peds - chapters 29, 30, 34 eye ear and dental
what CN are you testing with peripheral vision?
CN 2
at what age should you refer to an ophthalmologist if an infant cannot fixate or follow/track (binocularly and monocularly)?
3 months Birth to 2 weeks old ---- Infant sees and responds to change in illumination; refuses to reopen eyes after exposure to bright light; increasing alertness to objects; fixes on contrasts (e.g., black and white); jerky movements; pupillary reaction present. By 2 to 4 weeks old ----Infant fixes and follows on an object, though sporadically. By 3 to 4 months old ----Infant recognizes parent's smile; looks from near to far and focuses close again; beginning development of depth perception; follows 180-degree arc; reaches toward toy; few exodeviations; esotropia abnormal. By 4 months old ----Color vision near that of an adult; tears are present.
describe use for 38% diamine silver fluoride
ACTIVE tooth decay When tooth decay is present, subsequent dental visits may involve arresting the decay or more extensive restorative treatment by topically treating the decayed surfaces with 38% diamine silver fluoride (side effect is black staining of the carious lesion) In high-risk communities with poor access to dentists, PCPs can be trained in applying this treatment
you are examining an infant who has a family history of Retinoblastoma. what do you do?
Infants with family history of RB should be referred at 1-6 weeks for ophthalmologic exam
What is ankyloglossia?
1. tongue tied 2. thick lingual frenum resulting in limitation of tongue movement Usually no treatment is needed. If the extent of the ankyloglossia is severe, breastfeeding may be difficult and a minor surgical incision is likely to help improve feeding. If speech is affected later in life, a referral for a surgical correction is indicated.
describe a ranula
- a lesion that has clear or bluish mucous, fluctuant swelling of floor of mouth - retention of salive due to trauma to a salivary gland duct - may impair eating, swallowing and speech -cyst filled with mucin from a ruptured salivary gland. -It is associated with a major salivary gland in the sublingual area and is caused by lip or cheek biting. -large, soft, mucus-containing swelling in the floor of the mouth. The cyst should be excised by an oral surgeon
describe Pyogenic Granuloma
-Rapidly growing nodule (pulpy vascular lesion) -Common in childhood and pregnancy -an inflammatory hyperplasia It is usually a small outward growing lesion that is smooth or lobulated and sometimes hemorrhagic. It typically occurs on the gingival, lips, tongue, buccal mucosa, and hard plate. The surface color ranges from pink to red to deep purple, depending on how long the lesion has been present in the oral cavity. Pyogenic granulomas can occur after 4 years of age but are more common in pregnant women. tx: improved oral hygiene, 0.12% chlorhexidine gluconate rinses, surgical excision, cryosurgery, or intralesional injections of corticosteroids. Refer if hygiene ineffective
describe Bruxism
-aka Grinding -excessive grinding of the teeth -prevalence rate of 15% for sleep-related bruxism and slightly over 12% for wake-time tooth clenching. under 12 yo more likely to report sleep-related bruxism, whereas over 12 yo experienced more wake-time tooth clenching. -causes: underlying stressors, secondhand smoke. -clenching: more headaches and loud breathing during sleep -bruxism: TMJ clicking and sleep/behavioral issues. - No tx required for most part. -plastic night guards rarely eliminates grinding. -relaxation training for stress management and other self- management skills, including control of gum chewing, have been shown to be effective in helping to manage facial muscle pain and headache.
describe Benign Migratory Glossitis
-aka geographic tongue or erythema migrans -etiology is unknown. -usually asymptomatic, yellowish-white, circular or serpentine-bordered lesions with atrophic red centers varying in intensity on the anterior two thirds of the dorsum of the tongue -may experience pain when eating hot or spicy foods. Proposed risk factors for BMG include immunologic factors, hormonal changes, use of oral contraceptives, diabetes mellitus, and stress. Diagnosis is made by appearance; patients can be reassured that the lesions are benign and do not generally require treatment. If treatment is indicated for pain, topical steroids, zinc supplements, and topical anesthetic rinses have been used with varying success
How much toothpaste should children use?
A small amount of toothpaste (a smear or "rice-sized" for children under 3 years old and about "pea-sized" for children 3 years old and older) should be used. The child should not rinse after brushing. Swallowing these small amounts of toothpaste twice daily is not harmful. However, the amount of toothpaste used should be controlled by an adult because children can swallow a large amount of what is brushed on; this added systemic intake of fluoride can lead to an increased risk of enamel fluorosis prior to complete enamel maturation. In children at very high risk for tooth decay, parents should begin brushing teeth with fluoridated toothpaste with the eruption of the first tooth at 6 to 9 months old.
describe Diastema
A space between any neighboring two teeth During the mixed dentition stage, when both primary and permanent teeth are present, a midline space between the upper front teeth is normal. If the teeth are not otherwise crowded or malaligned, these spaces usually close by the time the permanent maxillary canines fully erupt, and referral is not needed. Diastemas caused by missing incisors or midline supernumerary tooth or teeth will persist in the permanent dentition stage and require referral.
A 3-year-old child with pressure-equalizing tubes (PET) in both ears has otalgia in one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do? a. Order ototopical antibiotic/corticosteroid drops. b. Prescribe a prophylactic antibiotic medication. c. Reassure the parent that this is a normal exam. d. Refer the child to an otolaryngologist for follow-up
ANS: A A normal, or type A, tympanogram in a child with PET may indicate a clogged tube. Ototopical antibiotic/corticosteroid drops can occasionally clear a clogged PET. Prophylactic antibiotics are not recommended to prevent otitis media. It is not necessary to refer unless the pain continues in spite of standard measures.
What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure-equalizing tubes (PET) in both ears? a. Parents should notice improved hearing in their child. b. PET will help by reducing the number of ear infections the child has. c. The child should use earplugs when showering or bathing. d. The tubes will most likely remain in place for 3 to 4 years.
ANS: A By reducing middle ear fluid, the child with hearing loss from this condition should show improvement in hearing. Children may still have infections but without persistent effusion. Earplugs are not necessary unless the child's head is submerged. PETs usually fall out on their own; if they are still in place 2 to 3 years after placement, they should be removed by the otolaryngology surgeon.
