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Chapter 18
Nursing Care of the Child
With a Disorder of the Eyes
or Ears
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Variations in Pediatric Anatomy and
Physiology
• Eyes
• Ears
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Medical Treatments
• Assessment
– Health history
– Physical examination
• Inspection and observation
• Palpation
• Laboratory and diagnostic testing
• See Common Laboratory and Diagnostic
Tests 18.1
• Nursing diagnoses and related interventions
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Disorders of the Eyes
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Visual Disorders
• Refractive errors
– Nursing assessment
– Nursing management
• Educating about eyeglasses use
• Educating about contact lens use
• Monitoring for fit and visual correction
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Question
• Is the following statement true or false?
• Laser surgery is rapidly replacing the use of eyeglasses
for vision correction in children.
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Answer
• False
• Rationale: Because of the continuing refractive
development in the child’s vision through adolescence,
laser surgery for vision correction is not recommended by
the Canadian Ophthalmological Society until 18 years of
age, although it may be performed experimentally in
some children.
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Visual Disorders (cont.)
• Astigmatism – causes light rays to focus on two points in
the back of the eye rather than just one
– Nursing assessment
– Nursing management
• Strabismus – a condition in which one eye cannot focus
with the other eye on an object because of the imbalance
of the eye muscles
– Nursing assessment
– Nursing management
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Visual Disorders (cont.)
• Amblyopia – an abnormal cortical response in the
occipital lobe of the brain
– Nursing assessment
– Nursing management
• Vision screening is a vital component of health promotion
– If vision disorders are diagnosed at an early age and
treatment is initiated, then vision may progress
normally
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Eye Conditions of the Newborn
• Nasolacrimal Duct Obstruction
– Nursing assessment
– Nursing management
• Congenital cataract
• Infantile glaucoma
• Nystagmus – rapid, irregular eye movement
• Retinopathy of prematurity (ROP) – rapid growth of
retinal blood vessels in the premature infant
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Question
• An infant who is diagnosed with glaucoma is likely to
require what intervention?
A. Regular use of beta-blocker eye drops
B. Eyeglasses
C. Surgery
D. Physical and occupational therapy
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Answer
• C – Surgery
• Rationale: Unlike adult glaucoma, in which medical
management is the first step, treatment of infantile
glaucoma is focused on surgical intervention. Infantile
glaucoma is treated surgically via goniotomy (removal of
obstruction of the aqueous humor).
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Infectious and Inflammatory Disorders
• Conjunctivitis – inflammation of the bulbar or palpebral
conjunctiva
• Can be infectious (viral or bacterial), allergic, or chemical
– See Table 18.2
– Therapeutic management
– Nursing process
• Health history
• Physical examination
• Laboratory and diagnostic tests
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Infectious and Inflammatory Disorders
(cont.)
• Conjunctivitis (cont.)
– Nursing management
– Alleviating symptoms
– Preventing infectious spread
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Eyelid Disorders
• Include hordeolum (stye), chalazion, and blepharitis
– Nursing assesment
– Nursing management
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Periorbital Cellulitis
• A bacterial infection of the eyelids and tissue surrounding
the eye
– Nursing assessment
– Nursing management
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Eye Injuries
• Include eyelid laceration, simple contusion, scleral
hemorrhage, corneal abrasion, and foreign body in the
eye
• See Table 18.3
• Nursing assessment
– Health history
– Physical examination
• Nursing management
– Managing non-emergent eye injuries
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Visual Impairment
• Refers to acuity between 20/60 and 20/200 in the better
eye on examination
• Nursing assessment
– Health history
– Physical examination
• Nursing management
• See Box 18.2 for tips on working with the
visually impaired child
– Supporting the child and family
– Promoting socialization, development, and education
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Disorders of the Ears
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Otitis Media
• Acute otitis media (AOM)
– Pathophysiology
– Therapeutic management
– Nursing assessment
• Health history
• Physical examination and diagnostic testing
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Otitis Media (cont.)
• Acute otitis media (AOM) (cont.)
– Nursing management
• Managing pain associated with AOM
• Educating the family
• Preventing AOM
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Question
• A two-year-old girl has signs and symptoms
characteristic of AOM. What is the most likely course of
action for initially treating this child’s health problem?
A. Ear irrigation with warm normal saline
B. Oral antibiotics
C. Watchful waiting and observation
D. Topical antibiotics
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Answer
• C – Watchful waiting and observation
• Rationale: Recommendations for AOM treatment in
previously healthy children include watchful waiting and
observation for 48 to 72 hours without antimicrobial
agents form most children who are older than 6 months
of age.
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Otitis Media (cont.)
• Otitis media with effusion (OME)
– Nursing assessment
• Health history
• Physical examination
– Nursing management
• Educating the family
• Monitoring for hearing loss
• Providing postoperative care for the child with
pressure-equalizing tubes
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Otitis Externa
• Nursing assessment
– Health history
– Physical examination
• Nursing management
– Managing pain
– Treating the infection
– Preventing reinfection
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hearing Loss and Deafness
• Nursing assessment
– Health history
– Physical examination and laboratory and
diagnostic tests
• Nursing management
– Augmenting hearing
– Promoting communication and education
– Encouraging education
– Providing support
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Question
• Is the following statement true or false?
• Infants are ordinarily born with the sense of hearing fully
developed.
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Answer
• True
• Rationale: Unlike the sense of sight, hearing is expected
to be fully developed in the healthy neonate.
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