Pamela Souza, 6 years old, was admitted to evaluate intrathecal spasticity control for her cerebral palsy. Medications like baclofen can help control her spasticity. The nurse will include gestational/perinatal history, head trauma history, feeding/weight, seizures, respiratory status, and motor function in Pamela's health history. Important nursing interventions include assisting with medications, assessing spasticity, and supporting Pamela and her family. The nurse should teach Pamela's family about her care, medications, and rehabilitation after discharge. Kyle Stephens, 15, was in a diving accident and may have spinal injuries. Important assessments include injuries, especially to the head and spinal cord,

1. 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
K.
The following is the information that the nurse is expected to
include in the health history regarding Pamela; history of head
trauma, gestational and perinatal events, find out if the baby is
She is 6yo..not a baby
feeding well and also identify any weight loss, seizure activity,
indicate the respiratory status of the child including any
coughs, sputum production, or increased work of breathing
development, presence of fever, any changes in physical state or
medication regimen, and motor functions of the baby(Perry et
al., 2017).

2. L. What nursing interventions would be important in Pamela’s
care?
The best nursing interventions that best suit Pamela’s case
include;
· Assisting with the administration of baclofen
· Assessment of spasticity before and after administration of
medication
· Preoperative care and teaching
· Postoperative care and teaching
· Emotional support for Pamela and her family
· The nurse should teach the parents about the programmable
delivery system, frequent checks and how to adjust dose and
programming.
· If the patient is eligible for baclofen, the nurse should give it
with caution to prevent hallucinations, possible psychosis, or
any other serious effects and also bare in mind that abrupt
discontinuation may lead to other serious reactions.
· 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.
M. What information would be important to include in a
teaching plan for Pamela and her family?
N. Information about the type of pump being inserted and how it
works
O. Information and expectations about intrathecal baclofen
treatment
P. Daily care of the surgical incisions
Q. Notify the physician or nurse practitioner if the child has a
temperature greater than 101.5ºF, or if the child has persistent
incision pain.
R. Avoid tub baths for 2 weeks.
S. Do not allow the child to sleep on the stomach for 4 weeks

3. after pump insertion.
T. Discourage twisting at the waist, reaching high overhead,
stretching, or bending forward or backward for 4 weeks.
U. When the incisions have healed, normal activity may be
resumed.
V. Wear loose clothing to prevent irritation at the incision site.
W. Carry implanted device identification and emergency
information cards at all times.
The nurse should include the following in the teaching plan; the
drugs should be taken exactly as they have been prescribed and
they should not stop giving Pamela the drugs without consulting
the healthcare giver because abrupt discontinuation may lead to
serious reactions. The family should also be aware that these
drugs may have side effects like dizziness, confusion,
drowsiness, nausea, insomnia, headache, frequent or painful
urination but these side effects will go away after
discontinuation of the drug. However, it is important to report if
the side effects of the drug persist or become severe(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.
1. 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-

4. 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).
1. 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. There is also a need for rehabilitation so that the
child can function normal again. Kyle should be taken through
bowel training, skin assessment, and also get assessed on 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.

5. Chapter 49: The child with an endocrine disorder
Case 1: Jalissa Twyman, 8 years old, was admitted to the
pediatric intensive care unit with a closed head trauma after
being involved in a bicycle/motor vehicle accident. Jalissa is
unconscious. The nurses caring for Jalissa document a weight
loss of 1.82 kg over a 24-hour period, decreased skin turgor,
and dry mucous membranes. Urine output for the same 24-hour
period is 3.5 L/m2
I. What further assessments should the nurse perform on
Jelissa?
The nurse should check if the child has a raised, swollen area
from a bruise or a bump, any cuts in the scalp, sensitivity to
light and noise, lightheadedness, confusion, and assess the
functionality of the nerves, arterial blood pressure, intracranial
pressure, heart rate and rhythm, central nervous pressure, and
core temperature (Perry et al., 2017).
II. Tachycardia
III. Increased respiratory rate
IV. Urine concentration
V.
VI. What laboratory tests should the nurse expect to be ordered
for Jelissa?
A complete blood cell count especially if the child is suspected
to have bleeding, CT scan, and MRI scan. Also, there is need to
carry out a coagulation profile of the patient.
VII. UA
VIII. CT scan, MRI, or ultrasound of the skull and kidneys
IX. Serum osmolarity
X. Serum sodium
XI. Fluid deprivation test
XII. What nursing interventions should be done for Jelissa?
The nurse should ensure that the neck is positioned at a midline

