Question

Case Studies Chapter 44: Nursing Care of the Child With a Neuromuscular Disorder 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. (Learning Objectives 2, 3, 4, and 6)

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

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

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

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

2. Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake. (Learning Objectives 1, 2, 3, 4, and 7)

a. What nursing assessments would be important for Kyle?

b. What diagnostic tests would the nurse expect to be ordered for Kyle? Kyle is found to have crushed vertebrae at the S4-5 level with a partially severed spinal cord.

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

Answer 1

1. Cerebral palsy

a) Medication:

Skeletal muscle relaxants- Dantrolene sodium, baclofen

Benzodiazepine- Diazepam, Clonazepam

Alpha 2 adrenergic agonist- clonidine, tizanidine

Botulinum toxins

b) Health history:

Prenatal/natal/post natal history includes birth asphyxia, infection for mother, birth trauma, hypoxia, preterm labor, low birth weight, childhood illness.

c) Nursing interventions:

Prevention of injury by side rails, safe environment

Prevent deformity by using cast, splint and orthosis

Promote adequate fluid and nutritional intake

Manage sleep and rest period

Facilitate communication by colorful pictures and sounds

d) Teaching plan:

Includes care at home like Mobility and rehabilitation plan, Nutritional plan and Personal assistant and vehicle modification, government assistance, community service and funding, education or various services.

2. Diving accident

a) Assessment:

Musculoskeletal assessment- Range of motion, joint pain

Cutaneous assessment- itching, mottled or marbled skin, swelling of the skin

Neurologic assessment- consciousness, nasuse and vomiting, visual disturbance, hearing, balance, weakness, paresthesia, urinary or fecal incontinence, seizure

Pulmonary assessment- shortness of breath, dry cough, burning chest pain aggrevated by breath

b) Diagnostic test:

Computed tomography

Magnetic resonance imaging

Neurological evaluation to assess the degree of impairment

c) Teachin points:

Acute care includes Reassurance, Pain management, bed rest, respiratory therapy to prevent pulmonary complications due to prolonged immobilty, prevention of bed sore

Rehabilitation muscle strengthening exercises, bowel and bladder retraining, occupational therapy