The primary care pediatric nurse practitioner performs a well child examination on a 9-month-old infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam? a. At 12 months of age b. At 24 months of age c. At 48 months of age d. At 60 months of age
ANS: A Children who have a history of ROP requiring treatment, even if ROP has completely resolved, will need yearly ophthalmologic follow-up. Less frequent follow-up is required for children with ROP who did not require treatment.
A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend? a. Chlorhexidine gluconate b. Diphenhydramine and Maalox c. Oral acyclovir d. Topical antiviral medication
ANS: A Chlorhexidine gluconate rinses are useful to treat aphthous ulcers. Diphenhydramine with Maalox and oral acyclovir are used to treat viral stomatitis. Topical antiviral medications are not indicated.
An 18-month-old child has horizontal, bright white lines along the upper gum line of the teeth. What is the most important question the primary care pediatric nurse practitioner will ask the child's parents? a. If the child is still drinking milk from a bottle b. If the child or the parents are brushing the teeth c. If they are brushing the child's teeth twice daily d. If they have taken the child to a dentist
ANS: A Horizontal, bright white lines along the gum line are commonly seen in children still drinking from bottles and are early caries lesions. The PNP should ask about weaning from the bottle. The other questions are an important aspect of dental health, but the issue of baby bottle tooth decay should be addressed first.
A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child? a. Insert a wick into the external auditory canal. b. Irrigate the external auditory canal with saline. c. Order systemic corticosteroids. d. Prescribe an oral antibiotic medication.
ANS: A If significant swelling is present, inserting a wick into the EAC is helpful and should be impregnated with antibiotics as long as it is in place. Irrigation is contraindicated during an acute infection. Systemic steroids and antibiotics are not indicated.
An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do? a. Recommend ice packs, NSAIDs, and a soft diet. b. Refer to a pediatric mental health specialist. c. Refer to an orthodontist for a surgical intervention. d. Suggest obtaining Botox injection treatments.
ANS: A TMJ is a biopsychosocial problem. Conservative treatment should always be the first course of treatment, so ice, NSAIDs, and dietary changes should be recommended to minimize discomfort. If conservative measures are not effective, children should be referred to a team of dentists and psychologists to manage the problem. Surgical intervention is not recommended. Botox injections are being studied but currently are not FDA approved.
A school-age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do? a. Refer immediately to an ophthalmologist. b. Attempt to visualize the glass fragment. c. Irrigate the eye with sterile saline. d. Instill a topical anesthetic.
ANS: A The PNP should never attempt to remove an intraocular foreign body or any projectile object but should refer immediately to an ophthalmologist. Visualizing the object, irrigating the eye, or instilling drops may further injure the eye.
A 9-month-old infant has developed two teeth since the 6-month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit? a. Apply sodium fluoride varnish to the infant's teeth. b. Encourage the parents to make an initial dental appointment. c. Prescribe oral fluoride supplementation. d. Teach the parents how to brush the infant's teeth with fluoride toothpaste.
ANS: A The U.S. Preventive Task Force has issued two recommendations for preventing caries in children, including a recommendation that primary providers apply sodium fluoride varnish to the primary teeth of all infants and children beginning at the onset of the first tooth. The American Academy of Pediatric Dentistry (AAPD) recommends establishment of a dental home by age 12 months, or 6 months after the eruption of the first primary tooth. Oral fluoride supplementation is given when local water supplies are fluoride deficient. Fluoride toothpaste is not recommended in infancy unless the risk for caries is high.
An adolescent has localized bleeding of the gums when brushing the teeth. An exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose. What will the primary care pediatric nurse practitioner recommend? a. Consistently brushing and flossing the teeth twice daily b. Referral to an oral surgeon for treatment c. Rinsing the mouth daily with chlorhexidine gluconate d. Using a xylitol-containing gum after meals
ANS: A The adolescent has gingivitis from poor dental hygiene, which is reversible with good hygiene. It is not necessary to refer to an oral surgeon. Chlorhexidine gluconate is not indicated. A xylitol-containing gum can prevent caries but does not improve hygiene.
A preschool-age child is seen in the clinic after waking up a temperature of 102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side. Which course of treatment is correct? a. Admit to the hospital for intravenous antibiotics. b. Obtain a lumbar puncture and blood culture. c. Order warm compresses 4 times daily for 5 days. d. Prescribe a 10- to 14-day course of oral antibiotics.
ANS: A This child has periorbital cellulitis and must be hospitalized because of having pain with movement of the eye, indicating orbital involvement. LP is performed on infants under 1 year of age. Warm compresses are used for mild cases. Oral antibiotics are not indicated.
A school-age child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure-equalizing tubes and a pearly-white lesion on one tympanic membrane. Which condition is most likely? a. Cholesteatoma b. Mastoiditis c. Otitis externa d. Otitis media with effusion
ANS: A This child has symptoms of cholesteatoma, especially with a pearly white lesion on the TM. Mastoiditis involves the mastoid bone behind the ear.
The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate a. color vision. b. ocular alignment. c. peripheral vision. d. visual acuity.
ANS: B The Hirschberg test, or corneal light reflex, assesses ocular mobility and alignment by looking for symmetry of reflected light. Color vision testing is performed with Richmond pseudo-isochromatic plates. Peripheral vision is tested by watching the child's response to objects as they are moved in and out of the visual fields. Visual acuity is performed using eye charts or visual-evoked potential readings.
The parents of a formula-fed newborn report that they get their drinking water from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant? a. Giving the infant a fluoride supplement b. Testing the fluoride level of their water source c. Using bottled water to prepare the infant's formula d. Using powdered formula with added fluoride
ANS: B Before adding any supplemental fluoride to the infant's formula, the water source should be tested for fluoride. Too much fluoride can cause fluorosis, and giving fluoride when the water supply of it is adequate can cause this.
