Presentation is loading. Please wait.

Presentation is loading. Please wait.

Chapter 13 Neurologic and Sensory Disorders

Similar presentations


Presentation on theme: "Chapter 13 Neurologic and Sensory Disorders"— Presentation transcript:

1 Chapter 13 Neurologic and Sensory Disorders
Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

2 The Nervous System Grows rapidly before birth and during the first year Central nervous system (CNS) Cerebrum, cerebellum, brainstem, spinal cord Myelinization is cephalocaudal and proximodistal Primary focus of Chapter 13 Peripheral nervous system (PNS) Cranial and spinal nerves Autonomic nervous system (ANS) Sympathetic/parasympathetic systems Choroid plexus: primary site of CSF formation Cerebellum: Center for consciousness, sensory input, thought, memory, motor activity. Coordinates all muscle movement. Myelinization/nervous system maturation lead to development of motor skills. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

3 Increased Intracranial Pressure
Caused by volume increase of brain, CSF, or blood which exceeds cranial capacity Signs and symptoms Cushing triad Increase in systolic blood pressure, widening pulse pressure, decrease in pulse, altered respiratory pattern Possible temperature elevation from inflammation, systemic infection, damage to hypothalamus More pronounced as consciousness deteriorates As ICP increases, cerebral perfusion decreases What does a decrease in cerebral perfusion cause? Further signs of increased ICP are throughout the chapter. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

4 Intracranial Hemorrhage
Description Broken blood vessels within the skull cause bleeding in the brain; from trauma or anoxia Complete recovery is likely if symptoms are mild Death results if there is a massive hemorrhage Diagnosis History of delivery, CT, MRI, increased CSF pressure, symptoms and course of the disease This injury may also occur during precipitated delivery or prolonged labor, or when the newborn’s head is large in comparison with the mother’s pelvis. Specifying intracranial hemorrhage location Subdural or subarachnoid Epidural or intraventricular What is the prognosis for an infant with intracranial hemorrhage? Brain cells do not regenerate like most cells. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

5 Intracranial Hemorrhage
Signs and symptoms Inability to move normally, lethargy, poor sucking reflex, irregular respirations, cyanosis, twitching, forceful vomiting, high-pitched shrill cry, convulsions Opisthotonic posture Tense, pressurized fontanel Pupil of one eye sometimes smaller than the other Some or all of these symptoms may be present. Occur suddenly or gradually, depending on severity. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

6 Intracranial Hemorrhage
Treatment and nursing care Newborn placed in an isolette Allows temperature control, ease in administering oxygen, continuous observation Head is elevated Doctor may prescribe medication to control bleeding and convulsions Nurse observes for signs of increased ICP and convulsions Nurse’s observation of convulsion aids the physician in determining the exact location of bleeding Points of interest for a convulsion Were arms/legs/face involved? Right or left side of body involved? Mild or severe? Length of convulsion? Condition before and after seizure? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

7 Head Injuries Description Complications
Falls, motor vehicle injuries, shaken baby syndrome, bicycle injuries, etc. Infants and toddlers have soft skulls to absorb impact By 2 years of age, both fontanels have completely closed; impact absorption decreases Complications Hemorrhage, infections, cerebral edema (swelling of the brain), and compression of the brainstem Increased ICP Toddlers especially receive blows to the head. Types of head injuries are discussed in Table 13-1. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

8 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

9 Head Injuries Treatment and nursing care
ABCs (airway, breathing, circulation), assess for spinal cord injury, document baseline vital signs Level of consciousness (LOC) Record type and amount of any drainage from ears/nose Fluids are carefully monitored to control cerebral edema Feeding difficulties should be noted as the child’s diet is increased Patients should be observed for signs of shock Watch for decerebrate/decorticate posturing What are decerebrate and decorticate posturing? It is important to teach parents about preventing head injury. How do we determine LOC? Pediatric coma scale, Fig. 13-2, based on adult Glasgow coma scale. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

10 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

11 Hydrocephalus Description Increased CSF in the ventricles of the brain
Causes increased head size, pressure changes in the brain May occur along with a meningomyelocele or as a sequela of infections, including encephalitis, meningitis, or TORCH Toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex Can also be caused by perinatal hemorrhage What causes the increase in cerebrospinal fluid? What are meninges? Hydrocephalus may be congenital or acquired. Early treatment is important as hydrocephalus can cause progressive cerebral damage. The body becomes thin, and the muscle tone of the extremities is often poor. Two forms of hydrocephalus are Arnold-Chiari malformation and Dandy-Walker syndrome. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

