NURS 2410 Unit 6 Nancy Pares, RN, MSN Metro Community College
Disorders of Eye • Visual disorders • Myopia • Astigmatism • Strabismus • Amblyopia
Disorders of Eye • Visual disorders • Cataracts • Glaucoma • Retinoblastoma • Color blindness • Retinopathy of prematurity (ROP)
Disorders of Ear • Otitis media • Otitis externa • Hearing impairment
Figure 24-2 Of the three anatomic differences in the eustachian tube between adults and small children (shorter, wider, more horizontal), which do you think could cause more problems for the child and why? Answer: More horizontal. Small children who are bottle fed in a supine position have a greater probability of developing otitis media because the eustachian tube opens when the child sucks and the horizontal angle provides easy access to the middle ear. In older children the greater angle helps keep foreign substances and germs away from the middle ear.
Disorders of Nose and Throat • Epistaxis • Nasopharyngitis • Sinusitis • Pharyngitis • Tonsillitis
Vision Screening • 20/20 by age 6 or 7 (visual acuity) • Screening starts at well-child exams when cooperative (screening timing and frequency)
Hearing Screening • Infant in hospital • Screening timing and frequency • Many states mandate • Observation for cues to hearing • Clinical manifestations
Risk Factors • Chronic ear infections • Chronic fluid/effusion • Follow-up needed for hearing deficit
Abnormalities of Eyes • Conjunctivitis • Bacterial • Antibiotic eye drops • Viral and allergic • Supportive care • Periorbital cellulitis • Oral or intravenous antibiotics
Abnormalities of Eyes • Other disorders • Multiple types of treatments based on etiology • Occlusion therapy • Compensatory lenses • Surgery • Vision therapy • Refer to eye specialist
Abnormalities of Ears • Otitis media • Antibiotic usage • Supportive care
Figure 24-7 Acute otitis media is characterized by abrupt onset, pain, middle ear effusion, and inflammation. Note the injected vessels and altered shape of cone of light. See Chapter 7for a normal tympanic membrane. Source: Courtesy of Kevin Kavanagh, MD, FACS.
Figure 24-8 Otitis media with effusion is noted on otoscopy by fluid line or air bubbles. Pneumatic otoscopy or tympanometry shows a nonmobile tympanic membrane. Note that the light reflex is not in the expected position due to a change in tympanic membrane shape from air bubbles. Where would you expect to see the light reflex? (See Chapter 7 for a description of normal findings.) Source: Courtesy of Kevin Kavanagh, MD, FACS.
Abnormalities of Ears • Recurrent otitis media or effusion • ENT referral for possible tympanostomy tube placement • Otitis externa • Antibiotic ear drops
Abnormalities of Ears • Hearing loss • Sensorineural • Cochlear implant
Abnormalities of Nose and Throat • Collaborative care includes antibiotics if bacterial in etiology • Nasopharyngitis • Pharyngitis • Tonsillitis • Tonsillectomy • Criteria for surgery • Sinusitis
Eye Abnormalities • Primary intervention is prevention • ROP interventions and prevention strategies • Protective eyewear
Ear Abnormalities • Prevention focus • Decrease otitis media • Increase access to care • Increase frequency of hearing screens • Reduce noise-induced hearing loss
Nose, Throat, and Mouth Abnormalities • Prevention measures • Education to prevent communicable diseases • Home care for common communicable diseases • Injury prevention • Dental emergencies • Tooth avulsion
Collaborate with Family of a Child with Human Immunodeficiency Virus (HIV) • Plan care • Age and developmentally appropriate • Medication regimen • Education on importance of regimen • Education on side effects • Promotion of general health • Avoid infectious individuals
Collaborate with Family of a Child with Human Immunodeficiency Virus (HIV) • Promotion of growth and development • Proper food • Proper atmosphere, toys, friends • Emotional support • Caregiver • Child • Support groups
Nursing Management of Systemic Lupus Erythematosus • Avoid triggers • Long-term planning for chronic illness • Maintain fluid balance • Promote adequate and appropriate nutrition
Nursing Management of Systemic Lupus Erythematosus • Promote skin integrity • Promote rest and comfort • Emotional support • Community activities and support groups
Nursing Management of Juvenile Arthritis • Pain relief • Maintain joint mobility • Prevent deformities • Promote self-care • Well-balanced diet • Hydration • Medication management
Latex Allergy • Increasingly common • Children at risk for allergy • Testing for latex allergy • Latex allergy questionnaire
Nursing Care for Child with Latex Allergy • Alternative products • Medical-alert ID bracelet • Epinephrine kit at home and school • Education of caregivers related to hypersensitivity reactions • Preparation to provide care
Hypersensitivity Reactions in Children • Type I • Definition • Type II • Definition • Type III • Definition • Type IV • Definition
Nursing Management • History • Assessment • Type I and Type II carry EpiPen
LEARNING OUTCOME 3 • Integrate information about oncologic emergencies into plans for monitoring all children with cancer.
Clinical Therapy • Therapy may be singular or combination of treatments • Surgery • Chemotherapy • Radiation • Biotherapy • HSCT • Complementary therapies • Palliative care
Nursing Care Plan • Based on type of cancer and therapy • Infection control • Pain • Nutrition • Growth and development • Emotional needs • Spiritual needs
Three Types of Oncological Emergencies • Metabolic • Tumor lysis syndrome • Septic shock • Hypercalcemia • Hematologic • Caused by bone marrow suppression • Require transfusion and careful RBC and WBC assessment
Three Types of Oncological Emergencies • Space-occupying lesions: tumors with extensive growth • Spinal cord compression • Increased ICP • Brain herniation • Seizures
Three Types of Oncological Emergencies • Space-occupying lesions: tumors with extensive growth • Hepatomegaly • Gastrointestinal obstruction • Cardiac and respiratory complications • SVC syndrome
Solid Tumors • Brain and central nervous system • Most common malignancy in children, next to leukemia • Treatment depends on type and location of tumor • Surgery • Radiation • Chemotherapy
Figure 29-13 Approximately 1,700 children under the age of 14 years are diagnosed annually as having tumors of the brain and central nervous system. The four most common brain tumors in children are medulloblastoma, cerebral astrocytoma, ependymoma, and brainstem glioma.
Solid Tumors • Neuroblastoma • Definition • Treatment based on protocol • Surgical • Chemotherapy • Radiation • HSCT
Solid Tumors • Wilms’ tumor • Define • Treatment based on stage • Requires surgical removal • Radiation • Chemotherapy