DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION, INC.

COLLEGE OF NURSING
2nd Semester, S.Y. 2019-2020

Worksheet in NCM
109: Lecture
Nursing care of a
Family when a
Child has a Vision
or Hearing Disorder
Submitted by:
KATYANA ANTOINE D. CESAR
BSN – 2B
1. ANATOMY & PHYSIOLOGY OF THE EYES
OUTER LAYER MIDDLE LAYER INNER LAYER
NAME OF FUNCTION NAME FUNCTION NAME OF FUNCTION
STRUCTU OF STRUCTUR
RE STRUCT E
URE
 PUPIL  The pupil appears
as a black dot in the
middle of the eye.
This black area is
actually a hole that
takes in light so the
eye can focus on
the objects in front
of it.
 IRIS
 The iris is the area
of the eye that
contains the
pigment which
gives the eye its
color. This area
surrounds the pupil,
and uses the dilator
pupillae muscles to
widen or close the
pupil. This allows
the eye to take in
more or less light
depending on how
bright it is around
you. If it is too
bright, the iris will
 LENS shrink the pupil so
that they eye can
focus more
effectively.

 The lens sits

directly behind the
pupil. This is a
clear layer that
focuses the light the
pupil takes in. It is
held in place by the
ciliary muscles,
which allow the
 RETIN lens to change
A shape depending on
the amount of light
that hits it so it can
be properly
focused.

 The light focused

by the lens will be
transmitted onto the
retina. This is made
of rods and cones
arranged in layers,
which will transmit
light into chemicals
and electrical
pulses. The retina is
located in the back
of the eye, and is
connected to the
 optic nerves that
will transmit the
images the eye sees
to the brain so they
can be interpreted.
The back of the
retina, known as the
macula, will help
 FOVE interpret the details
A of the object the eye
is working to
interpret. The
center of the
macula, known as
the fova will
increase the detail
of these images to a
perceivable point.

 The fovea is located

 MACU in the centre of the
LA macula region of
the retina. This tiny
area is responsible
for sharp central
vision essential for
reading, driving,
and any activity
where visual detail
is important.

 The macula is the

centre of the retina.
It is a very small
area but has a high
concentration of
light sensitive cells
(photoreceptors)
 OPTIC that allow us to read
NERV and see in fine
E detail. The detailed
vision is known as
our central vision.
The remaining
larger area of the
retina is responsible
for our peripheral,
or side, vision.