6. position to prevent jugular vein compression, ensure adequate
sedation, ensure that there is no increased pressure on the intra-
abdominal pressure, and also establish early enteral feeding
because the child has lost weight in 24 hours and needs energy.
Case 2: Aellai Gianopoulos, 13 years old, is brought to the
clinic by her mother, who states that Aellai is losing her hair.
Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78.
Height is 64 in., and weight is 81.5 kg.
Aellai has an olive complexion marred by acne, large brown
eyes, and long black hair that is very thin on the top of her
head. Her breasts are small and she has an abundance of hair on
her arms and legs. She reached puberty approximately 6 months
ago
She has classic s/s of a specific endocrine disorder.. a big clue
is that this is a girl.
a. What other information should the nurse gather in the health
history?
The nurse should note down if there are any history of
endocrine disorder cases in the family, the age of the onset of
the patient’s symptoms, the rate at which the symptoms are
progressing, history of menstruation, any other medical history
and any medications that the patient could be taking, or has
taken before regarding the symptoms (Clare, 2019).
b. What laboratory tests would the nurse expect to be ordered
for Aellai?
A twenty four hour urine collection test,
bone density test, For what she is 13yo?
ACTH stimulation test, CRH stimulation test, Incorrect
fine-needle aspiration Biopsy, of what?
oral glucose tolerance test, dexamethasone suppression test,
Incorrect
five day glucose sensor test, and TSH blood test.

7. c. What should the nurse include in the teaching plan for Aellai
and her family?
The nurse should develop a teaching plan for Aellai and her
family to enable them to understand what is happening to Aellai
and the care that she needs. The plan should include the
following; it is important to first of all know that children are
different and they grow at a different rate. However, their
Aellai has endocrine disorder whereby the hormones responsible
for the growth and development of her bone, reproductive
organs, and secondary sex characteristics, and the hormones
responsible for hair growth and skin pigmentation (Clare,
2019). Therefore, Aellai should visit an endocrinologist
regularly for correction and monitoring.
References
Clare, C. (2019). Endocrine Disorders. Learning to Care E-
Book: The Nurse Associate, 455.
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.
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

8. 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;
You need to learn what this is to answer this question.
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

9. · 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?

10. 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.
Child with a cardiovascular disorder
Chapter 41: Child with a cardiovascular disorder
Case 1: Baby boy Ellis, 2 hours old, is being evaluated in the
newborn nursery by the nursing staff. Findings include T 37°C;
apical heart rate 140 bpm; respirations 58 breaths per minute;
BP (arms) 70/47, (calves) 62/39; head circumference 34 cm;
chest circumference 31 cm; length 48 cm; weight 2,700 g. The
infant is crying.
i. Based on the physical findings, what should be the nurse’s
priority?
The nurse should first focus on the breathing rate and heartbeat
of the child. The baby has a slightly high apical heart rate and
temperature. Incorrect. Go review normal VS for a newborn,
Therefore, the baby’s temperature need to be reduced to normal

11. and he also needs to be put on oxygen to help him with
breathing until his breathing system has developed fully.
Look at the BPs again.. Why are UE BPs higher then LE?
This is the question/
ii. What assessment /tests should the nurse expect to be done on
this infant?
Cardiovascular magnetic resonance imaging,
fetal echocardiogram, the baby is born.. no longer a fetus
chest x-ray, pulse oximetry, cardiac catheterization, and
electrocardiogram tests are expected to be done on the infant
(Hockenberry & Wilson, 2018).
iii. What should the nurse include in the teaching plan for the
parents of this infant?
c. Need to answer the above correctly first.
The nurse needs to inform the parents that the child is receiving
intravenous (IV) fluids or having adjustments to make his
breathing easier. He or she should also assure the parent that
their baby is doing well. The nurse should teach the parents on
how to care for their child once he is discharged. For example,
they should always keep the baby warm to prevent cyanosis,
observe the baby keenly and report to the doctor anytime the
baby lacks enough oxygen and they should look out for
symptoms like blue skin color and difficulty in breathing for
this diagnosis, and also understand how to give medicine to the
baby (Hockenberry & Wilson, 2018).
CASE 2: Jennifer Collins, 13 years old, is admitted to the
pediatric floor with a diagnosis of probable acute rheumatic
fever?
1. What would the nurse include when performing an initial
assessment?
Nursing assessment for probable acute rheumatic fever include;
· History – the nurse will interview the caregiver to get an up to
date history of the child. He or she will enquire about any
recent respiratory infection or sore throat and also find out the
time that the symptoms begun.