12 Hydrocephalus Signs and symptoms
Depend on site of obstruction and the child’s age Impairment of CSF absorption within subarachnoid space (communicating) Obstruction of CSF flow within ventricles (noncommunicating) Increase in head size Bulging anterior fontanel Separation of cranial sutures Shiny scalp, dilated veins Eyes may appear deviated downward “Setting sun” sign Transillumination: a flashlight with a sponge rubber collar held tightly against the infant’s head in a dark room to indicate areas of increased luminosity. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

13 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

14 Hydrocephalus Diagnosis and treatment
Head circumference is measured daily Echoencephalography, CT, MRI locate enlarged ventricles and level of obstruction Ventriculoperitoneal (VP) shunt or ventriculoatrial (VA) shunt Prognosis has improved with modern drugs and surgical techniques What complications may be seen with the use of a shunt? When the child is lifted from the crib, the head must be supported by the nurse’s arm and chest. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

15 Shunts have a one way valve to prevent back pressure causing fluids
to enter the brain. Shunts have a filter also. Shunt malfunctions are frequently caused by filter becoming plugged with protein. A surgical revision then needs to be done as quickly as possible to prevent increased pressure from forming. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

16 Hydrocephalus Nursing care
The position of the infant must be changed frequently to prevent hypostatic pneumonia and pressure sores In addition to routine postoperative care and observations, the nurse observes the patient for signs of increased intracranial pressure (ICP) and for infection at the operative site or along the shunt line If the fontanels are sunken, the infant should be kept flat Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

17 Myelodysplasia and Spina Bifida
Both categorized as neural tube defects (NTD) Myelodysplasia CNS disorders characterized by abnormal development of the spinal cord and associated neural tube structures Spina bifida (divided spine) Congenital embryonic NTD; imperfect closure of spinal vertebrae Cause unknown; multifactorial Development of a cystic mass in the midline of the spine Meningocele (only meninges in sac) Meningomyelocele (meninges and spinal cord/ nerves in sac) What are the two forms of spina bifida? Although the cause of spina bifida is unknown, it is thought to be multifactorial. Maternal diabetes, alcohol use, hyperthermia, valproic acid use, and nutritional deficiencies may be contributing factors. Meningocele: contains portions of the membranes and CSF. Meningomyelocele/myelomeningocele: protrusion of membranes and spinal cord through the divided spine. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

18 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

19 Myelodysplasia and Spina Bifida
Treatment Spina bifida: surgical closure to prevent meningeal infection Observe for hydrocephalus, place shunt if necessary Prognosis depends on lesion location, involvement of spinal cord, presence of other anomalies Habilitation Vesicostomy may be necessary (surgical opening of bladder to external skin surface) Mobility assisted through bracing, surgery, wheelchair use. Child may eventually attain some degree of fecal continence and some type of emptying of the bladder. What is vesicostomy? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

20 Myelodysplasia and Spina Bifida
Nursing care Objectives of extensive nursing care *Preventing infection of or injury to the sac *Correct positioning to prevent pressure on the sac and deformities from developing *Good skin care, particularly if incontinent of urine and feces Adequate nutrition Tender, loving care Accurate observations and charting Education of the parents Continued medical supervision Habilitation (* are pre-operative but may continue post-operatively) Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

21 Bacterial Meningitis Description Inflammation of the meninges
Infective organisms invade via teeth, sinuses, tonsils, lungs, directly through the ear (otitis media), from neurological procedures, or from a fracture of the skull The presence of petechiae, small hemorrhages beneath the skin, is suggestive of meningococcal infection. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

22 Bacterial Meningitis Signs and symptoms
Onset generally follows two courses Typically URI or gastrointestinal problem followed by irritability and lethargy Sudden rapid onset: shock, purpura, changes in level of consciousness, disseminated intravascular coagulation Other nonspecific reactions: headache, drowsiness, delirium, irritability, restlessness, fever, vomiting, and stiffness of the neck and spine Petechiae: Small hemorrhages beneath the skin May have high-pitched cry, bulging tense fontanel Convulsions are common Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

