NUR602_MIDTERM_study_guide 2020

MIDTERM STUDY GUIDE: PART-1 TOPICS Covered o Chalazions o Blepharitis o Conjunctivitis o Hand-foot-mouth syndrome o Strep pharyngitis o Kawasaki disease o Rheumatic fever o Milia o Port-wine stain/Nevus flammeus o Salmon patch o Café-au lait spot o Impetigo o Molluscum Contagiosum o Verruca Vulgaris o Herpetic Whitlow o Hemanginoma o Otitis media o Otitis Externa CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid Causes – blockage of the meibomian cyst Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that reside in lash follicles Assessment – PAINLESS, NOT INVOLVING LASHES Lid edema, or palpable mass Red or grey mass on the inner aspect of lid margin Prevention – good eye hygiene Treatment – warm, moist compresses 3x per day Antibiotics not indicated because chalazion is granulomatous condition, if secondarily infected consider SULFACETAMIDE, ERYTHROMYCIN Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist BLEPHARITIS – Inflamation/infection of the lid margins (chronic problem) 2 types – seborrheic (non ulcerative) : irritants (smoke, make up, chemicals) s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of eyelashes, seborrhea dermatitis of eyebrows and scalp Ulcerative- infection with staphylococcus or streptococcus s&s – itching, tearing, recurrent styes, chalazia, photophobia, small ulceration at eyelid margin, broken or absent eyelashes ● the most frequent complaint is ongoing eye irritation and conjunctiva redness Treatment – clean with baby shampoo 2-4 times a day, warm compresses, lid massage (right after warm compress) For infected eyelids – antistaphyloccocal antibiotics BACITRACIN, ERYTHROMYCIN 0.05% for 1 week AND QUIONOLONE OINTMENTS For infection resistant to topical – TETRACYCLINE 250 MG PO X4 DOXYCYCLINE 100 MG PO X2 CONJUCTIVITIS – inflammation or irritation of conjuctiva Bacterial (PINK EYE) – in peds bacteria is the mosts common cause, contact lens, rubbing eyes, trauma, S&S – purulent exudate, initially unilateral, then bilateral Sensation of having foreign body in the eye is common Key findings – redness, yellow green, puru,ent discharge, crust and matted eyelids in am Self limiting 5-7 days. Eye drops – polytrim, erythromycin, tobramycin or cipro Improvement 2-4 days Most common organism H. influenza <7 Viral – adenovirus, coxsackie virus, herpes, molluscum S&S – profuse tearing, mucous discharge, burning, concurrent URI, enlarged or tender preauricular nose Antihistamines/decongestant Improvement, self limiting, 7-14 days Chlamydial – chlamydia trachomatis S&S – profuse exudate, associated with genitourinary symptoms, 1-2 weeks after birth Gonococcal – 2-4 days after birth, most concern can cause blidness PO azithromycin, doxycycline (tetracyclines increase photosensitivity, don’t use in pregnancy) Improvement 2-3 weeks Allergic – IgE mast cell reaction, environmental, cosmetics S&S – marked conjuctival edema, severe itching, tearing, sneezing Topical antihistamine or topical steroids Improvement 2-3 days Chemical –thimerosal, erythromycin, silver nitrate S&S conjuctival erythema, 30 minutes afer prophylactic antibiotics drops Avoid contact Can consider steroids Conjunctivitis never accompany vision changes Diagnostic studies: swap and scraping must be done, gram and Giemsa staining, ELISA, PCR testing, newborn < 2 weeks needs to be tested for gonorrhea Non –pharm – clean towels, change pillows, warm compress, no contacts, no eye make up – mascara Gonococcal conjunctivitis: newborn – give Ceftriaaxone IM once (don’t give if hyperbilirubinemia, Non-gonococcal – erythromycin 0.5% ointment Consider fluorescein staining if abrasion suspected CDC recommends prophylactic administration of antibiotic eye ointment (ERYTHROMYCIN) 1 hour after delivery Refer to ophthalmologist if herpes, hemorrhagic conjunctivitis or ulcerations present May return to work/school 24 hours after topical HAND-FOOT-AND-MOUTH DISEASE – HIGHLY CONTAGIOUS, viral illness clinical entity evidenced by fever, vesicular eruptions in the oropharynx that may ulcerate and a maculopapular rash involving hands and feet, the rash evolves to vesicles, especially on the dorsa of the hands and feet. Last 1 to 2 weeks. lesions appear on the buccal mucosa, palate, palms of hands, soles of feet and buttocs most common cause – COXSACKIE A 16 common in children <5 S&S – low grade fever, malaise, abdominal pain, enlarged anterior cervical nodes or submandibular Oral – small red papules on the tongue and buccal mucosa, which will progress to ulcerative vesicles EXANTHEM (papulovesicular) – occurs 1-2 days after oral lesions Differential – herpangina, Stevens- Johnson syndrome Treatment – maintain hydration, cool liquids, avoid spicy food, rest Topical aluminum hydroxide/ magnesium hydroxide gel with diphenhydramine applied to painful lesions Topical anesthetics – Kank A, Orabase Resolution with 7 days STREP PHARYNGITIS – An acute inflammation of pharynx/tonsils, associated with crowding (school) rare in children <3 Viral – rhinovirus, adenovirus, parainfluenza, Epstein-barr virus