EYE, EAR, NOSE AND THROAT FUNCTION

PEDIATRIC EYE DIFFERENCES

• Neonates-

• Visual acuity:
    - Ranges from 20/100 to 20/400

• Decreased accommodation

• Decreased color vision

• very near-sighted

• Infant and Young child
    - The cornea occupies a larger portion of the orbit compared to older children.

• Age 2-3 years:
    - Visual acuity approximately 20/50.

• Age 6-7 years:
    - Vision typically reaches 20/20.

PEDIATRIC ENT DIFFERENCES

• Eustachian tubes:
    - Shorter, wider, and more horizontal in infants, contributing to increased ear infections.

• Tympanic membrane:
    - Positioned closer to the surface in children. more easily injured, and why we say no Q-tips

• Nasal Breathing:
    - Infants are primarily nose breathers. till 6 months

• Tonsils:
    - Large in school-age children, noted as a normal characteristic of growth.

• 6 months- first tooth

• 2 years- all teeth

INFECTIOUS CONJUNCTIVITIS

• Refers to inflammation of the conjunctiva, commonly termed "Pinkeye" by parents.

• S+S- red, swollen. clear, yellow or white discharge

• Ophthalmia Neonatorum:
    - Conjunctivitis occurring in infants under 30 days old. get after birth delivery
    - Erythromycin is the treatment

• Chemical conjunctivitis

• Commonly caused by a response to prophylactic eye treatments.

BACTERIAL CONJUNCTIVITIS

• Affects children of any age.

• Symptoms:
    - Mucopurulent discharge, edema of the eyelid, red and swollen conjunctiva. eyes get shut during the night and have trouble opening them in the morning

• Older children will have itchy, burning, and scratching of the eyes

• Common Organisms:
    - Include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.

VIRAL CONJUNCTIVITIS

• Typically bilateral.

• Adenoviruses are the most common causative agents. snotty nose, wipe nose, and then rub their eye

• Herpes Virus Infections:
    - Treatment includes IV acyclovir and topical drops for neonates.

• topical and antivirals for older children

• S+S- similar to bacterial, just milder and a slower onset, also might have swollen by the ear

ALLERGIC CONJUNCTIVITIS

• Symptoms:
    - Intense itching, red eyes with watery discharge, cobblestone appearance of conjunctiva, and puffy, swollen eyes.

• This can be related to the change in season or a pet at home

DIAGNOSIS OF CONJUNCTIVITIS

• Nursing assignment example:
    - Infant with URI exhibiting watery discharge bilaterally and slightly reddened conjunctiva. The conjunctiva is slightly red and edematous
    - Key considerations for determining cause include the assessment of symptoms, medical history, and getting a culture of the drainage

• most likely viral bc of the watery and URI

TREATMENT OF CONJUNCTIVITIS

• Bacterial:
    - Treatment involves antibiotic drops or ointment and comfort measures. broad spectrum for 7-10 days

• Viral:
    - Primarily comfort measures, as viral infections generally self-resolve. warm or cool compress, dim lights, clean drainage away from the inner to the outer

• Allergic:
    - May require systemic or topical antihistamines and possibly decongestants with systemic antihistamines. comfort measures too

NURSING CONSIDERATIONS

• Conjunctivitis is highly contagious. still contagious until they are on the antibiotic for 24 hours. No school or daycare

• Administer antibiotics for at least 24 hours before patient interaction.

• Emphasize no sharing of medications or linens. This can be cross-contamination. Make sure we wash our hands, be careful with eye care, and use gloves. don’t have kid scrunch eye bc the medication will come all right back out

• Identify conditions that can mimic conjunctivitis- clogged tear duct

INSTILLING EYE DROPS

• Prioritize completing the full course of antibiotics.

PERIORBITAL CELLULITIS (PRESEPTAL CELLULITIS)

• infection of the eyelid and surrounding soft tissues.

