objective 10.8

Question 1

acute condition of the external ear canal
Pain and tenderness when manipulating the pinna or
tragus of the ear
TX: irrigation, topical antibiotics or antivirals

Answer 1

otitis externa

Question 2

Inflammation of the middle ear- most common in
children 6-36 months of age & early childhood
Occurs most often after an upper respiratory tract
infection
Infants are more prone than older children and adults
 Eustachian tubes are shorter, wider and straighter

Answer 2

otitis media

Question 3

what are the S&S of otitis media?

Answer 3

 Rubbing or pulling at ears
 Fever
 Irritability
 Possible hearing or speech changes depending on the
severity
 Headache, crying
 Rolling head side to side
 Reddened or bulging membrane
 Uninterested in ADL
 Drainage- if rupture happens

Question 4

what is the treatment of otitis media?

Answer 4

 aimed at finding cause & relieving symptoms
 Broad spectrum antibiotics
 Ensure to administer prescribed dose until all medication is used and
not stop when symptoms appear better
 Analgesics
 Comfort Measures
 Antipyretics, cold to reduce edema and pressure
What are the implication for administering ear drops ?
 Infant= pull pinna down and back
 Older children= pull pinna up and back

Question 5

Mom contracts communicable disease during
pregnancy, medications in pregnancy (German Measles ,
Accutane)

Answer 5

congenital hearing loss

Question 6

Loud noises, medications ie.
Gentamycin

Answer 6

sensorineural hearing loss

Question 7

Wax build up (impacted
cerumen), perforated TM

Answer 7

conductive hearing loss

Question 8

repeated infections

Answer 8

permanent hearing loss

Question 9

how do we diagnose hearing impairment?

Answer 9

 Early diagnosis and prompt treatment are primary requisites, regardless of age
 g loss of greater than 15 decibels (db) requires some interventions to prevent
developmental problems
 Routine newborn screens are recommended to be performed before discharge or
before 3 months
 Complete deafness usually discovered during infancy
 Partial deafness may be unrecognized until the child begins school

Question 10

what is the nursing care for hearing impairment?

Answer 10

 Need to be aware of symptoms of deafness in the child
 Newborn- lack of startle “moro” reflex in infants under 4 months of
age may be first sign of impairment
 No verbal attempts by 18 months needs a complete physical exam
 Be at Eye level, Face child when speaking, establish eye
contact, talk in short sentences, avoid use of exaggerated lip
or face movement
 Hearing aids or cochlear implants may be indicated – proper
teaching needed

Question 11

 An inflammation of the conjunctiva (the mucous membrane that
lines the eyelids
 Can be caused by a wide range of bacterial and viral agents,
allergens, irritants, toxins, and systemic diseases
 Can be infectious (Pink Eye) or noninfectious
 TX: topical antibiotic drops or ointments, warm compresses, wipe
from inner to outer and away from other eye, meticulous hand
washing

Answer 11

conjunctivitis

Question 12

 Myelodysplasia
 “divided Spine”
 Congenital Neural tube defect lack of closure of the spinal vertebrae

Answer 12

spina bifidawh

Question 13

what are the 2 forms of spina bifida?

Answer 13

occulta
cystica

Question 14

minor , small opening, no protrusion of structures

Answer 14

occulta

Question 15

involves development of a cystic mass…
meningocele or meningomyelocele

Answer 15

cystica

Question 16

how do we prevent and treat spina bifida?

Answer 16

Prevention- multivitamins and 0.4 mg Folic acid before conception
Treatment- Surgical closure, prevention of infection, skin care

Question 17

 Inflammation of the meninges
 Caused by various organisms bacterial, viral
 Group B Steptococcus
 Haemophilus influenza (type B)
 Vaccinations have decreased the incidents
 Bacterial meningitis is often called Purulent because a thick
exudate surrounds the meninges

Answer 17

meningitis

Question 18

what are the types of meningitis?

