Chapter 39: Nursing Care of the Child With an Alteration in Sensory Perception/Disorder of the Eyes or Ears

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?

Recently helped clean the basement Conjunctivitis may be classified as allergic, infectious or chemical. Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen as might be found when cleaning unused spaces. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse?

"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." While 20/20 vision isn't usually achieved until the age of 6 or 7 years, it is important to notify the physician in case there is another cause for the lack of vision clarity. Visual acuity can be assessed prior to the child's ability to read.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?

"Benzocaine drops should be placed in your ear to numb it and reduce pain." Benzocaine numbing eardrops can be prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear.

The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia ("lazy eye"). Which comment provides information most helpful for the parents to know?

"Give him a prize when he wears the patch." Occlusion therapy with a patch is frequently used as treatment. The more compliant the child is, the faster the recovery; rewarding a 4-year-old child for wearing the patch improves compliance and outcome. Information about prevention or completion of visual center development at age 7 will not affect treatment. The benefits of surgical treatment are not pertinent.

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided?

"It's an overgrowth of retinal blood vessels." The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.

The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child?

"Play tough, but wear protective gear." Every study cited shows that safety gear prevents injury. However, adolescents tend to ignore safety warnings. So, encouraging the child to play as tough as he pleases if he's wearing safety gear has the best chance of being heard. He won't pay attention to statistics.

A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.

A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply.

-"I will continue to use eye drops until the redness is gone." -"Our child can go back to school in 4 hours, after that thick yellow drainage is gone." Antibiotic eye drops or ointment should be used until the full course of treatment has been completed. The parent should not stop just because the redness is gone. The child can go back to school 24 to 48 hours, after the mucopurulent drainage is no longer present. The other choices are correct responses.

The nurse is educating the parents of an 18-month-old child being prepared to receive cochlear implants. Which statement by the parents requires further teaching?

After the implant surgery our child will have normal hearing. The cochlear implants will increase the child's hearing but do not restore normal hearing. This statement requires follow-up and further teaching by the nurse. Cochlear implants are surgically implanted and must heal for 2 to 3 weeks prior to activation. After activation, regular hearing tests and speech therapy are required to ensure that the implants are working and to promote speech and language development.

The 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area. The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube Organisms that cause otitis media gain entrance to the middle ear through the eustachian tubes. A cotton swab may damage the eardrum but will not cause otitis media. A child's eustachian tube is shorter, wider, and more horizontal than an adult's. Swimming and other water activity are associated with "swimmer's ear" and not otitis media.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? Myringotomy (incision of the eardrum) may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage. The procedure is done for children with chronic otitis media, not as soon as the child is diagnosed.

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?

Instill a few drops of a topical anesthetic into the affected eye Children who have eye injuries are usually in acute pain immediately after the injury. A few drops of a topical anesthetic instilled into the eye may be necessary to relieve the pain and allow the eye to be opened for examination. To visualize the inner surface of the lower lid and the bottom half of the eye globe, press firmly on the lower lid with your fingertip until it turns out. Grasp the eyelashes and gently stretch the upper eyelid downward. Place the stick of a cotton-tipped applicator horizontally against the center of the upper lid. While still grasping the eyelashes, pull the eyelid upward and over the applicator until it is everted. A foreign body, such as a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted.

The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss?

It is caused by chronic otitis media or another infection. In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.

A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is to keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.

The vision impairment in which the child can see objects at close range but not at a distance is known as:

Myopia Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.

The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child?

Shaking the head and pulling the ear With acute otitis media there is fluid and/or infection in the middle ear causing pain. The child may be very fussy, cry inconsolably, bat the head, tug at the ear or roll the head from side to side to help reduce the pain. Severe vomiting and confusion would be more related to gastroenteritis and dehydration. High-pitched cry and nuchal rigidity are associated with meningitis. Body stiffening and loss of consciousness are associated with seizures.

The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)?

The child cries out when the ear is grasped. External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.

A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?

