Ch. 17- Nursing Care of the Child With an Alteration in Sensory Perception/Disorder of the Eyes or Ears

The parent of a preschool-age child tell the nurse, "The pink part of the sac of my child's lower eye has been very red for the past couple of days. I bet it is caused by a stye." How should the nurse respond? A. "I can understand why you think it is a stye, but a stye does not typically cause redness in the eye." B. "You may be right. We will have to look into it further to determine the cause." C. "The health care provider is much more qualified to determine what is wrong with your child's eye." D. "Your child likely has some other type of an infection."

A. "I can understand why you think it is a stye, but a stye does not typically cause redness in the eye." Hordeolum (stye) is a localized infection of the sebaceous gland of the eyelid follicle, usually caused by bacterial invasion. Hordeolums do not cause redness of the conjunctiva. This response gives accurate information to the parent. Telling the parent that the "health care provider is much more qualified" belittles the parent and will make the parent defensive.

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

A. "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 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. A. "I will continue to use eye drops until the redness is gone." B. "All of us at home need to wash our hands really well." C. "We should not use a towel that our child has used." D. "This is really contagious." E. "Our child can go back to school in 4 hours, after that thick yellow drainage is gone."

A. "I will continue to use eye drops until the redness is gone." E. "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 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? A. "I will use Visine drops in his infected eye to help reduce redness." B. "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight." C. "I will encourage my son to not touch his eyes." D. "I will wash my hands immediately after caring for him."

A. "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 12-year-old child has developed a stye. Which may be included in the child's care? A. Apply hot, moist compresses to the affected area. B. Apply cool, dry compresses to the affected area. C. Manually express the lesion when a head forms. D. Apply petroleum jelly to reduce irritation.

A. 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 vision impairment in which the child can see objects at close range but not at a distance is known as: A. Myopia B. Exotropia C. Hyperopia D. Esotropia

A. 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 taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? A. Recently helped clean the basement B. Exposure to infective agents C. Recent upper respiratory infection D. Family history of conjunctivitis

A. 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 nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child? Select all that apply. A. Risk for injury B. Pain C. Risk for infection D. Impaired verbal communication E. Delayed growth and development

A. Risk for injury D. Impaired verbal communication E. Delayed growth and development A congenital (present at birth) hearing loss of 60 to 80 dB is considered severe loss. Therefore, this child is at risk for delayed growth and development and impaired verbal communication since he or she may not learn to read, speak, or interact with others at the expected age. This child would also be at risk for injury because he or she cannot hear warnings, verbal or otherwise. Risk for infection and pain would not likely be problems.

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? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Chlamydia trachomatis D. Haemophilus influenzae

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

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

A. The infant does not imitate facial expressions. Infants who have visual impairments may not "fix and follow," do not make eye contact, are unaffected by bright light, and do not imitate facial expressions.

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? A. how to administer the ear drops B. importance of administering antibiotics as prescribed C. option of administering acetaminophen or ibuprofen as needed D. option of using heat or cool compresses for comfort

A. 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 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 bestresponse by the nurse? A. "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision." B. "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." C. "Until your child can read we can't check the visual acuity." D. "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."

B. "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.

The school age child has been diagnosed with astigmatism. The parents state, "I never knew our child had trouble seeing at a distance." How should the nurse respond? A. "Well, all that is important now is that glasses will help astigmatism." B. "Astigmatism does not mean being nearsighted. It is actually a curvature of the cornea that causes blurry vision." C. "I am surprised this was never discovered during a vision screening exam." D. "Sometimes it is difficult to know when a child is nearsighted unless the child notices difficulty seeing at distances."

B. "Astigmatism does not mean being nearsighted. It is actually a curvature of the cornea that causes blurry vision." In astigmatism, the cornea's curvature is uneven, which results in an irregular quality of vision because the light rays are refracted unevenly. Children with astigmatism often have blurry vision and difficulty seeing letters as a whole, so their ability to read is affected; however, they may not realize this is a problem because they have never seen well before. Individuals who can see well up close but have difficulty focusing on items at a distance are said to have myopia or nearsightedness. The opposite is farsightedness or hyperopia, which is being able to see further out than up close. Both can be corrected with corrective lenses.

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? A. "The liquid inside the eye can't drain." B. "It's an overgrowth of retinal blood vessels." C. "This is caused by silver nitrate." D. "This can be genetic or acquired."

