"Nurse, my head hurts": a review of childhood headaches.

Headache, a frequent occurrence during childhood, can have a number of etiologies. Most headaches are benign, but all require appropriate assessment. Common types include sinusitis, migraine, and muscle contraction (tension). Headache assessment includes both history and physical examination. The headache history consists of the history of present illness, past history, family history, and environmental and social history. Physical examination begins with general observation and vital sign measurement and proceeds to specific inspection of the head, neck, and facial structures. The nursing interventions carried out are dependent on the interpretation of assessment findings. Pharmacologic interventions, commonly acetaminophen or ibuprofen, may be appropriate if pain management protocols exist. Nonpharmacologic strategies for headache relief include reassurance, rest, ingestion of simple and complex carbohydrate foods, relaxation exercises, or home care. Children with migraine headaches benefit from specific interventions, and children exhibiting headache warning signs should have emergency measures instituted.     

Not your "typical patient": cryptococcal meningitis in an immunocompetent patient.

Meningitis, when caused by the fungal mycoses Cryptococcus neoformans, is normally seen in immuno-compromised hosts. However, immunocompetent patients are also susceptible to cryptococcal meningitis (CM). In patients with an intact immune system, CM usually presents with the typical signs and symptoms of meningitis: fever, stiff neck, and headache. Major implications for the primary and advanced practice nursing plans of care for CM patients include a thorough history and physical exam, early diagnosis and treatment, and an individualized plan of care focused on minimizing sequelae and side effects of treatment and maximizing functional recovery.