FNP (boards study review)
Nurse Practitioner Process - ANS1. History
2. Assessments
3. Labs/Diagnostic
4. Diagnosis
5. Least invasive, least expensive
6. First Line treatment
Nurse Practitioner Process Continues - ANS1. Introduction
2. CC
3. ROS
4. Physical Exam
5. Plan
6. First line tx
Infection Markers
Erythrocyte Sedimentation rate (ESR)
Antinuclear antibodies (ANA)
C-Reactive Protein - ANSRheumatic Fever- (ESR), (C-reactive)
Lupus- (ESR), C-reactive, ANA
Rheumatoid Arthritis - ESR, ANA
Lymph Nodes - ANSLocated throughout the body, but visible and palpable when they are
enlarged or swollen.
Epitrochlear Lymph Nodes - ANSEpitrochlear lymph nodes- drains from the hand and forearm
proximally via epitrochlear lymph node
High Potency Steroids - ANScauses atrophy, telangiecatasia (spider veins), purport, and striae if
used on the face
Fundoscope Exam - ANSThe examiner
a. Uses right hand for ophthalmoscope, uses right eye for pts right eye
b. Start with wheel at 0
c. Starts about 12'' from the patient with both eyes open
d. Moves in to within 1-2'' from the patient's eye
e. Should function as one with ophthalmoscope
2. After obtaining a red reflex, exam should proceed from the optic disc and end with fovea of
each eye
,Inspection of the Optic Disc
1. Shape: Doughnut-like with an orange/pink neuroretinal rim and a central white depression
(physiological cup)
2. Cup disk ratio: Cup should not be more
than 1/2 the size of the diameter of disk diameter, the optic disk is area where optic nerve and
blood vessels enter the retina (if larger, consider glaucoma)
Retinal vessels
1. Arteries are brighter and narrower than veins; A:V ratio = 2:3 or 4:5, if raised area where a
artery and a vein meet
- Hypertension (AV Nickling)
Glaucoma optic disk - ANS
Macula - ANS1. Creamy yellow Centered: 2-2.5 disc diameter temporal to the optic disk and is
avascular
- Have the pt look directly in the scope if macula is difficult to visualize, or have the patient look
directly into the light
2. The fovea centralis is a 2.5 mm-diameter reflective area that looks slightly darker and lies in
the center of the macular region
- The fovea is composed of closely packed cones on the eye
-located in the center of the macula
-responsible for sharp central vision
3. Patient should look directly into the light of the ophthalmoscope, if the macula is difficult to
visualize
Cones of the eye - ANSResponsible of color
Visual Acuity
-Snellen Chart - ANS1. Snellen eye chart: 20/20 means that "the patient can see at 20 feet what
the normal person can see at 20 feet" (the larger the denominator, the poorer the patient's
vision)
-20/40 = a person can see at 20 feet what the normal person (without impairment) can see at 40
ft
-If 20/30 = Referral stage
CN II = Snellen chart
Hyperopia - ANS"Farsightedness" (on freeway and can't see the signs)
Myopia - ANSNearsightedness
,Presbyopia - ANSCommon after age 40; results in greater difficulty maintaining a clear focus at
a near distance die to a lessening of flexibility of the crystalline lens and weakening of the ciliary
muscles which control lens focusing
Arcus Senilis - ANS5. Arcus senilis: cloudy appearance of the cornea with a gray/white arc or
circle around the limbus due to deposition of the lipid material; the arcus has no effect on vision-
permanent change, need to make sure they are taking their statins
Pterygium - ANSRaised wedge-shaped growth of thin, noncancerous tissue over the
conjunctiva (conjunctiva is transparent and sits over the sclera)
Hordeolum (Stye) - ANS(Stye-this hurts)
Acute inflammation of the eyelid, usually caused by (staph aureus)
Signs/symptoms
Abrupt onset with pain and erythema of the eyelid (tender painful mass) (chalazion = painless)
Management
1. *Warm compressor*
2. Topical bacitracin or erythromycin opthalmic ointment
3. Refer to opthamalogist if not better x 2 days
Chalazion - ANS(No Pain)
Beady nodule on the eyelid, infection or retention cyst usually on upper eyelid
Signs/symptoms
-painless
-swelling
-tenderness to eyelid
-tearing
Management
1. Warm compresses
2. Refer for surgical removal
Blepharitis - ANSStaphylococcus infection or seborrheic dermatitis of the eyelid
Signs/symptoms
-red, scaly, greasy flakes (classic)
-thickened, crusted lid margins
-burning
-itching
-tearing
, Management
1. Hot compressed
2. Topical abx (bacitracin or erythromycin)
3. Vigrously scrub & rinse lashes, may use an old toothbrush
Conjunctivitis
Bacterial
Gonococcal or
Chlamydial
Allergic
Nurse Practitioner Process - ANS1. History
2. Assessments
3. Labs/Diagnostic
4. Diagnosis
5. Least invasive, least expensive
6. First Line treatment
Nurse Practitioner Process Continues - ANS1. Introduction
2. CC
3. ROS
4. Physical Exam
5. Plan
6. First line tx
Infection Markers
Erythrocyte Sedimentation rate (ESR)
Antinuclear antibodies (ANA)
C-Reactive Protein - ANSRheumatic Fever- (ESR), (C-reactive)
Lupus- (ESR), C-reactive, ANA
Rheumatoid Arthritis - ESR, ANA
Lymph Nodes - ANSLocated throughout the body, but visible and palpable when they are
enlarged or swollen.
