Alterations in Eye, Ear, Nose,
Transcript of Alterations in Eye, Ear, Nose,
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Alterations In Eye, Ear, Nose,and Throat Function
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Pediatric Differences- Eyes
Visual Acuity ranges between 20/100 and 20/400;20/50 by 2-3 years; 20/20 by 6-7 years
Lens are more spherical and cannot accommodate toboth near and far objects
The ability to distinguish color and other details isdecreased
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Snellen Chart
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Pediatric Differences- Eyes
The rectus muscles that control binocular vision maybe uncoordinated at birth
Alignment and coordinated movement by three
months Nystagmus(involuntary rapid eye movement) and
esotropia(momentary turning inward of the eyes) arecommon in neonates
Conjunctival and retinal hemorrhages may be observedin newborns as a result of the trauma of birth
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Retinal Hemorrhage
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Eyeball- that of an adult and unprotected laterally ,thus more easily injured. By 14 years normal adult size
Tears are produced but only produced enough tears tolubricate and protect the eye
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Note
Vision allows a child to acquire meaning from whatis seen
The brain learns to interpret messages as acuityimproves
Disturbances in vision affects the brains ability tointerpret visual input.
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DISORDERS OF THE EYES
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Infectious Conjunctivitis or pink eye
Inflammation of the conjunctiva
Causes- bacterial, viral, allergies, trauma or irritant .Bacterial more common in children
-Staph. A-H. Influenzae
-Strep. P
-E.coli
Usually a yellow or white discharge is seen
For infants under 30 days- opthalmia neonatarum
A blocked lacrimal duct can mimic conjunctivitis
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Manifestations- Bacterial
Edema of the eyelid
Reddened conjunctiva
Mucopurulent discharge
Itching Burning
photophobia
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Bacterial Conjunctivitis
Spread- hand eye contact
Common in institutions; schools, day are etc.
May be bilateral or unilateral
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Management
Culture
Antibiotic eye medication e.g. ciprofloxacin,norfloxacin
Antiviral acyclovir Antihistamine
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Nursing Interventions
Assessment and referral Give medication as prescribed
Educting parents
The importance of keeping child home
Careful hand hygiene practices
Avoidance of shared towels
Not rubbing eyes
Keep toddlers busy
How to instill eye drops
For children with allergies; s&s, use of wash cloth with
cold water over the eyes, avoiding contact lenses
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Periorbital Cellulitis
Infection of the eyelid and surrounding tissue Can occur after a scratch or bug bite around the eye
allow micro-organism to cause an infection.
Infection may extend to another site, e.g sinusitis
Average age of occurene; 6-8 yrs
Manifestations- Edema, tender red of purple eyelids,painful movement of the eye, fever
Treatment- hospitalization, IV antibiotics,application of hot packs. Must be prompt to avoidspread to the posterior orbit and nerves
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Nursing Intervention
Assessment and referral
Give antibiotics as prescribed
Monitor vital signs
Teach family members about infection
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Visual DisordersErrors of Retraction
Hyperopiafarsightedness; light rays focus posteriorto the retina resulting in the inability to focus on nearbyobjects. All children have some degree until 9 10 years
Myopianearsightedness ; light rays focus on the
anterior of the retina, resulting in an inability to see farobjects. Commonly develops at about age 8 yrs.Squinting and complaints of headaches are common
Astigmatism-light rays are refracted differently
depending on their place of entry to the eye. Thecurvature or cornea of the lens is not uniformly spherical,causing blurred vision. The child often holds pages closeto face
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Normal Refraction
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Visual Disorders- Strabismus
Strabismus- deviation of the eye (lazy eye) Lack of coordination between the extraocular muscles
problems with cranial nerve III, IV and VI
May be congenital or acquired
Symptoms; squinting, frowning when reading, closingone eye to see, trouble picking up objects, dizziness,headache
Associated with other conditions as cerebral palsy,
hydrocephalus, down syndrome Diagnosis vision testing
Treatment- Occlusion therapy, lenses, surgery of rectusmuscles, eye exercise
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Visual Disorders- Amblyopia
Reduced Vision in one or both eyes
Common caused- untreated strabismus alsocongenital cataract
Diagnosis- vision testing Treatment lenses, occlusion therapy 2-6 hours
daily, eye exercises, atropine 1%,
20/20 vision rarely attained
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Amblyopia
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Visual Disorders-Cataracts
Opaque lens prevents refraction of light ontoretina
May be congenital or acquired
Lens may be cloudy, symptoms of vision loss,distorted red reflex
Associated with fetal alcohol syndrome and downsyndrome
Treatment- surgical, corrective lenses
Post op- restraints, antibiotics, steroids
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Cataracts
RED REFLEX
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Visual Disorders -Glaucoma
Childhood glaucoma
also referred to ascongenital glaucoma, pediatric, or infantileglaucomaoccurs in babies and young children.It is usually diagnosed within the first year of life.