 The optic nerve is a

thick bundle of
nerve fibers that
connect the back of
the eye (retina) to
the brain. It
transfers all the
visual information
to the brain which
then interprets them
as images.
2. DISORDERS THAT INTERFERE WITH VISION
TREATMENT & NURSING
DISORDER DESCRIPTION ASSESSMENT FINDINGS
MANAGEMENT
1. Myopia Impaired far vision  Present when the second  It is possible for contact
(nearsightedness). number in the test result is lenses to be fitted for even
larger than the first (20/40). young infants. Children as
The higher the second young as 5 years of age are
 number, the poorer the capable of putting them in
vision. and taking them out if
taught properly.
 Glasses (advise parents to
choose frames fitted with
plastic or safety glass
(shatterproof) lenses so
that, if the lenses
accidentally break, the
child’s eyes will not be
injured) improve vision to
such an extent that after
trying them children will
continue to wear them.
However, throughout their
development, they may
need continued
encouragement to keep
wearing glasses until they
are old enough for contact
lenses or surgical
correction.
 Laser in situ keratomileusis
(LASIK) is laser surgery
for correction of myopia. It
involves making an
incision under the cornea to
change the contour of the
eye globe so that light rays
fall more accurately on the
retina.
2. Amblyopia A vision  A child with amblyopia has  The good eye is covered by
development 20/50 vision (normal for a patch held firmly in
disorder in which an preschool age) in one eye, place. This forces the child
eye fails to achieve and the other eye shows to use the poor eye, thus
normal visual acuity lessened vision (perhaps developing vision in that
(lazy eyes). 20/100). eye. The patch is removed
for 1 hour each day to
prevent amblyopia from
developing in the
nonamblyopic eye.
 Administration of levodopa
in addition to occlusion
therapy may also be
prescribed as this almost
immediately improves
vision in the poorer eye.
 Atropine, which causes
pupil dilation and blurred
vision when dropped into
the better eye, may be yet
another solution.
3. Strabismus Unequally aligned  Infants’ eyes may cross  If the fusion mechanism is
eyes (cross-eyes) occasionally until 6 weeks weak, eye exercises
caused by of age. If infants (orthoptics) may be
unbalanced muscle demonstrate strabismus past necessary.
control. this age, they should be  If eyes are diverging with
referred for diagnosis and attempted convergence
treatment. because of farsightedness
 Infants who demonstrate a or nearsightedness, the
constant strabismus before child needs glasses to
6 weeks of age need referral correct the basic visual
right away. Definite defect.
deviations are obvious.  If the misalignment is
These can be exotropia (eye caused by unequal muscle
turning out), esotropia (eye strength, eye muscle
turning in), or hypertropia surgery usually is
 (eye turning up). necessary to correct the
 If the deviation is not so problem, although injection
obvious and occurs only of botulinum toxin into the
when the child is fatigued eye muscle may be tried
or ill and, therefore, less first as temporary therapy
able to maintain fixation, or as an adjunct to surgery.
the terms used are
exophoria, esophoria, and
hyperphoria. If the parents
report that the deviation
occurs only when the child
is tired or sick, attempt to
assess the strabismus at
such a time, because then
the deviation will be most
striking.
 When children read small
print, they turn both eyes
medially, or converge, to
focus at the short distance.
If they are farsighted in one
eye, they will have to turn
the affected eye in more
than the other, causing
strabismus. If one eye is
nearsighted, they will not
need to turn that eye in as
far as the other one; this
results in divergence of the
nearsighted eye. Although
these children have good
eye alignment at rest, they
“cross their eyes” when
attempting to focus at a
reading distance.
 Some children have a latent
strabismus, but, because
they are able to maintain
fusion, the strabismus is not
overt. They maintain this
fusion at the expense of
eyestrain, however. They
may experience headaches;
tired, irritated eyes; and
perhaps even nausea and
vomiting.
 Children who have flat,
broad-bridged noses, a
narrow interpupillary
distance, and an epicanthal
fold or oval shaped
palpebral fissures may
appear to have strabismus
when they truly do not
(pseudostrabismus). These
children have less white
sclera visible in the inner
margin of the eye than
normally, so the eye
appears to be turned in
(pseudoesotropia). A cover
test reveals the true
condition. If
pseudostrabismus is
present, the covered eye
will not move after being
uncovered. It only appears
 to be turned medially
because of the obscured
sclera at the inner canthus.
Hirshberg’s test is another
method of detecting true
strabismus
 Once strabismus is
detected, it is important to
attempt to discern whether
it is concomitant (measures
the same in all directions of
gaze) or nonconcomitant
(greater in one direction
than in another; often called
paralytic strabismus).
Concomitant (nonparalytic)
strabismus is the most usual
type found in children. All
the muscles of the eye are
capable of function, but
they are not functioning
together. The deviation is
equally apparent in all
directions of gaze. Paralytic
strabismus is caused by
paralysis of a muscle or
nerve, perhaps from an
injury, such as a birth
injury, or an invading
lesion. The eyes appear
straight except when they
are moved in the direction
of the paralyzed muscle.
Then double vision occurs,
and the crossed eye is
evident. Such children often
close one eye or tilt their
head to decrease the double
vision. They may tilt their
head so much they appear
to have a torticollis, or “wry
neck”—an orthopedic
rather than an eye problem.
They are often fussy or
clumsy because of the
diplopia. They cannot see
well and may be too young
to describe what is
happening to them through
any means other than
fussiness.
