Reference no: EM133916549

Question

A case of Stephanie Brown, a 3-year-old female with a history of spastic cerebral palsy, was admitted to the hospital for intravenous antibiotic therapy, neurologic monitoring, and support for a diagnosis of acute meningitis. Upon arrival at the hospital, Stephanie Brown was febrile, drowsy, and lethargic. Her mother reported a history of vomiting and sever headache. Physical assessment resulted in nuchal rigidity, and positive responses were elicited for both Kernig's and Brudzinski's signs. Stephanie Brown was negative for bleeding, rash, petechiae, and photophobia. Cerebral spinal fluid (CSF) results were consistent with meningitis. Droplet precautions are started immediately because meningitis is a serious disease that can be transmitted by droplets. Intravenous antibiotic of Vancomycin was ordered to treat the infection. An intravenous infusion of D5 0.45 NS with 2 mEq of KCl/100 mL to run at 50 mL/hr was initially started at the Emergency which was changed the next day to a rate of 10 mL/hr over 24 hours. The next day when the nurse on duty was rounding, she noticed that the IV site had some swelling and reflected pain and discomfort. The nurse removed the IV and restarted in another site and resume the IV fluids as ordered with the current rate of 10 mL/hr.

At the age of 6 months, Stephanie Brown was diagnosed with cerebral palsy when her provider noted that she had persistent and asymmetric tonic neck reflex. She also has spasticity of her lower extremities. At present, she has mildly impaired strength and movement in her upper extremities with some spasticity.

She has tight heel cords. Her leg strength is mild to moderately impaired, and she has mild spasticity with movement. She wears ankle-foot orthotics. Stephanie Brown's mother indicated that she does some exercises and treatments and strategies at home.

A number of things in Stephanie Brown's history might have contributed to her cerebral palsy. She was born at 27 weeks gestation. Her mother had intermittent bleeding during her pregnancy that she did not report. She also smoked during much of her pregnancy, quitting late. Stephanie Brown was born with the umbilical cord around her neck and had Apgar scores of 3 and 4. She was in the NICU and received oxygen.

1. When children are hospitalized for an acute illness, you may find that they also have another disability or chronic illness that could have an effect on the hospitalization or on your care. Think about how you would provide care in such a situation. How do you get information? Who is in charge? Should you involve parents in the same ways you normally do?

Review Stephanie Brown's history. What factor(s) might have contributed to her cerebral palsy?

2. Think about nursing admissions procedures. What additional information would be especially important to have?

3. Should the nurse be supportive of Stephanie Brown's mother implementing the treatments and strategies she uses at home in the hospital? Why or Why not?

4. For what problem is Stephanie Brown at risk during her hospitalization? (Hint: You will need to consider Stephanie Brown's developmental age.)

5. Hospitalization can still be a time of growth. Explore which developmental tasks Stephanie Brown has achieved and which she has not. Comment on her development.

6. This is a good opportunity to explore Stephanie Brown's development further. One assessment tool that can be used is the Denver Developmental Screening Test II (DDST-II). Identify the areas assessed on this test.

7. Parents often express concern about their child's performance when the DDST II is used. Explain the purpose of this test and discuss what a screening test is.

8. What type of cerebral palsy does Stephanie Brown have? What are the signs that she manifests?

9. Cerebral palsy can have an impact on many aspects of a child's life. A number of problems can be associated with the behaviors the child manifests. What are some of these problems? (Note: Make sure that at least one is a psychosocial concern.)

10. Stephanie Brown's mother expresses guild over her daughter's condition and states that she knows now that she did some things that may have contributed to the condition, how would you respond?

11. What other preventive measures have been integrated into Stephanie Brown's regimen to prevent complications associated with cerebral palsy?

12. What is the role of the nurse in regard to supporting the mother's implementation of these measures?

13. Explain why nutrition is so important for the child who has cerebral palsy.