Pediatric Nursing: Eye, Ear, and Throat Problems

Question 1

Strabismus

Answer 1

• called “squint” or “cross eye”.
• condition in which eyes are not aligned because of lack of coordination of the extraocular muscles.
• most often result s from muscle imbalance or paralysis of extraocular muscle, but may also result from a congenital defect.
• amblyopia (reduced visual acuity) and permanent loss of vision may occur if not treated early.
• this condition, considered a normal finding in an infant, should not be present after about age 4m.
• treatment depends on the cause.
  Assessment:
• crossed eye, squinting, tilts the head or closes one eye to see, loss of binocular vision, impairment of depth perception, frequent headaches, diplopia, photophobia.
  Intervention:
• corrective lenses may be indicated, instruct parents regarding patching of the good eye to strengthen the weak eye. Prepare for surgery to realign the weak muscles and instruct the need for follow-up visits.

Question 2

Conjunctivitis

Answer 2

• an inflammation of the conjunctiva, also known as “pink eye”, usually caused bay allergy, infection, or trauma.
• types include viral, bacterial, or allergic; bacterial or viral are extremely contagious.
  Assessment:
• itching, burning, or scratchy eyelids. Redness, edema, and discharge.
  Interventions:
• viral infections will resolve in 7-14 days (some cases up to 3 weeks). Antiviral med may be prescribed to treat more serious forms such as caused by herpes simplex or varicella zoster.
• bacterial may improve without ATB treatment, but usually is prescribed as eyes drops or ointment to shorten the length of infection, reduce complications, and reduce the spread.
• when allergic, must remove the allergen from the environment and allergy meds and eyes drops may be prescribed.
• instruct a child who is wearing contact lenses to discontinue and obtain a new pair after treatment. Eye makeup should also be discarded and replaced.

Question 3

Otitis Media: description, prevention, and assessment

Answer 3

• inflammatory disorder caused by an infection of the middle ear occurring as a result of a blocked eustachian tube, which prevents normal drainage (can be acute or chronic).
• common complication of an acute respiratory infection.
• children have eustachian tubes that are shorter, wider, and straighter, which makes them more prone to otitis.
  Prevention:
• feed infants in upright position, maintain routine examinations, encourage breast-feeding for at least the 1st 6m of life, and avoid exposure to tobacco.
  Assessment:
• fever, ear pain, crying, irritability, lethargy, loss of appetite, rolling head from side to side, pulling on or rubbing the ear, purulent ear drainage. Red opaque, bulging, immobile tympanic membrane on otoscopic examination. Signs of hearing loss (indicative of chronic otitis).

Question 4

Otitis Media: Interventions

Answer 4

• encourage fluid intake and avoid chewing as much as possible during the acute period.
• provide local heat or cold as prescribed to relieve discomfort, and have the child lie with the affected ear down.
• instruct parents on appropriate procedure to clean drainage and adm of medications.
• in healthy infants older than 6m, usually, waiting up to 72h for spontaneous resolution is a safe and appropriate management.

Question 5

Otitis Externa

Answer 5

• inflammation of the external auditory canal, which can occur with or without infection; also known as “swimmer’s ear”.
  Assessment:
• rapid onset of symptoms (within 48h). Otalgia, pruritis, fullness, drainage, and impaired hearing.
• low grade fever may be present.
• tenderness on manipulation of the pinna and tragus, and may have lymphadenopathy.
  Interventions:
• topical ATB and may include neomycin with or without polymyxin B or a fluoroquinolone preparation.

Question 6

Ear medication (adm)

Answer 6

• in a child younger than 3 years, pull the earlobe down and back.
• in a child older than 3 years, pull the pinna up and back.

Question 7

Myringotomy

Answer 7

• surgical incision into the tympanic membrane to provide drainage of the purulent middle ear fluid (may be done by laser).
• tympanoplasty tubes, may be inserted into the middle ear to allow continued drainage and to equalize pressure and allow ventilation of the middle ear.
  PostOp interventions:
• keep the ears dry, child should wear earplugs while bathing, shampooing, and swimming (diving is not allowed).
• child should not blow nose for 7-10 days after surgery.
• if tubes fall out, it is not an emergency, but the PHCP should be notified.

Question 8

Tonsillitis and Adenoiditis: description and assessment

Answer 8

• tonsillitis refers to inflammation and infection of the tonsils.
• adenoiditis refers to inflammation and infection of the adenoids.
• both when enlarged can lead to an obstructive sleep apnea in children.
• can be result of a viral, bacterial, or fungal infection.
• group A streptococcus is a common bacterial infections, and mononucleosis is another possible cause.
• tonsillectomy and adenoidectomy may be necessary depending on the number of infections per year.
  Assessment:
• persistent or recurrent sore throat, enlarged bright red tonsils that may be covered with exudate, difficulty in swallowing, mouth breathing and unpleasant odor, fever, cough, snoring, or obstructive sleep apnea.

Question 9

Tonsillitis and Adenoiditis: Interventions

Answer 9

PreOp
- assess for signs of active infection, bleeding and clotting studies, and loose teeth.
PostOp
- postion the child prone or side-lying to facilitate drainage and have suction equipment available in case of an obstruction.
- monitor for signs of bleeding, discourage coughing, clearing the throat, or nose blowing.
- provide an ice collar or analgesics for discomfort.
- provide clear, cool, noncitrus and noncarbonated fluids (avoid red, purple, or brown liquids so not to simulate blood if child vomits).
- avoid milk products initially because they coat the throat, causing the child to cough.
- soft foods may be prescribed 1-2 days postop.
- do not give child straws, forks, or sharp objects that can be put into the mouth.
- mouth odor, slight ear pain, and low-grade fever may occur for a few days postop.
- usually the child is able to resume normal activities 1-2 weeks postop.

Question 10

Epistaxis

Answer 10

• the nose, especially the septum, is a highly vascular structure, and bleeding usually results from direct trauma, foreign bodies, and nose picking or from mucosal inflammation.
• recurrent epistaxis and severe bleeding may indicate an underlying disease.
  Interventions:
• have the child sit up and lean forward (not lie down).
• apply continuous pressure to the nose with the thumb and forefinger for at least 10 min.
• insert cotton or wadded tissue in each nostril, and apply ice or a cold cloth to the bridge of the nose if bleeding persists.
• is bleeding can not be controlled, packing or cauterization of the vessel may be prescribed.

Question 11

Allergic Rhinitis

Answer 11

• condition in which children are sensitized to environmental allergens.
  Assessment:
• itchy and watery eyes, runny nose, itchy throat.
• may be a family history of atopic disease.
• dark circles under eyes, cobblestoning of the conjunctiva, nasal polyps, fluid in the middle ear, cobblestoning of the posterior pharynx, wheezes, rhonchi, eczema, hives, angioedema.
  Interventions:
• children should be tested for environmental and food allergies, atopic dermatitis, and asthma.
• avoidance of triggers; adm of prescribed antihistamines, nasal corticosteroids, inhalers.