1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 18 Nursing Care of the Child With a Disorder of the Eyes or Ears

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Variations in Pediatric Anatomy and Physiology Eyes Ears

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4. Common Medical Treatments Assessment –Health history –Physical examination Inspection and observation Palpation Laboratory and diagnostic testing See Common Laboratory and Diagnostic Tests 18.1 Nursing diagnoses and related interventions

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Eyes

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Visual Disorders Refractive errors –Nursing assessment –Nursing management Educating about eyeglasses use Educating about contact lens use Monitoring for fit and visual correction

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Laser surgery is rapidly replacing the use of eyeglasses for vision correction in children.

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Because of the continuing refractive development in the child’s vision through adolescence, laser surgery for vision correction is not recommended by the Canadian Ophthalmological Society until 18 years of age, although it may be performed experimentally in some children.

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Visual Disorders (cont.) Astigmatism – causes light rays to focus on two points in the back of the eye rather than just one –Nursing assessment –Nursing management Strabismus – a condition in which one eye cannot focus with the other eye on an object because of the imbalance of the eye muscles –Nursing assessment –Nursing management

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

11. Visual Disorders (cont.) Amblyopia – an abnormal cortical response in the occipital lobe of the brain –Nursing assessment –Nursing management Vision screening is a vital component of health promotion –If vision disorders are diagnosed at an early age and treatment is initiated, then vision may progress normally

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Eye Conditions of the Newborn Nasolacrimal Duct Obstruction –Nursing assessment –Nursing management Congenital cataract Infantile glaucoma Nystagmus – rapid, irregular eye movement Retinopathy of prematurity (ROP) – rapid growth of retinal blood vessels in the premature infant

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question An infant who is diagnosed with glaucoma is likely to require what intervention? A.Regular use of beta-blocker eye drops B.Eyeglasses C.Surgery D.Physical and occupational therapy

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C – Surgery Rationale: Unlike adult glaucoma, in which medical management is the first step, treatment of infantile glaucoma is focused on surgical intervention. Infantile glaucoma is treated surgically via goniotomy (removal of obstruction of the aqueous humor).

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Infectious and Inflammatory Disorders Conjunctivitis – inflammation of the bulbar or palpebral conjunctiva Can be infectious (viral or bacterial), allergic, or chemical –See Table 18.2 –Therapeutic management –Nursing process Health history Physical examination Laboratory and diagnostic tests

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Infectious and Inflammatory Disorders (cont.) Conjunctivitis (cont.) –Nursing management –Alleviating symptoms –Preventing infectious spread

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19. Eyelid Disorders Include hordeolum (stye), chalazion, and blepharitis –Nursing assesment –Nursing management

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Periorbital Cellulitis A bacterial infection of the eyelids and tissue surrounding the eye –Nursing assessment –Nursing management

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Eye Injuries Include eyelid laceration, simple contusion, scleral hemorrhage, corneal abrasion, and foreign body in the eye See Table 18.3 Nursing assessment –Health history –Physical examination Nursing management –Managing non-emergent eye injuries

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23. Visual Impairment Refers to acuity between 20/60 and 20/200 in the better eye on examination Nursing assessment –Health history –Physical examination Nursing management See Box 18.2 for tips on working with the visually impaired child –Supporting the child and family –Promoting socialization, development, and education

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Ears

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Otitis Media Acute otitis media (AOM) –Pathophysiology –Therapeutic management –Nursing assessment Health history Physical examination and diagnostic testing

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Otitis Media (cont.) Acute otitis media (AOM) (cont.) –Nursing management Managing pain associated with AOM Educating the family Preventing AOM

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A two-year-old girl has signs and symptoms characteristic of AOM. What is the most likely course of action for initially treating this child’s health problem? A.Ear irrigation with warm normal saline B.Oral antibiotics C.Watchful waiting and observation D.Topical antibiotics

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C – Watchful waiting and observation Rationale: Recommendations for AOM treatment in previously healthy children include watchful waiting and observation for 48 to 72 hours without antimicrobial agents form most children who are older than 6 months of age.

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Otitis Media (cont.) Otitis media with effusion (OME) –Nursing assessment Health history Physical examination –Nursing management Educating the family Monitoring for hearing loss Providing postoperative care for the child with pressure-equalizing tubes

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32. Otitis Externa Nursing assessment –Health history –Physical examination Nursing management –Managing pain –Treating the infection –Preventing reinfection

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34. Hearing Loss and Deafness Nursing assessment –Health history –Physical examination and laboratory and diagnostic tests Nursing management –Augmenting hearing –Promoting communication and education –Encouraging education –Providing support

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Infants are ordinarily born with the sense of hearing fully developed.

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Unlike the sense of sight, hearing is expected to be fully developed in the healthy neonate.