Chapter 49 Nursing Care of a Family

Chapter 49 nursing care of a family when a child has a neurologic disorderastereognosis inability to judge the form of an object by touch automatism the performance of actions without conscious thought or intention. autonomic dysreflexia involves uncontrolled activation of autonomic neurons choreoathetosis movement disorder with features of both chorea and athetosis choreoid irregular and jerking movements decerebrate posturing posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe. decorticate posturing characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex. diplegia paralysis affecting like parts on both sides of the body dyskinetic difficult movement graphesthesia ability to "read" a number by having it traced on the skin hemiplegia paralysis of one side of the body infantile spasms Sudden, rapid flexion of neck and truck, adduction of shoulders and outstretched arms, variable flexion of lower extremities -Tx: vigabatrin kinesthesia system for sensing the position and movement of individual body parts paraplegia paralysis from the waist down pulse pressure difference between systolic and diastolic pressure quadriplegia paralysis of all four limbs of the body status epilepticus condition in which seizures recur every few minutes or last more than 30 minutes. stereognosis ability to recognize objects by feeling their form, size, and weight while the eyes are closed d) Use a doll with electrodes attached to the head Pg. 1383 An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is conducted by attached electrodes over sections of the head and obtains an electrical reading via a monitor. There is no pain involved in the procedure, but the child must lie still. The best way for the nurse to explain the procedure to the child is via a doll with attached electrodes that the child can play with, feel, and manipulate. This helps to reduce the child's anxiety and aids in cooperation. Videos can help with the education process but they do not allow for interaction and physical touching. The child can take a nap during the procedure but this does not prepare the child for the procedure. Assuring the child that the procedure will not hurt is not the best way to prepare the child. 1. The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child? a) Show the child a video of the procedure b) Tell the child he or she can take a nap during the procedure c) Assure the child the procedure will not hurt d) Use a doll with electrodes attached to the head d) "Use this information to teach family and friends" Pg. 1399 Families need and want information they can share with relatives, child care providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The child may be able to bike ride and swim with proper precautions. 2. The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? a) "If he is out of bed, the helmet's on the head" b) "You'll always need a monitor in his room" c) "Bike riding and swimming are just too dangerous" d) "Use this information to teach family and friends" c) While assessing the child's pupils, there is no change in diameter in response to a light Pg. 1384 To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination. 3. The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? a) While calling the child's name, the child stares straight ahead and does not turn to the sound b) While stimulating the child's foot, the big toe points upward and other toes fan outward c) While assessing the child's pupils, there is no change in diameter in response to a light d) While turning the child's head to the left, the eyes turn to the right a) Loss of motor activity accompanied by a blank stare Pg. 1397 An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness. 4. Absence seizures are marked by what clinical manifestation? a) Loss of motor activity accompanied by a blank stare b) Sudden, brief jerks of a muscle group c) Loss of muscle tone and loss of consciousness d) Brief, sudden onset of increased tone of the extensor muscle b) As the child grows, the gross and fine motor skills increase Pg. 1377 As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills. 5. What information is most correct regarding the nervous system of the child? a) The child has underdeveloped fine motor skills and well-developed gross motor skills b) As the child grows, the gross and fine motor skills increase c) The child has underdeveloped gross motor skills and well-developed fine motor skills d) The child's nervous system is fully developed at birth a) Clonic Pg. 1397 The initial rigidity of the tonic phase changes rapidly to generalized jerking muscle movements in the clonic phase. The child may bite the tongue or lose control of bladder and bowel functions. The jerking movements gradually diminish and then disappear, and the child relaxes. 6. The nurse is in the room when a child with a seizure disorder is having a seizure. The child is exhibiting generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Clonic b) Tonic c) Prodromal d) Postictal c) "You look funny. Well, both of you do. I see two of you" Pg. 1379 The caregiver should notify the health care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling nauseated is not a reason to notify the provider. 7. A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? a) "My stomach is upset. I feel like I might throw up" b) "I am glad that my headache is getting better" c) "You look funny. Well, both of you do. I see two of you" d) "It will be nice when you will let me take a long nap. I am sleepy" c) Cerebral edema Pg. 1391 The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure. 8. To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority? a) Cardiogenic shock b) Left-sided heart failure c) Cerebral edema d) Renal failure c) Trigeminal Pg. 1380 To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted. 9. During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? a) Accessory b) Facial c) Trigeminal d) Olfactory c) "I hate to think that I will need to be worried about my child having seizures for the rest of his life" Pg. 1395-1396 Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures. 10. The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? a) "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully" b) "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever" c) "I hate to think that I will need to be worried about my child having seizures for the rest of his life" d) "I need to set an alarm to wake up and check his temperature during the night when he is sick" c) Reassure the mother that her partner's reaction is a normal stage in the grieving process Pg. 1407 The family's first reaction to learning that the child may have cognitive impairment is grief because this is not the perfect child of their dreams. A parent may feel shame, assuming that he or she cannot produce a perfect child. Some rejection of the child is almost inevitable at least in the initial stages, but this must be worked through for the family to cope. 11. The mother of a child newly diagnosed with an intellectual disability tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which action by the nurse would be appropriate in supporting this mother? a) Recommend that the couple consider placing the child in foster care until they adjust to the diagnosis b) Suggest that the couple get a second opinion about the child's condition c) Reassure the mother that her partner's reaction is a normal stage in the grieving process d) Offer to speak with the partner to explain how the diagnosis was reached b) Bulging fontanels (fontanelles) Pg. 1384 Infants with increased ICP exhibit bulging fontanels (fontanelles). They typically have a decreased appetite, are restless, and have trouble sleeping. 