EENT (2) Flashcards
What is the visual acuity of neonates?
20/100 - 20/400
What is decreased in neonatal vision?
Accommodation and color
what is different about the cornea in infants and young children?
The Cornea occupies larger portion of the orbit
What is the visual acuity of 2 to 3 year olds?
20/50
What is the visual acuity of 6-7 y.o.s
20/20
what is important to know about the eustachian tubes in pediatrics?
They are shorter, wider, and more horizontal which allow for passage of their during sucking or yawning, allow for otitis media or ear infection
bybwhat age do children get their first tooth
6 mo
By what age do children have a full set of teeth?
2 y.o.
What is inflammation of the conjunctiva?
infectious conjunctivitis (pinkeye)
what are symptoms of infectious conjunctivitis?
Reddit swollen conjunctiva with clear, weight, or yellow discharge
what can cause infectious conjunctivitis?
Bacteria, viruses, allergy, trauma, other
what is the term for conjunctivitis in infants under 30 days old
ophthalmia neonatorum
How do infants get ophthalmia neonatorum
vaginal delivery from mother
what is the term for the allergic response to the prophylactic eye prescription
Chemical conjunctivitis
How long after administration of prophylactic eye prescription does chemical conjunctive it is happen?
24-48 hr
What ages does bacterial conjunctivitis affect?
all
What are symptoms of bacterial conjunctivitis?
eyelid edema, red conjunctive, enlarged lymph glands, Mucopurulent drainage, itching and burning
what organisms cause bacterial conjunctivitis?
StapH aureus, h. influenzae, strep pneumoniae, Moraxella catarrhalis
What ages does viral conjunctivitis happen in?
older children
What is the most common cause of viral conjunctivitis and how?
adenoviruses, rub and itch eyes
What is used when viral conjunctivitis is from herpes?
acyclovir IV and topical drops
What are symptoms of allergic conjunctivitis?
- intense itching
- red eyes with watery discharge
- conjunctivae- cobblestone appearance
- puffy, swollen eyes
Your nursing assignment for the day includes an infant with A URI. Doing your assessment you notice that the child has water discharge coming from both eyes. The conjunctiva is slightly redddend and edematous.
What do you think is the cause of this conjunctivitis?
Viral, URI and water drainage
how is the cause of conjunctivitis usually determined?
Getting a history, looking at signs and symptoms, culture of drainage
How long does treatment of bacterial conjunctivitis last?
5-7 days
What is used for the treatment of bacterial conjunctivitis?
Antibiotic drops or ointment, erythromycin
what is used to treat viral conjunctivitis?
comfort measures
What are comfort measures that can be used for viral conjunctivitis?
Warm or cool wet compresses, affording lights and reading
what is used for the treatment of allergic conjunctivitis?
Systemic or topical histamines; decongestants with systemic antihistamines
how long are decongestants with systemic antihistamines used for treatment of allergic conjunctivitis?
short!
What can be used to prevent reactions of allergic conjunctivitis?
mast cell stabilizaers
Is conjunctivitis contagious?
yes
How long are antibiotics needed for conjunctivitis at least?
24h (no school)
What other eye condition can mimic conjunctivitis?
Clogged tear duct
What is infection of the eyelid and surrounding tissues?
periorbital cellulitis
What causes periorbital cellulitis?
bacteria
What are symptoms of periorbital cellulitis?
- Swollen, tender, red or purple eyelids
- restricted, painful movement of area around eye
- fever
how quickly does periorbital cellulitis need to be treated?
quick!
Why does periorbital cellulitis require hospitalization?
IV antibiotics
What are visual disorders caused by?
Errors of Refraction
what type of visual disorder is where light falls behind the retina?
hyperopia
What kind of visual disorder is when light falls in front of the retina?
myopia
What is abnormal turning of the eye in or out that may lead to amblyopia?
strabismus
What can be used to help strabismus?
Occlusion therapy, patching the good eye in order to use the weak eye
what visual disorder is where one eye is poorer than the other, may result instrubitemis, genetic, lazy eye
amblyopia
what med can be used for treatment of amblyopis
atropine 1%
How do people get cataracts?
Congenital or acquired
What is the clouding of the lens?
cataracts
What are signs and symptoms of cataracts?
Distorted red reflex, symptoms of vision loss
What is the treatment of cataracts?
surgery
what is when immature blood vessels in the retina constrict and necrose
retinopathy of prematurity
what 3 things is retinopathy of prematurity associated with?
- oxygen therapy
- resp distress
- assisted ventilation
what age, sex, and race is retinopathy of prematurity most common in
- boys born before 28 weeks, weight less than 1600 gms
- whites
- alaskan natives
how is retinopathy of prematurity diagnosed?
ophthalmic exam
treatemnt of retinopathy of prematuroty
laser therapy
what is the most common cause of blindness in the US?
