lOMoAR cPSD| 47061011
NURS 355: Pediatric Test 2—
Eyes:
Anatomy & Physiology:
Vision Impairments: - Visual Acuity improves with
growth; infants cannot distinguish
Def: eyesight unable to be corrected to age-appropriate expectations colors; impairments up to 7 yrs.
• Linked Causes— old
o Prematurity, Rubella infection maternally, FAS - 20/20 at 6 years
• S/S— - Newborns can only see from
o Infants breast to face - Iris turns a permanent color at
Unable to tract objects/lights with eyes 6 months
Unable to make eye contact when spoken to - Tears newborns do not
Dull/Vacant stare without facial expression imitation produce any tears at first
o Toddler/Child
Rubs/shuts/covers eyes
Tilting the head for a better look
Holding an object close to the eyes
Bumping into objects more often
Squinting
• Nursing Care—
o Prior to age 6 children do not need corrective vision to have 20/20 vision o
Education—
Teach toddlers/parents to keep glasses clean and limit touching of the
lenses
Individualized Education Plan—is used to help the child meet their
educational needs Promote keeping things within the same location Refractory
Visual Disorders:
• Hyperopia farsightedness; cannot focus on near objects.
o NORMAL until 7 years!!!!!
• Astigmatism abnormal light refraction and curvature of cornea/lens causing blurry vision o Child
will hold pages close to the face for best image
• Myopia nearsightedness; cannot focus on fall-away objects o PROBLEM: cannot see teacher, poor
school performance = needs corrective lenses
Strabismus: o Squinting, dizziness, HA
• Tx—
• Esotropia —deviation of one eye inward o Patch the good eye = exercises the
• Exotropia —deviation of one eye outward bad eye
• S/S— o Glasses
, lOMoAR cPSD| 47061011
• Complications— o Amblyopia • Tx—
permanent lazy o Hospitalization + IV ABX +
eye + visual acuity impairment that Decongestants
occurs without proper treatment within 6
years.
• Education:
o To prevent —treat prior to 24 months Ears:
Others:
• Nystagmus abnormal eye movement (shakiness)
• Cataracts cloudy haze over the eye without red reflex
• Glaucoma increased IOP, atrophy, and visual impairment Nasolacrimal Duct
Obstruction:
• Def: obstruction of the tear duct causing excessive tearing of the eyes + red swollen eyelids that is
and within 6 years recurrent! Hearing Impairments:
• RISK—
• Indicative Signs o Absent startled
o Infection d/t decreased drainage
reflex, no turning to noise at 6 months o
• Tx— No response to parent’s voice, lack of
o Lacrimal Massage + topical ABX = simple speech at 1 year
usual resolution at 1 year o If not… dilation with • Conductive Hearing Loss o Sound
irrigation needed Periorbital Cellulitis: cannot reach the ear d/t
injury/trauma/blockage o Tx—
• Def: infection of eyelid and orbital tissues removal of blockage, ABX (if ear
surrounding eye infection), hearing aids
• S/S—
• Sensorineural Hearing Loss
o Swollen eyelid, decreased vision,
elevated IOP Anatomy & Physiology:
• Dx— - Eustachian Tube—shorter, horizontal = easier
for infections - Auditory Nerve develops fully
o Rule out/confirm MRSA infection (if multiple
at 5 months
abscesses noted)
- Proper screening/testing should be done 😊
o Hair cells are damaged d/t loud noises or ototoxic drugs causing bad bone conduction o
Tx—cochlear implants or bone conduction hearing aids
• Mixed
o Mixture of both causing central auditory imperfections in the brain = NO TREATMENT
Nursing Care:
• Promote Routine screening (6 month screening)
• Educate on other ways to communicate (lip reading, sign language, written)
• Educate on how to identify an ear infection—cranky, off balance, pulling at the ears, etc.
Neuro:
, lOMoAR cPSD| 47061011
Anatomy & Physiology:
Assessment: -conception (3-4 weeks) = In utero develops soon after EXTREME
• OBSERVATION = #1 VULNERABILITY ☹
o Observe spontaneous and elicited reflexes -learn about the environment; naming Serve and
Return—help the children
o How are they reacting to those in the room things for them and giving them time to o Do they
have a rooting reflex? respond (model the behavior and wait o Is the patient meeting their
developmental milestones? for a response).
• ASK
o Behavior changes o What is their baseline?
o History (familial + individual + birth history)
Increased ICP:
• BRAIN IN A BOX
• Causes increasing pressure = compression on the brain = herniation through brainstem
• S/S:
o Newborns
Irritable, poor feeders, high pitch cry, bulging fontanelles, cranial suture separation,
setting-sun eyes, distended scalp veins, Macewen sign (cracked pot sound)
o Children
HA, V/N, diplopia, blurred vision, irritability, somnolence, seizures, motor weakness,
dis-coordination.
o Late Signs
Decreased LOC, decreased motor response, decreased pain
response, increased BP, bradycardia, Cheyne-stokes
respirations, fixed and dilated pupils
Decorticate —arms to the CORE Decerebrate —arms
AWAY from the core
• Tx:
o Mannitol o Others- antiseizures, paralytics,
ABX, steroids
• Nursing Care:
o Head circumference for <6 months of age
o Position place the patient in a NEUTRAL POSITION, elevated 30 degrees,
midline neck o Activities limit noise (dim lights, no noise, no suction) o Supportive
Medication cough suppressants, stool softeners, antihistamines o Glascow Coma Scale 15
= Normal; 3 = ABNORMAL (use with low stimulation) Microcephaly:
• Def: abnormally small head d/t primary (genetic) or secondary (exposure/maternal infection/ETOH)
Dx head circumference 2 standard deviations below the mean Nursing Care: o Supportive
care—provide services, resources, equipment and promote developmental needs.
