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Final Pediatric StudyGuide|NR 602 -Topics 35- 36 Updated 2022/2023
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Final Pediatric StudyGuide|NR 602 -Topics 35- 36Updated 2022/2023
Eye disorders: Chalazion (caused by noninfectious occlusion) or Hordeolum
(caused by infection). However, a hordeolum will be painful. Both can
be treated with heat compresses.
At birth the maxillary and ethmoid sinuses are typically developed and
pneumatized.
By 9 months to a year of age the sphenoid sinuses typically become
pneumatized, and by 5 years of age, the frontal sinuses are
pneumatized.
Frontal sinuses continue to grow as the face grows and may be larger in boys.
Up to 10% of the population does not develop frontal sinuses.
Nosebleeds can be traumatic for both parents and children. A small
amount of blood can look like a great deal, which can be frightening.
Quite vascular, at Kiesselbach's plexus in the front- septal area.
Common site for bleeds to occur. Causes of epistaxis include but are not
limited to picking, trauma, dry environment, treatment with topical
nasal steroids, and vigorous rubbing or blowing.
Even though less than 5% of children with reoccurring epistaxis have a
bleeding disorder, this should not be excluded from the differential in
cases of repetitive and significant epistaxis.
Treatment includes having the patient sit up and then apply gentle-
pinching pressure to the soft area of the nose below the nasal bones
for at least 5 minutes. If still bleeding take to MD.
Soft packing, such as gel foam, can be inserted to absorb and
prevent further bleeding.
Prevention includes keeping the nares moist with saline nasal
gel or spray daily, humidifying the environment, and ensuring
that nasal medications are being used appropriately
Bulbar or palpebral conjunctival injection is a common
presentation, which can be unilateral or bilateral. The differential
diagnosis should include allergy, conjunctivitis, infection, foreign
body, chemical exposure, or systemic inflammatory disease,
irritation of the conjunctiva or cornea, and congenital glaucoma.
Therefore, a good examination for symptoms associated with
each is needed. Discharge from the eye varies based on cause.
Watery discharge can occur with allergies, nasolacrimal
obstruction, foreign bodies, viral infection, and iritis. However,
purulent or mucoid discharge can be noted with chronic
dacrocystitis or nasolacrimal obstruction. Even advanced allergic
conjunctivitis can have some mucoid production. To differentiate,
microscopic investigation of discharge may lead to other clues.
The eye is one of the most sensitive areas of the body and pain can
occur for many reasons. The NP should always complete a thorough
exam for trauma,
Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
, Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
foreign bodies, even trichiasis. Photophobia is a symptom
common of trauma and in infants with glaucoma or retinal
disease. Other non-eye related causes of photophobia include
migraines and meningitis.
A white pupil, or leukocoria, is a serious finding and demands
immediate referral to the pediatric ophthalmologist. Causes of
leukocoria include retinal detachment, cataract, retinal dysplasia,
retinopathy of prematurity, and in newborns retinoblastoma. All
newborns should have a fundoscopic examination within 24 hours of
birth and yearly on physical examinations.
Some children are at higher risk for the need of glasses, including
those with Down syndrome, Marfan syndrome, and Ehlers-Danlos
syndrome. Visual screening in all children at least once between
the ages of 3 and 5 is a formal recommendation of the USPSTF
(2011).
Summary of Recommendations and Evidence Population
Recommendation Grade Children, Age 3-5 Years. The USPSTF
recommends vision screening for all children at least once
between the ages of 3 and 5 years, to detect the presence of
amblyopia or its risk factors. B Children, <3 Years of Age The
USPSTF concludes that the current evidence is insufficient to
assess the balance of benefits and harms of vision screening for
children <3 years of age.
Common eye traumas that may present to primary
care are as follows:
o Scratch or laceration to the cornea
o Blunt trauma to the orbit; note that an orbital fracture can
cause muscle entrapment, compartment syndrome
o Hyphema
o Chemical or heat-related burns
o URIs often have peak incidence in winter and
spring months when communicability from
indoor exposure is highest.
o Common symptoms include congestion, sore throat,
rhinorrhea that can progress in color and amount as the URI
progresses, but does not mean that bacterial sinusitis is
present, and cough. Also, symptoms may include possibly
sneezing, myalgia, or low-grade fever.
o Current treatment, particularly for young children, is
hydration and over-the- counter antipyretics for low-
Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
, Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
grade fever or myalgia as directed by the provider.
o Normal saline rinse of the nares may be of some benefit and
clearing congestion but may not be well tolerated by some
children. Currently, cold and cough recommendations are
not recommended in children younger than age 4.
o Complications of URIs include otitis media and sinusitis.
Presumptive antibiotics should not be given to prevent
these complications. Sinusitis in children cannot be
diagnosed until at least 10 to 14 days with lack of symptom
improvement or development of new symptoms, such as
facial pain.
o Children with Asthma should be monitored for exacerbation
and may need home monitoring of peak flow and symptoms
or initiation of their asthma action plan for changes in the
airway.
Bacterial Rhinosinusitis
Caused by common URI infection. These children typically worsen
after 5 to 7 days of a URI or are not resolved in 2 weeks.
Children with a history of respiratory allergies or trauma may be at
higher risk. Symptoms should be present more than 10 days or
worsen within 10 days after initial improvement and include
purulent nasal congestion, nasal drainage, facial pain, headache,
purulent posterior pharyngeal drainage, and fever.
Musculoskeletal Injuries – assessment and treatment: Ch 43
● Bone age – radiographs of left hand and wrist
➢ Used to determine somatic maturation, and Measure of growth tempo
● Skeletal growth spurt in adolescents
➢ Tanner stage 2 in girls, and Tanner stage 3 in boys
● Long bones have growth plate (physis); blood supply through epiphysis; damage to epiphysis
can stop growth of bone (Fig. 43.1)
● Bone, muscle development influenced by use
➢ Protein, calcium, vitamin D necessary for growth and development of
musculoskeletal system
● Pathophysiology: Systemic problems
➢ Infection – viral, bacterial, tubercular
Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
, Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
➢ Hemophilia, sickle cell disease, arthritic disease
➢ Malignancy
● Genetic problems
➢ Osteogenesis imperfecta
➢ Down syndrome
➢ Marfan syndrome
➢ Growth plate fx’s
➢ Salter-Harris classification
● Mechanism of injury
● Fracture line related to layers of physis
● Prognosis for subsequent growth disturbance (rare in Types I and II)
● Salter-Harris classification
Salter-Harris Classification of Physical Fractures, Types I to V.
➢ Type I – fracture in physis/not surrounding bone
➢ Type II – metaphyseal fragment on compression side
➢ Type III – physeal separation – requires anatomic reduction
➢ Type IV – metaphysis, physis, epiphysis
➢ Type V – compression/crushing injury to physis
● Shaft fractures
➢ Mechanism of injury important – closed fractures while tripping; open fractures
with more force
● History
➢ Onset of symptoms; history of injury using OLDCARTS
➢ Pain – location, character, effect of activities
Final Pediatric StudyGuide|NR 602 -Topics 35- 36
Updated 2022/2023
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