4. Congenital A developmental  The cornea, which appears  Immediate surgery—a
Glaucoma anomaly in the angle enlarged, may be goniotomy, or
of the anterior edematous and hazy. In trabeculotomy, in which a
chamber prevents addition, there may be new opening to the canal of
proper drainage into tearing, pain, and Schlemm is constructed—
the canal. Later in photophobia (sensitivity to is scheduled for the infant
life, glaucoma light), all difficult to  A drug such as
occurs when the identify in a newborn. The acetazolamide (Diamox), a
canal becomes eye globe may feel tense to carbonic anhydrase
blocked. The finger palpation. inhibitor that suppresses
increased fluid  Tension greater than the the formation of aqueous
content that normal range of 12 to 20 humor, may be used
accumulates causes mm Hg is suggestive of temporarily to reduce eye
the globe of the eye glaucoma (measured by a pressure before surgery can
to increase in size. tonometer). be scheduled.
After it has  Newer surgical techniques
increased in size to
 the extent that it can, include laser therapy.
the pressure in the Before surgery, the infant
eye globe continues should not receive any
to rise, compressing drug, such as atropine
and ultimately sulfate, that dilates the
destroying the optic pupil, because this will
nerve. further occlude the canal of
Schlemm.
- After surgery, rough play
activities should be
restricted for 1 week.
Surgery may need to be
repeated before the new
opening for drainage of
fluid is adequate to keep
eye globe tension at a usual
level. Inform parents of this
possibility when surgery is
first proposed, so that they
will not think the additional
surgery is needed because
the first operation was
inadequate or was done
incorrectly. Children who
have eye injuries are
usually scheduled for a
follow-up appointment in 1
month for eye pressure
assessment. Stress the
importance of this visit
without alarming the
parents or child about the
possible complication.
5. Cataract A marked opacity of  When you inspect the pupil  Treatment of childhood
the lens. of a child with a cataract, cataract is surgical removal
the pupil opening appears to of the cloudy lens,
be white (leukocoria). The followed by insertion of an
red reflex elicited by internal intraocular lens.
shining a light into the pupil - Infants may be given a
appears white. sedative to help them rest
 Older children may report for 24 hours. Introduce
blurred vision because of fluids cautiously after eye
cataract formation. surgery so nausea and
 In the infant, this can be vomiting do not occur as
detected by lack of response vomiting increases IOP,
to a smile or inability to which could injure the
reach and grasp a nearby suture line. Encourage
object. The infant may also parents to stay with their
demonstrate nystagmus, infant, helping with care so
being unable to focus the that the infant does not cry
eye on objects. after surgery, because
crying also increases IOP.
 If they are unusually
restless, fussy, or crying
and seem to be in pain,
notify the physician
immediately.
 As a rule, children will be
given a mydriatic agent to
dilate the pupil and steroids
to prevent postoperative
development of pupillary
adhesions.
3. PLEASE LIST AT LEAST THREE DIAGNOSIS FOR EACH PATIENT
Chief Complaint NURSING DIAGNOSIS
1. A 12-year old diagnosed with  Disturbed sensory perception related to structural damage.
Astigmatism  Knowledge deficit related to impaired vision.
  Risk for injury related to impaired sensory function.
 Social isolation related to the limited ability to participate in
diversion activities and social activities secondary to impaired
vision.
2. 6-year old with Stye  Deficient knowledge related to importance of treatment of eye
infection
 Deficient knowledge related to the disease
 Risk for infection
3. 10-year old with Keratitis  Anxiety related to inability to perform daily activities
 Knowledge deficit related to lack of information about disease
processes
 Self-care deficit related to impaired vision
4. 8-year old with a piece of barbeque  Acute pain related to trauma
stick inside the eyeball  Anxiety related to pain
 Readiness for enhanced family coping related to child’s traumatic
injury
5. 11-year old with a black eye after a  Disturbed body image related to injury
quarrel with playmate  Risk for post trauma syndrome related to diminished ego strength
 Social isolation related to traumatic injury
4. PREPARE YOUR DISCHARGE INSTRUCTIONS FOR A 6-YEAR OLD CHILD WHO HAS UNDERGONE
SURGERY REMOVING A CHAZALION FROM HER EYELID.
 Instruct the patient to Avoid rubbing the eye.
 Inform the patient and the significant other for the f discharge instructions:
 EATING AND DRINKING
 After the anesthetic, your child can start eating a light diet such as sandwiches, pasta, soup or jelly. Avoid
fatty or junk food.
 NAUSEA AND VOMITING
 Do not worry if your child feels sick or vomits once or twice after leaving hospital.
 If they vomit or feel sick, stop giving food for about one hour. Then try a light diet if your child can
manage it without feeling ill.
 If your child keeps vomiting, please call your child's surgeon (number at the end of this page) or your
nearest hospital emergency department.
 WOUND CARE
 A small amount of discharge from the eye is common for a few days.
 You can clean this with saline water (sterile salt water) or with clean water and a clean face washer or
cloth.
 The eyes may look red for about two to four weeks.
 Sunglasses may help if your child is feeling sensitive to light.
 Remember to use eye medication as directed if it is prescribed.
 Your child's tears may be blood-stained red for the first few days. Don't be alarmed by this as it is quite
normal.
 ACTIVITY
 Your child can return to their normal activity when they're ready.
 Your child should not take part in any contact or competitive team sports for at least one week after the
operation.
 Your child should not go swimming for two weeks.
 PAIN RELIEF
 Paracetamol can be given at home every four to six hours for one to two days if needed. Read the
