NR_602_Final_Exam_Study_Guide. wk 5,6,7,8

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NR 602 Final Exam Study Guide Week 5 Pediatrics • Unit II - Child Development o Chapter 34 - Dermatologic Disorders o Chapter 35 - Eye and Vision Disorders o Chapter 36 - Ear and Hearing Disor... ders o Chapter 37 - Respiratory Disorders Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., ... & Schwartz, R. H. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. https://chamberlain-on-worldcatorg.chamberlainuniversity.idm.oclc.org/oclc/8588117369 Week 6 Pediatrics Unit IV - Common Childhood Conditions and Disorders • Chapter 38 - Cardiovascular Disorders • Chapter 39 - Hematologic Disorders • Chapter 46 - Neurologic Disorders • Chapter 43 - Musculoskeletal Disorders , G. C., Tulloh, L. E., & Tulloh, R. R. (2016). Kawasaki disease incidence in children and adolescents: an observational study in primary care. The British Journal of General Practice: The Journal of The Royal College of General Practitioners, 66(645), e271-e276. doi:10.3399/bjgp16X684325 (Links to an external site.) tin-Hermoso, M. R., Berger, S., Bhatt, A. B., Richerson, J. E., Morrow, R., Freed, M. D., & Beekman, R. H. (2017). The care of children with congenital heart disease in their primary medical home. Pediatrics, 140(5), e20172607. https://chamberlainon-worldcat-org.chamberlainuniversity.idm.oclc.org/oclc/7285161978 Week 7 Pediatrics Unit IV - Common Childhood Conditions and Disorders • Chapter 18 - Elimination • Chapter 40 - Gastrointestinal Disorders • Chapter 41 - Genitourinary Disorders • Chapter 45 - Endocrine and Metabolic Disorders • Chapter 33 - Atopic, Rheumatic, and Immunodeficiency Disorders Week 8 Pediatrics Unit IV - Common Childhood Conditions and Disorders • Chapter 15 - Behavioral and Mental Health Promotion • Chapter 24 - Injury Prevention and Child Maltreatment • Chapter 30 - Neurodevelopmental, Behavioral, and Mental Health Disorders Eye disorders 2 • USPSTF recommendations for vision screening for children 6 months to 5 years of age note that screening tests have reasonable accuracy in identifying strabismus, amblyopia, and refractive errors in children 3 to 5 years of age. • Refractive errors are the most common visual disorders seen in children o Myopia, or nearsightedness, exists when the axial length of the eye is increased in relation to the eye’s optical power. As a result, light from a distant object is focused in front of the retina rather than directly on it. A myopic child sees close objects clearly but distant objects are blurry. ▪ Myopia may be present at birth however more likely to develop between 6 and 9 years of age, with increased prevalence after the adolescent growth spurt. Mild hyperopia is normal in a young child and should decrease rapidly between 7 and 14 years of age. o Hyperopia, or farsightedness, exists when the visual image is focused behind the retina. As a result, distant objects are seen clearly but close objects are blurry. o Astigmatism exists when the curvature of the cornea or the lens is uneven; thus the retina cannot appropriately focus light from an object regardless of the distance, which makes vision blurry close up and far away. Rarely, astigmatism can be caused by an alteration in the corneal sphere caused by a soft tissue mass on the inner aspect of the eyelid, such as a chalazion or hemangioma. o Anisometropia is a different refractive error in each eye. It may consist of any combination of refractive errors discussed earlier, or it may occur with aphakia. • Amblyopia usually a unilateral deficit in which there is defective development of the visual pathways needed to attain central vision o Clear focused images fail to reach the brain, resulting in reduced or permanent loss of vision. o The condition is labeled (or typed) according to the structural or refractive problem that is causing the poor visual image to reach the brain: deprivational, or obstruction of vision (e.g., caused by ptosis, cataract, nystagmus), strabismic (caused by strabismus or lazy eye), or refractive (myopia, hyperopia, astigmatism, anisometropia). Diagnosis of amblyopia prevents permanent loss of vision in the affected eye. o clinical findings: ▪ Squinting, tendency