NURS 640 EXAM 1 LATEST
Acute conjunctivitis - ANSWERS-viral and bacterial
-Red, irritated eye with minimal pain. Visual acuity only slightly
reduced.
-Most common viral etiology is adenovirus. Causes watery discharge,
mild foreign body sensation, and photophobia
-bacterial infection produces more mucopurulent exudate
-mild cases treated empirically with broad spectrum topical ocular abx:
sulfacetamide 10%, polymyxin-bacitracin, trimethoprim-polymyxin
combo
External otitis - ANSWERS-Refers to a collection of diseases involving
auditory meatus
-Usually results from a combination of heat and retained moisture with
desquamation and maceration of the epithelium of the outer ear canal.
-Several forms:
localized ("furunculosis"): can develop in outer third of the ear canal.
Treatment is usually oral antistaphylococcal penicillin (dicloxacillin or
cephalexin)
diffuse ("swimmers ear"): heat, humidity, and loss of protective cerumen
lead to excessive moisture and elevation of pH in the ear canal which in
turn leads to skin maceration and irritation. Predominant pathogen is P.
aergunosa. Starts with progressive itching and then can lead to severe
pain which is elicited by movement of pinna and tragus. Onset of pain is
END OF
PAGE
1
, NURS 640 EXAM 1 LATEST
accompanied by development of erythematous, swollen ear canal, often
with scant white, clumpy discharge. Treatment consists of cleaning canal
to remove debris, hypertonic saline or mixtures of alcohol and acetic
acid. Glucocorticoids can be added to decrease inflammation. Most otic
treatments usually combine neomycin and polymyxin.
External otitis - ANSWERS-Chronic: caused primarily by repeated local
irritation, most commonly arising from persistent drainage from a
chronic middle-ear infection. Presents as erythematous, scaling
dermatitis in which predominant symptom is pruritis rather than pain.
Treatment consists of identifying and treating or removing the offending
process, although successful resolution is often difficult.
Invasive ("malignant" or "necrotizing"): aggressive and potentially life
threatening disease that occurs mostly in elderly diabetic patients and
other immunocompromised persons. It begins in the external canal as a
soft tissue infection that progresses slowly over weeks to months and
often difficult to distinguish from a severe case of chronic otitis externa
because of the presence of purulent otorrhea and an erythematous
swollen ear and external canal. Severe, deep seated otalgia is frequently
out of proportion to findings on exam. Characteristic finding is
granulation tissue in the posteroinferior wall of external canal, near the
junction of bone and cartilage. If left untreated it can migrate to the base
of the skull and onward to the meninges and brain. Should biopsy and
send for culture! IV antibiotic should be given for 6-8 weeks and
directed toward culture. For P. aeruginosa: antipseudomonal penicillin
or cephalosporin, often with aminoglycoside/fluoroquinolone.
END OF
PAGE
2
, NURS 640 EXAM 1 LATEST
Acute otitis media - ANSWERS-Results when pathogens from the
nasopharynx are introduced into the inflammatory fluid collected in the
middle ear. The diagnosis of acute otitis media requires the
demonstration of fluid in the middle ear (with tympanic membrane
immobility) and the accompanying signs/symptoms of local or systemic
illness. Treatment is generally empiric. Amoxicillin is typically first
choice drug. Therapy in uncomplicated acute otitis media is typically
administered for 5-7 days to patients older than 6 years old. Longer
therapy should be reserved for patients with severe disease. A switch in
regimen is recommended if there is no clinical improvement by the third
day. Decongestants and antihistamines are frequently used as adjunctive
agents to reduce congestion and relieve obstruction of the eustachian
tube.
Epistaxis - ANSWERS--Common in children and in dry climates.
Bleeding in the nasopharynx. Clues that epistaxis is a symptom of an
underlying bleeding disorder include lack of bleeding variation and
bleeding that requires medical evaluation or treatment including
cauterization.
Oral or throat candidiasis
-Most often C. albicans. Thrush occurs predominantly in neonates.
Immunocompromised patients and recipients of prolonged antibiotics or
glucocorticoids also typically get it. In addition to sore throat, patients
often report a burning tongue, and physical examination reveals friable
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PAGE
3
, NURS 640 EXAM 1 LATEST
white or gray plaques on the gingiva, tongue, and oral mucosa.
Treatment usually consists of an oral antifungal suspension (nystatin or
clotrimazole) or oral fluconazole. For the rare fluconazole-refractory
thrush in HIV/AIDS patients-itraconzaole or voriconazole as well as an
IV echinocandin or amphotericin B if needed.
Meningitis - ANSWERS-Patients present with fevers, nuchal rigidity,
and change in mental status
-Intracranial abscess - Headache is the most common symptom of
intracranial abscess. The headache tends not to be relieved by over-the-
counter pain medications. Patients may also have neck stiffness, change
in mental status (indicative of severe cerebral edema), and vomiting
(from increased intracranial pressure)..
STOP-Bang OSA - ANSWERS-questionnaire is an eight-item survey to
investigate OSA with information on:
snoring
Tiredness
observed apneas
blood pressure
BMI
END OF
PAGE
4
Acute conjunctivitis - ANSWERS-viral and bacterial
-Red, irritated eye with minimal pain. Visual acuity only slightly
reduced.