Increased Intraocular Pressure due to blockage of thecirculation of aqueous, or its drainage
Increased pressure may damage the optic nerve
Tearing, blinking, corneal clouding, progressiveenlargement of eye, photophobia
In older children the eye responds to increased intraocularpressure in a manner similar to adults. No increase in thesize of the eye and the cornea does not become cloudy.
Treatment surgery to reduce pressure followed by lenses
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Glaucoma
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Types
Congenital glaucoma is present at birth. Infantile glaucoma develops between the ages of 1-24 months. About
10% of primary congenital/infantile glaucoma cases are inherited Glaucoma with onset after age 3 years is juvenile glaucoma.
Another way to classify glaucoma is to describe the structural abnormalityor systemic condition which has caused the glaucoma. Most cases of pediatric glaucoma have no specific identifiable cause and
are considered primary glaucoma. When glaucoma is caused by, or associated with a specific condition or
disease, it is called secondary glaucoma. Examples of conditions whichcan be associated with childhood glaucoma include Axenfeld-ReigerSyndome, aniridia, Sturge-Weber Syndrome, neurofibromatosis,chronic steroid use, trauma, or previous eye surgery such as childhoodcataract removal.
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Danielle Fiarito, 16, was diagnosed with glaucoma atage 4
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Nursing Management
Assessment
Assess baby/child to see
How they follow objects
If they notice objects to right or left Move asymmetrically or one wanders off
Difficulty picking up objects
Learning difficulties
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Nursing Management
Disturbed Visual Sensory Perception
Risk for injury
Risk for altered growth an development
Risk for compromised family coping
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Desired Outcomes / Interventions
The child will receive adequate sensory input
Provide kinesthetic, tactile and auditory
stimulation e.g. talking, playing, noises during
daily activities
The child will be protected from hazards
Eliminate hazards
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Desired Outcomes/Interventions
The child has experiences necessary to foster
normal growth an development
Help parents plan activates
Provide opportunities for independent activities Provide environment rich in sensory input
Assess growth an development regularly
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Desired Outcomes/Interventions
The family identifies methods of coping
Provide explanation of disorder
Refer parents to organization and support groups
Assist parents to plan developmental, educational,safety needs
Allow to express feeling
Involve in the plan of care
Enhancing Development in Visually Impaired
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Enhancing Development in Visually ImpairedChild
Well lit setting Large print books
Expose to everyday sounds
Encourage the use of the sense of touch toys should
have different textures Encourage speech
Keep furniture in same position
Emphasize Childs abilities
Orient to new environment
Announce presence when approaching child
Identify contents of meals and positions
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Eye Injuries
Causes
Sports, fireworks, blunt or sharp instruments,chemical or thermal burns, irritants, abuse
See handout
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Ear Structure
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Pediatric Differences- Ear
The Eustachian tube which connects thenasopharynx the middle ear is shorter and wider andmore horizontal
During feeding the tube remains open formilliseconds allowing free passage
The external ear is soft with little cartilage
The external canal is small at birth thus the
tympanic membrane is close to the surface and easilydamaged
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Eustachian Tubes of Child vs Adult
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Otitis media
Inflammation of the middle ear About 70% of children have at least one case on their
first year of life
Occurs frequently in children with allergies, usepacifiers and in children exposed to tobacco smoke
Children with conditions as cleft palate and Downsyndrome also experience otitis media
Breast feeding appears to be a protective againstotitis media
May be acute or chronic which may lead to deafness
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Otitis Media
Causes Unknown
Dysfunction of the Eustachian tube
Upper respiratory tract infection
The infection causes the mucous membrane of theeustachian tube to become edematous. The air that flowsthrough the middle air is blocked and re-absorbed intothe blood stream. Fluid is pulled into the space from the
mucosal lining providing a good medium for rapidgrowth of the pathogen. The tympanic membrane andfluid behind it become infected