• caused by strep or staph infection

• Symptoms:
    - Swollen, tender eyelids, red or purple discoloration, painful movement and constriction around the eye area, and fever

• Treatment: treat promptly to prevent spread
    - Mild cases- oral antibiotics for 24-48 hrs and NSAIDs.
    - Severe cases- hospitalization for IV antibiotics and warm compresses/ comfort

VISUAL DISORDERS

• Errors of Refraction:
    - hyperopia (farsightedness), myopia (nearsightedness), and astigmatism. genetic in nature

• Strabismus:
    - Abnormal turning of the eye; either inward (esotropia/ crossed eye) or outward (exotropia), which may lead to amblyopia. present at birth

• Amblyopia:

• weaker vision in one eye, which is often referred to as "lazy eye."

• may result from strabismus

• treatment- occlusion therapy, wearing a patch on the good eye so the weak one can get stronger. 2-6 hours daily

CATARACTS

• congenital or acquired.

• Results in the lens becoming opaque (cloudy). Either all or partial

• Signs and Symptoms:
    - Distorted red reflex and vision loss. white pubis

• Treatment:
    - Surgery is necessary

• post-operative care includes eye protectors, restraints, and medications (antibiotics or steroid drops)

RETINOPATHY OF PREMATURITY

• immature retinal blood vessels in the retina constrict and necrose

• Associated with factors such as high-level oxygen therapy, respiratory distress, and assisted ventilation.

• Most significantly affects babies born before 31 weeks of gestation and weighing less than 1250 grams.

• Diagnosed through ophthalmologic examination

• Treatment can include laser therapy and promoting infant attachment interventions if blindness occurs

• won’t show until 4-6 weeks of life

EYE INJURIES

• Common across all ages, especially in boys aged 11 to 14 years.

• Causes- sports incidents, blunt or sharp objects, projectiles, darts, fireworks, chemical and thermal burns, and abuse.

• teach them prevention

TREATMENT FOR EYE INJURIES

• Black Eye:
    - application of ice to both eyes for 1-2 days, followed by warm compresses.

• Foreign Object:
    - Remove visible objects and irrigate eyes, patch, and then transport to ED

• Chemical Burns:
    - irrigation for 15-30 minutes and then transport to emergency services.

• Penetrating and Perforating Injuries:
    - Call for emergency transport immediately; do not attempt to remove objects.

EAR ASSESSMENT

• Key Assessment Areas:
    - Placement on the head, pinna, external auditory canal, and hearing functionality.

• infant hearing- use mom’s voice or a rattle

OTITIS MEDIA (ACUTE)

• Most common in cohorts such as:
    - Boys
    - Children in daycare
    - Children with allergies
    - Children exposed to tobacco smoke
    - Breastfeeding has a protective factor

• Indicators may include Eustachian tube dysfunction.

• cause is unknown

SIGNS AND SYMPTOMS OF OTITIS MEDIA

• Pain

• bulging of the tympanic membrane (TM). they will have increased pressure and will have trouble sleeping

• ear effusion- fluid in the ear

• Diagnosed through medical history and pneumatic otoscopy assessment.

TREATMENT FOR OTITIS MEDIA

• Treatment typically involves antibiotics for approximately 10 days.
    - Amoxicillin is often the first-line therapy.

• Pain management- Tylenol

• complication- hearing loss and language delays

RECURRENT OTITIS MEDIA (WITH EFFUSION)

• Not considered an infectious process

• persistent fluid behind the eardrum

• resulting in potential hearing loss and chronic recurrence

• Treatments may include myringotomy or tympanostomy tubes to alleviate fluid accumulation. The tubes will fall out of the ear at some point on their own

CONSEQUENCES OF HEARING IMPAIRMENT

• hearing loss may include:
    - Speech delay
    - Impaired learning
    - Poor cognitive development.

MANIFESTATIONS OF HEARING IMPAIRMENT

• Infants:
    - Diminished or absent startle reflex to loud sounds. Awakens only to touch
    - Does not turn head towards sounds by 3-4 months.
    - Little or no babbling observed.

• Toddlers:
    - Speech is often unintelligible; communicates primarily through gestures.
    - Appears developmentally delayed and emotionally immature. yells inappropriately. will be more interested in objects than people, and focus on facial expressions

• School-aged/Adolescents:
    - Asks for instructions to be repeated; answers questions inappropriately.
    - Poor academic performance, speech problems, sits close to the TV, and prefers to in play alone

EAR INJURIES

• Types include:
    - External ear (pinna): lacerations, infections, hematomas, cellulitis.

