PEDIATRIC ILLNESS AND CONDITIONS

Chapter 44: The child with a neuromuscular disorder 

Case 1: Pamela Souza, 6 years old, was born with cerebral palsy. Pamela suffers from general spasticity, mental impairment, impaired vision and hearing, and hydrocephalus. She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control.

A. Identify medications that might be used to help control Pamela’s spasticity?

Medications that can be used to control Pamela’s spasticity include; Baclofen, Tizanidine, Dantrolene sodium, Diazepam, Clonazepam, and Gabapentin. 

B. What information would the nurse include in the health history?

C. Gestational and perinatal events

D. History of head trauma

E. Feeding and weight loss

F. Seizure activity

G. Respiratory status: Has a cough, sputum production, or increased work of breathing developed?

H. Motor function: Has there been a change in muscle tone or increase in spasticity?

I. Presence of fever

J. Any other changes in physical state or medication regimen

K.

The following is the information that the nurse is expected to include in the health history regarding Pamela; history of head trauma, gestational and perinatal events, find out if the baby is She is 6yo..not a baby

 feeding well and also identify any weight loss, seizure activity, indicate the   respiratory status of the child including any coughs, sputum production, or increased work of breathing development, presence of fever, any changes in physical state or medication regimen, and motor functions of the baby(Perry et al., 2017). 

L. What nursing interventions would be important in Pamela’s care?

The best nursing interventions that best suit Pamela’s case include;

· Assisting with the administration of baclofen

· Assessment of spasticity before and after administration of medication

· Preoperative care and teaching

· Postoperative care and teaching

· Emotional support for Pamela and her family

· The nurse should teach the parents about the programmable delivery system, frequent checks and how to adjust dose and programming. 

·  If the patient is eligible for baclofen, the nurse should give it with caution to prevent hallucinations, possible psychosis, or any other serious effects and also bare in mind that abrupt discontinuation may lead to other serious reactions. 

· Strengthen family support – teach the patient’s family on how to treat and interact with her at home so that she feels supported.

· The nurse should also prevent deformity, encourage mobility, increase oral intake of fluids, manage rest and sleep periods, enhance self care, and facilitate communication. 

M. What information would be important to include in a teaching plan for Pamela and her family? 

N. Information about the type of pump being inserted and how it works

O. Information and expectations about intrathecal baclofen treatment

P. Daily care of the surgical incisions 

Q. Notify the physician or nurse practitioner if the child has a temperature greater than 101.5ºF, or if the child has persistent incision pain.

R. Avoid tub baths for 2 weeks.

S. Do not allow the child to sleep on the stomach for 4 weeks after pump insertion.

T. Discourage twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks.

U. When the incisions have healed, normal activity may be resumed.

V. Wear loose clothing to prevent irritation at the incision site.

W. Carry implanted device identification and emergency information cards at all times.

The nurse should include the following in the teaching plan; the drugs should be taken exactly as they have been prescribed and they should not stop giving Pamela the drugs without consulting the healthcare giver because abrupt discontinuation may lead to serious reactions. The family should also be aware that these drugs may have side effects like dizziness, confusion, drowsiness, nausea, insomnia, headache, frequent or painful urination but these side effects will go away after discontinuation of the drug. However, it is important to report if the side effects of the drug persist or become severe(Perry et al., 2017) 

Case 2: Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake.

1. What nursing assessments would be important to Kyle? 

The nurse should assess if Kyle has any injuries in the body especially on the head, the spinal cord should also be assessed to find out if it is injured, she should be assessed for the amount of water taken, check if the airways are functioning well, and also assess the breathing rate and temperatures for any infections. 

1. What diagnostic tests would the nurse expect to be ordered for Kyle?

An x-ray is expected to be ordered to confirm the crushed vertebrae and determine how severe it is and also check for any other damages around it. For the severed spinal cord, the nurse expects the following tests to be ordered; CT scan, MRI, or X-ray. All the above tests will enable the doctor to have a clear look at the abnormalities in the spinal cord (Chandy, D., & Weinhouse, 2019). 

1. What would be important teaching points for Kyle and his family?

Kyle should follow the exercises prescribed by the doctor with the help of the family members so that the spinal cord can heal faster, ensure to sleep in positions that do not harm the spinal cord further, avoid falls, and also ensure that Kyle is taken for follow up checks at the hospital so that his progress can be monitored. There is also a need for rehabilitation so that the child can function normal again. Kyle should be taken through bowel training, skin assessment, and also get assessed on sexual functioning.

References 

Chandy, D., & Weinhouse, G. L. (2019). Drowning (submersion injuries). UpToDate.

Perry, S. E., Hockenberry, M. J., Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Wilson, D. (2017). Maternal Child Nursing Care-E-Book. Mosby.