WEEK 3 Notes Flashcards
peds sensory peds skin issues (notes from class)
otitis media
results from inflammation in the middle ear
fluid accumulation causes pain and affects balance
bacterial, viral, or both
screening for otitis media
presentation of manifestations
signs would be: child pulling at ear, drainage, pain
otoscopic examination (green/brown drainage, red and inflamed membranes)
risk factors for otitis media
often cause is upper respiratory congestion
what to do before antibiotics for otitis media
wait and see method
fight off what is going on in their ear
medications to give for otitis media pain
Tylenol
Motrin
GIVEN BASED OFF WEIGHT
antibiotics for otitis media
amoxicillin
azithromycin
complete antibiotics fully, not just til you feel better
who does the hearing test for children?
audiologist (TEST Q)
types of hearing loss
conductive
sensorineural
mixed
acute vs. chronic
risk factors for hearing loss in children
meningitis
birth trauma (assisted deliveries)
high bilirubin levels (jaundiced) (hyperbilirubinemia)
TORCH infections (mom)
genetic anomalies
screening for hearing loss
after 1 month of age yearly until 21 years old at well visits
signs of hearing loss in children
lack of response
eye contact when speaking isn’t present
speech impediment
not engaged with other children
what signs are similar to hearing loss in children
signs of autism
3 R’s for pediatric hearing loss
rhythm, rhyme, repetition
strabismus
eye malalignment
types of strabismus
esotropia
exotropia
hypertropia
hypotropia
esotropia
one eye is straight and normal
one eye is looking in toward nose
exotropia
one eye is straight and normal
one eye is looking out toward ear
hypertropia
one eye is straight and normal
one eye is looking up
hypotropia
one eye is straight and normal
one eye is looking down
issues with strabismus
can’t read well
headaches
falls
treatment for strabismus
strengthen muscles and correct alignment
glasses
eye patches (over strong eye)
eye drops
eye surgery
eyeglasses can be what on a family?
financial strain
what to avoid with both otitis media, hearing loss, and vision impairments?
SMOKING
premature birth risks with vision
They have dyspnea but don’t put on O2 because 100% O2 can cause neuropathy
eye trauma
penetrating
perforating
penetrating eye trauma
goes in
perforating eye trauma
goes in and out
risk factors for eye trauma
rough kids that fight
curiosity
automobile injuries (wear seatbelts)
what to do if eye is blurry and bleeding?
eye trauma
DONT TOUCH ANYTHING IN IT. cover it up and go to the hospital
should the nurse ever remove anything from any eyes?
no
signs of eye injury
redness
itchy eyes
inflammation
CHEMICAL IN EYE: wash eye forever
water temp when rinsing eyes
tap water temp
not too hot
blindess
vision loss is not corrected by contacts/glasses/surgery
partial or complete
risk factors for blindness
vitamin A deficiency (eat carrots)
retinopathy of prematurity (babies on 100% O2)
legal blindness
20/200 or worse (with corrective devices)
blindness in children and lead to what risk?
risk of regression
might not milestones the same as other children
retinoblastoma
cancer from unknown growth of cells in the retina
retinoblastoma (hereditary vs not)
hereditary: both eyes
once you have it hereditarily, you are at an increased risk of other cancers later on in life
unilateral if NOT hereditary
risk factors for retinoblastoma
hereditary
young age
low maternal consumption of fruits/veggies
clinical presentation
Eye pain
Visual changes
Strabismus (misalignment)
Bleeding in the eye
Eye bulging
Non-reactive pupil
White pupil reflex
Pink appearance to the pupil
treatment for retinoblastoma
chemo/radiation
surgery, cryotherapy, and/or laser treatment
Rhabdomyosarcoma
soft tissue cancer within connective tissue
clinical presentation of Rhabdomyosarcoma
strabismus
bulging of the eye
vision changes
risk factors for Rhabdomyosarcoma
males
prenatal exposure to toxins (marijuana, cocaine, radiation)
treatment for Rhabdomyosarcoma
chemo
radiation
stem cell
surgery
Eustachian tubes in children are more
horizontal than adults
chronic vs. acute otitis media
chronic: long lasting and doesn’t resolve with treatment; can lead to necrosis and ischemia of tympanic tissue
acute: short term and complies with treatment
are females or males more commonly diagnosed with otitis media
males
most common clinical presentation of a child who has OM
rapid onset inflammation and pain in the ear
difficulty breathing
fever
tearfulness
diarrhea
poor appetite
vomiting
f the child is unable to verbalize their manifestations of OM…
one may notice the child pulling at the affected ear and turning head from side to side
otorrhea of OM
drainage of ear
yellow or green
tympanic membrane perforation
commonly cause by OM
manifestations:
abrupt ear pain
vertigo
tinnitus
hearing loss in affected ear
bloody otorrhea
most common age for ear infections in children
6 to 24 months old
A nurse is caring for a 20-month-old client newly diagnosed with acute otitis media. The client’s parent states, “My baby needs ear tubes. This is the second ear infection in two years.” Which of the following is the best response by the nurse?
“Normally, ear tubes are not inserted until there are four or more ear infections in a 12-month period.”
