Download NURS 652 - Test 1 Study Guide: Diagnosis and Management of Common Eye and Ear Conditions and more Exams Nursing in PDF only on Docsity!
Gonzaga NURS 652 - Test 1 study
guide dxs Exam
SOAP note elements-Answer subjective (CC, HPI, PMH, Allergies, Current meds/immunizations, living situation, occupation, ROS) objective (VS, pertinent systems), assessment (most likely dx, diff dxs, rationale), plan (diagnostics, treatment, education, f/u, referrals, goals)
Gonococcal conjunctivitis neonatorum presentation-Answer Occurs w/in 3-5 days of life; acute conjunctival inflammation, lid edema, erythema, excessive purulent discharge
Chemical conjunctivitis neonatorum presentation - Answer nonpurulent discharge and edematous bulbar and and palpebral conjunctiva
Herpes Simplex conjunctivitis neonatorum presentation - Answer mild conjunctivitis, erythema, corneal opacity serosanguineous discharge, vesicular rash on eyelids, often unilateral
Gonococcal conjunctivitis neonatorum managment - Answer IM ceftriaxone x1 dose; If extra-occular manifestations, 7 day course of IM or IV ceftriaxone (don't give to kids w/ hyperbilirubinemia - alternative cefotaxime)
Management of Herpes Simplex conjunctivitis neonatorum refer to hospital; require topical and systemic antivirals; risk of spread of virus to CNS, mouth and skin
Management of Chemical conjunctivitis neonatorum Answer Self-limiting; resolves spontaneously within 3-4 days w/out txt
Allergic Conjunctivitis presentation-Answer Severe itching and tearing Acute attacks precipitated by allergens Redness and swelling of the conuunctiva or eyelid Follicular reaction of the conjunctiva Stringy/mucoid discharge Bilateral involvement most
common Cobblestone papillary hypertrophy in the tarsal conjunctiva Vision normal Family hx: atopy or seasonal allergies Personal hx: rhinitis, eczema, and/or asthma
Management of Allergic Conjunctivitis: avoid allergens, mild: saline solution/artificial tears & cool compress, refer to allergist when rhinitis is present, refer to ophthalmologist if unresponsive to txt or if the following is present: corneal abrasion, impaired vision, need for corticosteroids, severe keratoconjunctivitis, or atypical manifestations; (suspect herpes if pain is present);Medications:topical decongestant (naphazoline hydrochloride), oral or topical antihistamines, topical mast cell stabilizers, antihitamine-decongestant combos (naphazoline hydrochloride + antazoline ophthalmic solution), or topical NSAIDs topical mast cell stabilizers (for maintenance therapy, chronic allergies, or vernal conjuctivitis) (cromolyn sodium 4%, nedocromil sodium 2% or lodoxamide tromethamine 0.1%); topical olopatadine hydrochloride 0.1% (mast cell stabilizer + antihistamine for children older than 3); ophthalmic histamine 1 blockers (ketotifen or levocabastine) for allergic conjunctivitis and ocular pruritus
Bacterial conjunctivitis presentation - Answer erythema of one or both eyes, usually begins in one eye Yellow-green discharge Encrusted and matted eyelids Burning/stinging/itching of eyes Feeling of foreign body Photophobia Petechiae on bulbar conuunctiva S/s of URI, otitis media or acute pharyngitis Vision normal
bacterial conjunctivitis management - Answer Diagnostics: gram stain and culture if chronic, recurrent or difficult to txt Medications: (limit atbs in older children and adolescents) trimethoprim sulfate + polymyxin B sulfate ophthalmic solution for 5- days; Azithromyin gtts (children >12 mos) for 5 days; fluoroquinolone ophthalmic gtts (children >12 mos) for 5-7 days (avoid aminoglycosides)
Presentation of viral conjunctivitis-Answer tearing and profuse clear, watery discharge; fever, headache, anorexia, malaise, URI ssj; pharyngitis w/ enlarged preauricular nodes; itchy, red, and swollen conjunctiva; hyperemia and swollen eyelids; photophobia w/ measles or varicella rashes; herpatic vesicles on the eyelid margins and eyelashes or on the conjunctiva and cornea
Management of viral conjunctivitis Good hygiene; self-limiting in 7-14 days; warm or cold compress; artificial tears; (atbs not indicated); if HSV infection suspected - refer urgently to ophthalmologist (avoid topical corticosteroids as may exacerbate course); molluscum on eyelid margin requires referral for excision