B. "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 parent of a 7-year-old child reports having difficulty cleaning the child's ears with a cotton swab. What information should be provided to the parent? Select all that apply. A. Encourage the parent to consider using a few drops of normal saline solution each evening to help keep the ear canal clean and free from wax buildup. B. Advise the parent that swabs can force the ear wax further down into the ear canal. C. Teach the parent that cleaning the ears with the swab may scratch the ear canal. D. Encourage the parent use a few drops of hydrogen peroxide each evening to help keep the ear wax softened. E. Suggest that the parent try a smaller swab to clean the ears.

B. Advise the parent that swabs can force the ear wax further down into the ear canal. C. Teach the parent that cleaning the ears with the swab may scratch the ear canal. Cerumen (earwax) serves the important function of cleansing the external ear canal as it gradually moves outward, bringing with it shed epithelial cells and any foreign object. Parents are often concerned that earwax will lead to a loss of hearing (or they view it as dirty) and so ask health care professionals to have it removed. Wax accumulation rarely is extensive enough in children that it interferes with hearing, and removing it can diminish its protective function, so it should not be removed routinely. Using cotton-tipped applicators to clean ears as a regular practice can also scratch the ear canal, creating a site for a secondary infection. This practice may also push accumulated cerumen farther into the ear canal, resulting in plugging of wax. Commercial softeners are available if cerumen accumulates to such an extent that hearing is affected. In some instances, a dilute solution of hydrogen peroxide may be necessary to dissolve cerumen. Again, this should not be done regularly because this will keep the ear canal constantly moist, an environment that leads to external otitis.

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: A. Refraction B. Astigmatism C. Hyperopia D. Myopia

B. 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.

A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client? A. Stye B. Conjunctivitis C. Blepharitis marginalis D. Chalazion

B. Conjunctivitis Conjunctivitis is inflammation of the conjunctiva and is demonstrated by watery eyes with reddened conjunctiva and sensitivity to light. Sticking of eyelids with pustular drainage is also a sign. It is very contagious and requires antibiotics for treatment. Blepharitis is a chronic scaling with discharge along the eyelid margin. A stye is a localized infection of the sebaceous gland of the eyelid. A chalazion is a chronic painless infection of the meibomian gland. The stye and blepharitis will require antibiotic treatment. A chalazion will clear on its own.

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

B. During this procedure, small tubes are inserted into the tympanic membrane. 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 nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? A. It is often undetected until the child goes to school. B. It is caused by chronic otitis media or another infection. C. It is caused by maternal rubella. D. It is generally severe and unresponsive to medical treatment.

B. 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? A. Performing handwashing B. Keeping ear canals dry C. Adhering to regular follow-up to assess for hearing loss D. Avoiding upper respiratory tract infections

B. 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.

After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher? A. Request a reader to help the child. B. Place the child close to the blackboard. C. Enable the captions with videos. D. Place the child further back in the room.

B. Place the child close to the blackboard. The most common cause of visual difficulties in children is refractive errors. This is where the light entering the lens does not bend appropriately. 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. This means that when in the classroom, the child would do best seated close to the blackboard or in the front row of desks. A child with hyperopia (farsightedness) sees better further away and has blurriness at close range. Enabling closed-captioning is used for those children who have more severe eye problems. A reader would not be necessary if the reading material is placed at the correct distance for the child's vision.

The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child? A. Educating the parents about proper antibiotic use B. Reassessing for language acquisition C. Telling parents not to smoke in the house D. Informing the parents to avoid nonprescription drugs

B. Reassessing for language acquisition Reassessing for language acquisition would be most important to the health of the child. There is a risk of otitis media with effusion causing hearing loss, as well as speech, language, and learning problems. Parents should not use over-the-counter drugs to alleviate the child's symptoms, nor should they smoke around her. In addition, proper antibiotic use is important; however, language acquisition is directly related to developmental health.

The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder? A. applying heated Aqua pad to site B. administering antibiotics IV as ordered C. administering morphine sulfate as ordered D. monitoring for increased intracranial pressure

B. administering antibiotics IV as ordered Intravenous antibiotics will be the primary therapy for this child, followed by oral antibiotics. Warm compresses will be applied for 20 minutes every 2 to 4 hours. However, opioid analgesics are not necessary to handle the pain associated with this disorder.