-Most common viral etiology is adenovirus. Causes watery discharge,
mild foreign body sensation, and photophobia
-bacterial infection produces more mucopurulent exudate
-mild cases treated empirically with broad spectrum topical ocular abx:
sulfacetamide 10%, polymyxin-bacitracin, trimethoprim-polymyxin
combo
External otitis - ANSWERS-Refers to a collection of diseases involving
auditory meatus
-Usually results from a combination of heat and retained moisture with
desquamation and maceration of the epithelium of the outer ear canal.
-Several forms:
localized ("furunculosis"): can develop in outer third of the ear canal.
Treatment is usually oral antistaphylococcal penicillin (dicloxacillin or
cephalexin)
diffuse ("swimmers ear"): heat, humidity, and loss of protective cerumen
lead to excessive moisture and elevation of pH in the ear canal which in
turn leads to skin maceration and irritation. Predominant pathogen is P.
aergunosa. Starts with progressive itching and then can lead to severe
pain which is elicited by movement of pinna and tragus. Onset of pain is
END OF
PAGE
1
, NURS 640 EXAM 1 LATEST
accompanied by development of erythematous, swollen ear canal, often
with scant white, clumpy discharge. Treatment consists of cleaning canal
to remove debris, hypertonic saline or mixtures of alcohol and acetic
acid. Glucocorticoids can be added to decrease inflammation. Most otic
treatments usually combine neomycin and polymyxin.
External otitis - ANSWERS-Chronic: caused primarily by repeated local
irritation, most commonly arising from persistent drainage from a
chronic middle-ear infection. Presents as erythematous, scaling
dermatitis in which predominant symptom is pruritis rather than pain.
Treatment consists of identifying and treating or removing the offending
process, although successful resolution is often difficult.
Invasive ("malignant" or "necrotizing"): aggressive and potentially life
threatening disease that occurs mostly in elderly diabetic patients and
other immunocompromised persons. It begins in the external canal as a
soft tissue infection that progresses slowly over weeks to months and
often difficult to distinguish from a severe case of chronic otitis externa
because of the presence of purulent otorrhea and an erythematous
swollen ear and external canal. Severe, deep seated otalgia is frequently
out of proportion to findings on exam. Characteristic finding is
granulation tissue in the posteroinferior wall of external canal, near the
junction of bone and cartilage. If left untreated it can migrate to the base
of the skull and onward to the meninges and brain. Should biopsy and
send for culture! IV antibiotic should be given for 6-8 weeks and
directed toward culture. For P. aeruginosa: antipseudomonal penicillin
or cephalosporin, often with aminoglycoside/fluoroquinolone.
END OF
PAGE
2
, NURS 640 EXAM 1 LATEST
Acute otitis media - ANSWERS-Results when pathogens from the
nasopharynx are introduced into the inflammatory fluid collected in the
middle ear. The diagnosis of acute otitis media requires the
demonstration of fluid in the middle ear (with tympanic membrane
immobility) and the accompanying signs/symptoms of local or systemic
illness. Treatment is generally empiric. Amoxicillin is typically first
choice drug. Therapy in uncomplicated acute otitis media is typically
administered for 5-7 days to patients older than 6 years old. Longer
therapy should be reserved for patients with severe disease. A switch in
regimen is recommended if there is no clinical improvement by the third
day. Decongestants and antihistamines are frequently used as adjunctive
agents to reduce congestion and relieve obstruction of the eustachian
tube.
Epistaxis - ANSWERS--Common in children and in dry climates.
Bleeding in the nasopharynx. Clues that epistaxis is a symptom of an
underlying bleeding disorder include lack of bleeding variation and
bleeding that requires medical evaluation or treatment including
cauterization.
Oral or throat candidiasis
-Most often C. albicans. Thrush occurs predominantly in neonates.
Immunocompromised patients and recipients of prolonged antibiotics or
glucocorticoids also typically get it. In addition to sore throat, patients
often report a burning tongue, and physical examination reveals friable
END OF
PAGE
3
, NURS 640 EXAM 1 LATEST
white or gray plaques on the gingiva, tongue, and oral mucosa.
Treatment usually consists of an oral antifungal suspension (nystatin or
clotrimazole) or oral fluconazole. For the rare fluconazole-refractory
thrush in HIV/AIDS patients-itraconzaole or voriconazole as well as an
IV echinocandin or amphotericin B if needed.
Meningitis - ANSWERS-Patients present with fevers, nuchal rigidity,
and change in mental status
-Intracranial abscess - Headache is the most common symptom of
intracranial abscess. The headache tends not to be relieved by over-the-
counter pain medications. Patients may also have neck stiffness, change
in mental status (indicative of severe cerebral edema), and vomiting
(from increased intracranial pressure)..
STOP-Bang OSA - ANSWERS-questionnaire is an eight-item survey to
investigate OSA with information on:
snoring
Tiredness
observed apneas
blood pressure
BMI
END OF
PAGE
4
