Strabismus

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Ashley Powell
MSN,RN,PCN
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Outline

Overview

  1. Lack of coordination between extraocular muscles resulting in inability to direct both eyes at the same point.  Often referred to as “cross-eyed”.

Nursing Points

General

  1. Normal finding in infant but should not be present after 4 months of life.
  2. Treatment should occur as early as possible to avoid lifelong visual problems.

Assessment

  1. Eyes crossed
  2. Poor depth perception
  3. Squinting of eyes and tilting of head
  4. Binocular vision is lost without treatment

Therapeutic Management

  1. Eyeglasses
  2. Vision therapy
  3. Surgery
  4. Combination therapy:
    1. Wearing an eye patch on the good eye will help strengthen the weak eye.

Nursing Concepts

  1. Sensory Perception

Patient Education

  1. Eye patch should be worn on the good eye

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Transcript

Hey guys, in this lesson we are going to talk about strabismus or what is often referred to as being “cross eyed” .

When a person or child has strabismus there is a lack of coordination between the muscles around the eyes. This results in the child not being able to focus both eyes on the same object at the same time. This is called lack of binocularity and can result in double vision, blurry vision and poor depth perception. Over time, if untreated the brain will learn to ignore the eye that isn’t focusing. When this happens you end up with amblyopia or what is often called a lazy eye. To prevent this from happening strabismus needs to be treated by the time a child is 4-6 years old.

The first thing noticed during assessment of a child with strabismus is that their eyes may appear crossed or not working in a coordinated way. Because of this lack of focus they will have double or blurred vision and poor depth perception. To compensate for this the child may squint their eyes or tilt their head to try and get a better focus on what they are looking at.

So, first things first, these kids need a full eye exam. This won’t likely fall to you as the RN, but could if you go on to train as a nurse practitioner. Tests use to further investigate for strabismus are the corneal light reflex test, and the cover test.

The first step to help treat the strabismus is to give the weaker eye a chance to get stronger and the way this is done is to put an eye patch over the stronger eye for a certain number of hours per day to let the weak eye learn to focus and take over.

Vision therapy is also used to help strengthen the eye muscles and teach the eyes to work together and it’s basically just like physical therapy for the eyes.

If these things don’t work then the child may need to have surgery to either loosen or tighten the muscles that are causing the problems.

Your priority nursing concepts for a pediatric patient with strabismus are sensory perception and human development.
Okay guys, lets go over the key points for this lesson! When a child has strabismus their eyes aren’t able to focus together on an object. This can lead to the eyes appearing crossed and the patient will experience double vision and have poor depth perception. The first step in treating this is to place an eye patch over the good eye to help the weaker eye get stronger. If this doesn’t work the child may need surgery. It’s super important to get this treated by 4-6 years to prevent amblyopia or lazy eye- where the brain basically permanently learns to ignore the weak, unfocused eye.

That’s it for our lesson on Strabismus in pediatric patients! Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!

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Family Nursing II

Concepts Covered:

  • Newborn Complications
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  • Labor Complications
  • Medication Administration
  • Newborn Care
  • Prenatal Concepts
  • Labor and Delivery
  • Prenatal and Neonatal Growth and Development
  • Postpartum Complications
  • Postpartum Care
  • Fetal Development
  • EENT Disorders
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  • Neurologic and Cognitive Disorders
  • Musculoskeletal Disorders
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  • Hematologic Disorders
  • Cardiovascular Disorders
  • Respiratory Disorders
  • Gastrointestinal Disorders
  • Shock
  • Noninfectious Respiratory Disorder
  • Cardiac Disorders
  • Studying
  • Infectious Disease Disorders
  • Renal Disorders
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  • Disorders of Pancreas
  • Integumentary Disorders

Study Plan Lessons

Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Preeclampsia (45 min)
Emergent Delivery (OB) (30 min)
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Ectopic Pregnancy Case Study (30 min)
Antepartum Testing Case Study (45 min)
Labor Progression Case Study (45 min)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Growth and Development – Prenatal
Growth & Development – Neonate
HELLP Syndrome
Nutrition in Pregnancy
Antepartum Testing
Eye Prophylaxis for Newborn (Erythromycin)
Rh Immune Globulin (Rhogam)
Meds for PPH (postpartum hemorrhage)
Uterine Stimulants (Oxytocin, Pitocin)
Prostaglandins
Magnesium Sulfate
Betamethasone and Dexamethasone
Meconium Aspiration
Newborn of HIV+ Mother
Fetal Alcohol Syndrome (FAS)
Addicted Newborn
Erythroblastosis Fetalis
Hyperbilirubinemia (Jaundice)
Retinopathy of Prematurity (ROP)
Babies by Term
Newborn Reflexes
Body System Assessments
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Initial Care of the Newborn (APGAR)
Subinvolution
Mastitis
Postpartum Hemorrhage (PPH)
Postpartum Hematoma
Postpartum Discomforts
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Postpartum Physiological Maternal Changes
Dystocia
Preterm Labor
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Placenta Previa
Prolapsed Umbilical Cord
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Leopold Maneuvers
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Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Infections in Pregnancy
Hyperemesis Gravidarum
Hydatidiform Mole (Molar pregnancy)
Ectopic Pregnancy
Disseminated Intravascular Coagulation (DIC)
Cardiac (Heart) Disease in Pregnancy
Anemia in Pregnancy
Gestational Diabetes (GDM)
Conjunctivitis
Strabismus
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Obstructive Heart (Cardiac) Defects
Mixed (Cardiac) Heart Defects
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Pediatric Vital Signs (VS)
Shock
Nursing Care and Pathophysiology for Asthma
Asthma
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Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Nursing Care and Pathophysiology for Valve Disorders
Rubeola – Measles
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Pertussis – Whooping Cough
Influenza – Flu
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Pneumonia
Umbilical Hernia
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nephrotic Syndrome
Enuresis
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Burn Injuries
Eczema
Impetigo
Epispadias and Hypospadias