Acute otitis media subjective presentation-Answer ear pain; irritability w/ infant or toddler; otorrhea fever; often premature, have craniofacial anomalies, or exposure to risk factors aka smoke; dizziness, lethargy, tinnitus and unsteady gait; inability to sleep/disrupted sleep; diarrhea and vomiting; suden hearing loss; stuffy nose, rhinorrhea, and sneezing; rare facial palsy and ataxia
Acute otitis media management-Answer Pain: ibuprofen or tylenol for pain, topical analgesics (benzocaine or antipyrine/bonzocain otic), distraction, oil application, or external use of heat or cold; ATB: amoxicillin 80-90mg/kg/day divided into two doses (1st choice), augmentin 80-90mg/kg/day divided into two doses if allergy to PCN; watchful waiting for 48-72 hours if child >/= 24 months w/out severe symptoms, young children w/out severe symptoms and fever <102.2, children not improving in 48-72 hours per physician improvement; refer to otolaryngology if txt has failed
TM perforation presentation-Answer often no symptoms, feel better after perf, evident on otoscopic exam, profuse otorrhea may be present from perf excluding view; tympanogram will be flat
TM perforation management- Avoid ototoxic gtts (those ending in -mycin). If due to AOM tx with otic drops as above; no swimming or other water exposure to ears in shampooing or cerumen irrigation; no instrumentation to the ear for at least 2 weeks. Most heal spontaneously. Refer if no improvement within 3 months.
Otitis externa subjective presentation-Answer itching and irritation; disproportionate pain to examination; pressure/fullness in ear, occasional hearing loss; rare otorrhea or systemic complaints and ss; sagging of posterior canal, periauricular edema, and preauricular and posauricular lymphadenopathy w/ more severe case
Otitis externa management Answer eardrops (ciprodex [>6mo], floxin otic [no steroid], or vasocidin ophthalmic) symptoms should improve in 7 days - refer to otolarynologist if no improvement wick helpful if canal very swollen no waterswimming f/u if child not improving at all w/in 72 hours to r/u other causes or blockages systemic atb only if severe systemic disease educate parent to give drops with child's ear facing up, fill EAC w/ drops until full, move pinna back and forth to get air out and make sure canal is full, lie on side for 5-7 minutes before moving
Congenital cholesteatoma presentaiton-Answer often negative may cause infection,
hearing loss, dizziness, and facial muscle paralysis if grown large enough/acquired include: chrnoicn OM w/ malogorous purulent otorrhea, vertigo and hearing loss, hx of pressure-equalizing tubes, pearly white lesion on or behind the TM
Congenital cholesteatoma management-Answer referral to otolaryngologist for surgical excision; examine siblings for same disorder
Mastoiditis presentation concurrent or recurrent AOM; fever and otalgia; resistant OM to atb therapy; post-auricular swelling (infants may have swelling above the ear, displacing the pinna inferiorly or laterally)
Mastoiditis management-urgent ENT referral; hospitalization, intravenous antibiotics, myringotomy and pressure equalizing tube placement (tympanocentesis w/ culture or gram stain help ID)
Otitis Externa objective presentation-Answer Pain with manipulation of tragus or pinna or with use of otoscope; edematous EAC with debris; visualization of tm difficult; otorrhea rarely present; regional lymphadenopathy occasionally present Raised red area of tragus may be deep and diffuse or superficial and pointing; red, crusty, or pustular spreading lesions; pruritus. w/ thick otorrhea, can be black, gray, blue-green, yellow, or white, and black spots over the TM - indicative of mycotic infection. Dry appearing canal w/ virtually no cerumen visible w/ chronic OE
Acute otitis media objective presentation - Answer bulging TM; decreased translucency of TM; absent or decreased mobility of the TM; air-fluid level behind the TM; otorrhea; ss of middle ear inflammation; may have increased bascularity w/ obscured or absent landmarks, red/yellow/or purple TM; thin-walled, sagging bullae filled w/ straw-colored fluid seen w/ bullous myringitis
Otitis Media with Effusion Objective Presentation-Answer decreased TM mobility, abnormal-apprearing TM (often described as dull), varying from bulging and opaque w/ no landmarks visible to retracted and translucent w/ visible landmarks and an airfluid level or bubble
