Exam 5- Eyes and Ears Saunders

The nurse is providing home care instructions to the mother of a 9-year-old child diagnosed with bacterial conjunctivitis. Topical antimicrobial therapy is prescribed for the child. Which statement by the mother indicates the teaching has been effective?

"My child will need to stay home from school until my child has received the eye medication for at least 24 to 48 hours." Bacterial conjunctivitis is extremely contagious. The child should be kept home from school or day care until the child has received topical antimicrobial therapy for 24 to 48 hours per pediatrician prescription.

The nurse provides discharge instructions to the mother of a child following a myringotomy with insertion of tympanoplasty tubes. Which statement by the mother indicates the need for further teaching?

"My child can swim in the lake or pool as long as the water is not too deep." Bath water and lake water are potential sources of bacterial contamination. Diving and swimming deeply under water are prohibited. Parents need to be instructed that the child should not blow the nose for 7 to 10 days. The child's ears need to be kept dry, and Vaseline on cotton balls or earplugs can be placed in the ears during a bath or shower.

The nurse prepares a teaching plan for the mother of a child diagnosed with bacterial conjunctivitis. Which, if stated by the mother, indicates a need for further teaching?

"It is okay to share towels and washcloths." Conjunctivitis is an inflammation of the conjunctiva. Bacterial conjunctivitis is highly contagious, and the nurse should teach infection control measures. These include good hand washing and not sharing towels and washcloths, cleaning eyes as prescribed, washing hands and giving eyedrops as prescribed.

The nurse is providing care to a child admitted for acute otitis media. What is the nurse's priorityconcern for this child?

-Acute pain In acute otitis media, symptoms and signs such as acute ear pain, fever, and a bulging yellow or red tympanic membrane usually are present. Nursing interventions focus on relieving pain. Analgesic medications such as acetaminophen or ibuprofen are used to treat mild pain. The priority concern for this condition would be acute pain.

A 4-year-old child is diagnosed with otitis media. The mother asks the nurse about the causes of this illness. Which risk factors should the nurse include in response to this mother?

Factors that increase the risk of otitis media include bottle-feeding, household smoking, exposure to illness from other children in day care centers, and congenital conditions such as Down's syndrome and cleft palate. The use of a pacifier beyond age 6 months has been identified as another risk factor. Allergies are also thought to precipitate otitis media.

An adolescent client is diagnosed with conjunctivitis, and the nurse provides information to the client about the use of contact lenses.

If the adolescent wears contact lenses, the adolescent should be instructed to discontinue wearing them until the infection has cleared completely.

On assessment during a well-baby visit, the nurse notes that a 6-month-old infant has crossed eyes. Which interpretation would the nurse make based on this finding?

Surgical intervention may be necessary to realign weak eye muscles. Strabismus (squint or crossed-eyes) is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. This condition, considered a normal finding in a young infant, should not be present after about age 4 months. Loss of vision can occur if not treated early. Patching of the good eye to strengthen the weak eye may be prescribed, and if nonsurgical intervention is unsuccessful then surgery may be necessary to realign the weak muscles.

The nurse has a prescription to give eardrops to a 5-year-old child. Which position should the nurse use to pull the pinna of the ear?

When giving eardrops to a child older than 3 years, the pinna is pulled upward and backward. To administer eardrops properly to a child who is younger than 3 years old, the pinna of the ear should be pulled downward and backward. The other options are incorrect.

Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics.

A myringotomy is the insertion of tympanoplasty tubes into the middle ear to promote drainage of purulent middle ear fluid, equalize pressure, and keep the ear aerated. The nurse must instruct parents regarding the administration of antibiotics. Antibiotics need to be taken as prescribed, and the full course needs to be completed.

The nurse is caring for a 2-year-old child with an ear infection who requires the administration of antibiotic eardrops.

To administer eardrops to a child younger than 3 years, the earlobe should be pulled down and back. In the older child, the earlobe is pulled up and back to obtain a straight canal. Gloves do not need to be worn by the parents, but hands must be washed before and after the procedure. The child needs to be in a side-lying position with the affected ear facing upward to facilitate the flow of medication down the ear canal by gravity.

The mother arrives at a well-baby clinic with her 1-month-old infant. She expresses concern because one of the infant's eyes appears to be crossed. What is the nurse's best response?

"This is normal in the young infant but should not be present after the age of about 4 months." Strabismus, is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. It is normal in the young infant but should not be present after the age of about 4 months. The remaining options are not appropriate responses to the mother of a 1-month-old infant.

