syndrome often have comorbid psychiatric conditions, including depression and anxiety. Although individuals who have Down syndrome may have difficulty learning certain skills, they do not express manifestations of learning disorders. 79 Fetal Alcohol Spectrum Disorder FAS is the most severe form experienced by the infant exposed to alcohol in utero. Persistent symmetric growth retardation Malformations of the face and skull Skeletal and cardiac malformations Decreased body weight CNS deficits Intellectual and developmental disabilities Children who have fetal alcohol spectrum disorder can display hyperactive behavior, inattentiveness, and memory difficulties 80 Failure to Thrive Children whose weight or rate of weight gain is below that of comparably aged children Dramatically smaller than peers Result of organic or medical causes Chromosomal abnormalities Defects of heart or lungs CNS damage to exposure to toxins 81 Autism Spectrum Disorders Atypical patterns of development Clusters of developmental problems and deficits Children who have autism spectrum disorder can display repetitive movements and ritualistic behavior Difficulty developing and maintaining social relationships Children who have autism spectrum disorder might have an aversion to being touched Symptoms noticeable by 3 years of age Can be as early as 1 year of age 82 Asperger Syndrome So-called high-functioning autism Distinct category within the autism spectrum Do not show the same level of disability as autism High levels of intellectual and language development Symptoms are social and emotional Rigidity regarding schedules, motor clumsiness, and organizational skill problems 83 Caring for the Child with Autism Children with autism are often unable to tolerate changes in routine Children who have autism spectrum disorder benefit from routine and can develop negative behavior and signs of anxiety when structure is not provided Change may cause the child to become Withdrawn Self-abusive Violent Children who have autism spectrum disorder benefit from a reward system for positive behavior 84 The Child with a Sensory Alteration Neonatal Development Sense organs develop quite early in gestation Eyes begin to develop at 22 days. Ears begin to develop during the 3rd week, with the critical period occurring at 4–6 weeks of gestation. Sensitive to teratogens Any interference in development can result in later sensory alterations. 86 Speech Development Fetus is capable of hearing during the second trimester. Able to hear voices and the mother’s heartbeat Adequate hearing is essential for the development of speech Babbling begins at 4−6 months. Followed by receptive and expressive language development 87 The Child with a Visual Impairment (1 of 2) Orient the child to the hospital environment by emphasizing spatial relations. Never touch the child without identifying yourself and explaining what you plan to do. When describing the environment, use familiar terms; avoid mention of color. Remember that parents are often the best source for communication. Identify noises for the child. 88 The Child with a Visual Impairment (2 of 2) Frequently orient the child to time and place. Keep all things in the same location and order. Provide detailed explanations and allow the child to progress through care in steps to learn the order. The nurse should use reading material written with a large print or printed with braille to promote learning. Allow as much control as possible. Supervise the child and counsel parents to supervise the child as needed. 89 Types and Etiology of Hearing Loss Conductive Sensorineural Result of damage or malformation of the inner ear Mixed Outer or middle ear affected by damage, inflammation, or obstruction Combination of conductive and sensorineural loss Central Result of damage to the conduction system between the auditory nervous system and the cerebral cortex 90 Hearing Screening 95% of newborns are screened for hearing deficits shortly after birth. Most states mandate hearing screening for all newborns before they leave the hospital after birth. Georgia is one of these states. The two tests in use do not diagnose hearing loss, but determine whether or not a newborn requires further evaluation Many children have mild to moderate hearing loss, despite screening. Hearing loss can affect both language development and school achievement. 91 Caring for the Child with a Hearing Loss (1 of 2) Encourage hearing aid use. Make sure the hearing aid is in place before speaking to the child. Look directly at the child’s face. Have the child’s complete attention before beginning to speak. 92 Caring for the Child with a Hearing Loss (2 of 2) Speak clearly but not loudly or slowly. Eliminate background noise. Use visual aids. Use basic sign language or an interpreter when necessary. 93 Language Disorders (1 of 2) Receptive disorder Child has a decreased ability to comprehend language Expressive disorders Disorder of the voice Alteration in pitch and intonation, resulting from a medical condition such as cleft palate 94 Language Disorders (2 of 2) Expressive disorders Fluency disorder Interruption in the flow of normal speech, including stuttering and lisping If stuttering persists beyond age 5, the child should be referred for speech evaluation. Articulation disorder Alteration in the way words are pronounced Most common type of speech defect May be caused by neuromuscular or structural abnormalities of nose, mouth, or throat 95