12. What finding is consistent with increased intracranial pressure (ICP) in an infant? a) Narcolepsy b) Bulging fontanels (fontanelles) c) Increased appetite d) Emotional lability a) Positive Kernig sign Pg. 1391 A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy. 13. A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Positive Kernig sign b) Negative Kernig sign c) Negative Brudzinski sign d) Positive Chadwick sign d) "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back" Pg. 1381 Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched. 14. The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? a) "The child will be placed in the prone position with the nurse holding the child still" b) "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible" c) "The child will be held by the mother on her lap with his back toward the health care provider" d) "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back" c) Collection of cerebrospinal fluid (CSF) and blood for culture Pg. 1391 Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy. 15. Antibiotic therapy to treat meningitis should be instituted immediately after which event? a) Identification of the causative organism b) Admission to the nursing unit c) Collection of cerebrospinal fluid (CSF) and blood for culture d) Initiation of IV therapy b) "She has been irritable for the last hour....seems like she is just upset for some reason" Pg. 1384 Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant. 16. The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? a) "She typically breastfeeds, but lately we have had to supplement with some rice cereal" b) "She has been irritable for the last hour....seems like she is just upset for some reason" c) "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper" d) "She always cries when the person holding her has on glasses...I guess glasses scare her" b) Check the child's neurologic status every 2 hours Pg. 1391-1392 The nursing interventions for the child with meningitis are related to the goals for this child, which include monitoring for complications related to neurologic compromise, preventing aspiration, keeping the child safe from injury during a seizure, and monitoring fluid balance. During a seizure, stay with the child, protect the child from injury, but do not restrain him or her. To prevent aspiration, position the child in a side-lying position, watch for and remove excessive mucus as much as possible, and use suction sparingly. Every 2 hours, observe the child for seizure activity, vital signs, neurologic changes, and change in level of consciousness. The child is placed on fluid restrictions if he or she has decreased urinary output, hyponatremia, increased weight, nausea, and irritability. 17. When caring for an infant who is hospitalized with Haemophilus influenzae meningitis, an important nursing intervention for the child would be for the nurse to: a) Restrain the child before and during a seizure b) Check the child's neurologic status every 2 hours c) Monitor intake and output and increase fluid intake every 4 hours d) Place the child in a side-lying position and keep the position using pillows c) Risk for injury related to seizure activity Pg. 1398 The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and if the child has a history of seizures, it would specifically impact airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis. 18. In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care? a) Ineffective airway clearance related to history of seizures b) Risk for acute pain related to surgical procedure c) Risk for injury related to seizure activity d) Delayed growth and development related to physical restrictions d) High-pitched cry and nuchal rigidity Pg. 1391 Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium. 19. The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which clinical manifestation would likely have been noted in this child? a) Shaking the head and pulling the ear b) Body stiffening and loss of consciousness c) Severe vomiting and confusion d) High-pitched cry and nuchal rigidity d) L4 or L5 Pg. 1381 Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow. 20. A 9-year-old girl who is suspected of having an infection of the central nervous system (CNS) is undergoing a lumbar puncture to withdraw cerebrospinal fluid (CSF) for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) L1 or L2 b) T3 or T4 c) C1 or C2 d) L4 or L5 d) Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Pg. 1397 Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure. 21. The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? a) Sudden, momentary loss of muscle tone, with a brief loss of consciousness b) Brief, sudden contracture of a muscle or muscle group c) Muscle tone maintained and child frozen in position d) Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention b) Teach the child and his parents to keep a headache diary Pg. 1402 A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury. 22. A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? a) Have the parents call the doctor if the child vomits more than twice b) Teach the child and his parents to keep a headache diary c) Review the signs of increased intracranial pressure with parents d) Have the child sleep without a pillow under his head a) Decrease environmental stimulation Pg. 1391 A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation. 23. A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? a) Decrease environmental stimulation b) Take vital signs every 4 hours c) Encourage the parents to hold the child d) Monitor temperature every 4 hours a) Port-wine birthmark on the upper part of the face Pg. 1386 A congenital port-wine birthmark on the upper part of the face that follows the trigeminal nerve is an indication of Sturge-Weber syndrome. Soft cutaneous tumors, irregular but excessive skin pigmentation, and pigmented nevi are all symptoms of neurofibromatosis (von Recklinghausen disease). 