Presentation of acute rhinosinusitis-Answer acute with high fever and purulent nasal
allergic rhinitis management Answer avoid allergen or irritant; avoid vaporizer; intranasal corticosteroids; non-sedating antihistamines for symptoms of rhinorrhea, sneezing, and nasal and eye pruritis- especially useful for seasonal AR (versus perennial or episodic) e.g. cetirizine; topical nasal antihistamine for seasonal AR (itching, sneezing, rhinorrhea, and congestion) e.g. azelastine (5 y.o and older); nasal cromolyn for perennial or seasonal AR, less effective than intranasal corticosteroids, frequent dosing required, 2 y.o. and older; intranasal corticosteroids for inflammation and nasal obstruction, congestions, rhinorrhea, itching, and sneezing: Before use, the nose should be cleaned. One of the most effective treatments to manage AR can be used long term. Benefits may take 4 weeks to be realized. Side effects include local burning, irritation, sneezing, or soreness, e.g flonase 50mcg/actuation (older than 4 y.o.) 1 spray/day, severe: 2 spray/day; leukotriene modifiers for seasonal and perennial AR, e.g. Montelukast 6 months to 5 years 4mg packet x1 daily morning or evening s/ AR, evening if asthma dx as well; treat secondary infections w/ atbs as appropriate; allergic immmunotherapy when symptoms unmanageable
Allergic rhinitis subjective presentation - Answer mouth breathing, snoring, nasal speech; itching of palate, pharynx, nose or eyes; sleep disturbances
Top 3 pathogens that cause bacterial pharyngitis - Answer GABHS, Group C and G streptococci
GABHS treatment - Answer If culture positive: PCN V 250mg BID or TID or children (>27kg) or adults 500mg BID or TID for 10 days.; Amoxicillin 50mg/kg daily (more palatable, equal efficacy); allergic to PCN: Pen Cephalexin (avoid if moderate hypersensitivity to PCN) or Clindamycin; antipyretics, fluid, rest, replace fomites (toothbrush, etc.) return to school when afebrile and on atbs for 24 hours
Bacterial pharyngitis objective presentation - Answer petechiae on soft palate and pharynx, swollen beefy-red uvula, red enlarged tonsils, yellow, blood-tinged tonsillopharyngeal exudate; enlarged, tender anterior cervical lymph nodes; bad breath; stigmata of scarlet fever-may see: scarlatinoiform rash, strawberry tongue, circumoral pallor
Bacterial pharyngitis subjective presentation-Answer Usually in 5-13 y.o., sudden onset w/o nasal symptoms, constitutional symptoms: arthralgia, myalgia, HA; moderate to high fever, malaise, prominent sore throat, dysphagia; N/V, abdominal discomfort; late winter or early spring, absence of cough or nasal symptoms
Viral pharyngitis subjective presentation-Answer pain, myalgia, atthralgia, fever, sore throat, dysphagia; the following: rhinitis, cough, hoarseness, stomatitis, stridor and conjunctivitis, nonspecific rash, or diarrhea point to viral
Viral pharyngitis objective presentation-Answer erythema of tonsils and pharynx, reactive cervical lymphadenopathy, EBV: exudate on tonsils, soft palate petechiae, and diffuse adenopathy; adenovirus: follicular pattern on the pharynx; Enterovirus: vesicles or ulcers on the tonsillar pillars and posterior fauces, coryza, vomiting, or diarrhea; Herpesvirus: ulcers anteriorly and marked adenopathy; parainfluenza and RSV: more lower respiratory tract disease; INfluenza: cough, fever, and multiple systemic complaints
Treatment of viral pharyngitis -Answer Throat culture to r/o GABHS, supportive care: fluids, acetaminophen or ibuprofen
Mono presentation-Answer 3 phases: Prodrome: mild symptoms such as malaise, fatigue, and possible fever; Acute: fever, sore throat, malaise, and fatigue; objective: discrete nontender, nonerythematous lymphadenopathy, tonsillopharyngitis; hepatomegaly or splenomegaly present in 50-60% of children, skin rash on trunk, arms, and palms in 3-15%l more common if taking amoxicillin or ampicillin; Resolution: symptoms begin to resolves, organomegaly may take 1-2 months to resolve
Mono treatment-Answer CBC to confirm > 10% atypical lymphocytes, elevated liver enzymes; monospot and serum heterophile test; viral culture and Epstein-Barr specific core and antibody testing if strongly suspected but other tests negative; adequate bed rest, OTC pain relievers, fluids, and increased calories; NO corticosteroids or acyclovir for routine cases; NO PCN; no sports or stenuous exercise for 4 wks; complete recovery for 95% of cases with no specific treatment
