http://allnurses.com en Sat, 21 Nov 2009 01:05:56 GMT vBulletin 60 http://img.an-file.info/misc/rss.jpg http://allnurses.com http://allnurses.com/pediatric-nursing/nursery-nurses-439949-new.html Thu, 19 Nov 2009 06:27:17 GMT Hi :) I am considering applying for a job in the Nursery at my local hospital, and was wondering... Hi :)
I am considering applying for a job in the Nursery at my local hospital, and was wondering if there are any Nursery nurses on here who could give me a bit of information about your typical duties in that unit? I would just like to be a little more familiar before I go for it!
Thanks everyone :D
(Oh and sorry if this is the wrong place to post this... I wasn't sure) ]]> Pediatric Nursing McBx3 http://allnurses.com/pediatric-nursing/nursery-nurses-439949.html http://allnurses.com/pediatric-nursing/question-pediatric-im-439939-new.html Thu, 19 Nov 2009 05:04:41 GMT I work in a very busy family practice clinic, and a big part of my job is doing pediatric... I work in a very busy family practice clinic, and a big part of my job is doing pediatric immunizations. Many of our pediatric patients are now getting the H1N1 and seasonal flu vaccine in addition to the required immunizations due for their age. Unfortunately, this results in some of our pediatric patients getting up to 6 injections in one visit! I am experienced in doing pediatric injections, but sometimes I'm not sure where I can safely give some of the IM injections. I understand that the vastus lateralis is the preferred site, and I will normally give no more than 2 IM injections in one leg. Sometimes I get into a situation where I have 6 IM injections to give, and I'm not sure if the deltoid is OK to use, especially in children 6-12 months. I don't normally use the deltoid in children that young, since the muscle may not be as developed. What is the maximum number of IM injections (0.5 ml each) you can safely give in the vastus lateralis? Can the deltoid be used in a child 6-12 months? Thanks for all replies. ]]> Pediatric Nursing Rhonda V http://allnurses.com/pediatric-nursing/question-pediatric-im-439939.html http://allnurses.com/pediatric-nursing/needs-advice-pediatric-439615-new.html Tue, 17 Nov 2009 19:27:49 GMT HI all I did my nursing in india,passed the RN exam after comming to US. I have 2 yrs of... HI all
I did my nursing in india,passed the RN exam after comming to US.
I have 2 yrs of experience in nursing in pediatrics.
due 2 my exams n all those stuff,i'm currently not working for past two years
so i need a thorough refreshing on my pediatric nursing knowledge n skills especially
of US NURSING.
so kindly plz reply on a good book on pediatric nursing
i've seen that wongs essentials of pediatric nursing and
pediatric nursing proceedures by vicky is good
i need a single book worth mentioning
plz jot in an apt book for me
i plan to pursue my career after 4 0r 5 months if God willing.
i dont want to be looked down by peers n i want to practice best in pediatrics!!
plz reply ]]> Pediatric Nursing jesusalmighty http://allnurses.com/pediatric-nursing/needs-advice-pediatric-439615.html http://allnurses.com/pediatric-nursing/bp-weight-child-439462-new.html Mon, 16 Nov 2009 23:44:32 GMT :dance:Chello everyone, I have a quick question. If you have a 101/2 yr. female that weighs... :dance:Chello everyone,