12. ·
· Physical exam – the nurse will begin with a thorough review
of all systems and note the physical condition of the child, look
out for any signs and classify them as either major or minor
manifestations, check temperature and pulse, examine swollen
or painful joints, subcutaneous nodules, and look for any signs
of chorea (Carapetis et al., 2005).
. History of recent streptococcal infection
. History of joint pain and/or fever
. Past history of ARF
. Observation for Sydenham chorea
. Observation for erythema marginatum
. Palpation of the surfaces of the wrist, elbows, and knees for
firm, painless, subcutaneous nodules
. Presence or absence of heart murmur
.
0. What tests would the nurse expect to be done on Jeniffer?
The diagnosis of acute rheumatic fever is confirmed.
The following tests are expected to be done on Jeniffer;
· Throat culture test
· Rapid antigen detection test – this is used to detect group A
streptococci antigen which allows the diagnosis of streptococcal
pharyngitis to be made.
· Antistreptococcal antibodies test – when antistreptococcal
antibodies are at their peak that is when the features of
rheumatic fever begin to show. This is the best test to confirm
acute rheumatic fever for people who show chorea as the only
diagnostic criterion.
· Heart reactive antibodies - this is a test to see if tropomyosin
is elevated in persons with acute rheumatic fever.
· Rapid detection test for D8/17 – this is a immunofluorescence
technique for identifying the B-cell marker D8/17 and see if it
is positive.
· Other tests will be chest radiography and Echocardiography.
0. What would the nurse be sure to include in the discharge
teaching plan for Jennifer and her family?

13. As the baby gets discharged, the nurse should include the
following in the teaching plan for Jeniffer and her family; they
should always be very keen on any symptoms of rheumatic fever
and see the doctor immediately because there is no cure for
rheumatic fever but the symptoms can be treated (Carapetis et
al., 2005). Also, the child will need to be to be taken back to the
hospital for follow ups with cardiology as symptoms of valve
damage may not be detectable until later in the future. Also,
matters hygiene should be included in the teaching plan. This is
because many studies have shown that there are higher
occurrences of rheumatic fever in places with poor sanitation
and overcrowding.
References
Carapetis, J. R., McDonald, M., & Wilson, N. J. (2005). Acute
rheumatic fever. The Lancet, 366(9480), 155-168.
Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care
of infants and children-E-book. Elsevier Health Sciences.
Running head: NURSING MANAGEMENT OF THE
NEWBORN
NURSING MANAGEMENT OF THE NEWBORN 8
NAME: Adebola Amoo Ross

14. As a postpartum nurse your next client is an LGA baby boy who
was born at 37 weeks' gestation. He had Apgar scores of 8 and
9. He was circumcised. The mother is breast-feeding. Your unit
requires a full assessment, screenings, discharge instructions,
and documentation. (Learning Objectives 4, 7, 8, and 10)
1. Describe what a normal head-to-toe assessment would be for
an infant born at 37 weeks' gestation. What test is used to
determine this gestational age? What is the scale used to
determine the Apgar score, and are this baby’s scores normal?
2. As the discharging nurse, you are responsible for what
screenings in an infant in the first 24 to 48 hours? What
immunizations would be required?
3. What discharge instructions would be pertinent to this
mother? How would you educate her or the family?
4. How would you document your discharge teaching? Write a
sample narrative of your teaching.
Definition of the Diagnosis
A new born baby usually undergoes several tests in order to
detect any disorders that might need immediate medical
attention (Susan, Terri & Susan, 2009). The test begins with
physical examination which includes measurement of weight,
length and head circumference. The heart rate, muscle tone,
skin color, reflexes and breathing effort is also examined and
scores of between 0 and 10 are given using the Apgar scale
depending on the observed conditions. A baby with good health
has an Apgar score above 7 whereas an Apgar score below 5
indicates that the baby may need immediate medical care. The
gestation age is determined using the Ballard scale. It could
either be small for gestation age (SGA), appropriate for
gestation age (AGA) or large for gestation age (LGA). LGA’s
refers to babies or infants whose age or gender is larger than
expectedor their birth weight greater than the 90th percentile.
Some of the common risks in LGA infants include birth trauma,
diabetes mellitus, metatarsus, adductus and hip subluxation
(Angelica , Flaminia , Mania, Simona, Sara , & Cristina, 2014).

