Peds Exam 4 - review game Flashcards
Amblyopia S/S
reduced visual acuity in one eye
asymmetry of corneal light reflex
Amblyopia is caused by what?
Strabismus, trauma, cataracts, or ptosis
Amblyopia Managment
Patching (the stronger eye) for several hours a day
atropine drops in the stronger eye daily, vision therapy, or eye muscle surgery
Amblyopia Reminder
Playing pirate for several hours a day and vision therapy makes me better (eye patch)
Congenital Cataracts
Opacity of the optic lens preventing light from entering into eye - lead to severe amblyopia if not treated
Congenital Cataracts can cause
leading cause of visual impairment & blindness
Congenital Cataracts - Nursing Assessment
Cloudy cornea
Absent red reflex in affected eye
leading cause of visual impairment & blindness?
CONGENITAL CATARACTs
Congenital Cataracts Managment
surgical removal of cataract and placing of implantable lens
Patching of normal eye after surgical eye has healed to strengthen vision
Sunglasses when outside to protect against UV rays
Surgical removal of cataract Post op teaching
Eye patching, Elbow restraints, Antibiotic & steroid drops
Otitis media with effusion (OME) - physical findings:
*Transient hearing loss and balance disturbances
Feeling of fullness in the ear
TM looks dull, opaque, orangish, visible fluid level, & air bubbles
Decreased tympanic movement
Vague findings including rhinitis, cough, diarrhea
OME Nursing Managment
antihistamines, steroids, and decongestants DO NOT HELP
usually goes away on its own but should be rechecked every 4 weeks
Do not feed in a supine position and avoid bottle propping
What if OME persists for >3 months?
refer to ENT and assess carefully for hearing loss or speech delay
If a child has hearing loss, what do we do?
Turn off music or TV
Position yourself in front of child within 3 feet, and face child
Use visual cues
Speak clearly in slightly raised volume only
Acute Otitis Media (AOM) - Physical Findings:
Rubbing/pulling on ear
TM will be dull, red, bulging, or opaque
hearing difficulties & speech delays
poor feeding
Difficulty sleeping, crying during night
Decreased or no tympanic movement =
AOM
how to check ear for children?
< 3 yrs – pull pinna down and back
> 3 yrs – pull pinna up and back
Otitis media dx tool for both =
Pneumatic otoscope - the thing dr puts in ear with light
Acute Otitis Media Tx
Antibiotic therapy DOES HELP:
Amoxicillin & azithromycin = po 10 - 14 days
Ceftriaxone IM (x one dose)
Acute Otitis Media symptomatic management
Warm heat or cool compresses
Acetaminophen or ibuprofen 4 pain
Benzocaine drops 4 pain if TM is not ruptured
manage otalgia = pain + fever
Types of hearing loss?
Conductive
Sensorineural
Mixed
Conductive hearing loss:
transmission of sound through the middle ear is disrupted (i.e. frequent OM)
Sensorineural hearing loss:
Damage to the hair cells in the cochlea or along the auditory pathway (i.e. ototoxic medication, meningitis, CMV, rubella, excessive noise)
Mixed hearing loss:
attributed to both conductive and sensorineural problem
Tympanostomy Tubes - funny reminder
I take the pressure off
I am needed when OM visits often
I allow the infection to get out
I fall out on my own
Tympanostomy Tubes (PE tubes)
PE tubes can be indicated for a child who has multiple episodes of OM
plastic or metal tubes placed in eardrum to equalize pressure and minimize fluid collection (effusion)
Tympanostomy Tubes Nursing Tx
Scheduled as OP surgery under general anesthesia (~15 minute surgery); PACU recover, discharged home same day
Tympanostomy Tubes post op teaching
Postop pain is not common
Teach ear drop administration if prescribed
Ear plugs recommended when swimming; if water enters ear, allow it to drain out
If any drainage is noted while PE tubes are in place -> see provider
how long do PE tubes remain in pace
remain in place for several months; usually fall out spontaneously (~8-18 months)
Infantile glaucoma funny reminders
I like to get in way of the aqueous humor flow
I cause optic nerve damage and vision loss
may see a gray or green light reflex in one eye
Surgery makes me go away
Infantile glaucoma physical cues?
Keeping eyes closed
Frequent eye rubbing
Spasmodic winking
Corneal clouding
Enlargement of eyeball
Excessive tearing or conjunctivitis
Red reflex may appear gray or green
Infantile glaucoma surgery post op care?
Protect surgical site: Elbow restraints: Maintain eye patch and bedrest; provide distraction activities
Infantile glaucoma surgery Discharge teaching:
Teach parents how to administer eye medications; No rough-housing or contact sports for 2 weeks
Infantile glaucoma first line Tx
Surgery – 3-4 surgeries may be needed
Infantile glaucoma
Autosomal recessive disorder with obstruction of aqueous humor flow and high intraocular pressure
Vision loss occurs as a result of retinal scarring and optic nerve damage
Tips for Interacting with Visually Impaired Child
Use child’s name to gain attention; Identify your presence first before touching child
describe people/objects to make child aware
Discuss upcoming activities
Use touch and tone of voice appropriate to the situation
Use simple and specific directions
Use parts of the child’s body as reference points for location of items
Encourage exploration of objects through touch
Cues of Hearing Loss in infants?
Wakes only to touch, not room noise
Does not babble by 6 months
Cues of Hearing Loss in young children?
Does not speak by age 2 years
Communicates needs through gestures
Focuses on facial expressions when communicating
Does not respond to doorbell or telephone
Cues of Hearing Loss in other children?