I have a quick question. If you have a 101/2 yr. female that weighs 132 and is 5'4. what would be a normal bp and pulse rate for her? Would you base the results on her age or weight and height????? :spin:. Thanks in advance.:yeah: ]]> Pediatric Nursing Hairstylingnurse http://allnurses.com/pediatric-nursing/bp-weight-child-439462.html http://allnurses.com/pediatric-nursing/cardiac-fenestration-439168-new.html Sun, 15 Nov 2009 06:13:38 GMT I have been trying to look up information regarding fenestration of a cardiac pt. I haven't been able to find much that has helped. I have heard of a fenestrated Fontan, and most recently I had a pt who was a fenestrated ASD so his O2 sats were 75-85%. Can someone please help explain this to me...thanks in advance!! ]]> Pediatric Nursing Heather91001 http://allnurses.com/pediatric-nursing/cardiac-fenestration-439168.html http://allnurses.com/pediatric-nursing/leaving-work-work-438098-new.html Tue, 10 Nov 2009 09:48:18 GMT Sorry, wrong forum. Can the moderators please delete this post? Sorry, wrong forum. Can the moderators please delete this post? ]]> Pediatric Nursing Eirene http://allnurses.com/pediatric-nursing/leaving-work-work-438098.html http://allnurses.com/pediatric-nursing/any-advice-new-437982-new.html Mon, 09 Nov 2009 21:49:55 GMT Hello all!! It has been my dream to either work as a peds nurse or a l&d nurse...and today one of those dreams came true!! I got my first job offer on a medical care unit at the Children's National Medical Center in DC after interviewing last week! It has been a long and depressing job search, but I pulled myself out of my slump and kept praying. Any advice for me?? I am going to be reviewing peds so I can brush up on what I learned in school and in clinical. I loved my peds rotation in school, and I hope...no, I KNOW I can be the best peds nurse I can be and give these kids the care they deserve.:redpinkhe ]]> Pediatric Nursing NewAggieGrad09 http://allnurses.com/pediatric-nursing/any-advice-new-437982.html http://allnurses.com/pediatric-nursing/baby-bucket-437106-new.html Thu, 05 Nov 2009 23:22:43 GMT found this store on my local cbs website, anyone else find this a bit dangerous? just wait until to... found this store on my local cbs website, anyone else find this a bit dangerous? just wait until to 1st parent fills the bucket full or leaves the child in it alone!

Got A Crying Kid? Stick'em In A Baby Bucket

Parents Going Ga-Ga Over Tummy Tub

MIAMI (CBS) ―
Click to enlarge 1 of 1
A parent dunks a baby to demonstrate how the Tummy Tub works. CBS




http://wcco.com/watercooler/baby.buc...2.1294156.html ]]> Pediatric Nursing snuffyRN http://allnurses.com/pediatric-nursing/baby-bucket-437106.html http://allnurses.com/pediatric-nursing/would-i-ok-436421-new.html Tue, 03 Nov 2009 14:11:40 GMT I've worked 2 years now on a med-surg/tele floor with adults. I've done my time. I'm SO ready to go. I did well, like the job ok, but just need a change.

I'm a mom of three, all different ages. My oldest is 21 and youngest is 8 w/ special needs. I've raised really good kids and felt I was a very good mom to them. Still am! :loveya: I don't expect, though, that being a mom will make me a good peds nurse. My kids were never acutely ill, and I realize there is a lot to pediatric nursing that as a parent, I have no clue about. Still, I feel it WILL give me a bit of insight into dealing with kids.

I've got a TON of patience, gleaned by raising this special needs youngster. I mean -- patience. I'm as patient as a TREE. I have dealt with so many meltdowns w/ this kid -- but we worked through it and he's so much better now. He is mildly autistic, and we've gone through behavioral training, special therapies, speech, special diets, you name, it. I also have a heart for special needs kids of all kinds.

Although I predict parents WILL make me crazy at times in pediatrics, at least as a parent, I feel I'll be able to identify with their passion for their kids and will understand why they are so irrational and concerned. I mean -- I'd be the same way if it were my child. In fact, for some reason, I really feel I'll be able to deal sincerely with this type of family members, vs the family members of older adults, who just drive me absolutely insane.

I'd like to go to peds because I feel the unit I'm on is not giving me a true med surg type experience. It's a speciality med surg unit -- more of a neuro focus, and I feel it's limiting me somewhat. I think peds is just like a mini med surg of sorts, and I'd like to get that more generalized experience.