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

B. using corrective lenses (glasses) C. covering the good eye with a patch D. administering atropine 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. Treatment can consist of wearing corrective lenses (glasses), covering the good eye with a patch, or a combination of the two. Wearing a patch over the good eye forces the child to use the poor eye, thus developing vision in that eye. A further option is the administration of atropine in addition to occlusion therapy, as this almost immediately improves vision in both eyes. Orthoptics are eye exercises to strengthen a weak muscle in the case of strabismus.

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

C. "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.

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? A. "Lots of girls your age wear glasses without issues." B. "We can talk with the doctor about referring you to a surgeon to get this taken care of." C. "Although there are surgeries for vision, they are not normally recommended for someone your age." D. "Let's talk with your mother about getting contact lenses."

C. "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 is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child? A. "Paintball eye injuries have doubled in the past two years." B. "56% of paintball eye injuries have poor outcomes." C. "Play tough, but wear protective gear." D. "Most sports injuries happen to guys your age."

C. "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? A. "There is an infection somewhere in the ear canal and their is fluid in the canal." B. "It's just a medical term that means an infection of the middle ear." C. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." D. "It would probably be best if you talked to the doctor again about the diagnosis."

C. "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.

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract? A. Sclera appears to be blue B. Excess watering of the eyes C. Absence of the red reflex D. Edema of the eyelids

C. Absence of the red reflex The absence of the red reflex and a white, opaque appearance of the lens are telltale signs of a cataract. A blue tinge to the sclera and excess watering of the eyes are signs of glaucoma. Edema of the eyelids is a sign of allergic conjunctivitis.

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? A. Diplopia B. Refractive error C. Lack of depth perception (stereopsis) D. Lack of accommodation

C. 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 parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent? A. Administer acetaminophen if needed for pain. B. Assure the parent that the scleral hemorrhages will resolve. C. Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours. D. Refer the child to an ophthalmologist for further evaluation.

C. Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours. A black eye is caused by a simple contusion to the eye. It affects the surrounding tissue of the eye but does not affect the eye itself. It produces swelling and bruising. It also causes scleral hemorrhage due to rupture of the blood vessels. The best treatment for the contusion is to place ice on for 20 minutes then off for 20 minutes for a 24-hour period. This helps reduce the swelling and pain. The bruising (the "black" eye) occurs from the vessels broken and leaking into the tissue. This may take about 3 weeks to go away. The nurse should assure the parent that scleral hemorrhages are benign but may take several weeks to resolve. The child would not need to be referred to an ophthalmologist unless the vision is impaired. Acetaminophen can be given for pain, but it is not the most important form of treatment for the problem.

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)? A. The ear canal is devoid of cerumen. B. Symptoms of upper respiratory infection are present. C. The child cries out when the ear is grasped. D. The tympanic membrane reacts to a puff of air.

C. 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.

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? A. "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes." B. "Our child will probably have a black eye for at least a couple of weeks." C. "The blood in the white part of the eye is normal with this type of injury." D. "I will need to apply heat to the eye four times a day."

D. "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.

The nurse in the clinic is providing discharge instructions to the parent of a toddler with conjunctivitis. Which comments by the parents require further instruction? Select all that apply. A. "I didn't know that conjunctivitis could be related to allergies." B. "I bet my child's eye infection is related to her upper respiratory infection." C. "I hope my child didn't get this infection from day care." D. "I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected." E. "Cold packs will be most helpful in treating this infection."

D. "I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected." E. "Cold packs will be most helpful in treating this infection." Inflammation of the bulbar or palpebral conjunctiva is referred to as conjunctivitis, and it can be infectious, allergic, or chemical in nature. Warm compresses are best for treating conjunctivitis, along with medications. Conjunctivitis is very contagious and is often transferred from one eye to the other in this age group because children often touch one eye then the other without washing their hands.

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? A. "Have you asked your child's surgeon about that?" B. "Your child's hearing will decrease while the tubes are in place." C. "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." D. "The tubes are inserted into a section of eardrum in which the hearing is not affected."

D. "The tubes are inserted into a section of eardrum in which the hearing is not affected." Myringotomy 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 having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? A. "You will have them replaced every 2 months until you reach age 18." B. "The tubes are not removed; they grow permanently into place." C. "The tubes remain in place for 6 months and then are dissolved by vinegar." D. "The tubes remain in place for 6 to 12 months until they come out by themselves."