23 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

24 Bacterial Meningitis Treatment
Spinal tap at first indication of meningitis Isolation is used until the patient has received at least 24 hours of antibiotic therapy Antibiotics are given in combination and are adjusted on the basis of culture and sensitivity reporting Dilantin may also be necessary if the child is having seizures What is syndrome of inappropriate antidiuretic hormone (SIADH)? Early recognition, appropriate antibiotic therapy, and supportive care have decreased the mortality of the illness. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

25 Bacterial Meningitis Nursing care
Frequent monitoring of the patient’s vital signs is necessary Fever may be controlled with the use of antipyretics, sponge baths, and a hypothermia blanket The patient’s intake and output are carefully observed and recorded Syndrome of inappropriate antidiruetic hormone (SIADH) Determined by weight, serum electrolytes, serum and urine osmolarities Treated by fluid restriction Because the patient is overly sensitive to stimuli, indirect lighting should be used. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

26 Encephalitis Description An inflammation of the brain parenchyma
Typically more severe than bacterial meningitis Can be caused by arboviruses, enteroviruses, and herpes virus types 1 and 2 Can be aftermath of upper respiratory tract infections, measles, an untoward reaction to vaccinations, lead poisoning Vaccination reactions are rare. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

27 Encephalitis Signs and symptoms
Headache followed by drowsiness, may proceed to coma Convulsions occur, particularly in infants Fever, cramps, abdominal pain, vomiting, stiff neck, delirium, muscle twitching, and abnormal eye movements are other manifestations of the disease Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

28 Encephalitis Treatment and nursing care
Corticosteroids/immune globulin Acyclovir for herpes virus encephalitis Parenteral antibiotics until bacterial cause is ruled out Sedatives, IV fluids, seizure control, monitoring for increased intracranial pressure Antipyretics as ordered, seizure precautions instituted Oxygen as needed, mouth and nose kept free of mucus Speech, mental processes, and motor abilities may be slowed, and permanent brain damage and mental retardation can result. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

29 Question 12.2 Which is typically more severe? Encephalitis
Bacterial meningitis Answer: A Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

30 Seizure Disorders Febrile seizures
Occur in association with a rapid increase of temperature Are a common pediatric neurological disorder and are generally transient in nature They usually occur between the ages of 6 months and 5 years and are common in toddlerhood Generally, the parents are educated on fever management and seizure precautions, although fever management (such as administering acetaminophen) does not typically reduce the risk for a seizure What virus has been associated with febrile seizures? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

31 Seizure Disorders Epilepsy
Recurrent paroxysmal attacks of unconsciousness or impaired consciousness May be followed by alternating contraction and relaxation of the muscles or disturbed feelings/behavior Disorder of the CNS in which the neurons or nerve cells discharge in an abnormal way Idiopathic epilepsy: unknown cause Symptomatic epilepsy: cerebral abnormality is found Symptomatic, also known as organic, epilepsy Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

32 Epilepsy Signs and symptoms Vary according to seizure type
Convulsive seizures Tonic phase, clonic phase, postictal state Abrupt onset preceded by aura; dizziness, visual images, nausea, headache, or abdominal discomfort Status epilepticus: series of convulsions, typically caused by withdrawal of anticonvulsants Nonconvulsive seizures Could be lapse in consciousness, loss of muscle tone, distorted sensations, automatisms See Table 13-3 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

33 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

34 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

35 Epilepsy Treatment and nursing care
First aid for a convulsive seizure includes protecting the child from harm, loosening clothing around the neck, turning on the side to maintain an airway, reassuring the child when consciousness returns Seizure precautions in the hospital setting include padding side rails and having oropharyngeal suction, oxygen, and an oral airway at the bedside Anticonvulsants A ketogenic diet* is sometimes prescribed for children who do not respond well to anticonvulsant therapy Surgery is considered with intractable seizures not responding to medication * see ‘1st do no harm’ with Susan Sarandon What diagnostic measures are used to determine the type, site, and cause of the seizure? If it is necessary for the child to take medication during school hours, the parents sign a consent form so that the school nurse may monitor administration. It is important that medication be reduced gradually under a physician’s supervision, because abrupt withdrawal of medications is the most common cause of status epilepticus. What is the purpose of a ketogenic diet? Some states do not allow people with controlled epilepsy to obtain a driver’s license. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

