[Exam 4] Chapter 39 – Alteration in Sensory Perception/Disorder of the Eyes or Ears Flashcards
Variations in Anatomy - Eyes: When is iris color determined?
By 6-12 months of age. They are born with blue eyes.
Variations in Anatomy- Eyes: Infant sees best at what distance?
8-10 inches
Variations in Anatomy- Eyes: When is 20/20 vision obtained?
By 6-7 years
Variations in Anatomy - eyes: When does binocular vision develop?
By 4 months of age
Variations in Anatomy -Ears: Main difference here between adult and child?
Eustachian tube is straight in a child, but slants as they grow older.
Common Medical Tx, Health Hx: Past medical history may be significant for what?
Prematurity, genetic defect, eye or ear deformity or deafness.
Common Medical Tx, Health Hx: When asking parents about history, ask then about onset and progression and presence of what?
Fever, nasal congestion, eye/ear pain, eye rubbing, ear pulling and headache.
Common Medical Tx, Health Hx, Inspection: Note what about the eyes?
Whether child uses eyeglasses, corrective lenses, or hearing aid. Observe eyes for positioning and variations in eyelids.
Common Medical Tx, Health Hx, Inspection: What to know about sclera in newborns?
They will appear bluish in newborns, but become white within the first few weeks of life.
Common Medical Tx, Health Hx, Inspection: Ears will be checked for what?
Size/Shape, Position, and Presence of skin tags, dimples.
Common Medical Tx, Health Hx, Palpation: Ears should be palpated for what?
Tenderness over tragus or pinna.
Common Medical Tx, Health Hx, Palpation: What does Typanometry do?
Probe in ear canal measures movement of eardrum
Acute Otitis Media (AOM): What is this?
Common illness in children, resulting from infection (bacterial or viral) of fluid in the middle ear.
Acute Otitis Media (AOM): Why are children more prone to get this?
Due to short length and horizontal positioning of the Eustachian tube, and limited respones to antigens
Acute Otitis Media (AOM): Biggest risk factors for this?
Eustachian tube dysfunction and susceptibility to recurrent upper respiratory infections
Acute Otitis Media (AOM) - Patho: What frequently precedes this?
Upper respiratory infection. They travel upward invading the middle ear space.
Acute Otitis Media (AOM) - Patho: What occurs acutely once invasion begins?
Fever and pain. Increased pressure behind membrane may cause proliferation resulting in decreased pain and yield drainage.
Acute Otitis Media (AOM) - Patho: What happens once infection clears?
Fluid remains in the middle ear space behind the tympanic membrane after several months.
Acute Otitis Media (AOM) - Patho: Most common complications from this?
Hearing loss, expressive speech delay, typanosclerosis, tympanic membrane perforation, and chronic suppurative otitis media.
Acute Otitis Media (AOM) - therapeutic mx: Viral treatment?
They usually resolve spontaneously
Acute Otitis Media (AOM) - therapeutic mx: Bacterial treatment?
Require treatment with an antibiotic.
Acute Otitis Media (AOM) - therapeutic mx: How can this be determined?
Culture of middle ear. Also can check fluid obtained via tympanostomy in children with AOM.
Acute Otitis Media (AOM) - therapeutic mx: Why does antibiotic resistance develop?
Due to overuse of antibiotics.
Acute Otitis Media (AOM) - therapeutic mx: Certain diagnosis of this is based on what?
Signs of fluid in middle ear, with moderate to severe bulging of tympanic membrane with complaint of ear pain.
Along with sign and symptoms of inflammation in middle ear.
Acute Otitis Media (AOM) - therapeutic mx: Current recommendation by AAP for treatment?
Allow for a period ob observation. Allows for natural resolution.
Acute Otitis Media (AOM) - therapeutic mx: When would observation be recommended and not antibiotics?
When there are not severe signs or symptoms
Acute Otitis Media (AOM) - Health Hx: Common sign and symptoms include?
