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37 terms

UNIT 2 pediatric Sensory Disorders

STUDY
PLAY
List the important historical aspects when considering a child experiencing eye disorders.
-Thorough prenatal history
-Growth & development history
-History of infections (including treatment)
-Previous trauma to the eye
-Changes noted in behavior (i.e. rubbing of the eyes)
-Changes in appearance (i.e. red, inflamed eyes; drainage [excessive or deficient] from the eye)
-Physical symptoms (i.e. reports of eye pain, headache, loss of vision, diplopia, blurred vision)
Discuss the important assessments of a child experiencing eye disorders.
-Visually assessing the eye
-Cover/uncover test
-Corneal light reflex
-Photo screening ???
Define acute conjunctivitis and its common name.
-an inflammation of the conjunctiva (the clear, membranous lining of the lid and sclera)
-"Pink eye" is the common name
List the causes and symptoms of acute conjunctivitis.
-Causes
-Allergies, bacteria, or virus
-Chlamydia is responsible for most eye infections in infants
-S&S
-Eye irritation, photophobia, itchy, burning eyes, "scratchy" eyelids
Itchy usually means allergic cause
-Redness, inflammation, drainage

sodium eye drops
Differentiate among the treatment of bacterial, viral, and allergic causes of acute conjunctivitis.
-Bacterial: antibiotic eye drops or ointments; systemic antibiotics (erythromycin) for Chlamydia to prevent
pneumonia
-Viral: antiviral eye drops or ointments
-Allergy: antihistamines (either oral or eye drop); if severe case, steroid and cromolyn
Develop a teaching plan for the parents of a child being treated for acute conjunctivitis.
Teach the parent hand-washing, administration of meds, to change linens frequently, avoid rubbing eyes,
don't send them to school or daycare.
Define stye and its most common cause.
-an infection of a sebaceous gland or oil gland of the eye
-Most common cause is Staphylococcus
Lists the common symptoms of a stye. (notes)
-Pain, redness, edema of the eyelid
-Preauricular lymph nodes enlarged
Discuss the treatment of a stye.
ophthalmic antibiotic ointment and warm, moist compresses
Define periorbital cellulitis and its most common causes.
-an inflammation of the subcutaneous tissue of the eyelid and surrounding orbit
-Most common causes;
trauma
insect bites
nfection of the ethmoid sinus (typically Staphylococcus aureus and S. pneumoniae)
Identify symptoms of periorbital cellulitis
-Often mimics acute conjunctivitis
-Fever, ↑ WBC, malaise, ↓ visual acuity
-severe eyelid edema, erythema, and an anteriorly displaced eye, ↑ intraocular pressure, and
pain
Discuss why it is important to obtain prompt treatment of periorbital cellulitis.
-This disease can rapidly progress to a systemic disease
-If left untreated it can spread to the optic nerve and then to the brain causing meningitis and blindness
Discuss the reasons why children are so susceptible to eye injuries.
-More susceptible due to the cornea being proportionally larger than the adults, and b/c the structures of
the eye are not well protected
Differentiate between penetrating injuries and non-penetrating injuries as it relates to causes and treatments.
-Penetrating
causes: toys, glass pencils, other sharp objects
-treatment:
sedation and removal of object by ophthalmologist or eye surgeon;
ophthalmic antibiotics;
patch affected eye;
tetanus booster if necessary
-Non-Penetrating
causes:
corneal abrasion
foreign object trauma
airbags
baseball bats
hyphema
-chemical burns
treatment:
removal
ophthalmic antibiotic
• water or saline irrigation for chemical burns
Identify appropriate nursing diagnoses for a child having eye surgery.
Disturbed Sensory Perception (visual impairment) related to eye patching or surgical procedure.
pre-op:
-explain expected vision changes (including patches);
-orient child to recovery room and hospital room, explain strange sounds that they might hear
post-op:
-provide orientation for the child;
-provide emotional support
-Risk for Injury related to increase intraocular pressure resulting from bleeding, edema, hematoma,
-postoperative vomiting.
Risk for Infection related to surgical incision.
-monitor post-op for redness, drainage, fever, and excessive tearing or edema
-administer antibiotics as ordered
• Acute pain related to surgical procedure.
Define hyphema and treatment.
-hemorrhage into the anterior chamber of the eye
-Treatment: patch both eyes ≥ 3-5d, bed-rest with HOB at 30-40o, prevent ↑ in intraocular pressure, allow
for reabsorption of blood...may have eye drops (steroid)
strabismus:
failure of the eyes to align due to lack of coordination of extraocular muscles
esotrophia:
turning of the eye inward (most common deviation with infants)
extropia:
turning of the eye outward (occurs when child tries to focus on a distant object
hypertropia:
vertical deviation of one eye
Describe the assessment of a child with suspected strabismus.
-Cover-uncover test
-Corneal light reflex test