36 Meds used to suppress seizures; not abortive meds
Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

37 Reye’s Syndrome Description Signs and symptoms
A pediatric disease characterized by a nonspecific encephalopathy with fatty degeneration of the viscera and altered ammonia metabolism Triggered by a virus, particularly influenza or varicella Patients noted to have taken aspirin before symptoms Signs and symptoms Typically recovering from URI or chickenpox Recuperation interrupted by general malaise Sudden onset of persistent vomiting and lethargy Diagnosis based on history, symptoms, laboratory data The American Academy of Pediatrics advises against giving aspirin to children with influenza or varicella because this drug appears to be linked to Reye’s syndrome. Marked decrease in incidence rate What is the diagnosis of Reye’s syndrome based on? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

38 Reye’s Syndrome Treatment and nursing care Admission to ICU
Medications include osmotic diruetics, sedatives, barbiturates Fluid management in conjunction with treatment of increased intracranial pressure (ICP) is crucial Nursing care similar to increased ICP with greater awareness of respiratory status Most survivors recover completely Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

39 Near-Drowning Signs and symptoms Treatment and nursing care
Prognosis affected by length of submersion, physiologic response, exposure to hypothermia Hypoxia is the primary problem (Hypoxic ischemic encephalopathy) Pulmonary edema (osmotic fluid shift), pneumonia Treatment and nursing care On-site CPR Immediate transportation to a trauma facility Intensive pulmonary care Risk of cerebral edema and anoxia Neurons begin to die after 4-6 minutes without adequate oxygen. Guilt of caregivers can be overwhelming; nurses must be supportive. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

40 Overview of Cognitive and Behavioral Disorders
Developmental disability: any mentally/physically disabling condition that begins in childhood and is expected to continue throughout life Intellectual disability (mental retardation): significantly below-average score on a test of mental ability, limited function in daily life American Association on Intellectual and Developmental Disabilities (AAIDD) Emphasizes both intelligence functioning and adaptive behavior as criteria for disability Intellectual disability affects 2-3% of the population. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

41 Overview of Cognitive and Behavioral Disorders
Signs and symptoms Failure to suck Unusual-looking stools Feeding difficulties Unusual odor to urine Spasticity Enlarged tongue Convulsions Asian appearance in white infants Listlessness, irritability Stubby fingers or toes Floppy, hypotonic muscles Failure to achieve developmental milestones (smiling, rolling over, sitting, etc.) Decreased alertness Unresponsive to eye contact Unusual clumsiness Jaundice Even though intellectual disabilities are often categorized by IQ levels, each child must be frequently reevaluated. Many children who receive early intervention outperform all expectations. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

42 Overview of Cognitive and Behavioral Disorders
Treatment and nursing care Be mindful that pace of development is slower Learn by habit formation; routine, repetition, relaxation Any progress that has been made at home should not be allowed to slip during hospitalization Like other children, set firm, consistent limits on behavior Situations become more complicated as the child develops physically but still requires constant supervision Nurses should familiarize families with community resources; i.e., The Arc Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

43 Attention Deficit/Hyperactivity Disorder
Description Refers to specific patterns of behavior that include inattention and impulsivity and might or might not involve hyperactivity Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

44 Attention Deficit/Hyperactivity Disorder
Signs and symptoms DSM-IV-TR criteria identifies three major patterns of ADHD Predominantly inattentive type Predominantly hyperactive-impulsive type Combined For ADHD diagnosis, symptoms must Persist for at least 6 months Appear before the age of 7 years Be identified in more than one setting Cause significant impairment in psychosocial or educational adjustment and functioning Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

45 Attention Deficit/Hyperactivity Disorder
Signs and symptoms (continued) Inattentive to details, careless with schoolwork or other activities Has difficulty organizing tasks Is unable to sustain attention for periods of time that would be appropriate for age Does not listen, follow instructions, or complete tasks Avoids activities and games that require concentration Is easily distracted and fidgety; has difficulty remaining seated and appears to have excessive energy Is forgetful, loses things Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

46 Attention Deficit/Hyperactivity Disorder
Treatment and nursing care The specific medications used for the treatment of behavior problems in ambulatory patients are listed in Table 20-1 Dietary modification (particularly eliminating food additives, such as preservatives and artificial flavors and colors) and the use of megavitamins Behavior therapy What is the difference in how boys are affected versus how girls are affected by ADHD? The cause of ADHD is not thoroughly understood. Proponents of a biochemical causation suggest that hyperactive children have a total lack or diminished amount of dopamine. Others attribute the problem to an alteration of the reticular activating system of the midbrain that causes the child to react to every stimulation in the environment rather than to selected ones. Newer evidence indicates that genetic factors may play an important role. These disorders have also been linked to fetal alcohol syndrome and lead toxicity. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