Retinopathy of prematurity
what ages and sex are eye injuries most common in
boys age 11-14
treatment for black eye
ice both eyes 1-2 days, then warm compresses
treatment for foreign objects in the eye
- remove if seen
- irrigate
- patch
- transport to ED
treatment for chemical burns of the eye
- irrigate 15-30 mins
- transport to ED
treatment for penetrating and perforating eye injury
- call emergency transport, NO CAR
- never try to remove object
what is included in an ear assessment
- placement
- pinna
- external auditory canal
- hearing
what is low-set ears associated with?
congenital renal disorders
what is inflammation of the middle ear, sometimes associated with infection
otitis media
what bacteria causes otitis media
streptococcus pneumoniae
what demographics is otitis media usually higher in?
boys, children in daycare, children with allergies, children exposed to tobacco smoke
.s/sx of otitis media
acute pain, rep tympanic membrane, ear effusion
how is otitis media diagnosed
history and pneumatic otoscopy
how long is otitis media treated with antibiotics in children under 2 years old
10 days
how long is otitis media treated with antibiotics in children 2-5 y.o.
7-10 days
how long is otitis media treated with antibiotics in children 6 + y.o.
5-7 days
what is the first line therapy for otitis media
amoxicillin
0what 2 things can be done for recurring otitis media
- myringotomy (equilizes pressure between external canal and middle ear)
- tympanostomy tubes
how much of everyday convo does a person with mild hearing loss lose?
50%
what are some consequences of having a hearing imapirment for children?
- speech delay
- imapired learning
- poor congitivie learning
what reflex is absent or diminished when a child has hearing loss
startle reflex
describe babbling in child with hearing loss
little or none
what is speech like in toddlers with hearing loss?
unintelligible (90% should be)
what can hearing loss be confused for?
developmentally delayed
manifestations of hearing loss in school age children
- asks for repeated isntruction
- answer questions inappropriately
- poor school performance
- speech probs
- sits close to TV
- pefers to play alone
what kind injuries occur to the external ear (pinna)?
- lacerations
- infection
- hematomas
- cellulitis
what kind if injuries occur to the ear canal?
- foreign body
- insects
what is done if theres an insect in the ear
mineral oil to immobilize and flush
what kind of injury happens to the tympanic membrane
ruptures
what is the source of blleding in nosebleeds?
kiesselbach’s plexus (anterior nares, plentiful veins)
what are the common causes of nosebleeds
- irritation from picking
- foreign bodies
- low humidity
what vitals should be taken in nosebleed
BP pulse
how should a child with nosebleed be positioned?
upright, head forward so they dont choke on blood or get nauseous from it
where and how long should nose be squezzed with nosebleed?
just below nasal bone 10-15 mins
what kind of infection id nasopharyngitis?
URI (common cold)
causes of nasopharyngitis?
- numerous viruses and bacteria
which viruses and bacteria cause nasopharyngitis?
rhinovirus, coronavirus, group A streptococcus
what are signs and symptoms of nasopharyngitis in infants less than 3 m.o.
- lethargic
- irritability
- poorm feeding
- fever
what are signs and symptoms of nasopharyngitis in infants 3 m.o. and older
- fever
- vomit
- diarrhea
- sneezing
- anorexia
- irritable, restless
what are signs and symptoms of nasopharyngitis in older children
- dry, irritated nose/throat
- chills, fever
- aches, headache
- post-nasal discharge
- sneezing
- nasal discharge
characteristics of viral pharyngitis
- gradual onset
- cough, coryza, diarrhea
- sore throat
- low grade fever
which kind of pharyngitis is most common?
viral (not strep)
characteristics of bacterial pharyngitis (strep throat)
- abrupt
- moderate/high fever
- headache
- red pharynx
- painful swallowing
- painful cervical nodes
- petechial mottling of soft pallate
- caused by group a strep
what bacteria causes bacterial pharyngitis
groupo a strep
what is the treatment of pharyngitis?
- pain relief (Acetaminophaen) (also used for fever)
- cool, non-acidic, soft food, ice chips, gargle warm salt water
- oral penicillin (erythromycin if allergic) (non contagious after 24h on antibiotic)
symptoms of tonsillitis
- frequent throat infections
- difficulty swallowing and breathing
- persistent redness
- enlargement of cervical nodes
how is tonsillitis treated?
symptomatically, recurrent episodes= removal
what defines a tonsillitis episode?
having a sore throat AND one of the following…
* fever > 38.3
* cervical adenopathy
* tonsillar exudate
* + group b strep
infection in what time frames qualifies for surgery (tonsillitis)
- 7 episodes in 1 year
- 5 episodes a year for 2 years
- 3 episodes a year for 3 years
post-op tonsillectomy meds
no antibiotics after removal, one dose of intraoperative IV dexamethasone for swelling
when to call the doctor after a tonsillectomy
if there is bright red bleeding or temp > 38.8
post-op tonsillectomy care
- drink cool fluids or chew gum
- acetaminophen as ordered
- apply ice on childs neck
- gargle with baking soda solution and salt in 8oz water
- rinse mouth with viscous lidocaine, then swallow
describe the three tooth injuries
fracture, partially knocked out, completely out
what is luxation
partially knocked out tooth
what is avulsion
completely knocked out tooth
how should a tooth be handled?
by crown, not root
what should you do if a tooth is fully knocked out?
place back in socket quickly!
what kind of fluid should a knocked out tooth be transported in?
isotonic fluid, like cows milk