And lastly, I LOVE kids. I'm fascinated by them and always have been. I was a past homeschooler of my own kids, and love teaching. I adore babies, of course, and would eventually like to become a lactation consultant as well, or Pediatric NP. I truly like kids of all ages, as well. Not just into babies. I love all ages and stages.

Time mangement -- good. I've got 2 years under my belt now, dealing w/ docs, hospital policies, paperwork, etc.

I think I'm ready, but I really want to impart this to whoever will be doing the hiring. Any hints? Suggestions?

I guess I also want to work with nurses who really, really care. I mean -- I hate to say this, but nurses of older adults -- some just don't seem to give a hoot. I can't believe that in pediatrics, you'd see this sort of attitude. I guess I'm looking to work w/ people who will inspire me a bit to be a better nurse. I'm just not getting that now, unfortunately.

Any thoughts? Thanks. ]]> Pediatric Nursing SoundofMusic http://allnurses.com/pediatric-nursing/would-i-ok-436421.html http://allnurses.com/pediatric-nursing/advice-pediatric-float-435674-new.html Fri, 30 Oct 2009 22:54:15 GMT Right now I'm a new grad doing L&D, and loving it, but I'm also interested in Peds and NICU and I heard my hospital has pediatric float positions for general Peds/PICU/NICU. I'm thinking after maybe 1 and a half or 2 years of L&D, if I'm ready for a change, I could apply for it. It seems like a good way to get cross-trained in all areas of maternal-child health and make me more marketable if I move to a different area and want to apply to a Children's Hospital. I also think all of the areas are interesting and wouldn't know how to choose one!

I'm wondering, do you think it's too broad a focus? Is it better to focus on one of them one at a time? Peds for a few years, NICU for a few years etc?

And would a nurse with less than 2 years experience in L&D (with occasional floating to postpartum) be able to handle a Peds float job like that?

They said they hire nurses without Peds experience for it. Which seems surprising to me. But I hope that means they train them well.

Also, would switching depts after about 2 years be frowned upon? I know nurse managers really don't like to see nurses who leave a first job after just a few months, but would they feel the same after about 2 years? (I know it's frustrating to them to rehire and retrain nurses)

(the reason I'm saying 1 and a half to 2 years is that I'm getting married in a few months and may want to have a baby in about 2 and a half to 3 years, so if I want to make a switch of depts and get re-oriented to another unit it might be good to do it before having a baby) ]]> Pediatric Nursing abnihon http://allnurses.com/pediatric-nursing/advice-pediatric-float-435674.html http://allnurses.com/pediatric-nursing/immunizations-and-autism-435618-new.html Fri, 30 Oct 2009 17:42:11 GMT I hear a lot about how immunizations for children may cause autism... Is there really any truth to... I hear a lot about how immunizations for children may cause autism... Is there really any truth to this? I haven’t found any research supporting this theory. IF anybody has any info I would like to hear about it. ]]> Pediatric Nursing Netto01 http://allnurses.com/pediatric-nursing/immunizations-and-autism-435618.html http://allnurses.com/pediatric-nursing/pediatric-nursing-ok-435595-new.html Fri, 30 Oct 2009 16:25:52 GMT Ok, so I'll admit it -- I'd truly like to become a lactation consultant someday. It's been a dream for a long time. However, I have no hours and I need experience working w/ moms and babes.

There are NO L&D jobs around, but there are pediatrics positions. Could I parlay this into lactation consulting in some way someday?

I am not doing peds simply to become a LC, and really am interested in pediatrics in and of itself, but also wonder if it could be a springboard to this other area?