Fever, complaint of otalgia (ear pain), fussiness, tugging on er, and fluid draining from ear.
Acute Otitis Media (AOM) - Health Hx: Risk factors for this?
Young age, day care attendance, previous hx, and antecedent or concurrent URI.
Acute Otitis Media (AOM) - Physical Exam/Diagnostic Testing: On otoscopic examination, how will tympanic membrane appear?
Dull or opaque appearance and is bulging and/or red. Greenish pus may be visible.
Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What has been proven to manage mild to moderate pain?
Analgesics such as acetaminophen and ibuprofen, and they may also reduce fever
Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What instructions should be given to parents about heating/cooling packs?
Lie on the affected side with the heating pad or covered ice pack in place to that ear.
Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What to know for eardrops?
Eardrops like benzocaine (auralgan) may be helping in event of acute, severe pain
Acute Otitis Media (AOM) - Nursing Mx, Educating Family: If treatment selected is observation, what should be taught to parents?
The imporance of returning for evaluation if child not improving within 48-72 hours.
Acute Otitis Media (AOM) - Nursing Mx, Educating Family: What must be taught to family once treatment begins?
To adhere to antibiotics. And that follow-up for resolution of AOM is necessary
Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: Why should mothers be encouraged to breastfeed?
Because they have a lower incidence of AOm. Encouraged to feed for 6-12 months.
Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: How to best prevent child from getting this?
Avoid those who have URI. Do not expose them to second-hand smoke.
Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: What to know about Xylitol Syrup?
It’s a sucrose substitute, and may be protective. May cause diarrhea with excessive dosing.
Otitis Media with Effusion (OME): What is this?
Presence of fluid within middle ear space, without signs of infection. May persist after AOM has resolved.
Otitis Media with Effusion (OME):Risk factors for this?
Passivesmoking, absence of breastfeeding, frequent URI, allergy, and male sex.
Otitis Media with Effusion (OME):Complications of this?
AOM, hearing loss, and deafness.
Otitis Media with Effusion (OME), Health Hx: What symptoms may they show?
May be asymptomatic or experienc a popping sesnation or fullness behind ear
Otitis Media with Effusion (OME), Physical Exam: Otoscopic exam would reveal what?
Dull, opaque tmpanic membrane that may be white, gray, or bluish.
If not opaque, fluid level or air bubble may be visualized.
Otitis Media with Effusion (OME), Physical Exam: What can determine diagnosis of this?
Tympanometry. Mobility may be absent or diminished
Otitis Media with Effusion (OME), Nursing Mx, Educating Family: What to teach parents about treating?
Usually resolves spontaneously, but children should be rechecked every 4 weeks.
Otitis Media with Effusion (OME), Nursing Mx, Educating Family: What should parents not do?
Feed infants in supine position and avoid bottle propping
Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: What is the main concern when OME persists?
Effect on hearing. This can depress language acquisition
Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: What should happen for child with chronic OME?
They should be referred to a specialist for hearing eval.
Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: How to communicate effectively with children with OME who have hearing loss?
Turn off music or television. Position within 3 ft when talking.
Face child when speaking.
Use visual cues
Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: Standard treatment for persistent OME is?
Surgical insertion of pressure-equalizing (PE) tubes into the tympanic membrane
Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: how long do tubes stay in place?
For seveeral months and fall out on their own.
Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: What must parents do postop?
Administer ear drops if prescribed.
Also wear ear plugs when in bathtub or swimming.
Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: What does placement of PE tubes allow for?
Adequate hearing, which encourages appropriate speech development.
Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: What happens if middle ear becomes infected with PE tubes in place?
Tube allows infected fluid to drain from the ear.
Which situation would cause the nurse to become concerned about possible hearing loss?
12-month old who babbles incessantly, making no sense 8-month old who says only “da” 3-month old who startles easily to sound 3-year old who drops the letter “s”
8-month old who says only “da”