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Acute otitis media
Acute otitis media bacterial infection in the middleear from pathogens transferred from thenasopharynx
Cause ; S.pneumoniae, H.influenzae, M. catarrhalis
S&S; ear pain/pulling at ear, rapid onset, irritability,malaise, poor feeding
On exam; bulging tympanic, fluid or air behind
tympanic, red, white or gray tympanic, membranedisplaced by light reflex
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Light Reflex
Light Reflex
The light reflex is a cone of light reflecting back fromthe otoscope as a result of the slightly conical shapeof the tympanic membrane
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Otitis media with effusion
Otitis media with effusion- collection of fluid in themiddle ear behind the tympanic membrane, notinfected with a bacteria
S&S; difficulty hearing in most cases
On Exam; no signs of inflammation, tympanicretracted or neutral, immobile or partly mobilemembrane, yellow or gray, opaque or thickened
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Retracted EarDrum
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Otitis Media
Other Signs and symptoms
Middle ear effusion
Vomiting
Diarrhea Irritability/waking up at nights and crying
Acting out
Otorrhea
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Otitis Media- Diagnostics
Otoscopic examination
Special gradient acoustic reflectometry
Flat tympanogram
Culture of the middle ear fluid Pneumatic otoscopy
Tympanometry
Audiological testing
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Otitis Media- Treatment
Antibiotic Therapy for 10 days in children under 6years; 5-7 days for children 6 years and over
Antibiotics are delayed for 48-72 hours afterdiagnosis in children 6mths 2yrs with non severesymptoms at presentation or uncertain diagnosis
First line therapy amoxicillin; 2ndline amoxicillinwith clavulmante or cefuroxime
Ibuprofen for pain if antibiotics are not prescribed Topical anesthetic ear drops if tympanic membrane
is intact
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Nursing Management
ND-Altered comfort- acute pain
Goal- The child will indicate absence of pain
Interventions
Give analgesic as prescribed Have child sit up, raise head on pillows or lie on
unaffected side- elevation decreases pressure from fluid
Apply heating pad or warm hot bottle- heat increases
blood supply and reduces discomfort Have child chew on gum or blow balloon relieves
pressure in the ear
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ND- Infection r/t presence of pathogens
Goal- The child will be infection free
Interventions
Encourage breastfeeding of infants- affords naturalimmunity
Administer meds as prescribed
Encourage parents to keep follow up appointment
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ND- Risk for care role strain r/t chronic conditionGoal- The parents will manage the childs condition
with minimal stress
Interventions
Determine the parents ability to manage condition
Provide information
Encourage parent in the plan of care- increases
confidence and ability to manage condition Allow parents to express feelings- reacting
empathically encourages parents to communicate
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Otitis Externa
Inflammation of the skin and surrounding tissue ofthe ear canal- Called swimmers ear
Injury can also occur because of injury by foreignobjects , irritants, or drainage from broken tympanicmembrane. The canal can become infected
S&S; pain, itching, swelling and redness of ear,drainage in canal
Tx-cleaning and irrigation with NS, steroid eardrops for inflammation reduction, antibiotic drops
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Otitis Externa
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Advice
Follow up care
Child should not return to swimming for about 5days
On return ear plugs or swim caps Ensure canal is dry after swimming or bath
Do not place cotton tipped applicators or foreignobjects in the canal
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Injuries to Ear
Causes-
Lacerations, infections, hematomas, placing of foreign
objects, insects entering canal, blow to head or ear
See handout
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Nose, Throat and Mouth
Up to 6 mths, infants are primarily nasal breathers
Immature immune system puts young children at riskfor URTI
Enlarged adenoids are commonly infected
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Disorders of the Nose and Throat
Epistaxis
Common in school aged children
Kisselbachsplexus, an area of plentiful veins locatedin the anterior nares are usually the source
Causes- irritation, from nose picking, foreign bodies,low humidity, forceful coughing, allergies,
congestion or nasal mucosa
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Epistaxis
Assessment Hx of nose bleeds
Contributing factors
Vital signs esp. pulse Examination of nasal mucosa, allow to blow gently to
look for clots, suction if necessary
