peds mod 4 chapter 17

Preventing Acute Otitis Media

Encourage mothers to breastfeed for at least 6 to 12 months, as breastfed infants have a lower incidence of AOM than formula-fed infants, and breast milk's immunologic benefits are well known

tympanometry

probe in ear canal measures movement of the eardrum quick and easy to perform.

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.

A child returns to the clinic after an episode of external otitis (acute otitis externa) that has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry

eyelid injuries

Laceration is noted at any point along the lid Vision is unaffected

Nasolacrimal duct obstruction

-chronic back up of tear fluid -tears pour over lower lid

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."

Which situation would cause the nurse to become concerned about possible hearing loss?

A 12-month-old who babbles incessantly, making no sense

Otitis Externa (Swimmer's Ear)

An infection of the outer ear, with severe painful movement of the pinna and tragus, redness and swelling of pinna and canal, scanty purulent discharge

Tragus of the ear

Cartilage projection anterior to the external opening of the ear

Amblyopia (lazy eye)

Reduced visual acuity in one eye

decibel

a logarithmic unit of sound intensity

strabismus

abnormal deviation of the eye cross eyes

nystagmus

Involuntary rapid eye movements

A 4-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder?

Otitis externa

Infants are ordinarily born with the sense of

hearing fully developed.

in a newborn what conjunctivitis is most common

chlamydia and gonorrhoeae

conductive hearing loss

hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles

myopia

nearsightedness

Refer the child with a large foreign body in the eye or one that is embedded in the globe of the eye to

the ophthalmologist for appropriate, safe removal.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?

"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided?

"I should continue to breastfeed my son because it lowers the incidence of acute otitis media."

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."

Tx of conjunctivitis

- warm wash cloth on eyes in a.m. to clear the drainage/crusted drainage; place cloth where it will not be used again after use - antibiotic eye drops or ointment may be prescribed

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube

Simple Contusion (Black Eye): Occurs as a result of blunt trauma to the eye area

Bruising and edema of lids or area surrounding eye PERRLA Extraocular movements intact Visual acuity intact No diplopia or blurred vision Pain surrounding eye but not within the eye

Otitis Media with Effusion (OME)

OME refers to the presence of fluid within the middle ear space, without signs or symptoms of infection

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

It is very important for children with amblyopia to receive appropriate treatment during the early years of visual development

Therapeutic management of amblyopia focuses on strengthening the weaker eye. This may be achieved through patching for several hours per day, using atropine drops in the better eye (once daily), vision therapy, or eye muscle surgery if the cause is strabismus.

hearing impairment

any degree of hearing loss

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

congenital cataract

is an opacity of the lens of the eye that is present at birth

periorbital cellulitis treatment:

outpatient: augmentin po inpatient for severe cases with IV: vancomycin + ceftriaxone

deafness

the complete inability to hear sound, recurrent ear infections, or ear surgeries, family history might be significant for eye or ear deformities or vision or hearing impairment or may reveal contacts for infectious exposure.

pinna

the visible part of the ear

hordeolum (stye)

hordeolum is a localized infection of the sebaceous gland of the eyelid follicle, usually caused by bacterial invasion.

blindness

inability to see

red reflex

red glow that appears to fill the person's pupil when first visualized through the ophthalmoscope

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.

Conjunctivitis

inflammation of the bulbar or palpebral conjunctiva is referred to as conjunctivitis. It can be infectious, allergic, or chemical in nature.

The nurse is teaching the parents of a visually impaired infant about development for their child. What education would the nurse add to the standard education on development milestones?

learning to use facial expressions

The nurse is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention?

Place the child prone postoperatively for comfort.

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

Play tough, but wear protective gear."

congenital cataracts untreated what happens

Sensory amblyopia will result if the infant goes untreated. Complications include visual developmental delay related to amblyopia. In children younger than 5 years of age, congenital cataract causes 16% of the cases of legal blindness

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important to understand?