to cover or close one eye when concentrating ▪ Abnormal vision, cover/uncover, and/or fundoscopic exam ▪ Pain in or around eyes and/or headaches (rare) ▪ Fatigue, dizziness ▪ Developmental delay ▪ Family history of refractive errors, strabismus, or amblyopia o Management: ▪ Refer to an ophthalmologist or optometrist for prescription corrective lenses. School-age children and teenagers should participate in the selection of frames; contact lenses may be considered. ▪ Once a refractive error has been determined or if a child is wearing glasses, annual evaluations are recommended. ▪ Moderate amblyopia usually responds to 2 hours of daily patching or weekend atropine (produces cycloplegia of nonamblyopic eye). ▪ Untreated or inadequately treated amblyopia in young childhood results in irreversible and lifelong visual loss • Strabismus defect in ocular alignment, or the position of the eyes in relation to each other;it is commonly called lazy eye. o strabismus may be hereditary or the result of various eye diseases (e.g., neuroblastoma), trauma, systemic or neurologic dysfunction that paralyzes the 3 extraocular muscles, uncorrected hyperopia, craniofacial abnormalities, accommodation, and accommodative convergence o A phoria is an intermittent deviation in ocular alignment that is held latent by sensory fusion. ▪ The child can maintain alignment on an object. Deviation occurs when binocular fusion is disrupted, most often during the cover/uncover test. o A tropia is a consistent or intermittent deviation in ocular alignment. ▪ A child with a tropia is unable to maintain alignment on an object of fixation. Intermittent tropia may occur when a child is tired. o Phorias and tropias are classified according to the pattern of deviation seen: ▪ • Hyper- (up) and hypo- (down) are used to classify vertical strabismus. ▪ Exo- (away from the nose) and eso- (toward the nose) describe horizontal deviations. • Esotropia can also be seen in those with a history of prematurity, low birth weight, cerebral palsy, hydrocephalus, and maternal substance or tobacco use ▪ Cyclo- describes a rotational or torsional deviation. o clinical findings: ▪ Intermittent exotropia in children (6 months to 4 years of age) who are ill, tired, exposed to bright light, or with sudden changes from close to distant vision. It is more often seen when the child is looking with distant fixation. ▪ When only one eye is affected (i.e., child always fixates with the unaffected eye). ▪ When both eyes are affected, the eye that looks straight at any given time is the fixating eye. ▪ The angle of deviation may be inconsistent in all fields of gaze. ▪ Persistent squinting, head tilting, face turning, overpointing, awkwardness, marked decreased visual acuity in one eye, or nystagmus may be seen. ▪ Cataracts, retinoblastoma, anisometropia, and severe refractive errors are rare o management: ▪ Any ocular misalignment seen after the age of 4 months is considered suspicious, and the child should be referred. Hyper-, hypo-, and exotropia, acquired esotropia or exotropia, cyclovertical deviation, or any fixed deviations is an indication for referral as soon as first observed. ▪ The unaffected (“good”) eye is occluded (using an adhesive bandage eyepatch, an occlusive contact lens, or an overplussed lens), which forces the child to use the deviating eye. Patching for 2 hours a day is as successful as patching for 6 hours a day ▪ Surgical alignment of the eyes may be necessary, but this does not preclude additional amblyopia therapy. ▪ Corrective lenses alone improve amblyopia in 27% of patients. Assessment for amblyopia should be done at every visit, even after straightening the eyes, because changes in alignment can occur through the fifth year. ▪ The ocular status of an affected child’s siblings is monitored. • Blepharoptosis or ptosis is drooping of the upper eyelids affecting one or both eyes (It can be congenital or acquired, secondary to trauma or inflammation) o Parents may remark that one eye appears smaller. o In severe cases, children may have a chin-up head position or adapt by raising their brow. o Management ▪ correct any underlying systemic diseas [Show More]

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