During a well-baby assessment on a 1-week-old infant who had a normal exam when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis? a. Chemical-induced conjunctivitis b. Chlamydia trachomatis conjunctivitis c. Herpes simplex virus (HSV) conjunctivitis d. Neisseria gonorrhea conjunctivitis
ANS: B C. trachomatis conjunctivitis usually begins between 5 to 14 days of life and causes moderate eyelid swelling, palpebral or bulbar conjunctivitis, and moderate, thick, purulent discharge. Chemical-induced conjunctivitis manifests as nonpurulent discharge. HSV is characterized by serosanguinous discharge. N. gonorrhea causes acute conjunctival inflammation and excessive purulent discharge.
A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the primary care pediatric nurse practitioner recommend to promote dental health in this child? a. Applying topical iodine every month b. Daily chlorhexidine gluconate rinses c. Ordering medications to prevent drooling d. Prescribing prophylactic antibiotics
ANS: B Daily chlorhexidine gluconate rinses are recommended for children with special health care needs to promote adequate oral hygiene and prevent caries. Topical iodine may be useful but is applied every 4 to 6 months. Medications that dry up salivary secretions make the problem worse. Prophylactic antibiotics are not indicated.
A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend? a. Cleaning ear canals well after swimming b. Drying the ear canal with a hair dryer c. Swimming only in chlorinated pools d. Using cerumenolytic agents daily
ANS: B Otitis externa is most frequently caused by retained moisture in the ear canal after swimming and when the protective barriers on the skin break down. Drying the ear canals with a hair dryer on a low setting helps to remove the moisture. Cleaning the ear canals, swimming in chlorinated water, and using a cerumenolytic remove the wax that protects the ear canal from superficial infection.
A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? a. Obtain a culture of the external auditory canal. b. Order ototopical antibiotic/corticosteroid drops. c. Prescribe oral amoxicillin-clavulanate. d. Refer the child to an otolaryngologist.
ANS: B Ototopical antibiotic/corticosteroid drops are the mainstay of therapy for OE. It is not necessary to obtain a culture unless the infection does not respond to treatment. Oral antibiotics are not indicated unless impetigo occurs and is severe. A referral to a specialist is not recommended.
The primary care pediatric nurse practitioner notes a small, round object in a child's external auditory canal, near the tympanic membrane. The child's parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object? a. Irrigate the external auditory canal to flush out the object. b. Refer the child to an otolaryngologist for removal. c. Remove the object with a wire loop curette. d. Use a bayonet forceps to grasp and remove the object.
ANS: B Spherical objects are the most difficult to remove and should be referred. Irrigation is not recommended for objects made of organic material and also increases the risk of pushing the object farther down.
The primary care pediatric nurse practitioner performs a well baby assessment of a 5-day-old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct? a. Administer intramuscular ceftriaxone 50 mg/kg. b. Admit the infant to the hospital immediately. c. Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks. d. Teach the parent how to perform tear duct massage.
ANS: B The infant has symptoms consistent with HPV conjunctivitis and requires hospitalization for topical and systemic antiviral medications to prevent spread to the central nervous system, mouth, and skin. IM ceftriaxone is given for gonococcal conjunctivitis. Oral erythromycin is given for chlamydial conjunctivitis. Tear duct massage is performed for lacrimal duct obstruction.
An 18-month-old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child? a. Amoxicillin 80 to 90 mg/kg/day in two divided doses b. An analgesic medication and watchful waiting c. Ceftriaxone 50 to 75 mg/kg/dose IM given once d. Ototopical antibiotic drops twice daily for 5 days
ANS: B This child has no previous history and only has a mild fever and can be managed by watchful waiting, with parents given instructions about when and why to notify the provider. Analgesia is essential so that the child can be comfortable. If antibiotics are indicated as a result of no improvement after 48 to 72 hours, amoxicillin is the first-line drug. Ceftriaxone is given if the child is vomiting. Topical antibiotics are given when there is a perforation in the tympanic membrane.
The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2-year-old child who has a history of three ear infections in the first 6 months of life. The child's tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? a. Amoxicillin twice daily for 10 days b. An analgesic medication and watchful waiting c. Antibiotic ear drops and ibuprofen d. Ceftriaxone given once intramuscularly
ANS: B This child has no recent history, is over 24 months, and has relatively mild symptoms, so can be treated by watchful waiting with adequate follow-up and analgesic medication. Antibiotics are not indicated unless the child worsens or does not improve in 48 to 72 hours.
The parent of a 4-month-old infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant? a. Acoustic reflectometry b. Audiometry c. Auditory brainstem response (ABR) d. Evoked otooacoustic emission (EOAE) testing
ANS: C ABR is not a direct measure of hearing but allows for inferences to be made about hearing thresholds and is useful for identifying hearing loss in a young infant. Although sedation is occasionally required, this test is useful in infants and young children unable to cooperate with EOAE or audiometry. Acoustic reflectometry is used to detect middle ear effusion. Audiometry requires a cooperative child. EOAE is used for universal screening in newborns. The American Academy of Pediatrics (AAP) Bright Futures guidelines (AAP, 2014) recommends pure-tone audiometry at 3, 4, 5, 6, 8, 10, 12, 15, and 18 years of age.
A 3-year-old child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order? a. A referral for tympanocentesis b. Amoxicillin twice daily c. Amoxicillin-clavulanate twice daily d. Intramuscular ceftriaxone
ANS: C Amoxicillin-clavulanate should be given for failed therapy with amoxicillin or when the child has had AOM treated with amoxicillin within the past month.
What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child's teeth? a. To allow the child to control the amount of toothpaste used b. To choose a toothpaste with a mint flavor c. To use a smear of toothpaste and not to rinse the mouth d. To use a toothpaste containing whitening agents
ANS: C As long as very small amounts of toothpaste are used, the child should not rinse the mouth. The adult should control the amount of toothpaste used; too much fluoride can be toxic. Toothpaste should have a sweet flavor. Strongly flavored toothpastes and those containing whitening agents or bleach are contraindicated.