NURS 355: Pediatric Test 2—
Eyes:
Anatomy & Physiology:
Vision Impairments: - Visual Acuity improves with
growth; infants cannot distinguish
Def: eyesight unable to be corrected to age-appropriate expectations colors; impairments up to 7 yrs.
• Linked Causes— old
o Prematurity, Rubella infection maternally, FAS - 20/20 at 6 years
• S/S— - Newborns can only see from
o Infants breast to face - Iris turns a permanent color at
Unable to tract objects/lights with eyes 6 months
Unable to make eye contact when spoken to - Tears newborns do not
Dull/Vacant stare without facial expression imitation produce any tears at first
o Toddler/Child
Rubs/shuts/covers eyes
Tilting the head for a better look
Holding an object close to the eyes
Bumping into objects more often
Squinting
• Nursing Care—
o Prior to age 6 children do not need corrective vision to have 20/20 vision o
Education—
Teach toddlers/parents to keep glasses clean and limit touching of the
lenses
Individualized Education Plan—is used to help the child meet their
educational needs Promote keeping things within the same location Refractory
Visual Disorders:
• Hyperopia farsightedness; cannot focus on near objects.
o NORMAL until 7 years!!!!!
• Astigmatism abnormal light refraction and curvature of cornea/lens causing blurry vision o Child
will hold pages close to the face for best image
• Myopia nearsightedness; cannot focus on fall-away objects o PROBLEM: cannot see teacher, poor
school performance = needs corrective lenses
Strabismus: o Squinting, dizziness, HA
• Tx—
• Esotropia —deviation of one eye inward o Patch the good eye = exercises the
• Exotropia —deviation of one eye outward bad eye
• S/S— o Glasses
, lOMoAR cPSD| 47061011
• Complications— o Amblyopia • Tx—
permanent lazy o Hospitalization + IV ABX +
eye + visual acuity impairment that Decongestants
occurs without proper treatment within 6
years.
• Education:
o To prevent —treat prior to 24 months Ears:
Others:
• Nystagmus abnormal eye movement (shakiness)
• Cataracts cloudy haze over the eye without red reflex
• Glaucoma increased IOP, atrophy, and visual impairment Nasolacrimal Duct
Obstruction:
• Def: obstruction of the tear duct causing excessive tearing of the eyes + red swollen eyelids that is
and within 6 years recurrent! Hearing Impairments:
• RISK—
• Indicative Signs o Absent startled
o Infection d/t decreased drainage
reflex, no turning to noise at 6 months o
• Tx— No response to parent’s voice, lack of
o Lacrimal Massage + topical ABX = simple speech at 1 year
usual resolution at 1 year o If not… dilation with • Conductive Hearing Loss o Sound
irrigation needed Periorbital Cellulitis: cannot reach the ear d/t
injury/trauma/blockage o Tx—
• Def: infection of eyelid and orbital tissues removal of blockage, ABX (if ear
surrounding eye infection), hearing aids
• S/S—
• Sensorineural Hearing Loss
o Swollen eyelid, decreased vision,
elevated IOP Anatomy & Physiology:
• Dx— - Eustachian Tube—shorter, horizontal = easier
for infections - Auditory Nerve develops fully
o Rule out/confirm MRSA infection (if multiple
at 5 months
abscesses noted)
- Proper screening/testing should be done 😊
o Hair cells are damaged d/t loud noises or ototoxic drugs causing bad bone conduction o
Tx—cochlear implants or bone conduction hearing aids
• Mixed
o Mixture of both causing central auditory imperfections in the brain = NO TREATMENT
Nursing Care:
• Promote Routine screening (6 month screening)
• Educate on other ways to communicate (lip reading, sign language, written)
• Educate on how to identify an ear infection—cranky, off balance, pulling at the ears, etc.
Neuro:
, lOMoAR cPSD| 47061011
Anatomy & Physiology:
Assessment: -conception (3-4 weeks) = In utero develops soon after EXTREME
• OBSERVATION = #1 VULNERABILITY ☹
o Observe spontaneous and elicited reflexes -learn about the environment; naming Serve and
Return—help the children
o How are they reacting to those in the room things for them and giving them time to o Do they
have a rooting reflex? respond (model the behavior and wait o Is the patient meeting their
developmental milestones? for a response).
• ASK
o Behavior changes o What is their baseline?
o History (familial + individual + birth history)
Increased ICP:
• BRAIN IN A BOX
• Causes increasing pressure = compression on the brain = herniation through brainstem
• S/S:
o Newborns
Irritable, poor feeders, high pitch cry, bulging fontanelles, cranial suture separation,
setting-sun eyes, distended scalp veins, Macewen sign (cracked pot sound)
o Children
HA, V/N, diplopia, blurred vision, irritability, somnolence, seizures, motor weakness,
dis-coordination.
o Late Signs
Decreased LOC, decreased motor response, decreased pain
response, increased BP, bradycardia, Cheyne-stokes
respirations, fixed and dilated pupils
Decorticate —arms to the CORE Decerebrate —arms
AWAY from the core
• Tx:
o Mannitol o Others- antiseizures, paralytics,
ABX, steroids
• Nursing Care:
o Head circumference for <6 months of age
o Position place the patient in a NEUTRAL POSITION, elevated 30 degrees,
midline neck o Activities limit noise (dim lights, no noise, no suction) o Supportive
Medication cough suppressants, stool softeners, antihistamines o Glascow Coma Scale 15
= Normal; 3 = ABNORMAL (use with low stimulation) Microcephaly:
• Def: abnormally small head d/t primary (genetic) or secondary (exposure/maternal infection/ETOH)
Dx head circumference 2 standard deviations below the mean Nursing Care: o Supportive
care—provide services, resources, equipment and promote developmental needs.
