EYE, EAR and THROAT DISORDERS

STRABISMUS
Called squint or lazy eye A condition in which

the eyes are not aligned because of lack of coordination of the extraocular muscle

 Most often results from muscle

imbalance or paralysis of extraocular muscles but also may result from conditions such as brain tumor, myasthenia gravis or infection Normal in the young infant but should not be present after about age 4 months

ASSESSMENT

Amblyopia if not treated early

Permanent loss of vision if not treated

early Loss of binocular vision Frequent headaches Squinting or tilting of the head to see

INTERVENTIONS
Connective lenses may be

indicated Instruct the parents regarding PATCHING (occlusion therapy) of the good eye to strengthen the weak eye

 Inform the parents that the injection of

BOTULINUM TOXIN wears off in about 2 months and if successful, correction will occur Surgery is performed before the age of two Needs follow up visits

 Also CONJUNCTIVITIS known as

PINK EYE and is the inflammation of the conjunctiva Usually caused by allergy , infection or trauma

 Bacterial or viral conjunctivitis is

extremely contagious Chlamydial conjunctivitis is rare in older children and if diagnosed in a child who is not sexually active, the child should be assessed for possible sexual abuse

ASSESSMENT
Itching, burning or scratchy eyelids

Redness, edema or discharge on the eye

INTERVENTIONS
Instruct in infection control measures such

as good handwashing and not sharing towels and wash clothes administration of the prescribed meds kept home from school or day care until antibiotic eye drops have been administered for 24 hours

Instruct the child and parents in the

Instruct the parents that the child should be

 Instruct in the use of cool compress to

lessen irritation and in wearing dark glasses for photophobia Instruct the child to avoid rubbing the eye to prevent injury Instruct the adolescent that make up should be discarded and replaced

OTITIS MEDIA
Is an infection of the middle ear

occuring as a result of a blocked eustachian tube which prevents normal drainage Is common complication of an acute respiratory infection Infants and children are more prone to otitis media because their eustachian tube are shorter, wider and straighter

ASSESSMENT
Fever, irritability and restlessness Loss of appetite and rolling of head

from side to side Pulling on or rubbing the ear Earache or pain, Signs of hearing loss Purulent ear drainage Red, opaque, bulging or retracting tympanic membrane

INTERVENTIONS
Teach the parents to feed infants in upright position
Instruct the child to avoid chewing during the acute period because chewing increase pain Provide local heat and have the child lie with the affected ear down Instruct the parents about the procedure for administering ear medications

Administration of Ear Med

In child younger than 3, pull the pinna down and back

In a child older than 3, pull the pinna up and back

MYRINGOTOMY
Insertion of tympanoplasty tubes into

the middle ear to equalize pressure and keep the ear from infection N/I postop
Instruct the parents and child to keep the ears dry The client should wear earplugs during bathing, shampooing and swimming Diving and submerging under water are not allowed

TONSILLECTOMY AND ADENOIDECTOMY

Tonsillitis refers to inflammation and infection of the tonsils Adenoiditis refers to inflammation and infection of the adenoids

ASSESSMENT
Persistent or recurrent sore throat Enlarged, bright red tonsils that maybe

covered with white exudates Difficulty swallowing Mouth breathing and unpleasant mouth odor Fever and cough Enlarged adenoids may cause nasal quality of speech, mouth breathing, heating difficulty, snoring or obstructive sleep apnea

N/I PRE OP
Assess for signs of active infection Assess bleeding and clotting studies because

the thraot is vascular Prepare the child for a sore throat post-op and inform the child that he or she will need to drink liquids Assess for any loose teeth to decrease the risk of aspiration during surgery

N/I POST-OP
Position client prone or side-lying to

facilitate drainage Have suction equipment available but do not suction unless there is an airway obstruction Discharge coughing or clearing the throat

