NUR 676 Final EXAM WITH ANSWERS
|\ |\ |\ |\ |\
otitis externa |\
is cellulitis of the external canal that may extend to the auricle
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(swimmer's ear). p391 |\ |\
otitis externa risks factors
|\ |\ |\
comprise the integrity of the inherent defense mechanism
|\ |\ |\ |\ |\ |\ |\ |\
against infection, including; removal of protective cerumen w
|\ |\ |\ |\ |\ |\ |\ |\
damage to fragile skin from vigorous cleaning, accumulation of
|\ |\ |\ |\ |\ |\ |\ |\ |\
moisture from swimming, and alterations to the tissues that
|\ |\ |\ |\ |\ |\ |\ |\ |\
result from wearing devices such as headphones or earplugs.
|\ |\ |\ |\ |\ |\ |\ |\ |\
p391
Otitis Externa Expected findings
|\ |\ |\
pain of the affected ear and auricle developing over the course of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
48 hours or less, feeling of fullness or itching. S&S that may be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
present drainage and hearing loss. Chronic Otitis externa-
|\ |\ |\ |\ |\ |\ |\ |\
pruritus
,Otitis Externa bacterial cause
|\ |\ |\
most common pseudonomas aeruginosa and staphyloccocus
|\ |\ |\ |\ |\ |\
aureus. Uncommon candida, and aspergillus organisms.
|\ |\ |\ |\ |\
otitis externa diagnostics
|\ |\
usually unnecessary, culture of canal if symptoms persist with
|\ |\ |\ |\ |\ |\ |\ |\ |\
antibiotic sensitivity if no improvement after 14 days of antibiotic
|\ |\ |\ |\ |\ |\ |\ |\ |\
therapy (C&S, and potassium hydroxide preparation of drainage).
|\ |\ |\ |\ |\ |\ |\ |\
otitis externa Oral antimicrobial therapy
|\ |\ |\ |\
Fluoroquinolone antibiotics- effective against s aureus and P. |\ |\ |\ |\ |\ |\ |\ |\
aeruginosa (ofloxacin, ciproflaxin). antibiotic-corticosteroids
|\ |\ |\ |\
(Cipro Hc) for infection and inflammation. Improvement should
|\ |\ |\ |\ |\ |\ |\ |\
occur within 48 to 72 hours, and resolution occurs usually at 7 to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
10 days. p392
|\ |\
Meniere's disease |\
chronic condition of the inner ear S&S recurrent vertigo and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
hearing loss. symptoms may or may not occur simultaneously
|\ |\ |\ |\ |\ |\ |\ |\ |\
dizziness describe as spinning vertigo, low frequency
|\ |\ |\ |\ |\ |\ |\
,sensorineural hearing loss, tinnitus, and feeling of fullness in the|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
affected ear p388 |\ |\
Meniere's disease pathophysiology |\ |\
excess fluid and pressure in the labyrinth of the inner ear that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
episodically distends the structure of the labyrinth and damages
|\ |\ |\ |\ |\ |\ |\ |\ |\
the vestibular system (Involved in balance) & cochlear cells
|\ |\ |\ |\ |\ |\ |\ |\ |\
(involve in hearing). Unknown etiology p388
|\ |\ |\ |\ |\
Meniere's disease clinical presentation |\ |\ |\
PCP should ask patient about history of recurrent symptoms.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Early-patients have intermittent attacks of vertigo that last from |\ |\ |\ |\ |\ |\ |\ |\ |\
minutes to hours often associated with nausea and vomiting.
|\ |\ |\ |\ |\ |\ |\ |\ |\
these symptoms usually are accompanied by ear pressure, low-
|\ |\ |\ |\ |\ |\ |\ |\
pitched tinnitus, fluctuating intensity, and unilateral hearing loss
|\ |\ |\ |\ |\ |\ |\
Meniere's disease diagnostics |\ |\
essential diagnostics- 2 episodes of spontaneous vertigo lasting
|\ |\ |\ |\ |\ |\ |\ |\
at least 20 minutes
|\ |\ |\
Audiogram- documented hearing loss |\ |\ |\
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
|\ |\ |\ |\ |\ |\ |\ |\
, Meniere's disease pharmacological management |\ |\ |\
should refer to otolaryngologist for testing and management.
|\ |\ |\ |\ |\ |\ |\
Goals of therapy-managing the episodes of vertigo and arresting
|\ |\ |\ |\ |\ |\ |\ |\ |\
the disease process drug therapy- short term oral steroid course,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
IM on affected ear may last longer.
|\ |\ |\ |\ |\ |\
symptom relief- Meclizine and antiemetics(least sedating),
|\ |\ |\ |\ |\ |\
Benzodiazepines prescribe for GABA agonist effect but not |\ |\ |\ |\ |\ |\ |\ |\
commonly used. Lorazepam has a quick onset may be |\ |\ |\ |\ |\ |\ |\ |\ |\
appropriate for infrequent use. |\ |\ |\
P.389
Oropharynx Pharyngitis |\
Streptococcus pyogenes. GAS can cause rheumatic fever. |\ |\ |\ |\ |\ |\ |\
Infection with GAS peaks in late winter. Group C is the most
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
common in college students. p438 |\ |\ |\ |\
Oropharynx Pharyngitis clinical presentation Allergies |\ |\ |\ |\
varies on the offending agent.
