P1

The Child With a Sensory or Neurological Condition

The Ears

  • The ear is considered part of the nervous system and contains the receptors of the eighth cranial (acoustic) nerve.

  • The fetus can hear at 20 weeks of gestation, with auditory nerve function fully matured by 5 months of age.

  • Two main functions of the ear:

    • Hearing

    • Balance

Nursing Care

Examination of the Ear

  • Exterior and Interior Observation:

    • Assess ear alignment; the top of the ear should cross an imaginary line from the outer canthus of the eye to the occiput.

    • Low-set ears may indicate kidney disorders and potential intellectual or developmental disabilities.

  • Inspection:

    • Cleanliness and drainage of the outer ear.

    • Use of an otoscope to examine the inner ear.

Disorders and Dysfunction of the Ear

1. Otitis Externa (Swimmer’s Ear)

  • An acute infection of the external ear canal.

  • Often caused by prolonged exposure to moisture.

  • Symptoms include:

    • Pain and tenderness when manipulating the ear.

    • Erythematous ear canal, while tympanic membrane remains normal.

  • Treatment: Irrigation and topical antibiotics/antivirals; rule out foreign body, cellulitis, diabetes mellitus, herpes zoster.

2. Acute Otitis Media

  • Inflammation of the middle ear, most common post upper respiratory tract infection.

  • Common in children aged 6 to 24 months.

  • Common organisms: Streptococcus pneumoniae, Haemophilus influenzae.

  • Symptoms include:

    • Rubbing/pulling at ear, rolling head, hearing loss, loud speech, inattentiveness, articulation/speech development issues.

  • Comfort measures: Antipyretics, warm compress, position on affected side if eardrum ruptures, keep the area clean.

3. Hearing Impairment

  • Congenital Hearing Loss can be hereditary or from in utero infections, low birth weight, etc.

  • Types:

    • Sensorineural Hearing Loss: Hair cell damage in cochlea/acoustic nerve due to toxins, genetics, or loud noises (e.g., certain toys can exceed 100 dB).

    • Conductive Hearing Loss: Sound hindered from middle ear (e.g., impacted ear wax, perforation). Common in older children and teens exposed to loud sounds.

Nursing Care for Hearing Impairment

  • Communicate effectively: Smile, body language, eye-level interaction.

  • Enhance communication: Use sign language, visual aids, writing, and drawing.

Home Care

  • Ensure speech therapy involvement.

  • Install flashing lights for alerting; provide TDD for phone communication.

  • Use closed captioning for TV viewing.

The Eyes

  • The eye develops as an outgrowth of the forebrain, starting in the 4-week embryo.

  • Retinal vessels mature at 40 weeks; premature infants often have sight issues.

  • Newborns keep eyes closed for most of the day but can focus on nearby objects for a few seconds.

Visual Examination

  • Check for symmetry, distance from the nose, pupil size, shape, movement, and light reaction.

  • Children should be explained the examination process.

  • Use visual acuity charts (e.g., Snellen) for testing ability.

Disorders and Dysfunction of the Eye

Amblyopia (Lazy Eye)

  • Reduction or loss of vision favoring one eye; can lead to bilateral amblyopia.

  • Early detection is critical.

Strabismus

  • Condition where both eyes cannot align on the same object, risking permanent impairment (amblyopia).

  • Surgery may be needed for correction.

Conjunctivitis (Pink Eye)

  • Inflammation of the conjunctiva due to bacteria, viruses, or irritants.

  • Symptoms include redness, irritation, and discharge.

  • Treatment involves warm compresses, topical antibiotics, and hygiene to prevent spread.

Periorbital Cellulitis

  • Infection surrounding the eye, often requires IV antibiotics. Symptoms include pain and swelling.

Retinoblastoma

  • Malignant tumor of the retina presenting with a white reflex seen in the pupil.

  • Treatment options vary, including enucleation for advanced cases.

Disorders and Dysfunction of the Nervous System

Reye’s Syndrome

  • An acute condition following viral illness, causing encephalopathy and hepatopathy.

  • Symptoms include vomiting and altered behavior.

  • Treatment aims to reduce ICP and restore oxygenation.

Sepsis

  • Systemic infection response, leading to multi-organ dysfunction if untreated.

  • Symptoms include fever, chills, tachycardia, and lethargy.

  • Prevention through vaccinations is recommended.

Meningitis

  • Inflammation of the meninges caused by bacteria or viruses; symptoms include fever, neck stiffness, and altered consciousness.

  • Care involves minimizing stimuli and watching for signs of increased ICP.

Encephalitis

  • Inflammation of the brain, treatments are supportive.

  • Children monitored for neurological changes post-treatment.

Seizure Disorders

  • Sudden, intermittent episodes causing altered consciousness and motor movements.

  • Febrile seizures occur due to rapid temperature rises in young children.

  • Nursing responsibilities include maintaining precautions and monitoring during seizures.

Status Epilepticus

  • A prolonged seizure lasting more than 30 minutes, requires immediate medical attention.

Other Conditions Causing Decreased Consciousness

  • Include issues like Cerebral Palsy which can result from prenatal brain abnormalities or postnatal injuries.

  • Treatment aims at maximizing abilities; physical therapy is crucial.

  • Ongoing support and education for parents regarding community resources and care at home.