24. The nurse is caring for a child diagnosed with Sturge-Weber syndrome. Which assessment finding supports this diagnosis? a) Port-wine birthmark on the upper part of the face b) Soft cutaneous tumors on the child's skin along nerve pathways c) Pigmented nevi or café-au-lait spots on the child's chest and arms d) Irregular but excessive skin pigmentation all over the child's body b) Sunsetting Pg. 1384 Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction. 25. The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: a) Decorticate posturing b) Sunsetting c) Doll's eye d) Nystagmus b) Institute droplet precautions in addition to standard precautions Pg. 1391 Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus. 26. A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? a) Encourage the mother to hold and comfort the infant b) Institute droplet precautions in addition to standard precautions c) Palpate the child's fontanels (fontanelles) d) Educate the family about preventing bacterial meningitis a) Monitor the child's breathing closely Pg. 1397 Tonic-clonic seizures consist of four stages: the prodromal period, when the child may be drowsy or dizzy; the aura, which is sensory event that serves as a warning immediately before the seizure; the tonic-clonic movements, when the child's muscles contract, the child may fall, and the child's extremities may stiffen. The contraction of respiratory muscles during the tonic phase may cause the child to become cyanotic and appear briefly to have respiratory arrest. During the postictal period, the child may sleep soundly and may have a period of confusion or stupor. 27. The nurse is providing education to the caregivers of a child recently diagnosed with tonic-clonic seizure disorder. What instructions should the nurse provide related to the tonic stage of this type of seizure? a) Monitor the child's breathing closely b) Be prepared for the child to be temporarily confused c) Ask the child whether he or she is experiencing any unusual sensory sensations d) Be prepared for the child to report being dizzy d) "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome" Pg. 1393 Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain, including respiratory arrest. 28. A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse? a) "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus" b) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution" c) "This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome" d) "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome" a) "Did you use any medications, like aspirin, for the fever?" Pg. 1393 Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child. 29. A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? a) "Did you use any medications, like aspirin, for the fever?" b) "How high did his temperature rise when he was ill?" c) "What type of fluids did your child take when he had a fever?" d) "Did you give your child any acetaminophen, such as Tylenol?" b) Support for maintaining self-esteem because of his altered lifestyle Pg. 1399 The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy. 30. The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition? a) Physical, occupational, and speech therapy to maximize his potential b) Support for maintaining self-esteem because of his altered lifestyle c) Multiple corrective surgeries to slowly remove diseased parts of his brain d) Hyperventilation therapy to counteract the periods of decreased oxygenation d) Assess the client's respiratory status Pg. The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not priority over ensuring the client maintains a patent airway. 31. The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? a) Measure the client's head circumference b) Monitor the client for signs of infection c) Educate the family on the shunt d) Assess the client's respiratory status d) "I always keep phenobarbital with me in case of a fever" Pg. 1395 Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises. 32. An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "My child will likely outgrow these seizures by age 5" b) "I have ibuprofen available in case it's needed" c) "The most likely time for a seizure is when the fever is rising" d) "I always keep phenobarbital with me in case of a fever" c) Semi-Fowler position with a parent at the bedside Pg. 1382 Proper positioning for an infant after a ventricular tap is to place the child in a semi-Fowler position to prevent additional drainage from the puncture site. Allow the parents or caregivers to comfort the child. Placing the child in the prone or supine position could allow for additional drainage from the puncture site. High-Fowler position is contraindicated immediately after this procedure. 33. A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure? a) Prone on the bed with a parent or caregiver on either side of the bed b) High-Fowler position while sitting on the parent's lap c) Semi-Fowler position with a parent at the bedside d) Supine on a parent's lap d) "I need to watch for any new bruises or bleeding and let my health care provider know about it" Pg. 1396 Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed. 34. The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? a) "I will give the medication to him when I first wake him up in the morning" b) "This medication may cause him to have trouble sleeping. He may need something else to help him sleep" c) "I'm glad to know he will only need this medication for a short time to stop his seizures" d) "I need to watch for any new bruises or bleeding and let my health care provider know about it" a) Avoid making noise when in the child's room Pg. 1392 Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation. 35. Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Avoid making noise when in the child's room b) Rock the child frequently c) Keep the lights on brightly so that he can see his mother d) Have the child's 2-year-old brother stay in the room c) Ataxic cerebral palsy Pg. 1389 Ataxic cerebral palsy is essentially a lack of coordination caused by disturbances in the kinesthetic and balance senses; it is characterized by an awkward and wide-based gait. Athetoid cerebral palsy is marked by involuntary, uncoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion; the whole body is in a state of slow, writhing muscle contractions whenever voluntary movement is attempted. Rigidity cerebral palsy is uncommon and is characterized by rigid postures and lack of active movement. Spastic cerebral palsy is characterized by scissoring caused by severe hip adduction. 36. The nurse is observing a group of children diagnosed with various types of cerebral palsy. One of the children has an awkward and wide-based gait. The nurse recognizes this characteristic as common in which type of cerebral palsy? a) Athetoid cerebral palsy b) Spastic cerebral palsy c) Ataxic cerebral palsy d) Rigidity cerebral palsy