47 Down Syndrome Signs and symptoms
Close-set and upward-slanting eyes, small head, round face, flat nose, mouth breathing, and a protruding tongue that interferes with sucking The hands of the baby are short and thick, and the little finger is curved Simian crease Undeveloped muscles (hypotonia) and loose joints enable the child to assume unusual positions Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

48 Down Syndrome Nursing care
Early infant stimulation enables children with Down syndrome to reach milestones as rapidly as possible The nurse should become familiar with services located in and near the community Allowing parents to become involved in care and planning for the infant from the start facilitates bonding Nurses need to be aware of their own feelings before they can give effective support to the child with a disability, and the parents. The parents need to grieve over the loss of the normal child they do not have. What community resources are available for the child with Down syndrome? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

49 Autism A complex developmental disorder of the brain, most likely caused by abnormalities in brain structure or function Affects social interaction, language, and communication, as well as behavior Typically appears in the first 3 years of life What is one of the best things that parents can do for autistic children? The Autism Society of America (ASA) can provide information about education, treatment programs, and resources for parents. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

50 Autism Autistic children do not interact well with others; they prefer to be alone They may play with toys in an unusual manner and live in their “own little world” Often there is some degree of mental retardation Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

51 Deafness Description Hearing loss falls into two major categories
Sensorineural hearing loss results from damage to the structures of the inner ear or auditory nerve Conductive hearing loss occurs due to an interruption in the transmission of sound waves (from structural problems) from the external or middle ear Some children have mixed hearing loss, which combines conductive and sensorineural causes When during prenatal life does the inner ear become fully formed? Sensorineural hearing loss can result from congenital defects of the inner ear or from the effects of certain conditions such as kernicterus or infection. Common causes of conduction deafness are otitis media (ear infections), injury, foreign bodies, and wax buildup. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

52 Deafness Signs and symptoms : Infant does not….
Startle with sudden loud sounds Turn his or her head toward a sound by 3 or 4 months Begin babbling by 6 months of age Respond by reacting to music around 8 months of age Attempt to speak syllables such as “da” by around age 1 year What is bilateral deafness? Behavior problems may arise because the children do not understand directions. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

53 Deafness Treatment and nursing care
The auditory brainstem response (ABR) and the otoacoustic emissions (OAE) provide identification of infants with hearing losses Audiometry—the measurement of hearing with an audiometer Tympanogram—measures the movement of the eardrum in response to sound waves Nurses should stress the importance of placing NO objects into the ear canal Early diagnosis and early intervention are important in the treatment of the deaf child to prevent adverse physical and mental complications. What points should be remembered when communicating with a deaf child? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

54 Deafness Treatment and nursing care (continued)
Lip reading, sign language, writing, closed captioning (on television), computers, visual aids, music, and amplified sound are some means of communication Flashing lights on the telephone and doorbell, hearing aid dogs, and telecommunications devices can facilitate communication Hearing aids and cochlear implants can boost hearing Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

55 Amblyopia Description Signs and symptoms Treatment and nursing care
A decrease in or loss of vision, usually in one eye The vision loss is not caused by structural eye damage but results from the brain “turning off” confusing visual images (brain turned off eye input so eye ‘ambles around’ because it is not used to see) Signs and symptoms An observant parent might notice that the child sits closer to the television or appears to have difficulty seeing Treatment and nursing care Glasses for significant refractive errors (hyperopia, myopia) and occlusion of the unaffected eye are used What is the goal of treatment for amblyopia? Conditions such as congenital cataract or strabismus can alert the ophthalmologist to the possibility of amblyopia. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

56 Strabismus Description
Ocular misalignment; a condition in which the child is not able to direct both eyes toward the same object (muscles do not align eye to focus on object) Most children with strabismus have esotropia, or an inward deviation of one or both eyes; some children have exotropia, which is outward turning When is transient strabismus normal? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

57 Strabismus Signs and symptoms Treatment and nursing care
Malalignment during the uncover/cover tests Uncover test: Eye is covered, child looks at a light source; a quickly uncovered eye should not move Cover test: one eye is covered, movement of the other is observed while looking at a distant object Treatment and nursing care Eye exercises and glasses Occlusion therapy Surgery is reserved for patients in whom nonsurgical methods are likely to be unsuccessful Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

58 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.


Download ppt "Chapter 13 Neurologic and Sensory Disorders"

Similar presentations


Ads by Google