Often asks for statements to be repeated
Inattentive or daydreams
Poor school performance
Monotone speech
Types of Skin Lesions?
Macule
Papule
Annular
Vesicle
Pustule
Macule
- circular, flat discoloration <1cm
Papule
– superficial, solid, elevated <0.5 cm
Annular
– ring-like with central clearing
Vesicle
– circular collection of free fluid < 1 cm
Pustule
– vesicle containing pus
Intentional Skin Injuries - poem to remember
Location…Location…Location
Mom says this, Dad says that of how I came to BE
Poverty, prematurity & chronic illness can lead to ME
The buttocks, back & thighs are hiding places of THEE
Pattern markings can be KEY
Risk Factors for intentional skin injuries
Poverty
Prematurity; (<1yr)
Chronic illness
Intellectual disability
Parent w/abuse history; unrelated partner
Alcohol/substance abuse
Extreme stressors
Be Suspicious of abuse if…
Injuries in uncommon locations
Bruises in infants <9 months (immobile child)
Multiple injuries other than LEs
Frequent ED visits; delay in seeking care
Inconsistent stories
Unusual caregiver - child interaction
BURNS - remember saying
Stages 1-4 are how I appear to BE
Thermal, chemical & electrical are common types of ME
I cause capillaries to be permeable and protein to leak
Total Body Surface Area (TBSA) is necessary to critique
To know what nursing actions to treat
Burns primary survey:
AIRWAY:
Respiratory effort, symmetry of breathing, breath sounds; Pulse oximetry, ABG, carboxyhemoglobin levels, skin coclor,
hr, pulse strength, perfusion status
BURN Secondary survey
Burn depth
Body Surface Area (BSA)
Other traumatic injuries
BURN Stages?
Sunscreen/Sunburn Prevention - remember quote
I’m busiest in the summertime:
15 or higher is the best # to be
Broad spectrum & Oxybenzone free is the best kind of me
I do my best work before and during fun in the sun
Sunscreen/Sunburn education?
Infants <6 months out of direct sunlight, minimal sunscreen use
Hats, sun shirts
Sunscreen:
Broad spectrum (screens out UVA & UVB)
**Fragrance and oxybenzone free
*SPF 15 or higher; Zinc oxide products for nose, cheeks, ears, shoulders
Apply 30 minutes prior to sun activity, reapply at least every two hours or every 60-80 minutes while in the water
Use on sunny & overcast days
What is another name for Atopic dermatitis?
Eczema
Atopic dermatitis (Eczema) - remember me
Temperature changes and sweating makes me come out to play
I can make you wiggle and scratch all day & night
Sometimes I bring my friend wheeze
I make IgE levels rise
Atopic dermatitis (Eczema) Physical cues
Extreme itching ***
Erythema, inflammation
Variety of lesions/rash + dry scaly patches (plaques, papules, scaling, vesicles) on face, scalp, wrists or arms, elbows/antecubital, knees/popliteal areas
Elevated IgE levels
Presence of wheezing (asthma is common)
Atopic dermatitis (Eczema) Meds
Topical corticosteroids & Immune modulators-tacrolimus
what do we avoid with Atopic dermatitis (Eczema)?
avoid: hot water and soaps that contain perfumes, dyes, or fragrances
avoid synthetic clothing/bedding and wool
avoid long finger nails- keep short
Atopic dermatitis (Eczema) teachings
bathe 2X/day in warm water
Pat skin dry and leave moist while apply moisturizers
get 100% cotton bed + clothes
Antihistamines at HS may assist with itching; Behavior modification during waking hours (clickers, distraction, reward)
2 types of Diaper dermatitis
Non-candida
Candida
Non-candida
red, shiny; affects skin on buttocks, thighs, abdomen & waist, usually not in the creases or folds
Candida
deep red lesions, scaly with satellite lesions (outside of diaper area), usually in the creases & folds
Diaper Dermatitis Managment
Change diapers frequently
Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
Candida diaper dermatitis management?
Antifungal (Nystatin)
Diaper-less for a period of time daily to allow healing
Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3-5 minutes
Candida diaper dermatitis Med?
Antifungal (Nystatin)
Non-Candida diaper dermatitis Med?
Skin barriers (zinc oxide + A, D & E ointments + petroleum)
Non-candida diaper dermatitis management?
Skin barriers (zinc oxide, A,D & E ointments, petroleum
15 year-old male presents with areas of commodones on forehead and cheeks and scattered pustules on back with hypertrophic scaring
Acne Vulgaris
Acne Vulgaris History
Onset of lesions and family HX (Begins as early as age 7, affecting 85% of adolescents)
Use of any medications that may exacerbate (steroids, lithium, phenytoin, isoniazid)
Date of LMP for females (worse 2-7 days prior to start of menses)
HX of endocrine disorder
Acne Vulgaris physical cues?
Presence of comedones (papules - blackheads or whiteheads), pustules, nodules, and hypertrophic scarring (occurs on face, chest and back)
*oily skin or hair
Acne Vulgaris education:
Avoid oil-based cosmetics and hair products; Headbands, helmets/hats may exacerbate; balanced diet
Clean skin with mild soap and water BID; Shampoo hair regularly
Avoid picking/squeezing comodones
Acne Vulgaris med
topical meds - may take 4-6 weeks
Tretinion
Benzoyl peroxide (OTC products)
Topical antibacterials
Isotretinoin
Oral contraceptives