[Exam 4] Chapter 39 – Alteration in Sensory Perception/Disorder of the Eyes or Ears

Question 1

Variations in Anatomy - Eyes: When is iris color determined?

Answer 1

By 6-12 months of age. They are born with blue eyes.

Question 2

Variations in Anatomy- Eyes: Infant sees best at what distance?

Answer 2

8-10 inches

Question 3

Variations in Anatomy- Eyes: When is 20/20 vision obtained?

Answer 3

By 6-7 years

Question 4

Variations in Anatomy - eyes: When does binocular vision develop?

Answer 4

By 4 months of age

Question 5

Variations in Anatomy -Ears: Main difference here between adult and child?

Answer 5

Eustachian tube is straight in a child, but slants as they grow older.

Question 6

Common Medical Tx, Health Hx: Past medical history may be significant for what?

Answer 6

Prematurity, genetic defect, eye or ear deformity or deafness.

Question 7

Common Medical Tx, Health Hx: When asking parents about history, ask then about onset and progression and presence of what?

Answer 7

Fever, nasal congestion, eye/ear pain, eye rubbing, ear pulling and headache.

Question 8

Common Medical Tx, Health Hx, Inspection: Note what about the eyes?

Answer 8

Whether child uses eyeglasses, corrective lenses, or hearing aid. Observe eyes for positioning and variations in eyelids.

Question 9

Common Medical Tx, Health Hx, Inspection: What to know about sclera in newborns?

Answer 9

They will appear bluish in newborns, but become white within the first few weeks of life.

Question 10

Common Medical Tx, Health Hx, Inspection: Ears will be checked for what?

Answer 10

Size/Shape, Position, and Presence of skin tags, dimples.

Question 11

Common Medical Tx, Health Hx, Palpation: Ears should be palpated for what?

Answer 11

Tenderness over tragus or pinna.

Question 12

Common Medical Tx, Health Hx, Palpation: What does Typanometry do?

Answer 12

Probe in ear canal measures movement of eardrum

Question 13

Acute Otitis Media (AOM): What is this?

Answer 13

Common illness in children, resulting from infection (bacterial or viral) of fluid in the middle ear.

Question 14

Acute Otitis Media (AOM): Why are children more prone to get this?

Answer 14

Due to short length and horizontal positioning of the Eustachian tube, and limited respones to antigens

Question 15

Acute Otitis Media (AOM): Biggest risk factors for this?

Answer 15

Eustachian tube dysfunction and susceptibility to recurrent upper respiratory infections

Question 16

Acute Otitis Media (AOM) - Patho: What frequently precedes this?

Answer 16

Upper respiratory infection. They travel upward invading the middle ear space.

Question 17

Acute Otitis Media (AOM) - Patho: What occurs acutely once invasion begins?

Answer 17

Fever and pain. Increased pressure behind membrane may cause proliferation resulting in decreased pain and yield drainage.

Question 18

Acute Otitis Media (AOM) - Patho: What happens once infection clears?

Answer 18

Fluid remains in the middle ear space behind the tympanic membrane after several months.

Question 19

Acute Otitis Media (AOM) - Patho: Most common complications from this?

Answer 19

Hearing loss, expressive speech delay, typanosclerosis, tympanic membrane perforation, and chronic suppurative otitis media.

Question 20

Acute Otitis Media (AOM) - therapeutic mx: Viral treatment?

Answer 20

They usually resolve spontaneously

Question 21

Acute Otitis Media (AOM) - therapeutic mx: Bacterial treatment?

Answer 21

Require treatment with an antibiotic.

Question 22

Acute Otitis Media (AOM) - therapeutic mx: How can this be determined?

Answer 22

Culture of middle ear. Also can check fluid obtained via tympanostomy in children with AOM.

Question 23

Acute Otitis Media (AOM) - therapeutic mx: Why does antibiotic resistance develop?

Answer 23

Due to overuse of antibiotics.

Question 24

Acute Otitis Media (AOM) - therapeutic mx: Certain diagnosis of this is based on what?

Answer 24

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.

Question 25

Acute Otitis Media (AOM) - therapeutic mx: Current recommendation by AAP for treatment?

Answer 25

Allow for a period ob observation. Allows for natural resolution.

Question 26

Acute Otitis Media (AOM) - therapeutic mx: When would observation be recommended and not antibiotics?

Answer 26

When there are not severe signs or symptoms

Question 27

Acute Otitis Media (AOM) - Health Hx: Common sign and symptoms include?

Answer 27

Fever, complaint of otalgia (ear pain), fussiness, tugging on er, and fluid draining from ear.