The mother of a child who has undergone a myringotomy, with insertion of tympanoplasty tubes, telephones and tells the nurse that the tubes have fallen out. Which is the appropriate response to the mother?

"This is not an emergency. I will speak to the primary health care provider and call you right back." A myringotomy is the insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep the ear aerated. The parent should be reassured that if the tubes fall out, it is not an emergency, but the primary health care provider should be notified.

An ambulatory care nurse makes a follow-up telephone call to the mother of a child who underwent a myringotomy with insertion of tympanoplasty tubes on the previous day. The mother of the child tells the nurse that the child is complaining of discomfort. What should the nurse instruct the mother to do?

-Administer acetaminophen. Following myringotomy with insertion of tympanostomy tubes, the child may experience some discomfort. It is not necessary to notify the primary health care provider (PHCP), and additionally, this response to the mother may alarm her. Aspirin should not be given to the child. Acetaminophen can be given to relieve the discomfort. Calling the pharmacist is inappropriate.

A 10-year-old child complains of ear pain that is aggravated by palpation of the auricle. A foul-smelling, tenacious yellow discharge is noted in the ear canal, and the child is diagnosed with acute otitis externa. In providing information to the child and parent, the nurse emphasizes which information?

-Nothing smaller than the child's elbow should be placed in the ear. The nurse should provide information about ear care to children because it is not uncommon for them to put sharp or small objects, such as cotton swabs, into their ears, and these behaviors can cause injury. A facecloth on a fingertip is safe to use for ear cleaning. Acute otitis externa may cause a low-pitched tinnitus but usually does not cause dizziness unless the condition has progressed to an otitis media. Audiography is performed during a screening done at school, usually every year, and does not necessarily need to be performed by a special primary health care provider.

The nurse is assisting in providing an educational session to new mothers regarding the methods that will decrease the risk of recurrent otitis media in infants. Which statement by a mother in the group indicates understanding?

To decrease the risk of recurrent otitis media, mothers should be encouraged to breast-feed during infancy, discontinue bottle-feeding as soon as possible, feed the infant in an upright position, and never give the infant a bottle in bed. Additionally, parents should be told not to smoke in the child's presence because passive smoking increases the incidence of otitis media.

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply.

-Provide a soft diet. -Administer ibuprofen for fever every 4 hours as prescribed and as needed. -Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy. Acute otitis media is an inflammatory disorder caused by an infection of the middle ear. The child often has fever, pain, loss of appetite, and possible ear drainage. The child also is irritable and lethargic and may roll the head or pull on or rub the affected ear. Otoscopic examination may reveal a red, opaque, bulging, and immobile tympanic membrane. Hearing loss may be noted, particularly in chronic otitis media. The child's fever should be treated with ibuprofen. The child is positioned on her or his affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur with chewing. Antibiotics are prescribed to treat the bacterial infection and should be administered for the full prescribed course. The ear should not be irrigated with normal saline because it can exacerbate the inflammation further. Antihistamines are not usually recommended as a part of therapy.

The primary health care provider prescribes patching for a child with strabismus of the right eye, and the nurse instructs the mother regarding this procedure. What should the nurse include in the instructions?

-Place the patch on the left eye. Patching may be used in the treatment of strabismus to strengthen the weak eye. In this treatment, the better-functioning eye is patched. This encourages the child to use the weaker eye. It is most successful when done during the preschool years. The schedule for patching is individualized and is prescribed by the ophthalmologist

The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition?

The child consistently tilts the head to see. Strabismus is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent headaches, squints, or tilts the head to see. Other manifestations include crossed eyes, closing one eye to see, diplopia, photophobia, loss of binocular vision, or impairment of depth perception.

The nurse in the health care clinic receives a telephone call from the mother of a child who reports that an insect has somehow flown into the child's ear. The mother reports that the child is complaining of a buzzing sound in the ear. Which priority instruction should the nurse provide to the mother?

Use a flashlight to coax the insect out of the ear. Insects that make their way into an ear often can be coaxed out using a flashlight or a humming noise. If this is unsuccessful, then the insect must be killed before removal. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which is then removed by means of an ear forceps. The mother should be instructed not to irrigate the ear or attempt to remove the insect by using tweezers because this could damage the ear. If the mother is unsuccessful in coaxing the insect out of the ear, she should be instructed to report to the clinic or the hospital emergency department.