Chapter 44: The child with a neuromuscular disorder

The child with a neuromuscular disorder

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

The nurse will include the following in the health history of Pamela; mental retardation, Oromotor dysfunction, document if the patient has language and speech disorder, hearing and Ophthalmologic disorders (Perry et al., 2017).

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

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

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admitted to the pediatric unit for evaluation of intrathecal spasticity control.

· Ensuring therapeutic communication – the nurse should communicate with Pamela’s parents and family so that he or she can learn the child’s activities at home.

· Enhance self esteem – the nurse needs to assist Pamela to increase her her personal judgement on oneself because most of the time children with cerebral palsy have a low self esteem because they are not like their peers.

· Provide emotional support – reassure the patient that all is well and she is doing well

· 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.

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

l. see above

After the baby will be discharge, care does not stop at that point. It still continues even at home. The following are some of the teaching aspects include teaching the family how to interact well with family, encourage her to play but also ensure that she is not in danger (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.

0. 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).

0. 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.

· Catheter care

· Bowel training

· Skin assessment

· Rehabilitation needs

· 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.