NR-569 Differential Diagnosis in
Acute Care Practicum
Final Exam (Latest Update)
Question:
ROS: EAR
Have you noticed any drainage or blood coming from the ear?
Answer:
Purulent drainage is a commonly reported finding with AOE and
cholesteatoma but may not be present.
Drainage is not associated with AOM and OME unless the TM has ruptured.
Question:
Otitis media with effusion (OME)
Answer:
Otitis media with effusion (OME) is fluid in the middle ear, without the
presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM infection. Mild pain,
conductive hearing loss may be present.
Air bubbles are seen behind the TM.
,Question:
Ear pain/infection: Management
Answer:
ear pain may be treated with OTC analgesics
avoid scratching, tugging, or inserting anything in the ear, including cotton-
tipped swabs
reinforce water precautions with TM ruptured
avoid getting water in the ear during bathing/shower
avoid submerging ear under water
Question:
Acute Mastoiditis
Answer:
*Bacterial infection of the mastoid process*
presents clinically with the same signs and symptoms as acute otitis medial
with the addition of *inflammation and palpatory tenderness over the
mastoid*,
hearing loss is commonly associated with it,
tympanic membrane is red, bulging, and immobile bc associated otitis
media,
should be suspected when discharge from middle ear is continuous for >10
days
,Question:
TMJ Dysfunction
Answer:
referred ear pain
acute: pain with opening mouth extremely wide
chronic: malocclusion (from enlarged masseter muscles)/arthritis of TMJ
clicking
palpable crepitus
Question:
impacted cerumen
Answer:
rarely bilateral
recurrent problem
normal otologic findings
Question:
Some clients who present with throat pain may be at risk for airway
compromise. The following signs/symptoms indicate the need for immediate
intervention?
Answer:
respiratory distress
drooling
, upper airway obstruction
stridor
Question:
Mono treatment
Answer:
Serum diagnostics:
Lymphocytosis
Possible thrombocytopenia,
mild relative and absolute neutropenia
Elevated aminotransferases.
Consider rapid strep test as symptoms mirror Group A Beta Hemolytic
Streptococcus
Monospot test will not become positive until symptoms present about 10
days.
Heterophile antibody tests or EBV specific antibodies.
There is no specific antiviral therapy used to treat the disease.
Confirmatory testing is utilized to acknowledge disease and explain
symptoms.
Risks of splenic rupture are concerning.
Educate patient and family on when to seek healthcare.
Avoid contact sports.
If EBV testing is negative, further evaluation is warranted to rule out HIV,
cytomegalovirus, and toxoplasmosis.
Acute Care Practicum
Final Exam (Latest Update)
Question:
ROS: EAR
Have you noticed any drainage or blood coming from the ear?
Answer:
Purulent drainage is a commonly reported finding with AOE and
cholesteatoma but may not be present.
Drainage is not associated with AOM and OME unless the TM has ruptured.
Question:
Otitis media with effusion (OME)
Answer:
Otitis media with effusion (OME) is fluid in the middle ear, without the
presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM infection. Mild pain,
conductive hearing loss may be present.
Air bubbles are seen behind the TM.
,Question:
Ear pain/infection: Management
Answer:
ear pain may be treated with OTC analgesics
avoid scratching, tugging, or inserting anything in the ear, including cotton-
tipped swabs
reinforce water precautions with TM ruptured
avoid getting water in the ear during bathing/shower
avoid submerging ear under water
Question:
Acute Mastoiditis
Answer:
*Bacterial infection of the mastoid process*
presents clinically with the same signs and symptoms as acute otitis medial
with the addition of *inflammation and palpatory tenderness over the
mastoid*,
hearing loss is commonly associated with it,
tympanic membrane is red, bulging, and immobile bc associated otitis
media,
should be suspected when discharge from middle ear is continuous for >10
days
,Question:
TMJ Dysfunction
Answer:
referred ear pain
acute: pain with opening mouth extremely wide
chronic: malocclusion (from enlarged masseter muscles)/arthritis of TMJ
clicking
palpable crepitus
Question:
impacted cerumen
Answer:
rarely bilateral
recurrent problem
normal otologic findings
Question:
Some clients who present with throat pain may be at risk for airway
compromise. The following signs/symptoms indicate the need for immediate
intervention?
Answer:
respiratory distress
drooling
, upper airway obstruction
stridor
Question:
Mono treatment
Answer:
Serum diagnostics:
Lymphocytosis
Possible thrombocytopenia,
mild relative and absolute neutropenia
Elevated aminotransferases.
Consider rapid strep test as symptoms mirror Group A Beta Hemolytic
Streptococcus
Monospot test will not become positive until symptoms present about 10
days.
Heterophile antibody tests or EBV specific antibodies.
There is no specific antiviral therapy used to treat the disease.
Confirmatory testing is utilized to acknowledge disease and explain
symptoms.
Risks of splenic rupture are concerning.
Educate patient and family on when to seek healthcare.
Avoid contact sports.
If EBV testing is negative, further evaluation is warranted to rule out HIV,
cytomegalovirus, and toxoplasmosis.