Thanks. ]]> Pediatric Nursing SoundofMusic http://allnurses.com/pediatric-nursing/pediatric-nursing-ok-435595.html http://allnurses.com/pediatric-nursing/soooo-excited-nervous-435222-new.html Thu, 29 Oct 2009 13:10:43 GMT I, officially, begin on Nov. 2nd as a pedi RN on a peds med-surg unit. I am so excited, as I have... I, officially, begin on Nov. 2nd as a pedi RN on a peds med-surg unit. I am so excited, as I have always wanted to work with pediatric patients, but I am also sooooo nervous. I am a new grad and really want to do well. There is so much to learn. Anyone out there willing to share some tips or advice with me? I would be so thankful. ]]> Pediatric Nursing arcoiris http://allnurses.com/pediatric-nursing/soooo-excited-nervous-435222.html http://allnurses.com/pediatric-nursing/management-child-polymicrogyria-433389-new.html Thu, 22 Oct 2009 14:30:03 GMT By Turkelson, Sandra L Martin, Caron When a child is diagnosed with polymicrogyria, it can be... By Turkelson, Sandra L Martin, Caron

When a child is diagnosed with polymicrogyria, it can be emotionally devastating because the parents are forced to face the loss of what could have been and the reality of what will be. This article will summarize the pathophysiology of polymicrogyria and its definition, causes, and clinical manifestations; typical patient management issues; and the need for collaborative healthcare. Education and support needs of the patient and/or parent will be emphasized. Pathophysiology and Etiology

During normal fetal development, neurons migrate from the innermost layer of the neuronal tube to the surface of the brain (Uher & Golden, 2000). This process is essential for the development of the cerebral cortex, which is responsible for higher level cognitive functioning such as judgment, language, and abstract thinking. The cortex is also involved in sensation interpretation and voluntary motor activities (Ciechanowski, Mower-Wade, McLeskey, & Stout, 2005). Different areas of the cortex are involved in various functions such as mobility, verbal skills, vision, and ability to eat effectively.

Neuronal migrational disorders occur when the cells do not properly migrate to the cortex, causing cerebral cortical malformation and resultant impairment in neurological function. Neuronal migrational defects include lissencephaly, pachygyria, heterotopia, focal cortical dysplasia, and polymicrogyria. Lissencephaly is characterized by a smooth brain surface due to a lack of gyri and sulci. In pacygyria, there are areas where the brain is smooth, but it does not involve the complete agyria that is present in lissencephaly. Heterotopia is an ectopic collection of neurons which can be located superficially close to the ventricle (Uher & Golden, 2000). Focal cortical dysplasia may involve mild cortical disorganization or may include abnormal neurons (Wang, Chang, & Barbaro, 2006). Polymicrogyria is characterized by abnormal fetal cortical development which results in many small gyri with shallow sulci and abnormal cortical layering (Villard et al., 2002).

The etiology of polymicrogyria is not definitively known. Potential causes include in utero infection with cytomegalovirus, a placental perfusion deficit, or a genetic component (Jansen & Andermann, 2005). Some possible environmental risk factors include exposure to ethanol, retinole acids, methylmercury, and radiation (Golden, 2001).

Patterns of Polymicrogyria With Associated Clinical Manifestations

The cortical defects of polymicrogyria can be focal or diffuse, bilateral or unilateral. Expressions of the disease range from minor impairment of cognitive function without seizure activity to major neurological dysfunction with intractable seizure activity (Jansen & Andermann, 2005). Several patterns of polymicrogyria have been identified based on the location and extent of the defect in the cortex (Villard et al., 2002). These patterns include bilateral frontal polymicrogyria, bilateral frontoparietal polymicrogyria, bilateral perisylvian polymicrogyria, bilateral generalized polymicrogyria, and bilateral parasagittal parieto-occipital polymicrogyria. The signs and symptoms relative to the specific patterns correlate to the part of the cortex involved (Jansen & Andermann, 2005).

The patient with bilateral frontal polymicrogyria often presents with a delay in motor and language development. Other associated findings include mild to moderate mental retardation and hemiparesis or spastic quadriparesis (Guerrini, Barkovich, Sztriha, & Dobyns, 2000). Seizures are present in approximately 38% of these patients and vary in severity, type, and age of onset (Jansen & Andermann, 2005). Table 1 lists classifications of seizures and contains the description of clinical manifestations.