The frequency of otitis media is reduced in breastfed infants. Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.

The nurse is taking a health history for a 9-year-old girl. Which finding would alert the nurse to a possible risk factor specifically associated with visual impairment?

being of Black race Black race is a risk factor specifically for visual impairment. Although family history of the disorder, genetic syndrome, and previous medication use are risk factors for visual impairment, they are also risk factors for hearing impairment.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the:

importance of patching as prescribed. Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. The need for UV-protective glasses postoperatively is a subject for the treatment of cataracts. The possibility of multiple operations is a teaching subject for infantile glaucoma. Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?

prevention and treatment of otitis media The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.

The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision?

visual acuity of 20/100 If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?

"We need to raise the volume of our voices significantly so he can hear us." It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The nurse is assessing a 4-year-old child who presented to the clinic with a reddened right eye (above). What will the nurse include in teaching for this family? Select all that apply.

-properly administering antibiotic eye drops -keeping the child home from preschool until 24 hours of treatment is complete -encouraging the child not to touch the eye -promoting regular hand hygiene This child is presenting with symptoms of bacterial conjunctivitis, which is treated with antibiotic eye drops. Because bacterial conjunctivitis is highly contagious, the child should stay home for 24 hours of antibiotic treatment and the child should wash hands regularly. The child should also be encouraged to avoid touching the eye to prevent spread. An eyewash product is not indicated; the parents can be taught to gently cleanse the eyelids with a clean washcloth and cool water. Warm compresses may also be used for comfort.

The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age?

2 months of age Newborns are born nearsighted. They prefer the human face to other objects. At 1 month they can recognize by site the people they know. By 2 months of age, the infant can focus and follow an object with the eyes. Binocularity develops at 6 months and color vision follows at 7 months.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is:

Astigmatism Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.

The nurse is caring for a child diagnosed with otitis media with effusion (OME). Which information is most important for the nurse to teach the parents?

Have the ear rechecked every 4 weeks. Otitis media with effusion (OME) occurs when there is fluid in the middle ear. It can occur with or without symptoms. It may occur independently of the child having acute otitis media or it may persist after the acute otitis media has resolved. The largest concerns for the child with this disease are hearing loss and deafness. OME generally resolves spontaneously but, during this time, it is most important to have the ear rechecked every 4 weeks. The parents should also be aware of any hearing loss during the time. If OME persists for greater than 3 months, a referral to a hearing specialist is necessary. Placing the child in the front of the class helps the child with hearing and clearer sounds. Smoking should always be discouraged, as it can indirectly cause this disease. Any symptoms of pain should be reported, as it can be indicative of acute otitis media.

A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse?

"Although there are surgeries for vision, they are not normally recommended for someone your age." In most cases, laser surgery for someone this young is not recommended. Explaining that other girls wear glasses does not answer the teen's original question. While contact lenses may be an option for consideration, this response does not address the teen's question.

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness." Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.

The mother of a 4-week-old infant is discussing her baby's vision with the nurse. What information should be included? Select all that apply.

-Infants experience blurry vision due to the immaturity of their eye structures. -Your baby can see about 8 to 10 inches. -Children will not have 20/20 vision until they are school age. The spherical shape of the newborn's lens does not allow for distance accommodation, so the newborn sees best at a distance of about 8 to 10 inches and a decreased number of cones further contributes to neonatal blurry vision. The optic nerve is not completely myelinated, so color discrimination is incomplete. Visual acuity develops over the first few years of the child's life. Visual acuity improves over the first few years of the child's life, with 20/20 achieved by age 6 or 7 years. The rectus muscles are uncoordinated at birth and mature over time so that binocular vision may be achieved by 4 months of age.

The nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child?

Assessing the child for asymmetric corneal light reflex. Assessing for asymmetric corneal light reflex is the priority intervention as strabismus may develop in the child with regressed retinopathy of prematurity. Observing for signs of visual impairment is not critical for this child, nor is teaching the parents to check how the glasses fit the child. Referral to early intervention would be appropriate if the child was visually impaired.