A child who was treated with amoxicillin and then amoxicillin-clavulanate for acute otitis media is seen for follow-up. The primary care pediatric nurse practitioner notes dull-gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action? a. Administering ceftriaxone IM b. Giving clindamycin orally c. Monitoring ear fluid levels for 3 months d. Watchful waiting for 48 to 72 hours
ANS: C Children with AOM may have effusion up to 3 months after the acute infection. The child should be monitored to ensure that this resolves. Antibiotics are not indicated. There is no acute infection, so watchful waiting for worsening of symptoms is not indicated.
A 5-year-old child is hit in the face with a baseball bat and is brought to the clinic by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment? a. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days. b. Refer the child to a dentist for reimplantation of the avulsed teeth. c. Refer the child to a dentist immediately for further examination. d. Remove the teeth, place them in saline, and refer the child to a dentist.
ANS: C Children with avulsed or fractured teeth should be referred immediately to a dentist for treatment to avoid tooth abscesses and dental pain. Tetracycline is not recommended in children under age 12. Reimplantation of primary teeth is not recommended. If teeth will be reimplanted, they should be placed in cold milk or physiologic saline.
What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures? a. Administer oral ibuprofen or apply topical salicylates. b. Apply a topical anesthetic such a benzocaine to the gums. c. Give the infant a cold teething ring or wet washcloth to chew. d. Try Baby Orajel on the infant's gums several times daily.
ANS: C Parents may be counseled to give infants a cool teething ring or a cool, wet washcloth to chew on. Topical medications are not recommended and may traumatize the gums or cause toxicity.
The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of -180 mm H2O. What does this value indicate? a. A normal tympanic membrane b. Middle ear effusion c. Negative ear pressure d. Tympanic membrane perforation
ANS: C The type C tympanogram has a sharp peak between -100 and -200 mm H2O and reflects negative ear pressure. A normal tympanogram has a sharp positive peak or a type A tympanogram. Middle ear effusion and a TM perforation both cause a type B tympanogram with either no peak or a flattened wave.
During a well child exam, the primary care pediatric nurse practitioner notes yellowish-white serpentine-bordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do? a. Order chlorhexidine gluconate rinses to treat the lesions. b. Prescribe oral acyclovir to shorten the course of the disease. c. Reassure the parent that these are benign lesions. d. Refer the child to a pediatric dentist for evaluation.
ANS: C These lesions are characteristic of benign migratory glossitis or "geographic tongue" and are benign. Chlorhexidine gluconate rinses, oral acyclovir, and referral to a dentist are not necessary.
A 14-year-old child has a 2-week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe? a. Saline solution or artificial tears b. Topical mast cell stabilizer c. Topical NSAID drops d. Topical vasoconstrictor drops
ANS: C This child has symptoms of allergic conjunctivitis. Topical NSAIDs work for acute symptoms to reduce inflammation and may be used in children over age 12 years. Saline solution or artificial tears are useful for milder symptoms. Topical mast cell stabilizers are useful for chronic symptoms and maintenance therapy. Topical vasoconstrictors should be avoided because of rebound hyperemia.
A 4-year-old child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications? a. Annually b. Twice yearly c. Every 3 to 6 months d. Every month
ANS: C This child is high risk and should receive fluoride varnish treatments every 3 to 6 months. Annual or twice yearly applications are for lower risk children. It is not necessary to apply fluoride varnish every month.
A school-age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend? a. Administration of a topical antiviral medication b. Taking oral acyclovir for 5 to 7 days c. Topical application of diphenhydramine and Maalox d. Using a chlorhexidine gluconate rinse
ANS: C Topical treatment with diphenhydramine and Maalox is useful for symptomatic relief of herpes stomatitis. Topical antiviral medications are not effective. Oral acyclovir is only effective if initiated within 3 days of onset. Chlorhexidine gluconate is not indicated.
During a well child assessment of an African-American infant, the primary care pediatric nurse practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-orange light reflex in the right eye. The nurse practitioner will a. dilate the pupils and reassess the red reflex. b. order auto-refractor screening of the eyes. c. recheck the red reflex in 1 month. d. refer the infant to an ophthalmologist.
ANS: D Any asymmetry, dark or white spots, opacities, or leukokoria should be referred immediately to a pediatric ophthalmologist. The PNP does not dilate pupils or order auto-refractor exams; these are done by an ophthalmologist. Because retinoblastoma is a concern, any unusual finding should be immediately referred.
During a well child exam on a 4-year-old child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend? a. Follow up with a visual acuity screen in 6 months. b. Refer to a pediatric ophthalmologist. c. Re-test the child in 1 year. d. Test the child's vision in 1 month.
ANS: D Children age 4 years and older who have difficulty cooperating with a vision screen should be retested in 1 month; if they continue to have difficulty cooperating, they should be referred for a formal examination. Children who are 3 years old should be re-evaluated in 6 months.
A 7-month-old infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillin-clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection? a. Order a second course of amoxicillin-clavulanate. b. Perform tympanocentesis for culture. c. Prescribe clindamycin twice daily. d. Refer the child to an otolaryngologist.
ANS: D Children who have persistent infection who have failed appropriate therapy and those who have had three or more episodes of AOM in 6 months should be referred to an otolaryngologist. Ceftriaxone is ordered when Augmentin fails. The PNP does not perform tympanocentesis. Clindamycin is used for ceftriaxone failure but only if the susceptibilities are known.
A 4-year-old child who has asthma has teeth with smooth, cupped-out teeth on the chewing surfaces. Which is the most likely explanation for this finding? a. Bruxism b. Bulimia c. Decreased saliva d. Gastroesophageal reflux
ANS: D Children with asthma have higher rates of GERD, so this is the most likely cause of dental erosion. Bruxism causes marked wear of teeth on the chewing surfaces. Bulimia can cause dental erosion but is unlikely in a 4-year-old child. Decreased saliva occurs with some medications.
A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment? a. Botulinum toxin injection b. Corrective lenses c. Occluding the affected eye for 6 hours per day d. Patching of the unaffected eye for 2 hours each day
ANS: D Deviations are initially treated by patching the unaffected eye for 2 hours each day to force the affected eye to move correctly. Botulinum toxin injection may be used with some deviations but is not a first-line therapy. Corrective lenses alone improve amblyopia in 27% of patients. The unaffected eye is patched; 2 hours per day is as effective as 6 hours per day.