Evidence of bilateral frontoparietal polymicrogyria is similar to that of bilateral frontal polymicrogyria. Patients typically experience serious delays in mental and motor development (Sztriha & Nork, 2002). One of the distinguishing signs in the patient with bilateral frontoparietal polymicrogyria is a dysconjugate gaze such as esotropia. Cerebellar dysfunction is likely, and seizures are present in 94% of these patients, typically of the generalized type (Jansen & Andermann, 2005).

Bilateral perisylvian polymicrogyria is the most common form of polymicrogyria. Its distinguishing feature is pseudobulbar involvement, causing issues with feeding, drooling, and dysarthria (Jansen & Andermann, 2005). Mild mental retardation and seizure disorders are also demonstrated in this form of polymicrogyria (Villard et al., 2002). Patients may present with infantile spasms, but it is more likely that seizures develop later in life. The seizures may be of multiple types, and often, seizure control is difficult (Jansen & Andermann, 2005).

Patients with bilateral generalized polymicrogyria have severe clinical deficits. Cognitive and motor developmental delays and seizure disorders are common. If the perisylvian region is involved, feeding issues may be present (Chang et al., 2004). In addition, the child may experience spastic hemiparesis or quadriparesis (Jansen & Andermann, 2005). Findings of bilateral parasagittal parieto- occipital polymicrogyria include seizure activity, impaired cognitive functioning, and average to low IQ scores. Partial (focal) seizures are often present and typically intractable (Jansen & Andermann, 2005).

Management of the Child With Polymicrogyria

Seizure Management

Seizure activity affects many children with the diagnosis of polymicrogyria. Priority nursing diagnoses include risk for injury and risk for aspiration (see Table 2). The seizures are often managed by antiepileptic drugs (see Table 3), and the specific drug prescribed depends on the seizure type the child is experiencing. It should be noted the seizure type may change as the child ages. These changes often occur during adolescence at which time drug therapy may need to be adjusted. Drug regimens may be altered based on the effectiveness of the seizure control and the adverse reactions the child may experience. Another consideration when starting a child on antiepileptic drugs is monotherapy versus combination therapy. Monotherapy is preferred; however, additional drugs may need to be added to achieve seizure control. When new drugs are added, the child must be monitored for the development of adverse reactions. It is important to note that most antiepileptic drugs can cause sedation and dizziness because they are central nervous system depressants (Benbadis & Tatum, 2001). Adverse reactions may intensify with higher drug doses and/or implementation of combination therapy.

A child with polymicrogyria may experience status epilepticus which is defined as a continuous or cluster of seizures lasting longer than 20 to 30 min during which the child does not regain consciousness (Bryant, 2005). This is an urgent and emergent situation. In the home or community setting, treatment options for this situation include rectal diazepam, intranasal midazolam or lorazepam, and buccal midazolam (Ahmad, Ellis, Kamwendo, & Molyneus, 2006; Mclntyre et al., 2005).

Children with polymicrogyria will be managed at home or in long- term care facilities. Part of the nurse's responsibihty is to teach parents and other caregivers about the use of antiepileptic drugs (see Table 4). Some seizures are not adequately controlled with these drugs, and children may experience adverse reactions. Alternative therapies may be suggested as options to assist in the management of seizure activity including the ketogenic diet and the vagus nerve stimulator (see Table 5). Antiepileptic drug therapy may be miiiimized or discontinued if the child has a positive outcome from these alternative therapies. Nurses should be knowledgeable about these treatment modalities and educate parents as needed.

Feeding Management

Some children with polymicrogyria have difficulty in meeting their daily oral intake needs, contributing to an alteration in nutrition. This nutritional deficiency may be related to ineffective oropharyngeal muscular coordination, potentially resulting in difficulty swallowing and aspiration. Signs of altered nutrition include loss of weight, alteration in growth and development, increased length of feeding times, and oxygenation interferences related to infections and structural damage to the lungs (Craig, Scambler, & Spitz, 2003). These children are also at risk of vomiting and development of gastroesophageal reflux (Guerriere, McKeever, Llewellyn-Thomas, & Berall, 2003).