 Monitor for signs of hemorrhage (frequent

swallowing) if hemorrhage occurs, turn the child to the side and notify AP Provide clear, cool, noncitrus and noncarbonated fluids Avoid red liquids which will stimulate the appearance of blood if the child vomits

 Do not give the child any straws, forks

or sharp objects that can be put in the mouth Instruct the parents to notify the physician if bleeding, persistent earache or fever occurs Instruct the parents to keep the child away from crowds until hearing has occurred

DYSPLASIA OF THE HIP

Is a condition which the head of the

femur is seated improperly in the acetabulum or hip socket of the pelvis Dysplasia can range from mild to severely located Can be congenital or can develop after birth

ASSESSMENT
NEONATES: laxity of the

ligaments around the hip which allows the femoral head to be displaced from the acetabulum on manipulation

 Infants beyond the newborn period:

Asymmetry of the gluteal and thigh skin folds when the child is placed prone and the legs are extended against the examining table Limited ROM in the affected hip Asymmetric abduction of the affected hip when the child is placed supine with the knees and hips flexed Apparent short femur on the affected side

 POSITIVE BARLOW OR ORTOLANI

MANEUVER
THE WALKING CHILD: Minimal to

pronounced variations in gait with lurching toward the affected side; positive trendelenburg sign

INTERVENTIONS
In the neonatal period, splinting of the hips with PAVLIK HARNESS to maintain flexion and

abduction and external rotation Following the neonatal period traction, and/or surgery to release muscles and tendons Following surgery, positioning and immobilization in a spica cast until healing is achieved, then use of an abduction splint Operative reduction possibly required in the older child Instruction to parents regarding proper care of a PAVLIK HARNESS OR SPICA CAST

CONGENITAL CLUBFOOT
Is a congenital malformation of the

lower extremities The defect maybe unilateral or bilateral Defects are rigid and cannot be manipulated for neutral position

 ASSESSMENT
The foot is plantar flexed with an inverted

heel and adducted forefoot INTERVENTIONS TX as soon as after birth as possible Manipulation and casting are performed weekly and if correction is not achieved in 3 to 6 months, surgery is indicated Monitor for pain

SCOLIOSIS
Is a lateral curvature of the spine
ASSESSMENT
Visible curve fails to straighten when the

child bends forward and hangs arms down toward the feet Hips, ribs and shoulders are asymmetrical

 INTERVENTIONS
BRACES

Usually worn 16 to 23 hours a day Inspect skin for signs of breakdown or redness Avoid using lotions and powders Advise to wear soft nonirritating clothing under the brace

SPINAL FUSION

JUVENILE RHEUMATIOD ARTHRITIS

Is an inflammatory disease affecting the joints;

occurs most often in girls Iridocyclitis (inflammation of the iris and ciliary body can occur) ASSESSMENT Stiffness, swelling, and limited ROM in the affected joints Joints are warm to touch Painful and tender joints

FRACTURES
A fracture is a break in the continuity of the

bone as a result of trauma, twisting or bone decalcification Fractures in children usually occur as a result of increased mobility and inadequate or immature motor and cognitive skills

 ASSESSMENT
Pain or tenderness over the involved

area Loss of function Obvious deformity Crepitation Ecchymosis Edema Muscle spasm

 INTERVENTIONS
REDUCTION Restoring the bone to proper alignment Closed reduction: manual alignment of the fragments followed by immobilization Open reduction: the surgical insertion of internal fixation devices, such as rods, wires or pins that help maintain alignment while healing occurs TRACTION

RUSSEL SKIN TRACTION Used to stabilized fracture femur before surgery Provides a double pull with the use of knee sling It is a traction that pulls at the knee and foot

BALANCED SUSPENSION Used with skin or skeletal traction Types include Thomas ring splint, splint with pearson attachment, Steinmann pin and Kirschners wires Maintain correct amount of weight as ordered Ensure that weights hang freely Monitor neurovascular status in the involved extremity Provide therapeutic and diversional play

Interventions for tractions:

CAST