D. "The tubes remain in place for 6 to 12 months until they come out by themselves." 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? A. Explain botulinum injection procedure and risks. B. Teach parents to make vinegar and alcohol eardrops. C. Assess vision to determine functional capability. D. Assess the child's ability to convey information.

D. 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 is caring for a child diagnosed with otitis media with effusion (OME). Which information is most important for the nurse to teach the parents? A. Report any symptoms of ear pain. B. Ask the teacher to place the child in the front during class. C. Avoid smoking in the home. D. Have the ear rechecked every 4 weeks.

D. 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 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? A. Over-the-counter drops can be used sparingly. B. Once the child is 6 to 9 months old a specialist will be able to drain the duct. C. Antiviral therapy can be prescribed to manage this condition. D. Most of these conditions will spontaneously resolve.

D. 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.

The nurse is preparing a toddler for surgery for insertion of pressure-equalizing (PE) tubes. The nurse is ensuring the parents understand the procedure. Which comments by the parents demonstrate to the nurse that they understand the procedure? Select all that apply. A. "I am excited to see if our child starts talking more after the tubes are placed." B. "We will need to schedule removal of the PE tubes in a couple of months." C. "We live on a lake and often swim with our child. We will be sure to use earplugs when swimming." D. "I am so happy that my child will no longer get ear infections." E. "Our surgeon may require the use of earplugs when bathing our child."

A. "I am excited to see if our child starts talking more after the tubes are placed." C. "We live on a lake and often swim with our child. We will be sure to use earplugs when swimming." E. "Our surgeon may require the use of earplugs when bathing our child." Placement of PE tubes does not prevent middle ear infection; if infection occurs with PE tubes in place, the tubes allow infected fluid to drain from the ear. After PE tubes are placed, young children often have rapid increases in language acquisition since their hearing is often improved. Because of possible bacteria contamination from lake water, earplugs are necessary to prevent infection. The tubes stay in place for at least several months and generally fall out on their own. In order to prevent water in the ear the surgeon may advise the use of earplugs in the bathtub or while swimming.

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? A. administering antibiotics as soon as they're available B. obtaining a culture of fluid from the middle ear C. determining if the girl's balance is shaky when walking D. administering antivirals to ensure broad coverage of all organisms

A. 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 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? A. washing hands frequently B. properly applying the prescribed antibiotic C. staying home from school D. keeping hands away from eyes

A. 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.

A child is being prepared for discharge after sustaining a simple contusion of the eye. Which advice would the nurse expect to include in the discharge instructions? A. Inform the parents to call their pediatrician if the bruising persists for more than 2 days. B. Tell the parents that although the condition is frightening, no intervention is needed. C. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. D. Teach the parents how to apply ophthalmologic antibiotic ointment properly.

C. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. To decrease the edema of a simple contusion, the parents should be instructed to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, continuing to repeat this cycle as often as possible during the first 24 hours. Bruising of the surrounding eye area may take up to 3 weeks to resolve. A sclera hemorrhage typically requires no treatment and resolves on its own over a period of a few weeks. A simple contusion does not require the use of antibiotic ointment. However, corneal abrasions may require antibiotic ointment.

The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed? A. slow increases in language development B. constant fluid draining from the child's ears C. improvement of the child's language and speech development D. decreased ability for the child to hear

C. improvement of the child's language and speech development Pressure equalizing tube placement allows for adequate hearing resulting in improvement of speech development and rapid increases in language acquisition. The drainage should not be constant, and parents should be instructed to call their health care provider if drainage is noted.

The school nurse is assessing a student complaining of left eye pain. Upon visual inspection, the nurse notes left conjunctivae redness and thick, colored discharge. The nurse understands that these signs and symptoms are consistent with which diagnosis? A. chalazion B. allergic conjunctivitis C. viral conjunctivitis D. bacterial conjunctivitis

D. bacterial conjunctivitis Bacterial, viral, and allergic conjunctivitis signs and symptoms include redness, edema, tearing, and eye pain. Bacterial conjunctivitis has colored, thick discharge; viral conjunctivitis has clear or white discharge; and allergic conjunctivitis results in watery discharge. Chalazion is a painless infection of the meibomian gland which may be visible as a small nodule on the lid margin. The conjunctivae remain clear with chalazion.

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

D. 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? A. tendency to act silly in the classroom B. suddenly doing poorly in school C. playing the radio loudly D. prevention and treatment of otitis media

D. 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.