The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer?

"The tubes are inserted into a section of eardrum in which the hearing is not affected." Tymanostomy tubes help to ventilate the cavities of the middle ear and balance the pressure on each side of the tympanic membrane..Tympanoplasty tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that something may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.

A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client?

Refer the child to a pediatric ophthalmologist The nurse would refer the child experiencing diplopia (double vision) to a pediatric ophthalmologist for further testing; it is imperative to determine the cause to properly treat diplopia. Treatment may be as simple as eye exercises or glasses or could entail surgery. CT or magnetic resonance imaging (MRI) may be prescribed to assist in determining the cause. Knowledge of previous testing would not be a priority at this time. Botulinum toxin injections may be prescribed for treatment. Surgery may be discussed once the underlying cause is identified.

The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification?

"I will need to apply heat to the eye four times a day." To decrease edema in the child with a simple contusion, instruct the parent to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours. Tell the parents and child that bruising of the surrounding eye area may take up to 3 weeks to resolve. Scleral hemorrhage is natural history of resolution without intervention over a period of a few weeks with this type of injury.

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The parent asks what can be done. What information should be included in the information provided to the parent?

Most of these conditions will spontaneously resolve. Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age. If it does not resolve then a specialist can insert a probe to open the canal at 7 to 9 months old with the child under general anesthesia. Antibiotics, not antivirals, would be given to manage infections. There are no eye drops that help with this situation.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia." Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused. Typically, this develops around age 8 years and then progresses. These children can read a book or a computer screen immediately in front of them but are unable to read the blackboard clearly from a distance. There is no indication that the child is experiencing issues with paying attention. This suggestion does not address the parent's initial complaint. Accommodation disorders present with complaints of diplopia and headaches. Hyperopia (farsightedness) presents with vision that is blurry at a close range and clear at a far range, which is opposite of what is being reported for this child.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder?

washing hands frequently Proper handwashing is the single most important factor to reduce the spread of acute infectious conjunctivitis. Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission; keeping the child home from school until she is no longer infectious and encouraging the child to keep her hands away from her eyes are sound preventive measures, but not as important as frequent handwashing.

The parents of a toddler have just learned that their child has profound hearing loss. The parents are very upset and state to the nurse, "It just isn't fair. We did everything right during our pregnancy all the way to this point." How should the nurse respond?

"I can't imagine how difficult this must be. When you're ready I would be happy to arrange a meeting with a support group of other parents with children who have hearing loss." This comment is the most empathic and supportive. Encouraging a support group, when the parents are ready, is very helpful. Those in a support group know how these parents feel and can also offer helpful options for dealing with a hearing-impaired child. Telling the parents to "think positively" or that "things could be much worse" disregards the concern the parents have voiced to the nurse. The nurse generalizes the parents' feelings by telling them "many children who have a profound hearing loss function very well....."

A school-age child was admitted to the emergency department following a simple contusion to the eye from playing baseball. The nurse has given discharge instructions to the parents. Which comment(s) by the parents indicate they understood the discharge teaching? Select all that apply.

"We should use ice intermittently for the first 24 hours." "When we apply ice to the eye, it should only be for about 20 minutes at a time." "It will likely take about 3 weeks or so for all of that bruising to go away." To decrease edema in the child with a black eye (simple contusion), the nurse will instruct the parents to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours. The nurse will also inform the parents and child that bruising of the surrounding eye area may take up to 3 weeks to resolve. The blood in the sclera may take several weeks to resolve and is not damaging to the eye. Wearing an eye patch does not hasten recovery following a simple eye contusion.

The nurse is caring for a male toddler with the genetic disorder of muscular dystrophy. The child has had numerous ear infections and is scheduled for pressure-equalizing (PE) tubes surgery. The parents state, "As if our child's muscular dystrophy isn't enough, now he has to endure ear surgery." What is the best response by the nurse?

