response .
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnoses with rationales.
An 8-month-old male patient was brought in by his parents who are concerned the child may be “crossed-eyed”. States the left eye is not focused and at times the mother noticed the right eye is also not focused. The physician informed the parents squinting is normal in babies, Due to the child-wide nose bridge area, it looks like he is squinting/crossed-eyed. The physician states it is known as pseudostrabismus. Both eyes were covered one at a time, to assess whether the other eye would focus which it did. The physician, however, reassured the parents and gave them a referral to an ophthalmologist to ease their concerns.
Differential Diagnoses
Epicanthal Folds- Epicanthal folds are skin folds that cover the inner corners of the eyes and can give the appearance of crossed or misaligned eyes, particularly in infants and young children. These folds can obscure the true alignment of the eyes, leading to a false appearance of strabismus or pseudostrabismus (Shin et al., 2017).
Broad Nasal Bridge- A broad nasal bridge can create the illusion of crossed or misaligned eyes, especially when viewed from certain angles. The width of the nasal bridge can cause the eyes to appear closer together or offset, leading to an apparent deviation in eye alignment. This can mimic the appearance of strabismus or pseudostrabismus (Gupta et al., 2020).
Physiological Esotropia- Physiologic esotropia, also known as infantile esotropia, is a type of inward deviation of the eyes that can mimic pseudostrabismus in young children. However, unlike pseudostrabismus, physiologic esotropia represents a true misalignment of the eyes due to underlying neurological or muscular factors rather than external facial features. It typically presents within the first few months of life and requires prompt evaluation and management by an ophthalmologist to prevent amblyopia (lazy eye) and ensure proper visual development (Kaur, 2023).
Mention the health promotion intervention for this patient.
The goal of health promotion interventions for pseudostrabismus is to reassure parents and other caregivers about their child’s eye alignment while also educating them about the issue. This includes providing details on how pseudostrabismus typically appears in newborns and early children, stressing that it is frequently a benign condition brought on by facial traits rather than a real misalignment of the eyes. If parents have concerns about their child’s vision or eye health, they should be urged to watch their child’s eye movements and behavior and get an evaluation from a physician or ophthalmologist. Furthermore, encouraging routine pediatric eye exams can help guarantee early identification and suitable treatment of any real strabismus or other eye problems that could need intervention to prevent visual damage (Mooss et al., 2022). This is especially important throughout infancy and early childhood. All things considered, health promotion initiatives should concentrate on increasing awareness, disseminating correct information, and making it easier for kids who may be suffering from pseudostrabismus to get prompt access to eye care services.
What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?
I learned that as a nurse practitioner, providing reassurance to the parents is essential. At times giving them a referral to ease their concern, although you may not think there’s a problem with the child is better than convincing them otherwise.
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