• Ear canal foreign bodies and insects

• tympanic membrane: ruptures

• Symptoms to go see a physician: earache, reduced hearing, imbalance, persistent bleeding, or discharge.

NOSE ASSESSMENT

• Assess through inspection, checking for patency and discharge.

• inspection: size, shape, symmetry, nasal flaring, and flattened nose bridge

EPISTAXIS (NOSEBLEEDS)

• Source of bleeding: Kiesselbach’s plexus (anterior nares and plentiful veins)

• Common causes include irritation from nose picking, foreign bodies, and dry air or low humidity imbalances.

EPISTAXIS TREATMENT AND PREVENTION

• take pulse, blood pressure, and examine the nasal mucosa.

• child sits upright with head forward- helps to prevent them from swallowing blood

• applying pressure to the nares for 10-15 minutes. Have them breathe through their nose

• TX- cotton balls with anything that will cause vasoconstriction

• preventions- bending over, drinking hot drinks, no strenuous exercise, sleep with HOB raised, increase humidity

NASOPHARYNGITIS (URI)

• Inflammation and infection of the nose and throat, commonly referred to as the common cold.

• Causative agents may include rhinovirus, coronavirus, and Group A beta-hemolytic Streptococcus

• Communicability: hours to several days

• can last 4-10 days

• symptoms being transmissible through respiratory droplets

NASOPHARYNGITIS SYMPTOMS

• Infants < 3 months:
    - Lethargy, irritability, poor feeding, and fever

• Infants ≥ 3 months:
    - Fever, vomiting, diarrhea, sneezing, anorexia, irritability, and restlessness.

• Older Children:
    - Exhibit dry and irritated nasal mucosa, pain, headaches, post-nasal discharge, sneezing, and nasal discharge.

TREATMENT FOR NASOPHARYNGITIS

• Viral:
    - Symptomatic relief with comfort measures. no antibiotics

• Bacterial:
    - antibiotics and additional symptomatic treatment- comfort measures

• Comfort measures:

• antipyretics- fever

• fluids- help thin secretions

• increased humidity

We need culture to determine viral or bacterial

MOUTH/THROAT ASSESSMENT

• Assessment areas include observation of:
    - Color, moisture, teeth, tongue, and palates (hard and soft), throat, and uvula.

PHARYNGITIS

• Viral Pharyngitis:
    - gradual onset, fever < 38.3°C, minimal tonsillar exudate, nasal congestion, mild sore throat, cough, conjunctivitis, and hoarseness, mildly tender cervical nodes

• Strep Throat:
    - abrupt onset, fever > 38.3°C, tonsillar exudate, severe sore throat, headaches, malaise, reddened pharynx, painful cervical nodes, and petechial mottling of the soft palate.

TREATMENT OF PHARYNGITIS

• pain relief- acetaminophen

• cool, non-acidic fluids, ice chips, and gargling with salt

TONSILLITIS

• Can be either viral or bacterial in nature.

• Symptoms:
    - Frequent throat infections, difficulty swallowing and breathing, persistent redness, and enlargement of cervical lymph nodes.

• Treatment: same as pharyngitis

• recurring= removal

SURGICAL TREATMENT FOR TONSILLITIS

• Recommended following criteria, such as at least:
    - 7 episodes in 1 year,
    - 5 episodes per year for 2 years
    - 3 episodes per year for 3 years.

• Episodes characterized by sore throat, fever, cervical adenopathy, tonsillar exudate, and positive Group A beta-hemolytic streptococcus (GBHS) tests

• sore throat and one more of the above

• often including adenoidectomy.

• don’t have them removed unless it is necessary

TONSILLECTOMY TEACHING
  - risk for bleeding
  - Temperature elevation over 38.8°C or bleeding (call the MD)

MOUTH & DENTAL EMERGENCIES

• fractures, luxation, or avulsion of teeth.

• In emergencies, use clean cloths to manage blood and seek dental or emergency medical care promptly.

• keep child from choking on the tooth

• preventions- mouth gear

TOOTH AVULSION

• Quick action is critical

• Handle the tooth by the crown rather than the root

• Rinse gently in tap water- no longer than 19 seconds

• insert into the socket

• child applying soft pressure.