A nurse is caring for a child experiencing re-current OM. Which of the following complications should the nurse know the child is at risk for?
speech delays
manifestations of strabismus
squinting
strabismus
vomiting
headache
diplopia
impaired depth perception
A nurse is caring for a child suspected of having strabismus. Which of the following is true about strabismus?
may experience depth perception impairment
A nurse is caring for a 6-year-old child in the outpatient ophthalmology clinic evaluated for possible strabismus. Which of the following findings by the ophthalmologist is indicative of the presence of strabismus?
Hirschberg test reveals asymmetrical light reflection.
Mindy expects the ophthalmologist to present information about which of the following treatment options for strabismus?
eye patch
atropine eye drops
glasses
eye surgery
penetrating trauma
Eye injury producing an entry wound without an exit wound
blunt force trauma
A forceful hit to the eye by an object
perforating trauma
Eye injury producing an entry and exit wound
ruptured globe
Caused by impaired integrity to the outermost layer of the eye
Eye trauma may present
obvious injury
bleeding
laceration
child may report what with eye trauma
pain
sensation that something in in their eye
photophobia
blurred vision
floaters
diplopia
A nurse is discussing eye injuries during a staff meeting. Which of the following activities is identified as having an increased risk for globe rupture injuries?
playing tennis
The nurse should identify that sports-related injuries such as football, baseball, and tennis are the most common causes of globe rupture injuries caused by blunt force trauma to the eye.
complications of ocular trauma
endophthalmitis
hemorrhage
traumatic cataract
retinal detachment
food sources of vitamin A
orange vegetables: pumpkin, Hubbard squash, carrots, sweet potatoes
eggs
green leafy vegetables
cantaloupes
retinopathy of prematurity
Disease involving the vessels of the retina that may lead to vision loss or blindness.
happens when you give babies 100% O2 after birth
A nurse is educating a parent about the benefits of feeding their child foods rich in vitamin A to support eye health. Which of the following statements by the parent indicates more education is needed?
Vitamin A is necessary to build eye muscle strength.
Which of the following is a risk factor for blindness?
malnutrition
genetics
eye trauma
prematurity
clinical presentation of blindness
unable to focus on an object or may not follow objects as they move
other manifestations:
photophobia
eye discomfort
floaters
sudden vision loss
The two most common types of malignant pediatric ocular cancers
retinoblastoma and rhabdomyosarcoma
A nurse is caring for a child who has rhabdomyosarcoma. Which of the following manifestations would the nurse expect to see in this child?
bulging of the eye
misalignment of the eyes
description of worsening of vision in the last month
age group most likely to be affected by retinoblastoma
children 2 years or younger
prolonged exposure to blue lights from electronics can result in what
macular degeneration when older
experiencing photophobia that leads to headaches
wear sunglasses while outdoors
what can eye trauma put child at risk for
infection
blindness
tear in the sclera
dermatitis
inflammation of the skin that results in manifestations of redness and itching
contact dermatitis
inflammation that occurs when the skin encounters an irritant
irritants that can cause contact dermatitis
substances like perfumes
jewelry
plants like poison ivy/oak/sumac
allergic contact dermatitis vs irritant contact dermatitis
ACD- allergen triggers an immune response
irritant contact- the irritant itself damages the skin
clinical presentation of irritant contact dermatitis
redness
pruritus (itchy)
swelling
oozing
vesicles
helpful non-medication treatment for contact dermatitis
calamine lotion
oatmeal baths
cool, wet compresses
what can be used for pruritis for contact dermatitis
OTC antihistamines
Clobetasol
topical corticosteriod
Decreases skin irritation, inflammation, and pruritus
prednisone
corticosteriod
Decreases inflammation and is used in dermatologic and a variety of other conditions
adverse effects:
Weight gain, fluid retention, hypertension, behavioral disturbances, stomach irritation, increased blood sugar, adrenal suppression, immunosuppression, increased risk of infection, osteoporosis
cephalexin
antibiotic; cephlosporin
Treats bacterial infections
adverse effects: Gastrointestinal upset, including nausea, vomiting, diarrhea, abdominal pain
take full course as directed by the provider
dicloxacillin
antibiotic: penicillin
diaphenhydramine
antihistamine
Treats allergic reactions and pruritus caused by histamine. Can be used off-label to help with sleep due to sedative effects.
adverse effects: Drowsiness, dizziness, blurred vision, constipation, dry mouth
avoid in kids under the age of 6
cetirizine
second-gen antihistamine
Treats allergic reactions and pruritus caused by histamine
can cause headache and drowsiness
antihistamines in children
can cause excitability
toxicity can occur (hallucinations or double vision)
clinical presentation of poison ivy
papule
vesicles
bullae
(linear)
bullae
large fluid filled blisters
papules
small, inflamed, raised areas on the skin
vesicle
A cyst or blister on the skin that is filled with fluid.
without treatment, how long does it take for poison ivy dermatitis to self-resolve
1-3 weeks
burned urushiol
can cause it to go into airway, so airway assessment and management is critical
medications that causes most exanthamtous drug eruption
antibiotics
human bite
more a semi-circle
can warrant as child abuse sometimes
what hormone is acne vulgaris related to
testosterone
atopic dermatitis
caused by water-loss on the skin and itchy skin
medications for severe psoriasis
oral methotrexate
does seborrheic dermatitis cause pain
aka cradle cap
no pain, it is mild manifestations, self-limiting