Assess flow, nose bleed on one side is often anterior,both sides posterior (suspect blunt trauma)
Swallowed blood may cause nausea
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Management
Anterior Place child upright, tilt head forward Squeeze nares just below nasal bone and hold for 10-15
minutes while child breathes through mouth Application of ice packs or cold compress on bridge of
nose If bleeding does not stop insert cotton soaked with
topical vasoconstrictor and anesthesia epinephrine,lindocaine
CauterizationPosterior Packing
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Management
Avoid Bending over, hot drinks, hot showers,strenuous exercise
Sleeping elevated
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Sinusitis
Inflammation of one or more of the paranasalsinuses
Usually become infected following a viral URTI
S&S- purulent nasal drainage fever above 102
degrees F, facial pain, malodorous breath, mouthbreathing, hyponasal speech, anorexia, headache
Treatment; antibiotics
Some clear on its own
Repeated cases should be referred to anotolaryngologist
h i i
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Pharyngitis
Infection of the pharynx and tonsils Common in children 4-7 yrs
May be bacterial or viral
Viral Strep
Nasal congestionMild sore throatConjunctivitisCoughHoarsenessPharyngeal rednessFever 38.3 deg C
Ph i i S I f i
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Pharyngitis- Strep Infection
Ph i i
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Pharyngitis
Diagnosis/Treatment Throat culture Antibiotics Pain relief
lozenges containing benzocaine or other anesthetics Nursing Intervention Administering meds Cool non acidic drinks and soft foods Humidification Gargling with warm salt water Rest Parent education
Ph i i
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Pharyngitis
Complications Rheumatic fever
Sinusitis
Glomerulonephritis Meningitis
T illiti d Ad iditi
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Tonsillitis and Adenoiditis
Inflammation of the palatine tonsils and adenoids Bacterial and viral infections can cause tonsillitis.
A common cause is Streptococcus bacteria. Othercommon causes include:
Adenoviruses
Influenza virus
Epstein-Barr virus
Parainfluenza viruses Enteroviruses
Herpes simplex virus
Manifestations
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Manifestations
Throat pain or tenderness Redness of the tonsils A white or yellow coating on the tonsils Painful blisters or ulcers on the throat
Hoarseness or loss of voice Headache Loss of appetite, nausea, vomiting Ear pain Difficulty swallowing or breathing through the mouth Swollen glands in the neck or jaw area Fever, chills Bad breath
T illiti d Ad iditi
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Tonsillitis and Adenoiditis
T t t
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Treatment
Throat culture Antibiotics if bacterial
Rest
Drink warm or very cold fluids to ease throat pain
Eat smooth foods, such as flavoured gelatin, ice cream Use a cool-mist vaporizer or humidifier in your room
Gargle with warm salt water
Suck on lozenges containing benzocaine or other
anaesthetics Take over-the-counter pain relievers such
as acetaminophen or ibuprofen.
S i l
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Surgical
Tonsillectomy and adenoidectomy (T&As)recommended for recurrent infections ( about threeper year), obstructive sleep apnea, problems withspeech, mouth breathing
Complication of Surgery
Bleeding
Pain
infection
C Aft T ill t
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Care After Tonsillectomy
Most children go home about four hours after surgery and require aweek to 10 days to recover from it. Parents are adviced to
Give Cool fluids- reduces spasm and the muscles surrounding throat
Avoid giving child milk products for the first 24 hours after surgery.
Pain meds
Apply ice or cool compress around neck
Gargle with baking soda and salt
Rinse with lidocaine before swallowing
Rest
For several days after surgery, child may experience a low-gradefever and small specks of blood from the nose or saliva. If fever isgreater than 102 degrees F and bright red blood is seen, refer todoctor
Nursing Diagnosis
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Disorders of the Nose and Throat
Acute pain related to inflammation risk for fluid volume deficit
Ineffective breathing patterns
Impaired swallowing
Disorders of the Mouth
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Disorders of the Mouth
Mouth Ulcers see hand out for causes andmanifestations
Txkeep mouth clean, topical analgesics, nonirritating foods
ND
Altered comfort pain
Impaired oral mucous membrane
Imbalanced nutrition less than
Mouth and Dental Emergencies
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Mouth and Dental Emergencies
Causes Trauma to mouth due to falls, sports, MVAs
Problems
Fracture jaws, tooth avulsion
References
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References
Pediatric Nursing- Caring for Children Ball & Binder4thEdition