"I know it is difficult but it's not unusual for children with genetic disorders to have ear structure problems. This will help prevent future ear infections." Congenital deformities of the ear are often associated with other body system anomalies and genetic syndromes. Showing empathy and explaining why the surgery is necessary is the best response. Simply telling the parents that the surgery is necessary or that the physician feels it's necessary is not sufficient.

A 4-month-old child underwent cataract surgery 3 hours ago. The parents ask why they are only allowed to give the child small amounts of fluid now. How does the nurse respond?

"Introducing fluids slowly reduces the risk of vomiting, which can increase intraocular pressure." After cataract surgery, the plan of care should include slow reintroduction of fluids to reduce the risk of vomiting, which can increase intraocular pressure (IOP). It should also include other measures to prevent increased IOP, such as comforting the child in order to decrease crying. Aspiration is not expected in the postoperative child who is awake after surgery. Bowel obstruction is unlikely after cataract surgery and fluids do not need to be limited for prevention. Electrolyte imbalances are not an anticipated side effect of oral fluid introduction.

A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority?

Relieving the child's pain Acute otitis media is caused by a bacterial or viral infection of fluid in the middle ear. The fluid behind the eardrum has difficulty draining back out because of the horizontal positioning of the eustachian tube. This causes increased pain. Antibiotics are prescribed to cure the infection. Children need pain relief until the antibiotic prescribed reduces the inflammation and pressure. Children pull on the ear as an attempt to reduce the pain and equalize the pressure. Pulling on the ears, especially in an infant, is one of the first signs the parent sees to warn of the ear infection. Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. A mydriatic is a drug that induces dilation of the pupils.

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important for the nurse to convey to the teacher?

Student placement in the room is important but all other teaching methods may remain the same. Amblyopia is when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called "lazy eye." The student can still see and, in some cases, has limited impairment due to brain compensation. It is associated with other conditions such as poor refraction, ptosis, cataracts, or strabismus. The child should be placed where he or she can be in direct view of the teacher or blackboard but the other teaching methods may remain the same. The methods do not need to be shortened nor does the child require a large percentage of the learning to be hands-on.

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?

administering antibiotics as soon as they're available Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than age 2 years.

The mother of a 10-day-old infant reports her baby has been having "lots of eye discharge." What is the best initial response by the nurse?

"Tell me more about this drainage." Tearing or discharge from one or both eyes is often first noted at the 2-week checkup. Obtain a thorough history about the eye drainage to distinguish it from neonatal conjunctivitis. Determine the onset and progression of symptoms, as well as the newborn's response to any interventions attempted so far. The best response by the nurse is an attempt to obtain additional information. Telling the child's mother this is normal in the absence of additional information is inappropriate. Asking if this looks like an infection is asking the child's mother to make a diagnosis. There is no need at this time to consult an eye specialist.

A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment?

how to administer the ear drops Acute otitis media is diagnosed when there is an acute onset of fever and ear pain. The fluid in the middle ear can be infected by either viruses or bacteria. It occurs more often in younger children due to the short length and the horizontal positioning of the Eustachian tube, the limited response to antigens, and the lack of exposure to pathogens. Treatment includes acetaminophen or ibuprofen for pain or fever, warm or cool compresses, and numbing ear drops. When giving instructions about treatment, it is most important for the nurse to teach the parent the correct way to position the pinna to administer the drops. Most parents know how to administer oral medications or apply a cool compress; however, it is rare for parents to know how to pull the pinna to place the ear drops correctly. Depending on the child's age and the severity of the infection, antibiotics may or may not be used.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?

"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 5 years of age, when most children have 20/20 vision. Hyperopia (farsightedness) is a refractive condition in which the person can see objects better at a distance than close up. Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?

Assess the child's ability to convey information. Children who are unable to hear during the first 36 months of life are unable to learn the language necessary for normal verbal communication; therefore, it will be important to assess the child's ability to convey information. Visual assessment is not indicated. Educating parents about botulinum injections is an intervention for strabismus. Vinegar and alcohol eardrops are a treatment for swimmer's ear.