GERD subjective presentation-Answer overfeeding, choking gagging, coughing, arching, discomfort, or refusal during feeding; recurrent illnesses especially croup, pneumonia, asthma; vomiting that is frequent, painful, w/ blood or bile, associated w/ fever, lethary, or diarrhea; sources of stress; family medical hx: significant illnesses, GI disorders, atopy
Bronchiolitis subjective presentation-Answer begins as URI symptoms; gradual development of respiratory distress /w wheezing and raspy breathing; low-grade to moderate fever up to 102 ; decrease in appetite, no prodome in some infants apnea can be initial symptom ; worst by 48-72 hours after wheezing starts
Bronchiolitis objective presentation - Answer Upper: coryza, mild conjunctivitis, phyngitis, otitis media; Lower: tachypnea, substernal &/or intercostal retractions, exp wheezing, fine or coarse crackles, varying signs of respiratory distress, abdominal distention, palpable liver and spleen
Bronchiolitis treatment Answer hydration, antipyretics prn, supplemental oxygen if O2 < 90%; nasal suctioning, saline drops, educate on how to feed w/ resp distress; Admit if: < 2 months with s/s of resp distress or older child: apnea, prog stridor or stridor at rest, increasing RR (> 50 during sleep), restlessness, pallor, or cynosis, hypoxia (Po2 <60 or O2 <92), rising CO2, unable to tolerate PO intake, depressed sensorium, chronic cardio disease or immunodeficiency disease, parent unable to manage at home for any reason
croup subjective presentation-Answer URI symptoms, acute onset of hoarse/barking-like cough, mild to severe laryngeal obstruction, mild to severe inspiratory stridor with dyspnea, gradual onset of symptoms, symptoms worse at night, sore throat (sometimes) duration usually 3-5 days, fever wtihout reoccurences differentiates it from spasmodic croup
croup objective presentation-Answer slight dyspnea, tachypnea, and retractions; mild, brassy, or barking cough; stridor; temperature usually low grade but may be elevated to 104; epiglottis will appear normal; substernal and chest wall retraction in severe cases; prolonged inspiration, wheezing and rales may be heard
croup treatment - Answer humidified air (cold air best but steam can be helpful); nebulized epi; corticosteroids (dexamethasone PO); NO cough or cold medicines; bronchodilators may be helpful; oxygen (if O2 <92%)
viral pneumonia presentation - Answer cough, coryza, hoarseness, crackles, wheezing, stridor, occasional fever, normal or slight elevation of WBC, xray shows: transient lobar infiltrates
bacterial pneumonia presentation Answer URI, cough, dyspnea, tachypnea, rales, diminished breath sounds, grunting, retractions, toxic appearance, may progress to severe respiratory distress; acute onset of fever (>/=102.2), WBC often > 15000; xray: lobar consolidation
bacterial pneumonia treatment Answer 2-3 months: azithromycin 5 days; 3months or older: amoxicillin 90mg/kg/day divided into 2 doses/day; if CAP suspected azithromycin: 10mg/kg/day on day one then 5mg/kg/day for the next 4 days
viral pneumonia treatment -Answer supportive therapy
when to hospitalize a 1-3month old w/ pneumonia -Answer fever, poor oral intake w/ signs of dehydration, pulmonary complications noted on radiographs (abscess, empyema, pneumatocele); any reason the parents are unable to care for the child at home
When to admit a child >3 months w/ pneumonia hypoxemia w/ O2 <90%, tachypnea > (2-11 months old) or >40 (1-5yrs old); grunting, dyspnea, or apnea; poor feeding w/ tachycardia and signs of dehydrations; Severe respirator distress, toxic appearance, failure to respond appropriate oral antibiotics; Any reason the parents are unable to care for the child at home
RS V has the same treatment and presentation as? -Answer Bronchiolitis
Risk factors for RSV-Answer major chronic pulmonary diseases; neuromuscular disorders; bronchopulmonary dysplasia; < preterm birth before 35 wks; congenital heart defects; male gender;crowded houshold, lack of breastfeeding; smoke exposure; day care attendance, having siblings, birth durin ghre winter months, and immunodeficienty.