A clinical nutritionist should be consulted to assess the adequacy of the child's diet. It is important for the child to maintain a desired body weight to avoid complications of being overweight or underweight. Types of seizures that are manifested by an increase in muscular activity can raise the caloric requirement (Wilson, 2005b). If the child is immobile, added weight can cause difficulty for the parent when transferring the child. In addition, obesity can contribute to the development of type 2 diabetes mellitus, coronary artery disease, respiratory dysfunction, arthritis, stroke, and certain types of cancer (Winkelstein, 2005). Obesity can also be associated with hypertension and the potential for skin breakdown. For these reasons, weight should be monitored regularly.

If nutritional needs cannot be met with oral feedings, a gastrostomy tube may be recommended. Information to be discussed with the parents should include details of the procedure of gastrostomy tube placement including anatomical location of the tube and anticipated postprocedure appearance of the child. Advantages and disadvantages of gastrostomy feeding, side effects of tube feeding, and the mechanics of administration of the formula and medications via the feeding tube should be discussed (Guerriere et al, 2003). Typically, formula is administered by bolus feeding, continuous, or cyclic infusion. Bolus feeding is less restrictive and may not limit daily activities as significantly as continuous feeding (Enrione, Thomlison, & Rubin, 2005). Education of the parent should begin prior to placement of the tube so that informed consent can be given (Craig et al., 2003). However, ongoing assessment of learning should continue, and information should be shared with parents in manageable doses. Positive outcomes of feeding via a gastrostomy tube include an increase in weight, an improvement in nutritional status, an improvement in growth, and decreased incidence of illness and infection. Disadvantages of gastrostomy feeding have been identified as concerns regarding performance of yet another procedure on the child as well as anxieties regarding whether there will be ample benefits of tube feeding. A gastrostomy tube can in- tensify feelings that the family unit is not normal because of mealtime changes related to feeding via a tube (Guerriere et al., 2003). Another concern is that enteral feeding may increase the difficulty of finding a babysitter or respite care (Rollins, 2006). There will be changes in family routines and po- tential restriction of activity and leisure time related to the enteral feedings. For some families, the psy- chosocial issues are more difficult than the asso- ciated medical problems with enteral feedings (Enrione et al., 2005). Inpatient programs such as Family- Centered Service and Creating Opportunities for Parent Empowerment can be utilized and continued after discharge (Craig et al., 2003).

Gastroesophageal reflux disease (GERD) can occur in up to 70% of children with neuromuscular involvement such as polymicrogyria (Craig et al., 2003). This can occur if the child is being fed orally or through a gastrostomy tube. A Nissen fundoplication may be necessary for the relief of the symptoms of gastroesophageal reflux disease. This surgery involves the wrapping of the fundus of the stomach around the distal portion of the esophagus for the prevention of gastric reflux. Potential complications of this surgery include the breakdown of the wrap, infection, gastric distention, and retching (Daigneau, 2005). When a child has this procedure, it is essential to limit the volume of formula administered at any one feeding. It is also important to check the residuals prior to each feeding, and if the residuals are greater than the amount specified by the surgeon, the formula is withheld for a specified time. When there is too much volume in the stomach, it can cause the Nissen to come unwrapped.

Management of Impaired Elimination

Children with polymicrogyria are potentially at risk for multiple issues with elimination. Priority nursing diagnoses to consider include urinary retention and constipation. Neurological impairment can lead to a lack of or a delay in bladder control because maturity of the neurological system is necessary to achieve urinary continence (Roijen, Postema, Limbeek, & Kuppeveit, 2001). The neurological dysfunction in polymicrogyria may lead to the development of neurogenic bladder. Children with neurogenic bladder may have difficulty with completely emptying the bladder and may also be unable to initiate the flow of urine (Lemke, Kasprowicz, & Worral, 2005).

