Chapter 17: Nursing Care of the Child With an Alteration in Sensory Perception/Disorder of the Eyes or Ears

The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder?

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, narcotic analgesics are not necessary to handle the pain associated with this disorder

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

During this procedure, small tubes are inserted into the typmpanic 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 vision impairment seen in a child 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.

The nurse is preparing an ongoing assessment plan for a child with multiple sensory disorders. What will best contribute to the detection and intervention of problems?

Ongoing parental assessments of their child's capabilities Parental observations of the child's abilities and responses are very important to accurate cognitive and behavioral assessment and prevention of problems. Making assessments only when the child is sick, hurt, or is experiencing problems are not preventive measures. Behavioral assessments should be made on a regular basis, not just when schools provide them.

The nurse has recently admitted a blind child to the pediatric unit. Which interventions should the nurse implement?

• Identify herself to let child know she is there before touching the child. • Allow the child additional time to think about a response to a question. • Explain what individuals are doing. Tips for interacting with the visually impaired include identifying yourself to let the child know you are there before touching them, encouraging independence while maintaining safety, explaining what other children and individuals are doing, allowing the child additional time to respond to questions, and providing directions that are simple and specific.

A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?

"Cataracts are only present in adults." A cataract is a marked opacity of the lens and may be present at birth.

The Caucasian 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?

"You probably won't know for sure the color of your baby's eyes until your infant is 6 to 12 months old." 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.

Regular use of cotton-tipped applicators to clean the ears is recommended.

False 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 an ear canal, causing an invasion site for a secondary infection. This practice may also push accumulated cerumen farther into the ear canal, causing a true plugging of wax.

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?

"Astigmatism doesn't mean being farsighted, it's 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

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?

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 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 Explanation: 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 the age of 2 years.

The mother of a 4-week-old infant is discussing what babies see with the nurse. What information should be included?

• Children will not have 20/20 vision until they are school age. • Infants experience blurry vision due to the immaturity of their eye structures. • Your baby can see about 8 to 10 inches. 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.

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

Relief of pain Acute otitis media is painful. Children need pain relief until the antibiotic also prescribed reduces the inflammation and pressure.

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 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 lens may be something for consideration, this response does not address the teen's question.

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 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 talking with the mother of a 4-year-old son who will soon be going to a prekindergarten 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?

"Children'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 7 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 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 empathetic and supportive. Encouraging a support group, when the parents are ready, is very helpful since these parent are truly the only ones who know what these parents are facing. They 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 child and parents feelings by telling them "many children who have a profound hearing loss function very well....."

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?

"It seems like bright lights really bother him." Photophobia occurs with infantile glaucoma, so bright light may bother the infant. Typically, the infant with infantile glaucoma will keep his eyes closed most of the time. The affected eye may appear enlarged with infantile glaucoma. Tearing is associated with infantile glaucoma.

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

"Play rough, 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 rough 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 of a toddler 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 AOM or may persist after the infectious process of AOM has resolved.

The mother of a child having myringotomy tubes placed asks, "Will my son lose his 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." Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing.

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves." Because myringotomy tubes are foreign objects, the tympanic membrane will extrude them after a time.

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.

An infant is born with congenital glaucoma. She is scheduled for surgery to relieve this condition at age 2 days. Which preoperative order would you question for her?

A preoperative injection of atropine Glaucoma means the exit for intraocular fluid is blocked. A drug that causes pupil dilation narrows the exit of fluid further and, thus, is contraindicated.

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 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; and hyperopia is farsightedness

If the child is following a normal development process, visual acuity gradually increases from birth. What is most accurate regarding the age children develop 20/20 vision?

Children usually develop 20/20 vision by 7 years of age. Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 7 years of age, when most children have 20/20 vision.

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?

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

Hearing aids can improve hearing for children who have inner ear or nerve deafness.

False For children who have conductive losses, an improvement in hearing usually can be achieved by use of a hearing aid (which intensifies the level of sound waves). Children who have inner ear or nerve deafness, however, cannot expect this kind of improvement.

The nurse is caring for an 11-year-old with otalgia and fever. When reviewing the child's medical record, which factor would place the client at risk for acute otitis media?

Her mother has had recurrent otitis media. A positive family history of acute otitis media, as evidenced by the report that her mother has had recurrent otitis media, is a risk factor. Breastfeeding is associated with decreasing the risk for otitis media. A first episode of acute otitis media before 3 months of age would be a risk factor. Crowding in homes or a large family size would be considered a risk factor.

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 ultraviolet-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 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, middle ear structures fail to carry sound waves to the inner ear. This type of impairment most often results from chronic serious otitis media or other infection.

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry Since moisture contributes to otitis externa, the priority is to keep the ear canals dry. Hand washing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not otitis externa. Hearing loss is not associated with otitis externa

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

Prevention and treatment of otitis media The most common cause of conductive hearing impairment is otitis media. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children

The mother of a child with conjunctivitis asks you if her son will develop amblyopia later in childhood because of the infection. You would teach her that amblyopia results from a condition such as:

Ptosis. Amblyopia occurs when vision in the two eyes shows a marked difference. It is associated with poor refraction, ptosis, and strabismus.

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

Recently helped clean the basement Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. 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.

A nurse is preparing a presentation for a group of parents who have children with significant visual impairment. Which action would the nurse be least likely to include as an example of a self-stimulatory action?

Shouting Shouting would not be considered an example of a self-stimulatory action or blindism. Head banging is an example of a self-stimulatory or blindism. Rocking is an example of a self-stimulatory action or blindism. Spinning is an example of a self-stimulatory action or blindism

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

A mother asks you if there is any way to prevent acute otitis media. What would the nurse state to the mother?

The frequency of otitis media is reduced in breastfed infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants, probably because of the more upright position in which they are fed.

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?

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

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?

Two months of age Newborns do not focus clearly but will stare at a human face directly in front of them. By two months of age, the infant can focus and follow an object with the eyes.

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 hand washing 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 preventative measures, but not as important as frequent hand washing.