foreign bodies.pptx

this is a condition that is commonly found in paediatrics patients.

1. Foreign bodies PAEDIATRICS IN NURSING Presentation by Ms Chibwe Gift.

2. Objectives Definition of foreign bodies Examples of foreign bodies Types of foreign bodies Investigations Nursing care/Management of foreign bodies Information Education Communication

3. FOREIGN BODIES Introduction Foreign bodies are objects and substances that are found where they are not supposed to be in the human body, these foreign bodies could be inhaled or swallowed or may be gotten from an injury to almost any part of your body , but the most common areas for foreign bodies are the ears , nose and throat. These foreign bodies are more common in small children, who sometimes stick things in their mouths, ears, eye and noses.  

4. Definition A foreign body is something that is stuck inside you but isn’t supposed to be there or these are substances that come from outside the body such that it causes uncomfortability to the body and area in which it is stuck.  foreign bodies of the ear, nose and throat refers to any object that is placed in the ear, nose or mouth that is not meant to be there and would cause harm with immediate medical attention(www.chkd.org/ent/foreign.htm).

5. Epidemiology These foreign bodies are most common in children than in adults. About 75% of foreign bodies of the ear occur in children younger than 8 years old. These foreign objects are usually asymptomatic and are often found accidentally. Foreign bodies in the airway accounts for nearly 9% of all home accidental deaths in children under five. And according to American Academy of Paediatrics , death in children occur mosre often in children under five. Infants younger than 1 year old account for two-thirds of choking victims. And insects are more common in children older than 10years and adults.

6. causes The vast majority of foreign bodies are placed in the nose voluntarily for an endless variety of reasons. Trauma is another common cause for items to get shoved inside the nose. When a person falls or gets struck in the face, it is important to consider the possibility that an object may be stuck in the nose and is completely out of view. Other causes could be as a result of carelessness.

7. Examples of foreign bodies   Beads Small parts from toys Food , fish bone. Rubbers Wood Marbol Insects like cockcroach , spider,bedbugs , fruit fly, ants and lice.  

8. Foreign Bodies of the ear The vast majority of objects found in ears are placed there voluntarily, usually by children, for an endless variety of reasons.

9. Types of foreign bodies The ear

10. Foreign body in the ear

11. 1.) The ear Insects such as cockroaches, bed bugs ,ants e.t.c Beads and small stones. Vegetative objects such as beans, maize seeds, peas and nuts Imparted cerumen or earwax build up .(accumulation of cerumen that causes symptoms which prevents assessment of the ear canal, tympanic membrane or the audiovestibular system. Small parts of the toys e.g tiny car and lego products. Tiny earings .

12. Foreign object in the ear

13. The nose is a deep space that extends directly back into the face. a relatively small portion of the nasal cavity is visible by looking into the tip of the nose. in the back of the nose, the space turns downward and connects to the back of the mouth. FOREIGN BODIES IN THE NOSE

14. . Common objects found in noses include food material, tissue paper, beads, toys, and rocks. Most of these cases of foreign bodies in the nose and nasal cavity are not serious and occur in toddlers and children from 1 – 8 years of age. In addition, an object stuck in the nose has the potential to dislodge and travel into the mouth where there is the danger of swallowing it, or even worse, inhaling it into the lungs, which may block airflow.

15. Nose and throat

16. 2.) The nose Buttons Beads Wood Cotton Paper Cloth toy parts Pebbles Candle wax.

17. 3.) The throat Fish bones Metal pins Small batteries Seeds Balloons Pieces of deformable plastics(permanent distortion subjected to tonsile becomes comprssive . Food boluses

18. Signs and symptoms Adults can tell that an object is in the nose. Typically, foreign items in the nose result in complaints of pain or difficulty breathing through the side of the nose or nostril involved. Nasal bleeding is also a common symptom of a foreign body in the nose because the tissues of the nose can be easily scratched.

19. Signs and symptoms The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved. Occasionally, a foreign body in the ear will go undetected and can cause an infection in the ear. Pain is the most common symptom. If the object is blocking most of the ear canal, the patient may experience a decrease in hearing on the affected ear. Ear irritation to the ear canal, this may cause nausea and vomit. Bleeding is also common, especially if the object is sharp. One of the most distressing experiences with this problem is having a live insect in the ear. The insect's movement can cause a buzzing in the ear and may be quite uncomfortable.

20. Clinical presentation Pain Dysphagia , difficulting in swallowing resulting from a painful blockage. Dyspnoea , laboured brearthins . Local inflammation, due to the harm caused. Nasal discharge Choking Coughing wheezing

21. Treatment Management /Self – Care at Home A person may complicate matters by pushing the object farther back into the throat and possibly cause the affected person to choke or injure the surrounding tissue. As such extra care should be observed. The following techniques can be tried safely to remove the object at home

22. Treatment Blowing the nose will potentially dislodge the object and is more likely to succeed if the uninvolved nostril is closed during such attempts. Hold the unaffected nostril closed by pressing a finger against the side of the nose. A sneeze will actually produce much more force and is an alternative way to push the object forward and out of the nose

23. Medical Treatment Treatment will largely depend on the location and identity of the object or objects involved. There are a variety of treatment options available at the clinic or health centre:

24. Medical treatment These catheters have an inflatable balloon at the tip which can be inflated and pulled back, along with the fallen body. Sedation may be considered for a child to allow calm and comfort during removal of the object.

25. Medical Treatment These catheters have an inflatable balloon at the tip, which can then be inflated and pulled back, along with the foreign body. Sedation may be considered for a child as an option to allow calm and comfort during removal of the object.  