Question 28

Acute Otitis Media (AOM) - Health Hx: Risk factors for this?

Answer 28

Young age, day care attendance, previous hx, and antecedent or concurrent URI.

Question 29

Acute Otitis Media (AOM) - Physical Exam/Diagnostic Testing: On otoscopic examination, how will tympanic membrane appear?

Answer 29

Dull or opaque appearance and is bulging and/or red. Greenish pus may be visible.

Question 30

Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What has been proven to manage mild to moderate pain?

Answer 30

Analgesics such as acetaminophen and ibuprofen, and they may also reduce fever

Question 31

Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What instructions should be given to parents about heating/cooling packs?

Answer 31

Lie on the affected side with the heating pad or covered ice pack in place to that ear.

Question 32

Acute Otitis Media (AOM) - Nursing Mx, Managing Pain: What to know for eardrops?

Answer 32

Eardrops like benzocaine (auralgan) may be helping in event of acute, severe pain

Question 33

Acute Otitis Media (AOM) - Nursing Mx, Educating Family: If treatment selected is observation, what should be taught to parents?

Answer 33

The imporance of returning for evaluation if child not improving within 48-72 hours.

Question 34

Acute Otitis Media (AOM) - Nursing Mx, Educating Family: What must be taught to family once treatment begins?

Answer 34

To adhere to antibiotics. And that follow-up for resolution of AOM is necessary

Question 35

Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: Why should mothers be encouraged to breastfeed?

Answer 35

Because they have a lower incidence of AOm. Encouraged to feed for 6-12 months.

Question 36

Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: How to best prevent child from getting this?

Answer 36

Avoid those who have URI. Do not expose them to second-hand smoke.

Question 37

Acute Otitis Media (AOM) - Nursing Mx, Preventing AOM: What to know about Xylitol Syrup?

Answer 37

It's a sucrose substitute, and may be protective. May cause diarrhea with excessive dosing.

Question 38

Otitis Media with Effusion (OME): What is this?

Answer 38

Presence of fluid within middle ear space, without signs of infection. May persist after AOM has resolved.

Question 39

Otitis Media with Effusion (OME):Risk factors for this?

Answer 39

Passivesmoking, absence of breastfeeding, frequent URI, allergy, and male sex.

Question 40

Otitis Media with Effusion (OME):Complications of this?

Answer 40

AOM, hearing loss, and deafness.

Question 41

Otitis Media with Effusion (OME), Health Hx: What symptoms may they show?

Answer 41

May be asymptomatic or experienc a popping sesnation or fullness behind ear

Question 42

Otitis Media with Effusion (OME), Physical Exam: Otoscopic exam would reveal what?

Answer 42

Dull, opaque tmpanic membrane that may be white, gray, or bluish. If not opaque, fluid level or air bubble may be visualized.

Question 43

Otitis Media with Effusion (OME), Physical Exam: What can determine diagnosis of this?

Answer 43

Tympanometry. Mobility may be absent or diminished

Question 44

Otitis Media with Effusion (OME), Nursing Mx, Educating Family: What to teach parents about treating?

Answer 44

Usually resolves spontaneously, but children should be rechecked every 4 weeks.

Question 45

Otitis Media with Effusion (OME), Nursing Mx, Educating Family: What should parents not do?

Answer 45

Feed infants in supine position and avoid bottle propping

Question 46

Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: What is the main concern when OME persists?

Answer 46

Effect on hearing. This can depress language acquisition

Question 47

Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: What should happen for child with chronic OME?

Answer 47

They should be referred to a specialist for hearing eval.

Question 48

Otitis Media with Effusion (OME), Nursing Mx, Monitoring for Hearing Loss: How to communicate effectively with children with OME who have hearing loss?

Answer 48

Turn off music or television. Position within 3 ft when talking. Face child when speaking. Use visual cues

Question 49

Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: Standard treatment for persistent OME is?

Answer 49

Surgical insertion of pressure-equalizing (PE) tubes into the tympanic membrane

Question 50

Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: how long do tubes stay in place?

Answer 50

For seveeral months and fall out on their own.

Question 51

Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: What must parents do postop?

Answer 51

Administer ear drops if prescribed. Also wear ear plugs when in bathtub or swimming.

Question 52

Otitis Media with Effusion (OME), Providing PostOp Care for Child with Pressure-Equalizing Tubes: What does placement of PE tubes allow for?

Answer 52

Adequate hearing, which encourages appropriate speech development.

Question 53

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?

Answer 53

Tube allows infected fluid to drain from the ear.

Question 54

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”

Answer 54

8-month old who says only “da”