Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 17 Nursing Care of the Child With an Alteration in Sensory Perception/Disorder of the Eyes or Ears
The nurse is explaining information to the parents of a 3-year-old boy who may have strabismus. The nurse should explain that which examinations will be performed first to find out if he has strabismus? a. Refractive examination b. Visual acuity test c. Corneal light reflex test d. Ophthalmologic examination
Answer: c The corneal light reflex is extremely helpful in assessment of strabismus. It consists of shining a flashlight into the eyes to see if the light reflects at the same angle in both eyes. Strabismus is present if the reflections are not symmetrical. The visual acuity test measures how well the child sees at various distances. Refractive and ophthalmologic examinations are comprehensive and are performed by optometrists and ophthalmologists.
The nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child? a. Assessing the child for asymmetric corneal light reflex b. Observing for rubbing, shutting the eyes, or squinting c. Referring the child to the local district of early intervention d. Teaching the parents to check how the child's glasses fit
Answer: a Assessing for asymmetric corneal light reflex is the priority intervention as strabismus may develop in the child with regressed retinopathy of prematurity. Observing for signs of visual impairment is not be critical for this child, nor is teaching the parents to check how the glasses fit the child. Referral to early intervention would be appropriate if the child was visually impaired.
The pediatric office nurse notes that several of the young children that are waiting to see the physician may have conjunctivitis. Which findings are consistent with bacterial conjunctivitis? Select all that apply. a. Only the right eye is involved b. The drainage is yellow and thick c. The drainage is white d. There is clear, watery drainage from both eyes e. The child suffers from seasonal allergies
Answer: a, b Bacterial infections are usually present unilaterally. Drainage from eyes that have been diagnosed with bacterial conjunctivitis is often thick and purulent.
The nurse works in a pediatrician office. Which children, who have been diagnosed with acute otitis media, does the nurse expect the physician to treat with antibiotics? Select all that apply. a. 12-year-old child who reports he has some mild ear pain with a temperature of 101.4°F (38.6°C) b. 8-year-old child who is crying due to ear pain and has a temperature of 103°F (39.4°C) c. 2-month-old child who is having difficulty sleeping and has a fever of 102.6°F (39.2°C) d. 5-month-old child who is fussy and pulling at her ears e. 22-month-old child who is irritable with the presence of purulent drainage from her right ear
Answer: b, c, d, e Children who are 2 years old or younger and have a severe form of acute otitis media with a temperature of 102.2°F (39°C) or higher will most likely receive antibiotics to treat the infection. Children who are older than 2 years of age with severe otalgia and a fever higher than 102.2°F (39°C) typically receive antibiotics. Children who are older than 2 years of age and have mild otalgia and a fever lower than 102.2°F (39°C) have a nonsevere illness. In these cases, the physician may just observe the children to see if their symptoms persist over time or get worse.
The young child has been diagnosed with a corneal abrasion. Which findings are most consistent with this diagnosis? Select all that apply. a. The child's pupils are equal, round, reactive to light and accommodation. b. The child denies any eye pain. c. The child reports that it hurts to look toward bright light. d. The child has a large purple bruise over the eye and edema on the eyelid. e. The child's eye is draining clear fluid and the child says it feels like it is full of tears.
Answer: a, c, e The child with a corneal abrasion may have a normal assessment of the pupils bilaterally. The child may experience photophobia and tearing noted in the eye. The child with a corneal abrasion will typically experience eye pain. The child with a simple contusion of the eye will have bruising and edema around the eye.
A 10-year-old boy has just been treated for otitis externa and now the nurse is teaching the boy and his parents about prevention. Which recommendation should the nurse include? a. Using alcohol and vinegar for soreness b. Using cotton swabs to keep the inner ear dry c. Using a hair dryer on cool to dry the ears d. Washing the hair only when necessary
Answer: c A mixture of ½ rubbing alcohol and ½ vinegar squirted into the canal and then allowed to run out is a good preventative measure, but not when inflammation is present. Cotton swabs should not be placed in the ears to dry them. He can wash his hair as needed. Using a hair dryer on a cool setting to dry the ears works well as long as the vent is clean and free from dust and hair that may have accumulated.
The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child? a. Informing the parents to avoid nonprescription drugs b. Telling parents not to smoke in the house c. Educating the parents about proper antibiotic use d. Reassessing for language acquisition
Answer: d Reassessing for language acquisition would be most important to the health of the child. There is a risk of otitis media with effusion causing hearing loss, as well as speech, language, and learning problems. Parents should not use over-the-counter drugs to alleviate the child's symptoms, nor should they smoke around her. In addition, proper antibiotic use is important; however, language acquisition is directly related to developmental health.
The nurse is caring for a 7-year-old girl in an outpatient clinic diagnosed with amblyopia that is unrelated to any other disorder. Which intervention should be most helpful at this time? a. Discouraging the child from roughhousing b. Explaining postsurgical treatment of the eye c. Ensuring follow-up visits with the ophthalmologist d. Educating parents on how to use prescribed atropine drops
Answer: d Therapeutic management of amblyopia may be achieved by using atropine drops in the better eye. Educating parents on how to use atropine drops is the most helpful intervention. Explaining postsurgical treatment and discouraging the child from roughhousing would be appropriate only if the amblyopia required surgery. While follow-up visits to the ophthalmologist are important, compliance with treatment is priority.
A child has been diagnosed with bacterial conjunctivitis. Which statements by the child's parent indicate the need for further education? Select all that apply. a. "I'll continue to use eye drops to help with the redness." b. "All of us at home need to wash our hands really well." c. "We should not use a towel that he has used." d. "He can go back to school in 4 hours after that thick yellow drainage is gone." e. "This is really contagious."
Answer: a, d Eye drops are not appropriate to use because rebound vasoconstriction may occur and it is not actually treating the infection. The child can go back to school 24 to 48 hours after the mucopurulent drainage is no longer present.
The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder? a. He frequently goes swimming b. He has good attendance at school c. He is experiencing recurrent nasal congestion d. He had recent bacterial conjunctivitis
Answer: c Recurrent nasal congestion contributes to the presence of otitis media with effusion. Frequent swimming would put the child at risk for otitis externa. Attendance at school is a risk factor for infective conjunctivitis. Although otitis media is a risk factor for infective conjunctivitis, infective conjunctivitis is not a risk factor for otitis media with effusion.
The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder? a. Applying heated aqua pad to site b. Administering antibiotics IV as ordered c. Administering morphine sulfate as ordered d. Monitoring for increased intracranial pressure
Answer: b 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.
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: a. need for ultraviolet-protective glasses postoperatively. b. importance of completing the full course of oral antibiotics. c. possibility that multiple operations may be necessary. d. importance of patching as prescribed.
Answer: d 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 teaching parents of a 9-year-old girl about the importance of wearing the prescribed glasses. Which subject is least important to promoting compliance? a. Getting scheduled eye examinations on time b. Checking condition and fit of glasses monthly c. Watching for signs that prescription needs changing d. Encouraging the use of eye protection for sports
Answer: d Encouraging the use of eye protection for sports would be more appropriate if the child was wearing contact lenses that may fall out during athletics. A sport strap would be more appropriate for this child. The child is less likely to wear her glasses if improper fit or incorrect prescription is causing a problem or if the glasses are unattractive. It is important to get scheduled eye examinations on time; watch for signs that the prescription needs changing; and check the condition and fit of glasses monthly.
