Chapter 18: Nursing Care of the Child with a Disorder of the Eyes Or Ears

Chapter 18: Nursing Care of the Child with a Disorder of the Eyes or Ears

Learning Objective 1.Discuss the anatomical and physiologic differences between the eyes and ears of children andthose of adults.

Discuss how the infant’s eyes are not fully developed at birth. Explain that the eyes are still spherical, the optic nerve is not completely myelinated, visual acuity and binocular vision have not been achieved, and retinal vascularization in the preterm infant is not complete. Explain the effects of these factors on vision.
Explain how a child’s hearing is fully developed at birth, but the Eustachian tubes are structurally different than in adults. Tell about the susceptibility to inner ear infection.

Learning Objective 2.Identify various factors associated with disorders of the eyes and ears in infants and children.

Discuss factors that may cause eye disorders such as prematurity, genetic defect, infectious exposure, family history of eye disorders, African-American heritage, previous eye injury, diabetes, HIV, and chronic steroid use.
Discuss factors that cause ear disorders such as short, horizontal Eustachian tubes; prematurity; persistent pulmonary hypertension of the newborn; family history; high noise levels; congenital abnormalities; infection; kernicterus; neonatal ventilation use; and ototoxic medications.

Learning Objective 3. Discuss common laboratory and other diagnostic tests useful in diagnosing disorders of the eyes and ears.

Discuss cultures of eye and ear discharge, tympanic fluid culture, and typanometry (refer to PowerPoint Slide 5 and Common Laboratory and Diagnostic Tests 18-1).

Learning Objective 4. Discuss common medications and other treatments used for treatment and palliation of conditions affecting the eyes and ears.

Describe treatments and medications for the eye including warm compresses, corrective lenses, patching, surgery of the eye muscles, oral and ophthalmic antibiotics, antihistamines, and analgesics.
Discuss treatments and medications for the ear including pressure-equalizing tubes, hearing aids, cochlear implants, analgesics, warm compresses, and antibiotic or antifungal eardrops.
Refer to Common Medical Treatments 18-1 and Common Drugs for Ear or Eye Disorders 18-1.

Learning Objective 5.Recognize risk factors associated with various disorders of the eyes and ears.

Discuss the risk factors for eye disorders, including those for conjunctivitis: age of less than 2 weeks, contact with other children, upper respiratory disease, pharyngitis, otitis media, chlamydial pneumonia, family history, asthma, allergic rhinitis, and atopic dermatitis. Also discuss risk factors for retinopathy of prematurity: low birth weight, early gestational age, sepsis, high light intensity, and hypothermia.
Explain the risk factors for disorders of the ear, includingshort length and horizontal positioning of the Eustachian tube, limited response to antigens, and lack of previous exposure to common pathogens. Also discuss passive smoking, absence of breastfeeding, frequent viral upper respiratory infection, allergy, young age, male sex, adenoid hypertrophy, Eustachian tube dysfunction, and certain congenital disorders.
Refer to Boxes 18-3 and 18-4.

Learning Objective 6.Distinguish between different disorders of the eyes and ears based on the presenting signs and symptoms.

Discuss the signs, symptoms, and risks for eye disorders including conjunctivitis, nasolacrimal duct obstruction, eyelid lesions, periorbital cellulitis, eye injuries, refractive errors, astigmatism, strabismus, amblyopia, nystagmus, infantile glaucoma, congenital cataract, retinopathy of prematurity, and visual impairment (refer to Tables 18-1 and 18-2 and Figs. 18-4a, 18-4b, and18-5–18-9).
Discussthe signs, symptoms, and risks for ear disorders including acute otitis media, otitis externa, otitis media with effusion, hearing loss, and deafness.
Refer to PowerPoint Slides7–40, Tables 18-1–18-3, Boxes 18-3 and 18-4, and Figs. 18-4a, 18-4b, 18-5–18-9, 18-10a, 18-10b, and 18-11–18-13.

Learning Objective 7.Discuss nursing interventions commonly used in disorders of the eyes and ears.

Describe interventions to alleviate symptoms and prevent the spread of infection with conjunctivitis; massage the nasolacrimal duct and clean the eyes when nasolacrimal duct obstruction is present; apply antibiotic ointment and hot compresses to treat eyelid disorders; treat nonemergent eye injuries; encourage the child to wear corrective glasses, contact lenses, or eye patches;and to provide proper postoperative follow-up.Explain that teaching is needed for parents so that they can provide proper home care (refer to Teaching Guideline 18-1 and Nursing Care Plan 18-1).
Discuss the use of warm compresses, antibiotics, antifungals, and analgesics; discuss monitoring for hearing loss, parent and child support, and teaching (refer to Teaching Guideline 18-2 andNursing Care Plan 18-1).

Learning Objective 8.Devise an individualized nursing care plan for the child with a sensory impairment or other disorder of the eyes or ears.

Discuss interventions to improve vision and hearing; reduce risk of infection; reduce pain; encourage growth and development; improve communication; educate the family; encourage appropriate family interactions; and prevent injury (refer to Nursing Care Plan 18-1).

Learning Objective 9.Develop patient/family teaching plans for the child with a disorder of the eyes or ears.

Discuss the value of multiple teaching formats,multiple teaching opportunities, demonstration, repetition, and written presentation, as well as the importance of developmentally appropriate communication of information about the child’s care, developmental growth, prevention of infection and injury, medications, therapies, and psychosocial support (refer to Teaching Guideline 18-1 and 18-2 and Healthy People 2010 18-5 and 18-8).

Learning Objective 10.Describe the psychosocial impact of sensory impairments on children.

Explain that visually impaired children may develop self-stimulatory actionsbecause ofa lack of visual stimulation, and that these actions may interfere with the child’s ability to socialize. Explainearly intervention programs and individualized education plans for visually impaired children under 3 years of age.
Discuss the how the symptoms of hearing loss may affect the child’s socialization, and how it is important to use hearing aids, sign language, and lip reading to augment hearing and improve socialization.
Refer to Common Medical Treatments 18-1 and Table 18-4.