packaging for the correct dose for your child according to their age. Ask for help if you are unsure. Do
not give any medicine with paracetamol in it more than four times in 24 hours.
 For more severe pain call your child's surgeon or see your family doctor.
 FOLLOW-UP
 Arrange a follow-up appointment as discussed with your child's surgeon. 
 Contact your child's eye surgeon if you have any questions or concerns about their care at home. 
5. ANATOMY & PHYSIOLOGY OF THE EARS
OUTER EAR MIDDLE EAR INNER EAR
NAME OF NAME OF NAME OF FUNCTION
STRUCTU FUNCTION STRUCTU FUNCTION STRUCTUR
RE RE E
 PINNA  COCHL  The cochlea
 The pinna is a  TYMPA  The tympanic EA resembles a snail
prominent skin- NIC membrane is shell or a wound-
MEMB commonly up hose and is
covered flap
 filled with a fluid
located on the RANE known as the called perilymph
side of the head, (EARDR eardrum, and and contains two
and is the UM) separates the closely positioned
visible part of ear canal from membranes. These
the ear the middle ear. membranes form a
externally. It is It is about 1cm type of partition
shaped and in diameter wall in the cochlea.
supported by and slightly However, in order
cartilage except concave for the fluid to
for the earlobe. (curving move freely in the
It collects sound inward) on its cochlea from one
waves and outer surface. side of the partition
channels them It vibrates wall to the other,
down the freely in the wall has a little
external ear response to hole in it (the
canal through sound. The helicotrema). This
patterns formed membrane is hole is necessary,
on the pinna highly in ensuring that the
known as innervated, vibrations from the
whorls and making it oval window are
recesses. Its highly transmitted to all
shape also sensitive to the fluid in the
partially shields pain. For the cochlea.
sound waves membrane to  VESTIB
that approach move freely ULAR
the ear from the when air  The vestibular is
rear, therefore strikes it, the another important
 EAR enabling a resting air part of the inner
CANAL person to tell pressure on ear. The vestibular
whether a sound both sides of is the organ of
is coming the tympanic equilibrium. The
directly from membrane vestibular’s
the front or the must be equal. function is to
back. The outside of register the body's
the membrane movements, thus
is exposed to ensuring that we
atmospheric can keep our
pressure balance.
 The ear canal is (pressure of
roughly 3cm the
long in adults  The vestibular
environment consists of three
and slightly S- in which we
shaped. It is ring-shaped
find ourselves) passages, oriented
supported by through the
cartilage at its in three different
auditory tube, planes. All three
opening, and by so that the
bone for the rest passages are filled
cavity in with fluid that
of its length. which it is
Skin lines the moves in
located, called accordance with
canal, and the tympanic
contains glands the body's
cavity, is movements. In
that produce continuous
secretions that addition to the
with the cells fluid, these
mix with dead in the jaw and
skin cells to passages also
throat area. contain thousands
produce cerume Normally, the
n (earwax). of hair fibers which
auditory tube react to the
Cerumen, along is flattered and
with the fine movement of the
closed, but fluid sending little
hairs that guard swallowing,
the entrance to impulses to the
yawning and  AUDIT brain. The brain
the ear canal, chewing pull ORY
helps prevent then decodes these
the tube open, NERVE impulses which are
airborne allowing air to
particles from used to help the
enter or leave body keep it balance.
reaching the the tympanic
inner portions cavity. This
 of the ear canal, opening of the
where they auditory tube
could allows air  The auditory nerve
accumulate or pressure in the is a bundle of
injure the middle ear to nerve fibers that
eardrum and equilibrate carry information
interfere with with between the
hearing. atmospheric cochlea in the inner
Cerumen pressure, so ear and the brain.
usually dries up that the The function of the
and falls out of pressures on auditory nerve is to
the canal. both sides of transmit signals
However, it can the tympanic from the internal
sometimes membrane ear to the brain.
become impact become equal
and disrupt to each other.  The hair fibers in
hearing. Excessive the cochlea are all
pressure on connected to the
 either side of auditory nerve and,
the tympanic depending on the
membrane nature of the
dampens the movements in the
sense of the cochlear fluid,
hearing different hair fibers
because the are put into
tympanic motion. When the
membrane hair fibers move
cannot vibrate they send electrical
freely. When signals to the
external auditory nerve
pressure which is connected
changes to the auditory
rapidly, for center of the brain.
example In the brain the
during air electrical impulses
flight, the are translated into
eardrum can sounds which we
bulge recognize and
painfully understand. As a
because as the consequence, these
pressure hair fibers are
outside the ear essential to our
changes, the hearing ability.
pressure in the Should these hair
middle ear fibers become
remains damaged, then our
unchanged. hearing ability will
Yawning or deteriorate.
swallowing in
this instance
opens up the
auditory tube,
allowing the
pressure on
both sides of
the tympanic
membrane to
equalize,
relieving the
pressure
distortion as
the eardrum
“pops” back
into place.
Since the
auditory tube
connects the
 jaw/throat
areas to the
ear, it allows
throat
infections to
spread
relatively
easily to the
middle ear.
Middle ear
infection is
common in
children
because their
auditory tubes
are relatively
short,
compared to
adults. This
leads to fluid
accumulation
in the middle
ear, which is
not only
painful but
also disrupts
the
transference of
sound across
the middle ear.
If the infection
is left
untreated, it
can spread
from the cells
near the jaw,
causing menin
gitis(inflamma
tion of the
brain lining).
Middle ear
infection can
also cause the
fusion of the
ear ossicles,
resulting in
hearing loss.