The primary care pediatric nurse practitioner performs a vision screen on a 4-month-old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do? a. Patch the right eye to improve coordination of the left eye. b. Reassure the parents that the infant will outgrow this. c. Recheck the infant's eyes in 2 to 4 weeks. d. Refer the infant to a pediatric ophthalmologist.
ANS: D Esotropia that continues or occurs at 3 to 4 months of age is abnormal, so the infant should be referred to a pediatric ophthalmologist. The PNP does not determine whether an eye patch should be used. Because it is abnormal at this age, the PNP will not reassure the parents that the infant will outgrow this. Esotropia after 3 to 4 months of age must be evaluated by a specialist and not reevaluated in 2 to 4 weeks.
The primary care pediatric nurse practitioner is treating an infant with lacrimal duct obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant's symptoms have not improved. Which action is correct? a. Perform massage more frequently. b. Prescribe an oral antibiotic. c. Recommend hot compresses. d. Refer to an ophthalmologist.
ANS: D Infants treated for a secondary bacterial conjunctivitis with lacrimal duct obstruction who do not improve after 1 to 2 weeks of topical antibiotic therapy must be referred to an ophthalmologist for possible lacrimal duct probe. Performing the massage more often or applying hot compresses will not help clear the infections. Oral antibiotics are not indicated.
The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend? a. Culture of the lesion to determine causative organism b. Referral to ophthalmology for incision and drainage c. Topical steroid medication d. Warm, moist compresses 3 to 4 times daily
ANS: D The child has symptoms of hordeolum, or stye. Although these often rupture spontaneously, warm, moist compresses may hasten this process. It is not necessary to culture the lesion unless symptoms do not resolve. Referral to ophthalmology is made if the hordeolum does not rupture on its own. Steroids are not indicated.
A school-age child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct? a. Administer an oral analgesic medication. b. Apply a Fox shield and reevaluate the eye in 24 hours. c. Instill anesthetic eyedrops into the affected eye. d. Refer the child immediately to an ophthalmologist.
ANS: D This child has a traumatic injury with hyphema to the eye, and an ophthalmologist must examine the eye to rule out orbital hematoma or retinal detachment. Any further attempt to examine the child may result in further injury. A Fox shield is used once more serious injury is excluded.
The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate? a. The cornea has not been damaged. b. There is too little stain on the cornea. c. There is damage to the cornea. d. There is too much stain on the cornea.
ANS: D When fluorescein stain is applied and the entire cornea appears cloudy, it means that there is too much of the stain. Damaged areas of the cornea should appear greenish after staining with fluorescein dye.
A parent asks about ways to promote dental health in school-age children while on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend? a. Getting fluoride varnish treatments prior to vacations b. Giving the children fluoridated water after meals c. Having the children use a chlorhexidine gluconate oral rinse d. Offering gum containing xylitol after meals
ANS: D Xylitol has been demonstrated to prevent and control tooth decay when used from 3 to 7 times daily, with topical effects. Chewing gum containing xylitol is effective. It is not necessary to have fluoride varnish treatments prior to vacations. Giving fluoridated water after meals is not indicated. Chlorhexidine gluconate rinses do not prevent caries.
A preschool-age child who attends day care has a 2-day history of matted eyelids in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow-green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct? a. Culture the conjunctival discharge. b. Observe the child for several days. c. Order an oral antibiotic medication. d. Prescribe topical antibiotic drops.
ANS: D Young children with bacterial conjunctivitis may be treated with topical antibiotic drops. Culturing the eyes is not necessary unless there is no improvement. While most cases of bacterial conjunctivitis are self-limiting, using a topical antibiotic will hasten the return to day care. Oral antibiotics are not indicated.
you suspect a child has an abscess 1 week after they had a tooth filling. what is the treatment
Abscesses may appear as swelling on the buccal or palatal gingival mucosa and frequently present with purulent drainage. Untreated abscesses may develop into life-threatening bony facial space infections, requiring surgical drainage and parenteral antibiotic treatment. They require urgent dental referral If a dentist or oral surgeon is not immediately available for drainage and the abscess is uncomplicated, antibiotics and pain medication are appropriate interventions prior to further consult. Penicillin is the drug of choice. In the case of penicillin allergy, azithromycin or clindamycin are alternatives. Amoxicillin-clavulanic acid (dose using the amoxicillin component) can also be used, as well as cefoxitin.
what is the difference between canker sores and Herpes Stomatitis
Canker sores: not contagious round and white, with a red border. appear because of a weakness in your immune system, nutritional deficiency, stress, hormones, bacteria, celiac disease, HIV, and Crohn's disease Herpes stomatitis: contagious fluid-filled blisters many small, sore, open blisters inside the mouth and on the gums and tongue Young children commonly get it when they are first exposed to HSV. The first outbreak is usually the most severe
wtih cavities, what are they sensitive to/what causes pain?
Cavities can be hot, cold, or sweet sensitive.
describe Cavities that spontaneously arrest
Cavities may spontaneously arrest: This is thought to occur when cavities are exposed to saliva high in fluoride or when the diet changes (such as, after weaning). Arrested caries appear as open cavities that are black or dark brown. If the child has such open cavities, is asymptomatic, the teeth are primary teeth, and access to dental care is problematic, these teeth can be left alone and allowed to shed normally. The discoloration also may be the result of previous topical treatment by a dentist with diamine silver fluoride or silver nitrate in an attempt to arrest and prevent caries.
people with excessive dry mouth are at risk for what?
Dental Erosion
Preeruption cysts
Eruption hematomas When a tooth starts erupting through the gingival tissue, a blood-filled cyst may precede it. Alarmed parents may report a purple, reddish, black, or blue bump or bruise in their child's mouth. If the enlargement is on the alveolar ridge, reassurance is all that is required. The symptom will resolve as the tooth erupts
what's Gingivitis and how does it present? tx?