Answer 18

viral
bacterial

Question 19

 Illness which could lead to viral meningitis ie. Measles, mumps
 Mild to easy to treaqt
 Viral patient is better in 7 to 10 days

Answer 19

viral meningitis

Question 20

 More serious
 Usually leads to brain damage and sometimes death
 Peak incidence Occurs usually in infants age 6-12 months of age

Answer 20

bacterial meningitis

Question 21

what are the S&S of meningitis>

Answer 21

• Both types have an acute onset
• May be preceded by an URI
• Newborns – changes in behaviour
• Severe headache, drowsiness, delirium, irritability,
  restlessness, fever, nausea & vomiting, and stiffness
  of the neck
• Characteristic high pitch cry is noted in infants
• Several days of GI Symptoms (Poor Feeding)
• Complete disorientation

Question 22

• Seen in children with brain and meningeal injury
• Back is arched so that head is on an even level with heels
• Involuntary aching of back & extension
• Seen in Severe cases

Answer 22

opisthotonos position

Question 23

 Inability of patient to extend legs completely without
extreme pain
 Pain is what limits the passive extension of the knee

Answer 23

kernig’s sign

Question 24

 Flexion of Neck causes flexion of knee & hip
 Involuntary action (seen in children with meningitis)

Answer 24

brundzinski’s neck sign

Question 25

what is the treatment of meningitis?

Answer 25

 CSF Fluid obtained through spinal tap
 Isolation until 24 hours after antibiotic treatment started
 IV
 Antibiotics- minimum of 10-14 days
 Sedative
 Anticonvulsants

Question 26

what is the nursing care of meningitis?

Answer 26

 Single room
 Neuro checks
 Dimly lit room with decrease stimuli/ noise
 Reposition slowly
 Slowed pulse, irregular resp and increased BP reported
immediately- indicate Increased ICP
 Antipyretics
 Oxygen
 Seizure precautions (padded rails)

Question 27

 Neurological condition that affects motor function of the brain
 Does not always result in mental delay

Answer 27

cerebral palsy

Question 28

what are the causes of cerebral palsy>

Answer 28

 preexisting prenatal brain abnormalities
 exposure to maternal chorioamionitis in utero
 Due to bacteria which enters uterus from vagina
 Increase risk of mom developing this with each PV exam done in the last month
of pregnancy/ Labor
 Prematurity
 severe hypoglycemia.
 Can be a result of shaken baby syndrome, meningitis, or encephalitis

Question 29

what are the symptoms of cerebral palsy?

Answer 29

 Vary with each child, range from mild to severe
 Suspected during infancy if there are feeding problems,
seizures, and developmental delays
 Developmental milestones are not achieved at expected
age levels
 Persistence of primitive reflexes –Moro and tonic neck
reflexes

Question 30

 Occur with movement
 When child tries to move voluntary
muscles (jerky motions result)
 Eating walking & other coordinated
movements difficult
 Related to cerebral asphyxia
 Lower extremities usually
involved. Legs cross & toes
point inward

Answer 30

spastic cerebral palsy

Question 30

what are the 4 types of cerebral palsy?

Answer 30

spastic, athetoid, atacix, and mixed

Question 31

 Continuous involuntary
purposeless movements interfere
with normal motion
 Writhing movements
 Writhing= to make twisting or turning
movements; contort the body, as in
agony, squirm
 Speech, sight & hearing may be
complications
 Associated with hyperbilirubinemia

Answer 31

athetoid cerebral palsy

Question 32

 Uncoordinated movements and
ataxia from a lesion in the
cerebellum which is located
towards the base of the brain
 Responsible for balance and
coordination of movements
 Ataxia= loss of ability to
coordinate muscular movement

Answer 32

ataxia cerebral palsy

Question 33

Usually a combination of spastic
and athetoid

Answer 33

mixed cerebral palsy

Question 34

what is the treatment and nursing care of cerebral palsy>

Answer 34

 Medication regimen (to reduce spasticity, seizures, pain control)
 Dental hygiene (related to Dilantin use and gum hyperplasia)
 Physical Therapy
 Support
 Skin care
 Prevention of Contractures (ROM, Splints, Braces, Independence)
 Feeding problems
 Vitamin, minerals, or protein supplements may be required for some children
 Swallowing and sucking may be difficult, Vomiting is a common occurrence because of
overactive gag reflex
 ++ Patience to help child feed. See Skill 24.3 for modifications and precautions in feeding
techniques