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Child Abuse. Box 16-12 Pg. 688 Need to know S&S, accurate documentation & appropriate reporting Collaborate with team Protect child Family education & support. Communication Models. Permissive/Restrictive Warmth/Hostility Authoritarian/Dictatorial Permissive/Laisse-Faire
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Child Abuse • Box 16-12 Pg. 688 • Need to know S&S, accurate documentation & appropriate reporting • Collaborate with team • Protect child • Family education & support
Communication Models • Permissive/Restrictive • Warmth/Hostility • Authoritarian/Dictatorial • Permissive/Laisse-Faire • Authoritative/Democratic
Resiliency • McCubben-family stress involves need for adjustment & adaptation • Resilient families demonstrate commitment; good problem-solving & communication; take initiative, adapt, persevere & bounce-back • Nurses need to foster resiliency
Nurses Roles • Assess family strengths/challenges • Set realistic goals • Allow periods of adjustment • Provide education & anticipatory guidance
Meningitis • Inflammation of the meninges • Causes: bacterial & viral • Pathology: • A] enter thru bloodstream, then spreads thru CSF • B] trauma • C] neurosurgery • D] foreign body
Vascular congestion edema, IICP, necrosis of cells, causes permanent brain damage & death • Complications: obstructive hydrocephalus, thrombi, abscesses,deafness, blindness & paralysis
Meningococcal meningitis sepsis • Waterhouse-Friderichsen syndrome-disseminating intravascular coagulation [DIC] • Adrenal hemorrhage & purpura Pg. 1678 • Mortality is 90%
Diagnosis: LP • clinical manifestations: fever, vomiting, opisthotonus, headache, altered sensorium, nuchal rigidity, Kernig’s sign, Brudzinski sign, petechial rash • Nsg Care: V/S. I&O, neurological assessment, isolate, meds, support
Encephalitis • Inflammation of CNS • Direct invasion by virus or post-infectious involvement • Clinical manifestations similar to meningitis • Diagnoses-primarily based on symptoms • Treatment-symptomatic
Closed Head Injuries • Brain injury, skull fractures & hematomas • Causes-falls, MVA’s, bicycle accidents, seizure disorders, gait instability, cognitive delays, poor judgment, alcohol & drug use
Skull Fractures • Severity depends on velocity, force, mass, area of skull & age • Linear • Comminuted • Compound • depressed, • Basilar • Diastatic
Brain Injury: Hemorrhage • Epidural-rapid deteriorationdilated & fixed pupils, seizures, paralysis, deep tendon reflexes, coma & brain herniation
Subdural-within 48 hrs, more common than epidural • Headache, agitation, confusion, drowsiness • LOC -Box 37-4 Pg. 1648 • IICP-Box 37-1 Pg. 1645
Chronic-S&S appear at a later date • Subdural & subarachnoid hemorrhages may be sign of child abuse
Cerebral Edema • Often with head injury • Pressure causes tissue anoxia • If unchecked leads to fatal anoxia or herniation • Box 37-5 Pg. 1669
Glasgow Coma Scale • 3 part response: eye opening, verbal & motor • Score of 15 = unaltered • 8 or below = coma • Lowest 3 = coma or death
Brain Death • Need complete cessation of clinical evidence of brain function & irreversibility of condition
Pain Pg. 1047 • Complex assessment in children • Fallacies & Facts Box 26-7 Pg. 1049 • Pain Scales- Table 26-2 Pg. 1052 • Developmental Box 26-9 Pg. 1054 • Guidelines Pg. 1059 • Analgesics Pg. 1060-1066