The healthcare professional should educate the parents regarding effective management of the child's urinary elimination. The goal of care should focus on effective bladder emptying and prevention of urinary tract infection. See Table 2 regarding the nursing diagnosis of urinary retention. Intermittent catheterization may be necessary for bladder management to prevent urinary retention, but this increases the risk of urinary tract infection. Sterile technique is utilized in most healthcare agencies, and parents are often taught clean technique of catheterization for home management. Current literature indicates that the clean technique is acceptable because it is costeffective without significantly increasing the risk of urinary tract infection. Additional research may need to be conducted (Lemke et al., 2005).

The neurological impairment of polymicrogyria can lead to neurogenic bowel which refers to colon dysfunction related to a neurological disease or damage. Signs and symptoms include constipation, abdominal pain, and distention. The goal of care is to promote regular bowel movements (Coggrave, 2005). See Table 2 regarding the nursing diagnosis of constipation.

Management of Impaired Physical Mobility

Children with polymicrogyria frequently experience some degree of impaired physical mobility. Impaired physical mobility has been defined as limited independent movement (Hur, Park, Kim, Storey, & Kim, 2005). Nursing interventions are included in Table 2.

Parents should be taught to monitor the child for evidence of complications of impaired physical mobility. The potential for complications will vary with each child as the degree of the impairment in physical mobility differs according to the level of neurological dysfunction. Some of the complications for which parents and healthcare professionals should assess include loss of joint mobility and muscle mass, osteoporosis, edema, skin breakdown, and infection. Others include decreased chest expansion leading to inadequate oxygenation, poor cough, respiratory infection, thrombus formation from venous stasis, constipation, and urinary retention (Wilson, 2005 a).

Bone demineralization is a potential complication of impaired physical mobility. Proper nutrition including an adequate supply of calcium and vitamin D is essential to minimize this potential complication. Some antiepileptic medications such as Phenytoin and phenobarbital may increase the risk of bone demineralization. Children with impaired physical mobility may be required to have dual emission x-ray absorptiometry scans to monitor bone mineral density (Palisano & Lally, 2007).

Assistive technology can be utilized to promote independence with activities of daily living to the highest degree possible considering the child's neurological status (Palisano & Lally, 2007). Assistive technology includes equipment for positioning, mobility, and lifting. The home environment may need to be altered with ramps and widened doors and with bathroom modifications to assist with bathing and toileting. Funding for these modifications may be possible through community resources. Visitation by a home care nurse or occupational therapist would be beneficial to assess the home environment and guide implementation and evaluation (Palisano & Lally, 2007).

Seating systems are important as the upright position assists in mininiizing the potential complications of impaired physical mobility. The child's neurological dysfunction will guide the specific seating system, but components to consider include a head- rest, seat and back inserts, anterior and lateral trunk supports, and arm and leg supports. A shoulder harness and seat belt may be needed to ensure safety if a child uses a wheelchair (Palisano & Lally, 2007). Position changes while in the wheelchair should be considered to relieve pressure and prevent skin breakdown. Often, orthotics are utilized to aid in maintaining the child's functional ability. One such example is the ankle-foot orthotic, which helps to maintain the correct angle of the ankle and foot for walking or positioning while sitting in a wheelchair. The ankle-foot orthotic can also be used to prevent further deformity of the joint. Referrals to occupational and physical therapists may be needed because these professionals have the most up-to-date information on available equipment to assist with transfer, hygiene, strengthening, and positioning.

Management of Psychosocial Issues

When a child is diagnosed with a chronic condition such as polymicrogyria, the entire family is affected. The dream of having a typical child is no longer a reality, and the family will experience many changes over time. Many of these children may live into adulthood and will be cared for in the home or communities by their parents or caregivers (Meleski, 2002).