-Simultaneous red reflex test
Discuss the treatment for strabismus.
-Corrective lenses
-Patching
-Orthoptics
-Miotic medications
-Surgery (most indicated with amblyopia [lazy-eye] and should be preformed before 2yrs of age)
amblyopia
lazy-eye, reduced vision in one eye caused by disuse or misuse associated with strabismus, unequal refractive errors, or otherwise impaired vision; also called lazy eye
Develop a teaching plan for the parents of a child being patched for the treatment of strabismus.
-Where the eye patch for the amount of time prescribed
-Patching will not harm the child's strong eye, it forces the weak eye to get to be used
-Apply patch directly to face making sure to cover whole eye
- If the child has glasses, wear them over the patch
-Be patient, understanding, and supportive; it can be frustrating to have to wear a patch. However, patching
must be non negotiable
-Praise child to cooperating with treatment
Define amblyopia and the dangers of it not being treated.
-lazy eye; reduction of vision in one eye
-w/o treatment vision may be permanently lost in affected eye as well as permanent loss of depth
perception
-problem is usually not treatable after adolescence
Discuss the possible causes of chlamydial conjunctivitis.
Infants can acquire chlamydial conjunctivitis from passage through the birth canal if the mother is infected.
Develop a discharge plan for a child with a patched eye after a corneal abrasion
-If patching is prescribed (not indicated unless abrasion is large) eye should be covered for 24hrs.
-Do not remove the patch (even for application of ointments) for the 24hrs.
-The eye should be examined in 24hrs
Discuss the important aspects of the history and assessment of a child's ear.
-thorough prenatal history
-Growth & development history
-History of infections (including treatment)
-Previous trauma to the ear
-Changes noted in behavior (i.e. turning up the volume on the TV, decreased attention span)
-Changes in appearance (i.e. drainage from the ears)
-Physical symptoms (i.e. reports of ear pain, headache, nausea or vomiting)
-Inspection: external ear for symmetry, proportion, color; external ear canal for drainage, color, and wax
-Palpate mastoid process
-Assess hearing acuity
Discuss the common causes of hearing loss in the child.
-Autosomal recessive inheritance (causes of 50% of congenital cases) Her notes say autosomal dominant
-Infection: rubella, toxoplasmosis, measles, mumps, otitis media
-perinatal asphyxia and anoxia from birth trauma
-trauma from noise
-head trauma
-Ototoxic drugs, radiation
Identify the symptoms of hearing impairment as they related to the different age groups
-Infant: may not startle at loud noises, may fail to be soothed by mother's voice
-Older infant: may not imitate sounds
-Toddler: no response when name is called, uses nonverbal language
-Preschooler: frequently asks for instructions to be repeated, looks curious when given instructions, needs to watch person's lips to understand
Discuss the treatment options available for the child who is hearing impaired, including cochlear implants.
-Speech therapy
-Lip reading
-Sign language
-Hearing aid: converts sound into electrical impulses across the tympanic membrane
-Cochlear implants: for sensorineural hearing loss; a small electronic device surgically implanted in the
cochlea that delivers electrical stimulation to the inner ear, causing nerve impulses to travel to the brain
where they are interpreted as normal sound.
younger than 12mths.
-These are highly successful in infants
Define otitis media
inflammation of and effusion in the middle ear
List the common precipitating factors involved in otitis media.
-like daycare centers
-native american
-cigarette smoke
-pacifier use
-bottle feeding
-URI
-Allergies
List the signs & symptoms of otitis media and how they may differ with the various age groups.
-URI w/ fever and otalgia (earache); Older child reports pain; younger child pulls at ear
-Irritability
-Vomiting
-Diarrhea
-Bulging, opaque tympanic membrane (looks red)
-Drainage, usually yellowish green, purulent, and foul smelling (this indicates perforation of eardrum)
-may have throat infection
Differentiate between the appearance of a healthy tympanic membrane and one of a child with otitis media.
-Normal: pearl gray w/ light reflex
-OM: red bulging w/ diminished or absent light reflex
Discuss the various treatments of otitis media.
-Broad-spectrum antibiotics
-Decongestants
-Analgesics
-Antipyretics
-Myringotomy for recurrent otitis media
Develop a teaching plan for the care of a child with otitis media and methods of prevention.
-Info about medication administrating
-Prevention
-Stop smoking around your kids
-that's how we do it at the MAN Hospital
-Discontinue pacifier use
-Guard against water in the ears with children that have tubes placed (use earplugs)
myringotomy
surgical incision in the eardrum to create an opening for the placement of tympanostomy tubes