Care for Child With Alteration in Sensory Perception/Disorder of the Eyes or Ears

A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority? 1 Relieving the child's pain 2 Administering a mydriatic 3 Cautioning the child not to pull on the ear 4 Cautioning the child not to blow the nose

1 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. NOT 3 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. 4 Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. 2 A mydriatic is a drug that induces dilation of the pupils (Mydriasis - dilation of the pupil)

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision? 1 Amblyopia 2 Exotropia 3 Diplopia 4 Nystagmus

1 Amblyopia, if untreated, will get worse in the poorer eye and will cause strain on the better eye, which may also lead to worsening of acuity in that eye. Eventually blindness will result in one or both eyes. NOT 2 Exotropia can develop into amblyopia but not lead to a loss of vision. 3 Diplopia can cause vision impairment but not loss of vision. 4 Nystagmus (rapid involuntary movement of eyes) can cause vision impairment but not lead to a loss of vision

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? 1 administering antibiotics as soon as they're available 2 obtaining a culture of fluid from the middle ear 3 determining if the girl's balance is shaky when walking 4 administering antivirals to ensure broad coverage of all organisms

1 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 US Academy of Peds / Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. NOT 2 It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. 3 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. 4 Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than age 2 years

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? 1 Instill a few drops of a topical anesthetic into the affected eye 2 Press firmly on the lower lid with the fingertip until it turns out 3 Grasp the eyelashes of the upper eyelid and evert it 4 Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator

1 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. 2 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. 3 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. 4 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? 1 It is caused by chronic otitis media or another infection. 2 It is caused by maternal rubella. 3 It is generally severe and unresponsive to medical treatment. 4 It is often undetected until the child goes to school.

1 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. NOT 4 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. 3 This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. 2 Rubella causes sensorineural hearing loss.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement? 1 encouraging the child to keep his hands away from his eyes 2 washing the child's hands and face when returning from outdoors 3 rinsing the child's eyelids with a clean washcloth and cool water 4 making sure the child showers and shampoos before bedtime

1 Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. NOT 2.3.4. Washing the child's hands and face when returning from outdoors, rinsing the child's eyelids, and showering and shampooing before bedtime are all things the parents can supervise and ensure occurs, and thus would be less difficult to implement

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? 1 During this procedure, small tubes are inserted into the tympanic membrane. 2 This procedure is performed as soon as otitis media is diagnosed. 3 A small incision is made in the earlobe during this procedure. 4 The purpose of this procedure is to decrease or stop the drainage.

1 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

The parent of a child having myringotomy tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? 1 "The tubes are inserted into a section of eardrum in which the hearing is not affected." 2 "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." 3 "Your child's hearing will decrease while the tubes are in place." 4 "Have you asked your child's surgeon about that?"

1 Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. NOT 2.3. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. 4 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 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? 1 "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." 2 "It's just a medical term that means an infection of the middle ear." 3 "There is an infection somewhere in the ear canal and their is fluid in the canal." 4 "It would probably be best if you talked to the doctor again about the diagnosis."

1 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

The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion? 1 "It seems like bright lights really bother him." 2 "He opens his eyes quite frequently when he's awake." 3 "His eye looks about the same size as his other eye." 4 "His eye doesn't seem to tear much."

1 Photophobia occurs with infantile glaucoma, so bright light may bother the infant. NOT 2 Typically, the infant with infantile glaucoma will keep his eyes closed most of the time. 3 The affected eye may appear enlarged with infantile glaucoma. 4 Tearing is associated with infantile glaucoma

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? 1 Keeping ear canals dry 2 Performing handwashing 3 Avoiding upper respiratory tract infections 4 Adhering to regular follow-up to assess for hearing loss

1 Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is to keep the ear canals dry. NOT 2 Handwashing would be a priority for preventing infections such as conjunctivitis. 3 Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). 4 Hearing loss is not associated with otitis externa

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? 1 "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." 2 "Even when we do the right thing, it doesn't always ensure that our child will be healthy. It's important to think positively." 3 "There could be much worse things to happen to your child. At least your child is healthy in all other aspects." 4 "Many children who have a profound hearing loss function very well. There are lots of treatments available."