 The tympanic
cavity
contains the
body’s three
smallest bones
and two
smallest
muscles. The
bones are also
referred to as
auditory
ossicles, and
connect the
eardrum to the
inner ear.
From the
 outermost to
innermost, the
bones are
called
the malleus,
incus
and stapes.

 The malleus is
attached to the
eardrum. It
has a handle
that attaches to
 AUDITOR the inner
Y
surface of the
OSSICL
ES AND eardrum, and a
MUSCL head that is
ES suspended
from the wall
of the
tympanic
cavity.

 The incus is
connected to
the malleus on
the side closer
to the
eardrum, and
to the stapes
on the side
closer to the
inner ear

 MALL
EUS
 The stapes has
an arch and a
footplate. This
footplate is
held by a
ringlike piece
of tissue in an
opening called
the oval
window,
which is the
entrance into
 INCUS the inner ear.

 The stapedius is
the muscle of
the inner ear
that inserts on
the stapes.
 STAPE The tensor
S tympani is the
inner ear muscle
that insert on
the malleus
 STAPE
DIUS
AND
TENSO
R
TYMP
ANI: 
6. ILLUSTRATE HOW A HEARING AID AND COCHLEAR IMPLANT WORKS.

 Hearing aids pick

up sound through
a microphone,
convert the
sound waves into
electrical
impulses, and
amplify them
across the
tympanic
membrane. They
are powered by
batteries that
must be changed
periodically.
 Hearing aids are designed to be as inconspicuous as possible so that
children will not feel self-conscious wearing them. The receiver of
the hearing aid may be incorporated into eyeglasses, molded into a
plastic form that fits behind or in the ear, or housed in a small box
(the size of a cellphone or iPod) that children wear on a cord around
their neck or carry in a blouse or shirt pocket. Teach children to
remove hearing aids before washing their hair, showering, or
swimming. Hearing aids should be turned off when removed, to
preserve the life of the batteries.
 Cochlear implants are mechanical devices consisting of a
microphone, a speech processor, a transmitter/receiver, and an
arrangement of electrodes that send impulses from the receiver to
the auditory nerve. The auditory nerve then transmits the impulses
to the brain where they are interpreted as words or common noises.
 Cochlear implants have the potential to replace a nonfunctioning
inner ear and create the ability to receive and interpret sounds in an
ear that has sustained nerve damage (Berg et al., 2007). The implant
consists of an external portion that sits behind the ear and a second
portion that is surgically implanted under the skin. After
implantation, hearing is often reported as “muffled” but adequate.
Months of training are necessary to help a child interpret these
distorted
impulses
correctly.
Hearing-
challenged adults
may be reluctant
to consent to a
cochlear implant
for their child,
believing that the
change from
hearing-
challenged to
non–hearing-challenged status will remove their child from their
deaf culture. Children who spoke with an impediment before
implantation usually need speech therapy afterward to improve their
speech pattern.
7. ENUMERATE THE KEY POINTS OF YOUR DISCHARGE INSTRUCTIONS TO THE FAMILY WITH A
CHILD WHO IS HEARING CHALLENGED.
 Always allow hearing-challenged children to see you before you touch them as they will not find this nearly as
intrusive as being touch without warning.
 If children are sleeping when you approach them, use a light touch to waken them gently.
 Some children turn off their hearing aid or remove it while they sleep. You may need to turn it on before you call
them to wake them, or they may need to replace the hearing aid as soon as they awaken.
 Children as young as 2 years of age are effective lip readers as long as you are facing them. Position yourself at
eye level, so the child can view your face.
 Ask parents of children who are hearing challenged to draw pictures or demonstrate the sign language symbols
their children use for important words such as pain, drink, and bathroom. Encourage children to use or draw
pictures of what they want if they are still too young to write words and you cannot understand what they are
saying.
 Use photographs, drawings, or demonstration with hearing-challenged children to help them learn new skills.
Contact a signing interpreter as appropriate to be certain that children understand instructions.
 Ask the family to investigate home safety measures that protect the hearing-impaired child from inadvertent
injury.
8. DISORDERS OF THE EAR