|\ |\ |\ |\
non-infectious- sore throat and dryness, if allergens are the cause |\ |\ |\ |\ |\ |\ |\ |\ |\
S&S rhinorrhea, postnasal drip, and watery eyes
|\ |\ |\ |\ |\ |\ |\
|\ |\ |\ |\ |\
otitis externa |\
is cellulitis of the external canal that may extend to the auricle
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(swimmer's ear). p391 |\ |\
otitis externa risks factors
|\ |\ |\
comprise the integrity of the inherent defense mechanism
|\ |\ |\ |\ |\ |\ |\ |\
against infection, including; removal of protective cerumen w
|\ |\ |\ |\ |\ |\ |\ |\
damage to fragile skin from vigorous cleaning, accumulation of
|\ |\ |\ |\ |\ |\ |\ |\ |\
moisture from swimming, and alterations to the tissues that
|\ |\ |\ |\ |\ |\ |\ |\ |\
result from wearing devices such as headphones or earplugs.
|\ |\ |\ |\ |\ |\ |\ |\ |\
p391
Otitis Externa Expected findings
|\ |\ |\
pain of the affected ear and auricle developing over the course of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
48 hours or less, feeling of fullness or itching. S&S that may be
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
present drainage and hearing loss. Chronic Otitis externa-
|\ |\ |\ |\ |\ |\ |\ |\
pruritus
,Otitis Externa bacterial cause
|\ |\ |\
most common pseudonomas aeruginosa and staphyloccocus
|\ |\ |\ |\ |\ |\
aureus. Uncommon candida, and aspergillus organisms.
|\ |\ |\ |\ |\
otitis externa diagnostics
|\ |\
usually unnecessary, culture of canal if symptoms persist with
|\ |\ |\ |\ |\ |\ |\ |\ |\
antibiotic sensitivity if no improvement after 14 days of antibiotic
|\ |\ |\ |\ |\ |\ |\ |\ |\
therapy (C&S, and potassium hydroxide preparation of drainage).
|\ |\ |\ |\ |\ |\ |\ |\
otitis externa Oral antimicrobial therapy
|\ |\ |\ |\
Fluoroquinolone antibiotics- effective against s aureus and P. |\ |\ |\ |\ |\ |\ |\ |\
aeruginosa (ofloxacin, ciproflaxin). antibiotic-corticosteroids
|\ |\ |\ |\
(Cipro Hc) for infection and inflammation. Improvement should
|\ |\ |\ |\ |\ |\ |\ |\
occur within 48 to 72 hours, and resolution occurs usually at 7 to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
10 days. p392
|\ |\
Meniere's disease |\
chronic condition of the inner ear S&S recurrent vertigo and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
hearing loss. symptoms may or may not occur simultaneously
|\ |\ |\ |\ |\ |\ |\ |\ |\
dizziness describe as spinning vertigo, low frequency
|\ |\ |\ |\ |\ |\ |\
,sensorineural hearing loss, tinnitus, and feeling of fullness in the|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
affected ear p388 |\ |\
Meniere's disease pathophysiology |\ |\
excess fluid and pressure in the labyrinth of the inner ear that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
episodically distends the structure of the labyrinth and damages
|\ |\ |\ |\ |\ |\ |\ |\ |\
the vestibular system (Involved in balance) & cochlear cells
|\ |\ |\ |\ |\ |\ |\ |\ |\
(involve in hearing). Unknown etiology p388
|\ |\ |\ |\ |\
Meniere's disease clinical presentation |\ |\ |\
PCP should ask patient about history of recurrent symptoms.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Early-patients have intermittent attacks of vertigo that last from |\ |\ |\ |\ |\ |\ |\ |\ |\
minutes to hours often associated with nausea and vomiting.
|\ |\ |\ |\ |\ |\ |\ |\ |\
these symptoms usually are accompanied by ear pressure, low-
|\ |\ |\ |\ |\ |\ |\ |\
pitched tinnitus, fluctuating intensity, and unilateral hearing loss
|\ |\ |\ |\ |\ |\ |\
Meniere's disease diagnostics |\ |\
essential diagnostics- 2 episodes of spontaneous vertigo lasting
|\ |\ |\ |\ |\ |\ |\ |\
at least 20 minutes
|\ |\ |\
Audiogram- documented hearing loss |\ |\ |\
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
|\ |\ |\ |\ |\ |\ |\ |\
, Meniere's disease pharmacological management |\ |\ |\
should refer to otolaryngologist for testing and management.
|\ |\ |\ |\ |\ |\ |\
Goals of therapy-managing the episodes of vertigo and arresting
|\ |\ |\ |\ |\ |\ |\ |\ |\
the disease process drug therapy- short term oral steroid course,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
IM on affected ear may last longer.
|\ |\ |\ |\ |\ |\
symptom relief- Meclizine and antiemetics(least sedating),
|\ |\ |\ |\ |\ |\
Benzodiazepines prescribe for GABA agonist effect but not |\ |\ |\ |\ |\ |\ |\ |\
commonly used. Lorazepam has a quick onset may be |\ |\ |\ |\ |\ |\ |\ |\ |\
appropriate for infrequent use. |\ |\ |\
P.389
Oropharynx Pharyngitis |\
Streptococcus pyogenes. GAS can cause rheumatic fever. |\ |\ |\ |\ |\ |\ |\
Infection with GAS peaks in late winter. Group C is the most
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
common in college students. p438 |\ |\ |\ |\
Oropharynx Pharyngitis clinical presentation Allergies |\ |\ |\ |\
varies on the offending agent.
|\ |\ |\ |\
non-infectious- sore throat and dryness, if allergens are the cause |\ |\ |\ |\ |\ |\ |\ |\ |\
S&S rhinorrhea, postnasal drip, and watery eyes
|\ |\ |\ |\ |\ |\ |\