The nurse refers a 2-year-old child to a speech-language pathologist because of limited vocabulary and delayed speech. The speech therapy program requires hearing screening to be completed prior to admission into the program. How does the nurse explain the reason for this to the parents?

Hearing loss can be a cause of delayed speech, so we want to assess this and treat both the hearing and the speech delays if needed. Delayed speech can be a sign of hearing loss and many speech-language pathologists and speech therapy programs require referral to a hearing screening. If there is hearing loss, the child will still benefit from speech therapy, but the hearing loss should also be addressed concurrently.

In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect?

Lack of depth perception (stereopsis) Depth perception or stereopsis is the ability to see objects as three-dimensional. Children with vision loss in one eye do not develop stereopsis and, consequently, tend to reach farther or closer than the actual distance of an object when attempting to grasp it. Accommodation is the adjustment the eye makes to focus on a close image. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). Refractive errors, such as hyperopia (farsightedness) and myopia (nearsightedness), which cause visual impairment, are one of the most common visual deficits in school-age children.

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation?

Moving a penlight toward the client's nose and observing whethe eyes can follow it To test for accommodation, ask a child (over 6 months of age) to follow a penlight as you move it in toward the nose. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). The Stereo-Fly dot test, a test where the image of a fly is constructed from a series of colored dots, is used to test stereopsis. When asked to touch the fly's wings, a child with good depth perception touches them accurately. A child with poor depth perception touches a spot 2 or 3 inches above the pattern. Hirschberg test is used to detect true strabismus. The Weber test is a test for hearing.

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?

Staphylococcus aureus S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.

The nurse admits a 13-year-old client with possible appendicitis to the hospital, accompanied by the parent. The client and parent are both deaf and use sign language to communicate. The nurse needs to assess baseline vital signs and the intake assessment. What should the nurse do while awaiting the arrival of the sign language interpreter?

Write a note to explain the need to assess vital signs. Clients with hearing impairment have a right to be provided with a sign language interpreter and the nurse should defer nonurgent components of the assessment until the interpreter arrives. The nurse should not assume that the child can lip-read or will understand gestures. At age 13, written communication is the best option to communicate the key components of the assessment and to obtain consent and understanding from this child and parent.

When teaching a parent about amblyopia, it would be most important to explain that:

amblyopia is correctable if the child is properly treated before 6 years of age. Amblyopia is poor vision which develops in an otherwise structurally normal eye. With this condition the vision in one eye is decreased because the eye and the brain are not working together. The condition is known as "lazy eye" because one eye is stronger than the other. Amblyopia can be treated if discovered before 6 years of age. This is the reason early detection is so important. Strabismus, not amblyopia, is the rapid movement of the eye. Amblyopia is not caused by a refractive error in the eye. Telling the parent that if the child does not get treated, the child will resent it is not educating the parent. It is the nurse forcing judgment onto the parent, which should not happen.

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

ensuring the protective eye patch is securely in place The priority intervention is to protect the operative site with an eye patch. Teaching about the use of protective sunglasses would be done later in the postoperative period in preparation for the child's discharge. Teaching the parents about administering eye drops would be done later in the postoperative period in preparation for the child's discharge. Explaining about eye patching would be done later in the postoperative period in preparation for the child's discharge.

A school nurse knows that most of the students in the community's elementary school have not received routine vision screening because the families live below the federal poverty threshold. What is the most effective method to promote vision screening for this client population?

offering vision screening to all students in kindergarten The inequities in vision screening and eye care are greater in communities with families whose incomes are below the federal poverty threshold, who are uninsured, and who are members of ethnic minority groups. Many children in these communities never have vision screening. Offering vision screening universally in school could prevent many challenges with health and literacy, and this is the most effective way to screen this population. Vision screening is ideally offered between ages 3 and 5, so screening all students in kindergarten is the best method to promote vision health, rather than waiting until grade 6. Sending home information about screening or signs and symptoms of visual problems does not address the barriers and challenges of affordability and access to vision screening.