NURS 2410 Unit 6 and 7 Nancy Pares, RN, MSN Metro Community College
Objective 1 • Identify pathophysiology and nursing process of selected sensory/neurological system alterations inclusive of: • Visual, hearing, retinoblastoma (covered in onco unit), hydrocephalus, cerebral palsy, spina bifida, muscular dystrophies, spinal cord injuries and systemic lupus
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
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
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
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
Neurological Anatomic Differences in Children • Cranial bones are not completely ossified • Allows for brain growth • The posterior fontanel closes at 3-4 months • The anterior fontanel closes at 18 months • Increases risk for brain and spinal cord injury
Figure 33-2 The skull and brain grow and develop rapidly during early childhood. Infants and young children are at higher risk for injury to the brain and spinal cord because of developing anatomic structures.
Nursing Assessment of Altered Levels of Consciousness and Other Neurological Conditions • Levels of consciousness—most important indicator of neurological dysfunction • Consciousness—receptiveness to stimuli • Alertness—arousal, ability to react • Cognitive power—ability to process data and respond • Altered levels of consciousness • Causes
Nursing Assessment of Altered Levels of Consciousness and Other Neurological Conditions • Levels of consciousness assessment • Categories: confusion, delirium, lethargy, obtunded, stupor, and coma • Decorticate and decerebrate posturing
Figure 33-3A, Decorticate posturing, characterized by rigid flexion, is associated with lesions above the brainstem in the corticospinal tracts.
Figure 33-3 (continued)B, Decerebrate posturing, distinguished by rigid extension, is associated with lesions of the brainstem.
Nursing Assessment of Altered Levels of Consciousness and Other Neurological Conditions • Increased intracranial pressure • Scales for responsiveness
Nursing Assessment of Altered Levels of Consciousness and Other Neurological Conditions • Increased intracranial pressure • Glasgow coma scale
Figure 33-4 Pupil findings in various neurological conditions with altered consciousness. A, A unilateral dilated and reactive pupil is associated with an intracranial mass. B, A fixed and dilated pupil may be a sign of impending brainstem herniation. C, Bilateral fixed and dilated pupils are associated with brainstem herniation from increased intracranial pressure.
Status Epilepticus • An acute seizure that lasts over 30 minutes • Electrolytes, glucose, blood gases, temperature, and blood pressure need monitoring if a seizure occurs for longer than 10 minutes
Nursing Management for Seizures • Maintain airway • Ensure safety • Administer medications • Provide emotional support • Provide education