Gingivitis is marked by the presence of gingival inflammation without noticeable loss of bone or clinical attachment of structures that help anchor the teeth. The gingiva will present with localized or generalized bleeding when brushed or flossed. The teeth will be covered in varying degrees of plaque and calculus secondary to poor or irregular hygiene. The teeth will not be loose. The treatment is consists of brushing and flossing. It can take several days for the gingiva to respond to the improved hygiene. Gingivitis is reversible.
a child has painful tooth decay. what is the recommended tx until the pt can see a dentist?
If tooth decay has resulted in pain and a draining tract, analgesics, warm-water or saline rinses, and a bland diet are recommended. In the presence of cellulitis and fever, antibiotic therapy is appropriate Penicillin is the drug of choice. In the case of penicillin allergy, azithromycin or clindamycin are alternatives. Amoxicillin-clavulanic acid (dose using the amoxicillin component) can also be used, as well as cefoxitin.
a baby is born with a tooth. what would you suspect?
Natal and neonatal teeth occur in about 50 different syndromes, of which about 10 are associated with chromosomal aberrations. More than 90% of these prematurely erupting teeth are mandibular central incisors with normal shape and color. Supernumerary teeth may be abnormal in shape and color and only loosely attached to the gingiva. Natal or neonatal teeth can lead to gingivitis, self-mutilation of the tongue, and trauma to the mother during breastfeeding. However, they should only be extracted if they are loose enough to involve risk of aspiration, sublingual ulceration, or if feeding is severely disturbed. Most will develop normally with normal root structure
describe TMJ disorder (s/s, tx)
On examination, the facial muscles are tender to palpation, often unilaterally, but there is usually no swelling or skin bruising. The individual will be afebrile. Tooth pain, if present, is nonspecific. There may be a deviation to the painful side when the mouth is opened. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Viewed as a biopsychosocial problem avoiding extreme jaw movements, soft diet, muscle relaxation and gentle stretching exercises, application of ice packs, analgesics, and anti-inflammatory medication. Individuals who do not respond to the basic recommendations need referral to specialized centers where teams of dentists and psychologists work together.
how do you treat strabismus and improve or prevent amblyopia?
Patching, occlusive contact lens (a last resort method), optical penalization (overplusses the lens on the sound eye), or pharmacologic penalization with 0.5% or 1% atropine (not used in infants) may be used to treat strabismus and improve or prevent amblyopia by blocking vision in the sound eye.
children with systemic childhood diseases, including Papillon-Lefevre disease, Down syndrome, hypophosphatasia, leukocyte adherence deficiency, agranulocytosis, and cyclic neutropenia are at higher risk for what dental problem?
Periodontitis as a Manifestation of Systemic Disease (Prepubertal Periodontitis) It is a rare disease that typically manifests with the eruption of the primary tooth up to 5 years old. There are localized and generalized forms, both of which can result in loose teeth secondary to bone and attachment loss. Refer the child to a dentist or periodontist
what is the use of iodine in preventing caries?
Polyvinylpyrrolidone (PVP) iodine (10% PVP-I or povidone-iodine [betadine solution]) can be painted on the teeth before the application of fluoride varnish for an additive effect to depress the tooth decay-causing mutans streptococci in high-risk children (Tut and Milgrom, 2010). Application of topical iodine alone at 3month intervals over 12 months has been shown to cause a significant reduction in the growth of flora (Simratvir et al, 2010). The teeth are dried with cotton gauze or air, the povidone iodine is painted onto the teeth and gums with a cotton-tip applicator, and then immediately wiped off with gauze or rinsed with air and water.
a parent has dental caries. what teaching would you give?
Preventing Person-to-Person Spread of Caries-Causing Bacteria. Eating utensils should not be shared between caregivers and children, especially if the caregiver has untreated cavities in the mouth. Parents should not use their own saliva to clean pacifiers or bottles, and children should be discouraged from sharing beverages using the same cup. Dental visits are especially important for pregnant women because of the association between untreated cavities in the mother and future development of cavities in the child.
Congenital Epulis
Rare soft tissue tumor that occurs predominately on the alveolar ridges of newborn infants; no evidence of neural origin Congenital epulis is a fibrous, pedunculated, soft-tissue enlargement that occurs on the maxillary alveolar ridge at birth (Fig. 34-3). This condition is more common in female babies. It typically regresses with time, but large lesions should be excised.
what type of color blindness is linked? what type is acquired?
Red-green deficiency is X-linked or may indicate optic nerve disease Blue-yellow deficiency is acquired (Diabetes, infections, optic neuritis, and toxins)
what is refraction? (eyes)
Refraction is the bending of light rays as they pass from one transparent medium (air) to another (cornea or lens). The lens modifies the degree of refraction to create the sharpest image on the retina.
what are Remineralizing pastes and Fluoride Varnish used for?
Remineralizing topical pastes are used by some dentists to prevent, reverse, or arrest white or brown tooth decay lesions. Fluoride Varnish: Early white spot lesions in primary and permanent teeth can be remineralized using topical fluoride varnish. Fluoride varnish is the agent of choice for young children and has been shown to be more effective than the fluoride gels that are still widely used in the United States. Fluoride gels are difficult to apply in preschool children and are not recommended because of the risk of acute toxicity. In many states, PCPs are permitted to apply fluoride. Twice-yearly applications have been shown to reduce tooth decay by about one third; more frequent applications may be needed in high-risk children (every 3 to 6 months). If the level of risk is uncertain, treating the child as high risk is efficacious until more objective assessment over time is ascertained. Fluoride Varnish is painted onto the teeth
what is Strabismus
Strabismus is a defect in ocular alignment, or the position of the eyes in relation to each other; it is commonly called lazy eye. In strabismus, the visual axes are not parallel because the muscles of the eyes are not coordinated; when one eye is directed straight ahead, the other deviates. As a result, one or both eyes appear crossed.
what is supernumerary teeth?