Epitrochlear Lymph Nodes - ANSEpitrochlear lymph nodes- drains from the hand and forearm
proximally via epitrochlear lymph node
High Potency Steroids - ANScauses atrophy, telangiecatasia (spider veins), purport, and striae if
used on the face
Fundoscope Exam - ANSThe examiner
a. Uses right hand for ophthalmoscope, uses right eye for pts right eye
b. Start with wheel at 0
c. Starts about 12'' from the patient with both eyes open
d. Moves in to within 1-2'' from the patient's eye
e. Should function as one with ophthalmoscope
2. After obtaining a red reflex, exam should proceed from the optic disc and end with fovea of
each eye
,Inspection of the Optic Disc
1. Shape: Doughnut-like with an orange/pink neuroretinal rim and a central white depression
(physiological cup)
2. Cup disk ratio: Cup should not be more
than 1/2 the size of the diameter of disk diameter, the optic disk is area where optic nerve and
blood vessels enter the retina (if larger, consider glaucoma)
Retinal vessels
1. Arteries are brighter and narrower than veins; A:V ratio = 2:3 or 4:5, if raised area where a
artery and a vein meet
- Hypertension (AV Nickling)
Glaucoma optic disk - ANS
Macula - ANS1. Creamy yellow Centered: 2-2.5 disc diameter temporal to the optic disk and is
avascular
- Have the pt look directly in the scope if macula is difficult to visualize, or have the patient look
directly into the light
2. The fovea centralis is a 2.5 mm-diameter reflective area that looks slightly darker and lies in
the center of the macular region
- The fovea is composed of closely packed cones on the eye
-located in the center of the macula
-responsible for sharp central vision
3. Patient should look directly into the light of the ophthalmoscope, if the macula is difficult to
visualize
Cones of the eye - ANSResponsible of color
Visual Acuity
-Snellen Chart - ANS1. Snellen eye chart: 20/20 means that "the patient can see at 20 feet what
the normal person can see at 20 feet" (the larger the denominator, the poorer the patient's
vision)
-20/40 = a person can see at 20 feet what the normal person (without impairment) can see at 40
ft
-If 20/30 = Referral stage
CN II = Snellen chart
Hyperopia - ANS"Farsightedness" (on freeway and can't see the signs)
Myopia - ANSNearsightedness
,Presbyopia - ANSCommon after age 40; results in greater difficulty maintaining a clear focus at
a near distance die to a lessening of flexibility of the crystalline lens and weakening of the ciliary
muscles which control lens focusing
Arcus Senilis - ANS5. Arcus senilis: cloudy appearance of the cornea with a gray/white arc or
circle around the limbus due to deposition of the lipid material; the arcus has no effect on vision-
permanent change, need to make sure they are taking their statins
Pterygium - ANSRaised wedge-shaped growth of thin, noncancerous tissue over the
conjunctiva (conjunctiva is transparent and sits over the sclera)
Hordeolum (Stye) - ANS(Stye-this hurts)
Acute inflammation of the eyelid, usually caused by (staph aureus)
Signs/symptoms
Abrupt onset with pain and erythema of the eyelid (tender painful mass) (chalazion = painless)
Management
1. *Warm compressor*
2. Topical bacitracin or erythromycin opthalmic ointment
3. Refer to opthamalogist if not better x 2 days
Chalazion - ANS(No Pain)
Beady nodule on the eyelid, infection or retention cyst usually on upper eyelid
Signs/symptoms
-painless
-swelling
-tenderness to eyelid
-tearing
Management
1. Warm compresses
2. Refer for surgical removal
Blepharitis - ANSStaphylococcus infection or seborrheic dermatitis of the eyelid
Signs/symptoms
-red, scaly, greasy flakes (classic)
-thickened, crusted lid margins
-burning
-itching
-tearing
, Management
1. Hot compressed
2. Topical abx (bacitracin or erythromycin)
3. Vigrously scrub & rinse lashes, may use an old toothbrush
Conjunctivitis
Bacterial
Gonococcal or
Chlamydial
Allergic