26. . A caregiver should not threaten a child when asking about this possibility, because the child may deny having put something in the ear in order to avoid punishment. This denial could easily result in a delay of its discovery and increase the risk of complications. Insects crawl into the ear, usually when one is sleeping. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience. The ear canal, where most objects get stuck, is very sensitive

27. Investigations Take history and consider signs of a foreign body in the nose gathering information in regard to what kind of foreign object. Do X – ray of the upper respiratory tract system including nasal cavities which will show the object. CT scan may be considered.

28. Investigations X-ray Endoscope Audiography

29. Assessment of the ear; history Obtain thorough history on what happened Ask what time this happened

30. Evaluation of gross auditory acuity A general examination of the patient’s hearing can be made by assessing his/her hearing ability by; A whispered phrase or a ticking watch etc , testing one ear at a time is used A Weber and Linne Tests may be used to distinguish conductive loss from sensory neural loss when hearing is impaired

31. . Whisper Test Exclude one ear from testing, the examiner covers untested ear with the palm of the hand then whispers softly from a distance of 45 – 60cm from the uncovered ear and out of sight. The patient with normal acuity can correctly repeat what was whispered. Weber Test (named after Friedrich Eugen Weber 1823 – 1891, a Gerontologist ; scientist who study the effects of aging and age related diseases on humans).

32. . The Weber Test uses the bone conduction to test lateralization of sound. A tuning fork is set in motion by grasping it firmly and tapping it in the examiner’s hand or knee and then is set on the patient’s head. The patient is asked to identify where the sound is heard i.e. the middle of the head, right or left ear. A person with normal hearing will hear the sound equally in both ears or describe the sound as central or on the middle of the head. In cases of conductive hearing loss, the sound is heard better in the affected ear. In cases of sensory neural hearing loss the sound localizes to the better hearing ear. The Weber test is used for detecting unilateral hearing loss

33. . Linne Test In the Linne Test, the examiner shifts the step of the vibrating tuning fork between the two positions, 6cm from the opening of the ear canal (ear conduction) and against the mastoid bone (bone conduction), as the position changes, the patient is asked to indicate which tone is louder or the tone is no longer audible. Normally sound heard by air conduction is audible longer than that heard by bone conduction. The Linne test is useful for distinguishing between conductive and sensory neural hearing loss.

34. Physical examinatio Inspection Palpation Observation

35. Management of foreign body of the nose Foreign body must be removed through the route of entry. Irrigation of the nose or pushing the objects backwards must be avoided. Use local anaesthesia in difficult cases. Refer to ENT specialists in cases of failed measures.

36. Assessment of foreign bodies in the throat Foreign bodies of the throat are a life threatening situation, which requires prompt action by specialists. If objects obstruct the entire airway, signs of asphyxia are evident and this calls for emergency assessment and management

37. Assessment of the throat HISTORY History taking to determine the problem PHYSICAL EXAMINATION Assessment of the airway breathing and circulation Inspection Assess vital signs and respiratory status noting signs of respiratory distress

38. Signs of respiratory distress Dyspnoea Tachycardia Inspiratory stridor Restless

39. Management of foreign bodies in the throat Treatment of the problem varies with the degree of airway blockage. If the object is visible and large, forceps are used to remove it. If not visible x-ray may be done Heeblich manoeuvre is performed. If object is in the trachea with respiratory distress, a tracheostomy is performed.

40. Medical/Surgical Care Where there is ear infection antibiotic ear drops can be administered. Dripping mineral oil into the affected ear kill the insect. This is safe as long as there is no hole in the ear eardrum. Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened.

41. Medical/Surgical Care Urgent removal is indicated if the object is causing significant pain or discomfort. Commonly used techniques include applying gentle suction to the object, small forceps, or instruments that have a loop or hook at the tip are used. If the object is metallic, a long instrument may be magnetized to assist in gently pulling the object from the ear.

42. . Another common technique involves irrigating the ear. If the eardrum appears intact, warm water can be gently squirted past the object using a small catheter. The water will turn around at the end of the ear canal and often wash the object out. A child with this problem may be sedated to allow calm and comfortable removal of the object.

43. complications Airway obstruction Laryngeal oedema Pushing of the foreign body into the sub- glotic spaces, oesophagus or trachea. The object may be pushed completely into the bony portion of canal, lacerating the skin and perforating the tympanic membrane leading to loss of hearing and deafness. Secondary infections leading to septicaemia and bacteria. ( Hockenberry , 2004).

44. Complications ear; Bleeding Lacerations of the ear canal Tympanic membrane perforation Otitis externa and acute otitis media. Nose;

45. Nose ; Nasal septal perforation Mucosal damage Infection aspiration Meningitis Sinusitis Acute epiglottitis Respiratory arrest Acute otitis media Periorbital cellulitis Tetanus Bloody nose/bleeding

46. Eyes; If the foreign body is not removed from the eye it may cause scarring. Infection Corneal scratch and abrasions Decreased visual acuity Photophobia blepharospasm  

47. Health teaching Keep objects out of the ear Clean ears with only a clean wash cloth and finger. Avoid use of body pins and cottons tipped applicators to pock the ear. Ensure that children are monitored as they play with toys. Ensure to keep small parts of toys e.g lego out of reach of children.

48. summary A foreign body is something that is stuck inside you but it is not supposed to be there, it can be inhaled , swallowed or inserted. Foreign bodies may cause one to have an injury or trauma of the part affected. Foreign bodies are more common in small children, who sometimes stick things in their mouths, ears and noses when they are playing.