Supernumerary teeth (ST) (aka hyperdontia) are odontostomatologic anomaly characterized by as the existence excessive number of teeth in relation to the normal dental formula. This condition is commonly seen with several congenital genetic disorders such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. Hyperdontia is more common with permanent teeth than baby teeth. Extra teeth don't usually cause symptoms. In some cases, extra teeth may need to be removed to prevent crowding or displacing of other teeth. In other cases, extra teeth may be left alone and observed over time if they're not causing any problems.
third molar removal is associated with what?
TMJ disorder
what are the clinical findings of Early caries lesions?
These appear as horizontal bright white or brown lines or spots along the upper central gum line or gingival margin, more commonly in populations using baby bottles because the cavity causing fluids pool in these areas of the mouth. In cultures where bottle use, especially at night or naptime, is less common the damage may occur in back teeth first as a function of other dietary patterns. When white lesions occur, the dentin is initially damaged. Then, as the lesion progresses, the hard enamel breaks, and a clinical cavity is evident
what are the clinical findings of Advanced tooth decay?
This appears as cavitations (holes) in the teeth. Nearly all cavities in permanent teeth in children in the United States begin on the biting surface of the molars. The initial lesion appears as a pinhole surrounded by a white, opaque halo. As the lesion enlarges greater damage to the enamel becomes apparent. Lesions typically appear about 1 year after the eruption of the tooth and frequently begin while the tooth is still erupting.
describe Pericoronitis Associated with Partially Erupted Wisdom Teeth
This condition is due to a partially erupted lower wisdom tooth with a tissue flap covering part of the crown. A foreign body, such as a piece of food, is forced under the flap, causing a localized infection. In some cases, upper wisdom teeth will erupt with the crown rubbing against the buccal mucosa and cause pain. Partially erupted wisdom teeth can create an environment in which the distal surface of the second molar becomes decayed, because it cannot be cleaned. PCPs may recommend irrigation of the area with sterile water or saline, prescribe analgesics, and start amoxicillin if the individual is febrile. Not all wisdom teeth need to be removed. Wisdom teeth do not cause other teeth to become crooked. if there is space for the erupting teeth, there is no reason to remove them.
describe Necrotizing Periodontal Disease
This is an aggressive bacterial disease resulting in damage to the gum tissue between the teeth. The gum tissues harbor high levels of bacteria, and invasion of the tissues has been demonstrated. Predisposing factors are viral infections (including human immunodeficiency virus [HIV] and other systemic diseases), malnutrition, emotional stress, and lack of sleep. Children have severe gingival pain and fever. The triangular area of gums between the teeth is ulcerated and necrotic and covered with a gray film. There may be a fetid mouth odor. Careful oral hygiene and a bland diet are recommended. Address the predisposing conditions. As with all suspected periodontal conditions, individuals should be referred to a dentist or periodontist
Bohn Nodules
White bumps present on maxillary alveolar ridge Bohn nodules are present at birth and appear as firm nonpainful nodules on the buccal surface of the alveolar ridge (Fig. 34-4). They are remnants of dental lamina connecting the developing tooth bud to the epithelium of the oral cavity. No treatment is required because they will resolve spontaneously. If they appear in the midline of the palate, they are referred to as Epstein pearls.
tx for aphthous ulcers
aka canker sores The goal of treatment is to decrease the ulcers, relieve pain, and reduce frequency of occurrence. Minor lesions generally resolve spontaneously in 10 to 14 days and heal without treatment or scarring. A bland diet and oral analgesics may be appropriate. Vitamin or mineral replacement may prevent recurrence if history suggests a deficiency A mild mouthwash, such as sodium bicarbonate dissolved in warm water, may provide comfort. Chlorhexidine gluconate mouthwash (0.12%) can reduce the severity of an episode. Thalidomide has been used in severe cases associated with HIV infection
what are signs of fluorosis on the teeth?
appears as white specks or streaks that are largely unnoticeable advisability of introducing fluoridated toothpaste for very young children should be based on the risk of tooth decay. When caries risk is high (e.g., if the mother or siblings have tooth decay, or child has poor hygiene and diet), the benefit outweighs the risk of mild or moderate fluorosis
When does tooth eruption begin? when is primary teeth complete? when do permanent teeth start and complete?
begins around 6 to 8 mo complete by 36 months (3 yrs) permanent teeth start around 6y (school age) and complete by 5th grade
describe Mucocele
blockage of a salivary gland duct It is most common on the lower lip and has the appearance of a fluid-filled vesicle or a fluctuant nodule with the overlying mucosa normal in color. The patient should be referred to an oral surgeon for surgical excision of the involved accessory salivary gland
What are aphthous ulcers? what is the etiology?
canker sores Single or multiple small, shallow mucosal lesions are present on alveolar or buccal mucosa, tongue, soft palate, or the floor of the mouth. The ulcers are surrounded with an erythematous halo and covered by gray, yellow, or white plaques. The etiology is not well understood. Infectious agents, such as Helicobacter pylori, HSV-1, and measles, have been implicated in the etiology. Emotional and physical stress, local trauma (braces, toothbrush abrasion), hormonal factors, genetics, food hypersensitivity, and sodium lauryl sulfate in toothpaste have been implicated. Vitamin and mineral deficiencies (B vitamins (1, 2, 6, and 12), iron, folic acid, and zinc) also can cause. The lesions may be seen with inflammatory bowel disease, Behçet disease, gluten-sensitive enteropathy, sweet syndrome, HIV infection, and neutropenia.
describe dental erosion
chemical process that leads to irreversible acid demineralization of tooth structure. GERD, bulimia, vomiting, acidic beverages, methamphetamines, citrus fruits (e.g., sucking on lemons), and medications (e.g., chewable vitamin C tablets). Factors that can aggravate dental erosion include xerostomia (dry mouth) smooth, cupped-out teeth on chewing surfaces; fillings that are raised above the normal level of the tooth; overly shiny silver fillings; enamel cuffing along the gums; and tooth hypersensitivity. Individuals with bulimia usually have very smooth lingual surfaces of the permanent teeth tx: fluoridated toothpastes or topical fluoride treatments (helps with sensitive teeth), tx for gerd/bulimia, diet counseling, soft toothbrush, low-abrasive fluoridated toothpaste, and fluoride rinses Severe dental erosion can lead to dental nerve (pulp) exposures, which can necessitate root canal treatment.
