Nurs 629 Exam 3 (Maryville) Questions With 100% Correct Answers

Nurs 629 Exam 3 (Maryville) Questions With 100% Correct Answers Otitis media pathogens - answerCaused by: S. Pneumoniae (most common); H. Influenzae, M. Catarrhils Otitis media Symptoms: - answerFever, Pain, discharge from ear, tugging at ear, irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI Objective findings in otitis media - answerRed, bulging OM; Retracted with pus; no movement of TM, Inability to see landmarks; occasional hole in TM Treatment for AOM + Conjunctivitis d/t : H. Influenzae - answerAmoxicillin-clavulanate 80- 90 mg/kg/day BID x 10 days Treatment for AOM d/t S. Pneumoniae (most common): - answerAmoxicillin 80-90 mg/kg/day BID x 10 days (high dose) Treatment for AOM with PCN Allergy: Non-Type 1: - answerCefdinir, Cefuroxime Treatment for AOM with PCN Allergy: Type 1: - answerAzithromycin, clarithromycin OR Ceftriaxone 1-3 days Predisposing factors of otitis externa: - answerFrequent moisture, local trauma, aggressive cleaning, Allergies/skin conditions Causative organisms for otitis externa: - answerPsuedomonas aeruginosa (20-60%); Staphylococcus Aureus (10-70%); 10% fungal infection Symptoms of otitis externa: - answerDischarge from ear, recent history of swimming or placing something in the ear, low-grade fever, pain with movement of tragus, decreased hearing, redness around ear Objective findings of otitis externa: - answerOtalgia ( inner or outer ear pain), discharge, fullness, itching, pain with movement of tragus, redness around ear, decreased hearing. Treatment of pain and therapeutic management of otitis externa: - answerWarm compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick ) When to wick with otitis externa: - answerIf lumen is reduced to >50%, wicks can help ensure delivery of topical abx to medial canal. Treatment of otitis externa: - answerTopical fluroquinolones (Ciprofloxacin, Ofloxacin), ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid) Hallmark sign of otitis externa: - answerTraction of pinna elicits pain When do we begin hearing tests in clinic for children - answer4 years old What is a normal audiology test result and how are results read - answerNormal -10 to +15 The higher the number, the greater the loss, Severe loss 71-90 (learning disability, limited vocabulary), Profound loss 90 Risk factors related to elevated cholesterol - answerObesity, Diabetes, Hypertension, Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes Clinical findings for tetralogy of Fallot: - answerCyanosis: caused by blood low in oxygen, Shortness of breath and rapid breathing, especially during feeding or exercise, Loss of consciousness, Clubbing of fingers and toes, Poor weight gain, delayed growth, Polycythemia, metabolic acidosis, Systolic murmur at 2nd left ICS & holosystolic murmur at LLSB What criteria would you have to consider inpatient admission in a patient with pneumonia - answerInfants less than 4 months old, Infant with poor feeding, grunting, O2 saturation <92%, respiratory rate >70 , Older child with grunting, inability to tolerate oral intake, oxygen saturation ≤ 92 percent, respiratory rate > 50 breaths per minute, Any age: Comorbidities (e.g., chronic lung disease, asthma, unrepaired or incompletely repaired congenital heart disease, diabetes mellitus, neuromuscular disease) Visual acuity of a 2-month-old - answer• Vision is 20/400 • Fix and follow objects Viral conjunctivitis etiology (causative agent): - answerAdenovirus is the most common cause. Other causes: HSV, herpes zoster, and varicella Viral conjunctivitis symptoms: - answero Watery discharge (profuse and clear), foreign body sensation, redness o URI symptoms are common including sore throat and fever o Itchy conjunctiva and swollen eye lids o Often bilateral Viral conjunctivitis Clinical findings - answero Normal visual acuity, PERRLA, EOMI, Fundus normal o Mucoid-profuse watery discharge o Mild, diffuse injection and itching o *Preauricular lymphadenopathy Viral conjunctivitis Treatment: - answerSymptomatic Only - Warm or cool compresses, Strict hand hygiene Pharyngitis - answerTypically viral Causative organism for bacterial pharyngitis - answerGroup A Beta Hemolytic strep Subjective findings for strep pharyngitis: - answerRapid onset of sore throat, abdominal pain, headache, dysphasiay Objective findings for strep pharyngitis: - answerFever >103, Swollen glands, anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry tongue, anterior cervical lymphadenopathy Treatment for strep pharyngitis - answerAmoxicillin 5mg/kg/day x10 days If allergy to first line tx for strep pharyngitis, what do you prescribe? - answerCephalosporin or macrolide (azithromycin) Therapeutic tx for strep pharyngitis (in addition to abx) - answerWarm water gargle/apap/ibu Education re strep pharyngitis: - answerDiscard toothbrush after 24hs on an abx and after treatment completion When may pt return to school with strep pharyngitis: - answerThis is contagious. May return to school after 24 hours on abx Scarlet fever: - answerOccurs secondary to strep throat and progresses to acute rheumatic fever if no intervention Is scarlet fever common or rare? - answerRare Subjective/Objective findings of scarlet fever: - answerScarlatina begins on face and spreads down and out/strawberry tongue/Fever/pharyngitis Treatment of scarlet fever: - answeramoxicillin 50-80 mg/kg/day x7 days Classic triad of mononucleosis Pharyngitis: - answerFever, equative pharyngitis POSTERIOR cervical lymphadenopathy Subjective sx of mononucleosis: - answermalaise, fatigue, headache, anorexia, Objective s/sx of mononucleosis: - answerAbnormal LFTs, splenic enlargement, CBC c diff- lymphocytosis c atypical cells, monospot positive, EBV virus specifics - VCA-IgM, VCA AgG, EA, EBNA, negative rapid strep c culture Treatment for mononucleosis: - answerSymptomatic unless severe Treatment for mononucleosis with strep - answerMacrolide to avoid pcn rash (azithromycin, erythromycin, clarithromycin) Education for mononucleosis: - answerF/u in 1-2 weeks, Avoid contact sports until 1 month after symptoms subside - concern for rupture