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

1. PAEDIATRICS IN NURSING
Presentation by
Ms Chibwe Gift.

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

3.  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.  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.  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.  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.  Beads
 Small parts from toys
 Food , fish bone.
 Rubbers
 Wood
 Marbol
 Insects like cockcroach, spider,bedbugs, fruit fly, ants and lice.

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

9.  The ear

11.  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.

14. FOREIGN BODIES IN THE NOSE

15.  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.

17.  Buttons
 Beads
 Wood
 Cotton
 Paper
 Cloth toy parts
 Pebbles
 Candle wax.

18.  Fish bones
 Metal pins
 Small batteries
 Seeds
 Balloons
 Pieces of deformable plastics(permanent distortion subjected to
tonsile becomes comprssive.
 Food boluses

19.  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.

20.  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.

21.  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

22.  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

23.  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

24.  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:

25.  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.

26.  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.


27.  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

28.  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.

29.  X-ray
 Endoscope
 Audiography

31.  Obtain thorough history on what happened
 Ask what time this happened

32.  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

33.  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).

34.  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

35.  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.

36.  Inspection
 Palpation
 Observation

37.  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.

38.  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

39.  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

40.  Signs of respiratory distress
 Dyspnoea
 Tachycardia
 Inspiratory stridor
 Restless

41.  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.

42.  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.

43.  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.

44.  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.

45.  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).

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

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

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

49.  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.

50. 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.