tx for an avulsed permanent tooth?
clean (less than 10 sec) and replant immediately. Do not rub the root surface. bite gently on a handkerchief to keep the tooth in place abt for 7 days (doxycyline or Pen VK are standard). If unable to immediately replant the tooth, place the tooth in transport media (ViaSpan, Hanks Balanced Sat Solution, cold milk, saline, or saliva [buccal vestibule]) to prevent dehydration. successful replantation decreases with time. A tooth that is allowed to dehydrate will not be viable after 1 hour. f/u within 10 days Tooth fracture: put in saline Tooth fractures with bleeding from the stump are emergencies. Simple fractures not involving the pulp or nerve tissue are not emergencies but still may be repaired.
when a baby is teething, what should you discourage?
discourage OTC topical or oral meds
describe Gingival Hyperplasia
fibrous enlargement of gingival tissue around the teeth. The enlargement is typically caused by drugs (phenytoin, cyclosporine, nifedipine), hormones, chronic inflammation, leukemia, or heredity. The gingival tissue can be normal, red-blue, or lighter than the surrounding tissue. It may be spongy or firm and dense. The tissue is generally not inflamed, and patients are asymptomatic. Treatment consists of improved oral hygiene and 0.12% chlorhexidine gluconate mouth rinse.
Aggressive Periodontitis: what is it? s/s? tx?
is a bacterial infection of the gums and bone. results in rapid loss of periodontal attachment and supporting bone around the primary or permanent teeth. This infection either involves the surrounding gums and bone around primary incisors and molars (localized) or all teeth (generalized). The teeth may become loose, but in the localized form there is generally no inflammatory response, suppuration, or fever All children with suspected periodontitis should be referred to a dentist for local débridement (deep cleanings) and systemic antibiotics (tetracyclines [age appropriate] or metronidazole in combination with amoxicillin).
when is Intermittent exotropia normal?
normal children 6 months to 4 years old who are ill or tired or when they are exposed to bright light or with sudden changes from close to distant vision. It is more often seen when the child is looking with distant fixation. but, any ocular misalignment seen after 4 months old is considered suspicious, and the child should be referred. Hypertropia or hypotropia, exotropia, acquired esotropia or exotropia, cyclovertical deviation, or any fixed deviation is an indication for referral as soon as it is first observed.
describe Halitosis
oral malodor or bad breath poor oral hygiene, mouth breathers, postnasal drip, dry mouth, use tobacco products, avoid mints/gums The individual may also need to be evaluated for systemic disease, sleep apnea, and other airway-related conditions.
what is the difference between phoria and tropia? what are the prefixes that classify them?
phoria - intermittent deviation in ocular alignment that is held latent by sensory fusion. can maintain alignment on an object. tropia - consistent or intermittent deviation in ocular alignment. unable to maintain alignment on an object of fixation. Phorias and tropias are classified according to the pattern of deviation seen: • Hyper- (up) and hypo- (down) are used to classify vertical strabismus. • Exo- (away from the nose) and eso- (toward the nose) describe horizontal deviations. • Cyclo- describes a rotational or torsional deviation.
what is the most common disorder of the eye?
refractive errors: ---myopia [nearsighted] ---hyperopia [farsighted] ---astigmatism [irregularly shaped curve of the lens] exists when the curvature of the cornea or the lens is uneven. thus the retina cannot appropriately focus light from an object regardless of the distance, which makes vision blurry close up and far away. ---anisometropia [eyes focus unevenly bc they are different sizes or shapes] is a different refractive error in each eye. It may consist of any combination of refractive errors discussed earlier, or it may occur with aphakia. In a normal eye, light from a distant object focuses directly on the retina. When variations in axial length of the eyeball or curvature of the cornea or lens exist, light focuses in front of or behind the retina. This abnormal focusing produces an alteration in the refractive power of the eye that results in a visual acuity deficit.
Providers should be alert for signs of ocular misalignment when examining infants and children. Treating _________ and ________ early greatly reduces long-term amblyopia and improves visual acuity.
strabismus (cross-eye) and amblyopia (lazy eye)
describe Herpes Stomatitis
usually caused by herpes simplex virus type 1 (HSV-1) Lesions heal without treatment in 7 to 14 days. Supportive therapy is appropriate, such as cold liquids and analgesics. Topical treatment with an equal mixture of diphenhydramine and Maalox may provide symptomatic relief. Antimicrobials are not appropriate. Oral acyclovir is recommended to reduce the degree and length of symptoms if initiated within 3 days of the onset of the initial episode. Topical antiviral agents are ineffective -Remove the child from day care or school during the drooling phase of the illness. -Encourage parents to clean the teeth with a soft toothbrush or cloth. -Children with herpes are at risk for dehydration. parents watch for s/s -hand washing - prevent autoinoculation or transmission of infection to the eyes -urgent referral to ophthalmology is needed if ocular spread is suspected Herpes stomatitis/labialis may be confused with aphthous ulcers (canker sores), ulcerative gingivitis, hand-foot-and-mouth disease, trauma, herpangina, or chemical burns.
you document the following: LP, H/M at 1 ft, C/F at 1 ft what does this mean?
• Shine a penlight into the eye from a lateral position and turn the light off and on several times to assess light perception. If the child can identify when the light is on or off, vision is described as "LP" (light perception). • Move a hand back and forth with periodic cessation 12 inches from the child's face. Indication of search and recognition is documented as "H/M at 1ft" (hand motion). • Ask the child to count the number of fingers (C/F) seen when one, two, or three fingers are held up 12 inches from the child's face. If the child is correct, document the vision as "C/F at 1 ft."
what does the eye assessment in a child include?
• The red reflex is tested in all ages - TO BE DONE AT EVERY WELL EXAM (darken room. look for asymmetry, dark or white spots, opacities, leukokoria) • OLDER THAN 5 years old - funduscopic exam • growth of head/shape of head • gross inspection of structures • corneal light reflex • cover-uncover test (near and far, "how many cows do you see?")