H. influenza presentation - Answer sudden onset of high fever (102-106); HA; chills, coryza, vertigo, sore throat, pain in the back and extremities; dry hacking cough (can resemble pertussis) vomiting, diarrhea, and croup can occur in young children as well as conjunctival infection an depistaxis; infants can appear septic; in severe causes
base
Severe asthma objective presentation - Answer use of accessory muscles plus lower rib and substernal retractions; nasal flaring; inspiratory and expiratory wheezing or no wheezing heard w/ poor air exchange; suprasternal retractions w/ abdominal breathing, decreased breath sounds throughout base
impending respiratory arrest s/s - Answer diminished breath sounds over entire lung field; tiring, inability to maintain respirations; severely prolonged expiration if breath sounds are heard; drowsy, confused
Asthma treatment in children 0-4 years: Step 1/Intermittent: SABA prn; Step 2: low dose ICS; Step 3: medium-dose ICS; Step 4: medium dose ICS + LABA or montelukast; Step 5: High dose ICS + LABA or montelukast; Step 6: High dose ICS + LABA or montelukast + oral corticosteroids ICS
Asthma treatment for children 5-11 - Answer Step 1/Intermittent: SABA prn; Step 2: Low-dose ICS; Step 3: Low-dose ICS + LABA, LTRA, or theophylline or Medium dose ICS; Step 4: Medium dose ICS + LABA; Step 5: High dose ICS + LABA; Step 6: High dose ICS + LABA + oral corticosteroids
Asthma treatment for children 12+ - Answer Step 1/Intermittent: SABA prn; Step 2: Low-dose ICS; Step 3: Low-dose ICS + LABA or Medium dose ICS; Step 4: Medium dose ICS + LABA; Step 5: High dose ICS + LABA; Step 6: High dose ICS + LABA + oral corticosteroids and consider omalizumab for pts with allergies
most commonly used SABA - Answer albuterol inhaler
most commonly used ICS inhaled corticosteroid - Answer beclomethasone QVAR, budesonide pulmicort
most commonly used LABA long acting beta agonists - Answer salmetrol serevant diskus, fluticasone flovent
most commonly used LTRA leukotreine receptor antagonists - Answer montelukast, singulair
most commonly used oral corticosteroids - Answer prednisone, prednisolone
asthma severity chart symptoms, nighttime awakenings, SABA use, activity limits - Answer
PEF-peak expiratory flow-the maximum forced expiratory flow measured with a peak flow meter; may be in green zone (80-100% of personal best), yellow zone (50-79% of personal best signals caution), or red zone (between 0-50% of personal best signals major airflow obstruction); PEF normals vary depending on weight and height
Exercise-induced asthma: usually answers within 3-15 minutes of exercise, resolves by 60 minutes; s/s SOB, cough, chest tightness, and hoarseness or stridor is uncommon - warning for paradoxical vocal fold motion
exercise induced asthma management - Answer Do NOT avoid asthma; measure PEF before and after exercise, improve cardiovascular fitness can help; warmer and more humid air helps; Rx: prevention by taking asthma meds; use: beta-2 agonists &/or cromolyn sodium before exercise (or SABA w/ well controlled asthmatic who are only symptomatic during exercise); SABA for quick relief of symptoms; if exercise multiple times a day use inhaled glucocorticoid or LTRA instead (SABAs cause tachyphylaxis if used too much)