1 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. NOT 2.3. Telling the parents to "think positively" or that "things could be much worse" disregards the concern the parents have voiced to the nurse. 4 The nurse generalizes the parents' feelings by telling them "many children who have a profound hearing loss function very well....."

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? 1 Moving a penlight toward the client's nose and observing whether his eyes can follow it 2 Having the child touch the fly's wings in an image constructed of colored dots 3 Performing Hirschberg test 4 Performing a Weber test

1 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). NOT 2 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 (perception of depth). 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. 3 Hirschberg test is used to detect true strabismus. 4 The Weber test is a test for hearing

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? 1 "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." 2 "We don't check a child's vision until they are 6 to 7 years old because their visual acuity hasn't peaked until then." 3 "Until your child can read we can't check the visual acuity." 4 "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision."

1 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

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment? 1 The infant can "fix and follow." 2 The infant does not imitate facial expressions. 3 The infant makes eye contact. 4 The infant blinks quickly when a bright light is shone in the eyes.

2 Infants who have visual impairments may not imitate facial expressions NOT 3 Do not make eye contact 4 Are unaffected by bright light 1 Do not "fix and follow"

The parents of a newborn state, "We are so excited that our baby was born with blue eyes! We were hoping the baby would take after our other child." How should the nurse respond? 1 "It's not uncommon for babies to be born with blue eyes." 2 "You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old." 3 "You can hope they stay that color. There is no guarantee." 4 "The baby's iris will likely become more pigmented, so it's unlikely the eyes will not be blue."

2 Light-skinned children are often born with blue eyes. The iris becomes pigmented over time and eye color is determined by 6 to 12 months of age.

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? 1 "He might be suffering from hyperopia and probably will need glasses now." 2 "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." 3 "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." 4 "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school."

2 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. NOT 1 Hyperopia (farsightedness) is a refractive condition in which the person can see objects better at a distance than close up. 3 Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions.

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: 1 Refraction 2 Myopia 3 Astigmatism 4 Hyperopia

3 Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. NOT 1 Refraction is the way light rays bend as they pass through the lens to the retina. 2 Myopia is nearsightedness 4 Hyperopia is farsightedness

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? 1 properly applying the prescribed antibiotic 2 staying home from school 3 washing hands frequently 4 keeping hands away from eyes

3 Proper handwashing is the single most important factor to reduce the spread of acute infectious conjunctivitis. NOT 1 Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission 2.4. 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

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? 1 "You will have them replaced every 2 months until you reach age 18." 2 "The tubes remain in place for 6 months and then are dissolved by vinegar." 3 "The tubes remain in place for 6 to 12 months until they come out by themselves." 4 "The tubes are not removed; they grow permanently into place."

3 The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears

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? 1 Assess vision to determine functional capability. 2 Explain botulinum injection procedure and risks. 3 Teach parents to make vinegar and alcohol eardrops. 4 Assess the child's ability to convey information.

4 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. NOT 1 Visual assessment is not indicated. 2 Educating parents about botulinum injections is an intervention for strabismus. 3 Vinegar and alcohol eardrops are a treatment for swimmer's ear

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)? 1 The tympanic membrane reacts to a puff of air. 2 Symptoms of upper respiratory infection are present. 3 The ear canal is devoid of cerumen. 4 The child cries out when the ear is grasped.

4 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. NOT 2 Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. 1 The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. 3 The absence of cerumen in the ear canal is not related to external otitis.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: 1 need for ultraviolet-protective glasses postoperatively. 2 importance of completing the full course of oral antibiotics. 3 possibility that multiple operations may be necessary. 4 importance of patching as prescribed.

4 Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. NOT 1 The need for UV-protective glasses postoperatively is a subject for the treatment of cataracts. 3 The possibility of multiple operations is a teaching subject for infantile glaucoma. 2 Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.