Student placement in the room is important but all other teaching methods may remain the same.

myringotomy

incision into the tympanic membrane (performed to release pus or fluid and relieve pressure in the middle ear) (also called tympanocentesis)

Risk Factors for Acute Otitis Media

daycare attendance tobacco exposure allergies bottle propping at bedtime pacifier use formula feeding significant family history of AOM male gender lower SES respiratory allergies onset of otitis in first year of life conditions affecting craniofacial structures (e.g. cleft palate, down syndrome, etc) Native American

A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply.

"I will continue to use eye drops until the redness is gone." "Our child can go back to school in 4 hours, after that thick yellow drainage is gone."

The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification?

"I will need to apply heat to the eye four times a day."

The most common complications of AOM include:

Hearing loss Expressive speech delay Tympanosclerosis (scarring of the tympanic membrane; usually has no effect on hearing) Tympanic membrane perforation (acute with resolution or chronic) Chronic suppurative otitis media (chronic drainage via perforation or tympanostomy tubes) Acute mastoiditis (infection of the mastoid process) Intracranial infections, including bacterial meningitis and abscesses

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.

Unlike adult glaucoma, infantile glaucoma what to.

in which medical management is the first step, therapeutic management of infantile glaucoma is focused on surgical intervention. Infantile glaucoma is treated surgically via goniotomy (removal of obstruction of the aqueous humor). Laser surgery is being used as well. Sometimes several surgeries may be necessary to correct the problem. Ongoing medication therapy may also be required

The vision impairment in which the child can see objects at close range but not at a distance is known as:

Myopia

A 16-year-old girl is brought to the emergency department after a fight. Her sclera is red. Scleral hemorrhage is suspected. Which findings are in support of this potential diagnosis? Select all that apply.

the child's vision is unaffected; the sclera is red.

Acute Otitis Media (AOM) most common pathogens

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

Foreign Body: May be dirt, glass, or other small particle. Signs and symptoms.

Tearing Complaint of "something in the eye" PERRLA Vision may be blurry

The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)?

The child cries out when the ear is grasped.

The nurse is performing the intake assessment of a 6-month-old in the pediatrician's office. The nurse alerts the physician that the child is showing signs of hearing loss based on what assessment findings? Select all that apply.

The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react. The parent reports that the infant does not wake up when the siblings are being loud during nap time. The infant does not turn the head when the nurse stands next to the infant and calls their name.

diplopia

the perception of two images of a single object

If pupillary reaction is abnormal

vision is affected (decreased acuity from the child's norm, diplopia, or blurriness), or extraocular movements are affected, the child should be immediately referred to an ophthalmologist for further evaluation

the best visual outcomes occur for congenital cataracts

when cataracts are removed prior to 3 months of age. Glaucoma may occur as a complication after cataract surgery.

When patching is prescribed

encourage the family to comply with this modality. Encourage eyeglass wearing if prescribed. Provide appropriate postoperative care by protecting the operative site with eye patching.

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness."

Scleral Hemorrhage

Caused by blunt trauma or increased pressure such as with coughing Painless Appears as erythema in the sclera; can be quite large initially Vision unaffected

The child with otitis externa usually has significant ear pain.

Pressure on the tragus should be avoided, as it can worsen the pain.

esotropia

cross-eyed

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."

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."

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."

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided?

"It's an overgrowth of retinal blood vessels."

A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present."

Periorbital cellulitis

eyeball moves staph, Hib, strep pneumo

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract?

Absence of the red reflex

The 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area.

hyperopia

farsightedness

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 tympanic membrane.

infantile glaucoma

Infantile glaucoma is an autosomal recessive disorder that is more common in interrelated marriages or relationships. It is often associated with other genetic disorders.

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?

Instill a few drops of a topical anesthetic into the affected eye

vision impairment in children

Legal blindness" is a term used to refer to vision of less than 20/200 or peripheral vision less than 20 degrees. In most cases, vision may be augmented with corrective lenses. Some blind children can differentiate light versus dark, while others live in total darkness.

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation?

Moving a penlight toward the client's nose and observing whether his eyes can follow it

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?

Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

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?

Reassessing for language acquisition

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

Recently helped clean the basement

Corneal Abrasion:

Results from foreign body such as sand, grit, or other small object scratching the cornea May have tearing Eye pain PERRLA Vision may be blurry Photophobia may be present

A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?