TREATMENT &
ASSESSMENT
DISORDER DESCRIPTION ETIOLOGY NURSING
FINDINGS
MANAGEMENT
1. External Otitis Also called The two most Mild discomfort, Treatment includes
swimmer's ear, common isolates itching, and minimal the removal of
involves diffuse are Pseudomonas edema to severe pain, offending agents
inflammation of the aeruginosa and S complete canal and the use of
external ear canal taphylococcus obstruction, and topical or systemic
that may extend aureus. involvement of the corticosteroids.
distally to the pinna pinna and surrounding
and proximally to skin. Pain is the
the tympanic symptom that best
membrane. correlates with the
severity of disease. Mild
fever may be present.
2. Acute Otitis Media Acute otitis media Complication of Severe bulging of the  Active
(AOM) is a painful eustachian tube tympanic membrane, monitoring for
type of ear dysfunction that new onset of otorrhea recurrence of
infection. It occurs occurred during not caused by otitis symptoms,
when the area an acute viral externa, or mild bulging persistent
behind the eardrum upper respiratory of the tympanic infection,
called the middle tract infection. membrane associated OME.
ear becomes with recent onset of ear  Adjuvant
inflamed and pain (less than 48 hours) therapy: Pain
infected. or erythema. relief, including
local drops,
analgesics,
heating pad,
warm oil.
 Instructions to
parents:
 When to
follow-up
 Directions on
how to give the
medicine
including the
importance to
complete the
entire
prescription
 Tell parents
that the
medicine will
not help URI
symptoms 
 Tell the family
 that pain may
persist for up to
24 hours after
starting
treatment.
3. Otitis Media with A common Streptococcus Hearing loss or aural  Pharmacologic
Effusion condition of pneumoniae, fullness but typically do management of
childhood Haemophilus not involve pain or otitis media
characterized by influenzae, and  fever. In children, with effusion
the presence of Moraxella hearing loss is generally (OME)
fluid in the middle catarrhalis. These mild and is often includes
ear without signs or pathogens are detected only with an administration
symptoms of also the most audiogram. Serous otitis of antimicrobial
infection. In some frequent media is a specific type agents, steroids,
instances, organisms of otitis media with antihistamines
aspiration may associated with effusion caused by and
yield the presence sinusitis and transudate formation as decongestants,
of bacteria. pneumonia. a result of a rapid and mucolytics.
decrease in middle ear  Surgery has
pressure relative to the become the
atmospheric pressure. most widely
The fluid in this case is accepted
watery and clear. therapeutic
intervention for
persistent otitis
media with
effusion (OME)
Sources:

 Pillitteri, Adele. Maternal & Child Health Nursing: Care of The Childbearing & Childrearing Family. Philadelphia,
PA: Lippincott Williams & Wilkins, 2007.
 Weber, Janet. Kelley, Jane, Health Assessment In Nursing. Philadelphia: Lippincott Williams & Wilkins, 2003.
 https://healthengine.com.au/info/ear
 https://www.aafp.org/afp/2013/1001/p435.html
 https://pedclerk.bsd.uchicago.edu/page/acute-otitis-media-and-otitis-media-effusion
 https://emedicine.medscape.com/article/858990-overview#a1
 https://www.lei.org.au/services/eye-health-information/eye-diagram/
 https://robertsonopt.com/parts-of-the-eye-their-function/
 https://www.hear-it.org/The-inner-ear-1
 https://healthengine.com.au/info/ear