Any chronic illness is stressful. An important factor to note is that parents had many responsibilities prior to the birth of a child with chronic disabilities. With the additional responsibilities that must be managed, the stress level of the family may increase and can lead to frustration and exhaustion (Emione et al., 2005).

Certain factors or transitional times can be very stressful for the families of children with chronic disabilities. Five such transitional events have been identified and include receiving the initial diagnosis, reorganizing tasks within the family, performing skills necessary to manage the condition, recognizing the child's failure to reach appropriate age-related milestones, and observing a change in the course of the child's illness (Meleski, 2002). It is helpful for the healthcare professional to be aware of these transitional times and to intervene with encouragement and guidance to help the family adapt to the situation. Interventions include providing support options, sharing information about the disorder, helping in the management of the child, supporting families with role changes, and assisting families with normalizing their lives (Meleski, 2002).

Family assessments should be completed to determine needs. Support is extremely beneficial for families to better adapt to the child's condition. Assessment of their support systems should be conducted during times of transition. This support can come from the extended family, healthcare professionals, spiritual sources, and support groups for families of children with chronic illness or disabilities (Meleski, 2002). One support group that is very specific for the family of a child with polymicrogyria is the Lissencephaly Network which has a Web site (http:// www.lissencephaly.org/). This is a nonprofit organization that serves children and families affected by lissencephaly and other neuronal migrational disorders including polymicrogyria. When parents understand the child's condition and potential prognosis, they are better able to realistically plan for the future. Healthcare professionals can continue to educate the parents regarding the nature and progression of this disorder to help them anticipate possible limitations and needed adaptations (Meleski, 2002). Management of the child typically falls into the hands of the parents, and a positive relationship with the healthcare provider is important to enhance communication and facilitate a positive outcome for the family. A multidisciplinary approach is beneficial. The parents may need to learn about new skills, medications, use of equipment, and new technologies as appropriate (Meleski, 2002). Parents also need to be educated about the child's right to an education in the least restrictive environment. Personnel from the child's school district can be helpful in giving the parents this information.

The family members will most likely experience changes in their roles and responsibilities as they care for the child with chronic disabilities (Meleski, 2002). The lives of the members of the family will be changed forever. To manage, parents may have to make subtle and/or major changes in their routine. Often, the mother may decrease the number of hours worked outside of the home or the father may increase his number of hours worked (Seltzer, Greenberg, Floyd, Pettee, & Hong, 2001). Siblings of the child with disabilities may take on new responsibilities as well.

Families want to be as normal as possible while caring for their child with a disability. Several interventions can be helpful to assist the family in normalizing their fives. Assessing the families' needs in terms of support systems, coping strategies, and community resources will be helpful in planning appropriate interventions. Some of these include the distribution of tasks, how to coordinate normal routines and care of the child with the disability, and making available names of community services that may be appropriate for the family (Brown-Hellsten, 2005). Parents need to be told to take time for themselves to better enable them to manage the ongoing care of their child (Meleski, 2002).

Polymicrogyria can be a devastating condition for the child and family because management is complex. As neuroscience nurses, we must remember that it is the family who is the most constant variable in the child's life (Meleski, 2002). Listening to the parents is essential when caring for the child, and including the parents in the management is important to help obtain the best possible outcome. Education of the parent regarding the management of clinical manifestations is an important role of the healthcare professional. Anticipatory guidance helps decrease the stress of caring for a child with a chronic disability. A multidisciplinary approach will help address the many different needs of children with polymicrogyria and their families.

Acknowledgment

We dedicate this article to Ashley Turkelson, who was diagnosed with polymicrogyria shortly after her birth. She is the inspiration behind the development of this article. We learn so much from children like Ashley. We hope this article will be beneficial for healthcare providers and caregivers.

Copyright American Association of Neurosurgical Nurses Oct 2009

(c) 2009 Journal of Neuroscience Nursing. Provided by ProQuest LLC. All rights Reserved.

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