The frequency of otitis media is reduced in breastfed infants.

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.

Foreign bodies may be removed from the eye by

gently everting the eyelid and wiping the foreign body away with a sterile cotton-tipped applicator. Irrigation with normal saline may also wash the foreign body away.

A 2-year-old has been prescribed eye patching for strabismus 6 hours per day. What teaching does the nurse provide for the mother?

Try to patch 6 hours per day, but if you miss some it is OK.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

What you are describing may be what is called myopia."

Strambismus

a condition in which there is deviation from perfect ocular alignment.

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

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

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?

amblyopia

When teaching a parent about amblyopia, it would be most important to explain that:

amblyopia is correctable if the child is properly treated before 6 years of age.

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

tympanic fluid culture

culture of fluid aspirated from the middle ear. to determine specific bacteria present and appropriate antibiotic coverage. performed only by specially trained physicians

astigmatism

defective curvature of the cornea or lens of the eye

culture of eye or ear discharge

easy to collect, relatively pain free. if drainage must be removed from within the ear canal, more likely to be painful.

chalazion is a

is a chronic painless infection of the meibomian gland.

Acute Otitis Media (AOM)

is a common illness in children, resulting from infection (bacterial or viral) of fluid in the middle ear. Increased susceptibility in infants and young children may be partly explained by the short length and horizontal positioning of the Eustachian tube, limited response to antigens, and lack of previous exposure to common pathogens

Retinopathy of Prematurity (ROP)

is a disorder characterized by rapid growth of retinal blood vessels in the premature infant. In the fetus, retinal vascularization begins at 4 months and progresses until completion at 9 months or shortly after birth. The premature infant is born with incomplete retinal vascularization, yet new vessels continue to grow between the vascularized and nonvascularized retina. Risk factors include low birthweight, early gestational age, sepsis, high light intensity, and hypothermia. Changes in oxygen tension resulting from hypoxia, oxyhemoglobin dissociation curve changes that occur when adult blood is transfused to the premature infant, and the duration/concentration of supplemental oxygen are thought to play an important role in the development of ROP.

exotropia

outward turning of the eye

Laser pointers

pose a risk of retinal damage in infants and young children. Damage occurs if the child stares at the red light for longer than 10 seconds. They should not be used as toys (U.S. Food and Drug Administration,

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

prevention and treatment of otitis media

avoid the use of vasoconstricting eye drops such as Visine to rid the eyes of redness. It may cayse

rebound vasodilation to occur, and with it the redness returns.

blepharitis

refers to chronic scaling and discharges along the eyelid margin.

amblyopia

refers to poor visual development in the otherwise structurally normal eye. It develops within the first decade of life and, if left untreated, is the most common cause of vision loss in children and young adults, occurring in about 1% to 4% of children

sensory perception

refers to the ability to receive sensory input and, through various physiologic processes in the body, translate the stimulus or data into meaningful information.

retinopathy of prematurity

retinal tissue is replaced with fibrous tissue due to using high levels of oxygen therapy in premature babies with immature lungs

photophobia

sensitivity to light

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

pressure equalizing tube (PE tube)

small tube surgically placed in eardrum; assists in draining trapped fluid and equalizing pressure between middle ear cavity & atmosphere

It is extremely important to treat strabismus appropriately in the developing years

so that equal visual acuity may be achieved in both eyes. Therapeutic management of strabismus may include patching of the stronger eye or eye muscle surgery. Corrective lenses are also used for strabismus. Complications of strabismus include amblyopia and visual deficits.

A child has recently been diagnosed with cataracts. The treatment for cataracts is:

surgery

typanostomy

surgical creation of an opening through the eardrum to promote drainage

If the pupillary reaction is abnormal, vision is affected( decreased acuity from the child's norm, diplopia or blurriness), or extraocular movement are affected.

the child should be immediately referred to an ophthalmologist for further evaluation

ptosis

the eyelid failure to open fully is termed potsis, droopy eye lid.

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?

wash hands frequently

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

the itching of allergic conjunctivitis may be relieved

with a cool compresses. An easy way to accomplish this is to have the child hold a tube of yogurt over the affected eye.