Pediatric Nursing Demystified

Nursing Intervention

 Range of motion exercises—active or passive.

Turn and position patient.

Monitor neurologic status for changes; typically use the Glasgow Coma

Scaleor similar tool to grade response to stimuli (highest score: 15):

• Eye opening response:
  Spontaneous 4
  To sound 3
  To pain 2
  None 1


• Motor responses:
  Obeys commands 6
  Localizes pain 5
  Withdrawal (normal) 4
  Abnormal flexion 3
  Extension 2
  None 1


• Verbal responses:
  Oriented 5
  Confused conversation 4
  Inappropriate words 3
  Incomprehensible sounds 2
  None 1
  Provide a quiet environment to decrease unnecessary stimulation.
  Monitor fluid input and output.
  Explain to the family that home care is needed and that the patient must
  be turned and positioned every 2 hours. Also alert the family to adverse
  reactions and side effects of medication and interactions with other med-
  ications.

Reye Syndrome

What Went Wrong?

During the urea cycle, ammonia is changed to urea in the liver. Urea is then

excreted by the kidneys. In Reye syndrome, there is a disruption in the urea

cycle resulting in an increase in ammonia levels in the blood and increased

fatty acids that infiltrate the kidneys, muscles, and neuronal cells. Reye syn-

drome occurs within 3 days from a viral infection and is linked to the use of

aspirin in children.

Recovery is related to the degree of cerebral edema. If the patient is diag-

nosed and treated in the early stages, recovery is excellent; otherwise the

patient may die within a few days. The prognosis is poor for a patient who has

lapsed into a coma.

3

(^210) Pediatric Nursing Demystified