15. Gestation diabetes is the common cause of LGA babies, other
causes include, excessive maternal weight gain, fetal sex,
increased gestation age and use of amoxicillin and pivambicillin
antibiotics during pregnancy (Lawrence, 2017).
Common Signs and Symptoms
The common signs and symptoms for LGA babies are those that
are related to the complications that may occur.
Potential Complications
Some of the potential complications associated with LGA
newborns are birth injuries, perinatal asphyxia, difficult
delivery, meconium aspiration, low Apgar score, lung problems,
hypoglycemia, birth defects, and polycythemia (Cervellin,
Comelli , Bonfanti, Numeroso , & Lippi, 2019).
Head to Toe Assessment
Vital Signs: Temperature, 98.6°F; blood pressure, 45/80 mm
Hg; heartbeat, 160 beats/min; respiratory rate, 60 breaths/min,
oxygen saturation 100% on room air
HEENT:
Head: the average head circumference of 33 to 35cm, overriding
sutures, caput succedaneum
Eye: visual acuity 20/400, normal red reflex, no discharge,
white sclera.
Ear: normal configuration that is a third angle of the eye and
response to sound
Nose: symmetrical
Mouth: normal configuration; Epstein’s pearl, no cleft palate.
Neck: normal rotation.
Chest: average circumference of 30 to 33 cm, clear heart and
lung sounds.
Abdomen: slight protrusion, cord drying, 3 umbilical vessels,
liver 2 cm below costal margin, presence of bowel sounds.
Skin: pink skin, erythema toxicum, Mongolian spots,
acrocynosis, milia
Genitalia: an open and properly placed urethra; presence of
testes in the scrotum.
Limbs: presence of limbs, pink nails and no deformities.

16. NANDA Nursing Diagnosis
1. Birth injuries
2. Hypoglycemia
3. Lung problems
4. Heart diseases
5. Obesity
Infant screening
1. Otoacoustic emissions (OAE) test and auditory brain stem
response (ABR)
The OAE tests is used to determine the response of some parts
of the ear to sound while the ABR test is used to evaluate the
auditory brain stem and brains response to sound (Angelica et
al., 2014).
Desired outcome
Normal hearing
Interventions and rationale
1. Place a miniature earphone and a microphone on the baby’s
ear and play a sound.
Rationale: Back reflection of an echo into the ear canal shows
normal hearing
Place Band-Aid-electrodes on the baby’s head
Rationale: sound response indicates normal hearing
2. Pulse oximetry test
The pulse ox is a non-invasive test that measures the amount of
oxygen in the blood.
Desired outcome
Normal oxygen levels.
Interventions and rationale
Place a pulse CO oximeter on the baby’s skin. The CO oximeter
measures the fractional oxyhemoglobin.
Rationale: an oxygen saturation level of more than eighty-nine
percent is an indication of healthy individual.
3. Bilirubin test
A jaundiced look on the baby would indicate bilirubin test is
required.
Immunization Vaccines

17. · BCG vaccine
· Hepatitis B
· OPV
Discharge Instructions
· Keep the circumcision wound dry and clean and apply
ointment daily.
· Breast feeding of the baby every two or three hours’ time
· Avoid any other food apart from the breast milk
· Wrap the baby to maintain normal temperatures
· Bathing the baby daily and take good care of the umbilical
cord
· Contact the doctor in case of any abnormal signs and
symptoms.
Documentation of the Discharge Teaching
The discharging teaching is done using the Focus, data, action,
Response way. Mother of a circumcised LGA baby boy born at
37 weeks educated on wound care, baby care, breast feeding and
follow up.
Documentation sample
Date
Time
focus
Notes
15/02/2020
12:57pm
Health education
The mother is able to follow the guidelines given and can
handle the baby well.

18. References
Angelica D., Flaminia C., Mania G., Simona C., Sara C, &
Cristina O. (2014). Investigation of the 1H-NMR based urine
metabolomics profiles of IUGR, LGA and AGA newborns on the
first day of life. The Journal of Maternal-Fetal & Neonatal
Medicine: 27(2)
Cervellin G., Comelli I., Bonfanti L., Numeroso F., & Lippi G.
(2019). Emergency diagnostic testing in pregnancy. Journal of
laboratory and precision medicine: 5(2). doi:
10.21037/jlpm.2019.10.04
Lawrence E. (2017). A matter of size: Part 2. Evaluating the
large-for-gestational-age neonate. PubMed journals
Susan S., Terri K., & Susan C. (2009). Maternity and Pediatric
Nursing, 2nd ed. ISBN: 978-1-60913-747.