A child has recently been diagnosed with cataracts. The treatment for cataracts is:

A cataract is marked opacity of the lens. It can be present at birth. Treatment for childhood cataracts is surgical removal of the cloudy lens, followed by insertion of an internal intraocular lens

A 5-year-old child is diagnosed with amblyopia. What treatment option(s) is helpful? Select all that apply. 1 covering the good eye with a patch 2 using corrective lenses (glasses) 3 administering atropine 4 covering the bad eye with a patch 5 using orthoptics

Amblyopia is "lazy eye," or subnormal vision in one eye, which causes a child to use only one eye for vision while "resting" the other eye. 2.1. Treatment can consist of wearing corrective lenses (glasses), covering the good eye with a patch, or a combination of the two. NOT 4 Wearing a patch over the good eye (NOT bad eye) forces the child to use the poor eye, thus developing vision in that eye. 3 A further option is the administration of atropine in addition to occlusion therapy, as this almost immediately improves vision in both eyes. 5 Orthoptics are eye exercises to strengthen a weak muscle in the case of strabismus

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 to understand? 1 Hands-on learning should account for 90% of the teaching method. 2 Student placement in the room is important but all other teaching methods may remain the same. 3 Teaching sessions will need to be shortened due to eye strain. 4 There are no teaching methods that need to be considered.

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 (dropping of upper eyelid), cataracts, or strabismus. 2 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. NOT 3.1.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 works in a pediatrician office. Which children, who have been diagnosed with acute otitis media, does the nurse expect the physician to treat with antibiotics? Select all that apply. 1 12-year-old child who reports he has some mild ear pain with a temperature of 101.4 F (38.6 C) 2 8-year-old child who is crying due to ear pain and has a temperature of 103 F (39.4 C) 3 2-month-old child who is having difficulty sleeping and has a fever of 102.6 F (39.2 C) 4 5-month-old child who is fussy and pulling at her ears 5 22-month-old child who is irritable with the presence of purulent drainage from her right ear

Children who are 2 years old or younger and have a severe form of acute otitis media with a temperature of 102.2 F (39 C) or higher will most likely receive antibiotics to treat the infection. Children who are older than 2 years of age with severe otalgia and a fever higher than 102.2 F (39 C) typically receive antibiotics. Children who are older than 2 years of age and have mild otalgia and a fever lower than 102.2 F (39 C) have a nonsevere illness. In these cases, the physician may just observe the children to see if their symptoms persist over time or get worse (2.3.4.5.)

The nurse is planning an education program on ear infections in children. What information should be included? Select all that apply. 1 Breastfed and bottle-fed infants have similar rates of ear infections. 2 Otitis media occurs more in the winter months. 3 Otitis media is most common in male children. 4 The disorder is most common in school-age children. 5 Decongestant drops may be needed for about a week in the management of the infection.

Inflammation of the middle ear (otitis media) is one of the most prevalent diseases of childhood. 1 Infants who are formula-fed are more likely to be impacted than breastfed infants. Formula-feeding leads to this because infants are held in a more slanted position while feeding, allowing milk to enter the eustachian tube. 2 The incidence of otitis media is highest in the winter and spring because it frequently follows an upper respiratory infection 3 Children most susceptible to it are males. NOT 4 It occurs most often in children 6 to 36 months of age and again at 4 to 6 years.

Myopia

Myopia (nearsightedness) is caused when the light falls in front of the retina. With this problem, children see well at close range and cannot see well at a distance. The most common cause of visual difficulties in children is refractive errors. This is where the light entering the lens does not bend appropriately.

Exotropia

Outward turning of the eye(s) A form of strabismus

Stereopsis

The process by which the visual cortex combines the differing neural signals caused by binocular disparity, resulting in the perception of depth

Stye cause & management

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. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

The Weber test

Tuning fork test that evaluates bone conduction of sound in both ears at the same time

Hirschberg test

akaCorneal light reflex examination checking for ocular alignment

Strabismus

cross-eyed / abnormal deviation of the eye