NURS 620 Exam 1 questions well solved!2022/2023

NURS 620 Exam 1 questions well solved!2022/2023What is the difference between a hordeolum and a Chalazion? Primary difference is that a chalazion and hordeolum is that chalazia are a result of inflammation and hordeola or styes are infectious. (p.266) Hordeolum An acutely presenting, erythematous, tender lump within the eyelid External Hordeolum (Stye) Inflammation/infection of the eyelid margin affecting the hair follicles of the eyelashes Internal Hordeolum (Stye) Inflammation/infection of the Meibomian glands Chalazion A granulomatous infection of a Meibomian gland, presenting in the form of painless swelling on the eyelid. Initially may be tender and erythematous before evolving into a non-tender lump. Blepharitis is frequently associated with chalazion. What is the difference between allergic and bacterial conjunctivitis? Allergic symptoms include red, itchy watery eyes. Bacterial (such as staphylococcus aureus p.274) is mucopurulent discharge (significant thick, yellow, sticky exudates on the eyelids). Bacterial Conjunctivitis Symptoms -Redness-injected eyes - Purulent or mucopurulent (yellow-green) discharge - Unilateral at onset - Eyelids glued shut in morning - Edematous, shiny red appearance to the lower lids - Itching and tearing Bacterial Conjunctivitis Treatment •*Erythromycin ophthalmic ointment -Dosage: ½" four times daily for 5 to 7 days •*Polymyxin-trimethoprim drops-not for contacts -Dosage: 1 to 2 drops four times daily for 5 to 7 days •Fluoroquinolone ophthalmic drops (preferred agent in contact lens wearers) -Dosage: Generally, 1 t0 2 drops four times faily for 5 to 7 days (regimens vary by medication) •Azithromycin drops -Dosage: 1 drop twice a day for 2 days; then, 1 drop daily for 5 days Warm compress Allergic Conjunctivitis Symptoms - Bilateral redness - Watery, stringy discharge - Itching - Crusty in morning - Allergy symptoms - sneezing, rhinorrhea, an a scratchy throat Allergic Conjunctivitis Treatment - Cold compresses - Lubricants - Topical antihistamines/decongestants/NSAIDs/mast cell stabilizers - Systemic antihistamines - No-tears shampoo to wash eyelids ***DO NOT give topical corticosteroids Signs and Symptoms of Otitis Externa "Swimmer's Ear" o Inflammation of the membranes lining of the auditory canala and/or contiguous structures of the outer ear o Commonly caused by microbial infection (p.306) o Subjective: acute, severe otalgia with sudden or gradual onset o Pain may be worse at night, chewing may elicit otic pain o Pruritic o Purulent discharge o Tenderness on traction of the pinna o Auditory canal usually is edematous and erythematous, preventing full visualization of the external canal and tympanic membrane o May culture the fluid in the ear for antibiotic sensitivity Treatment of Otitis Externa - Heat, NSAIDS or acetaminophen, keep ear dry, no swimming 4-6 weeks - Ciprofloxacin HC: 3 gtts BID x 7days - Neomycin/PolymyxinB HC (Cortisporin) 3gtts TID x7days - Cortane B AQ: 4-5gtt TID x7days - Systemic Cipro (if needed): 500mg BID x7days Otitis Media o Inflammation of the structures of the middle ear o Chronic otitis media is usually more than 3 months and related to tympanic membrane perforation o Most significant precipitating even is a recent or concurrent URI (p.311) o Allergies, sinusitis, rhinitis and pharyngitis can all cause swelling of the membranes lining the eustachian tube and cause OM Subjective Signs of Otitis Media - Stuffiness, fullness, and a loss of auditory acuity in the affected ear only - OME: Pain is rare; may describe popping, crackling, or gurgling sounds when chewing, yawning, or blowing the nose - AOM: "deep" ear pain and fever, unilateral hearing loss, otic discharge, some may have vertigo or dizziness. Pain usually subsides if the tympanic membrane ruptures because it relieves pressure - Rare vertigo Objective Signs of Otitis Media - Mucous membranes of nasal and oral cavities may be injected or edematous - The eardrum may be dull but usually is not bulging, and eardrum mobility typically decreases on pneumatic otoscopy What is the difference between Otitis Media and Otitis Externa? Inflammation of the auditory canal and/or eternal ear, including the pinna and tragus, occur in Otitis Externa. These structures are usually not affected in otitis media, and otitis externa typically does not involve the tympanic membrane" (p.315, last paragraph). Signs and Symptoms of Group A B-Hemolytic Strep (GABHS) Acute onset of fever, sore throat, headache, pain, cervical lymphadenopathy (anterior part of the neck), tonsilllopharyngeal exudates What is the first line of treatment for GABHS? •Pen V 500mg BID x 10 days •Benzathine Pen G IM 1.2 million units •Amoxicillin 500 mg BID x 10 days •If pen allergy: erythromycin, cephalexin, cefadroxil, and azithromycin are alternatives What is Closed Angle Glaucoma? Sudden onset severe eye pain, vomiting, impaired vision and headache. Rainbow around lights at night and blurred vision ***MEDICAL EMERGENCY-refer to ophthalmologist ASAP Symptoms of Closed Angle Glaucoma May report seeing rainbow halos around lights. Will have corneal cloudiness with diffuse conjunctival hyperemia. Pupil may be moderately dilated and completely unresponsive to light. Refer to ophthalmologist immediately. (p.275) First Line Treatment for Acute Bacterial Rhinosinusitis (ARBS) •Analgesics •Intranasal steroids •Decongestant •Second-generation antihistamines (allergy component) •Nasal saline irrigation •Local heat, good hydration •Not enough data to support the use of guaifenesin **Start abx if symptoms worsen after 7 days, no improvement after 10 days, high-grade fever + severe pain What is second line treatment of ARBS after first line treatment fails? -Augmentin 875mg/125mg BID Treat for 10 days -If treatment failure or risk factors for resistance: HD Augmentin 2000mg/125mg BID for 10 days -If PCN allergy: Doxycycline 100mg BID for 10 days, or Clindamycin 150mg QID + cefixime 400mg daily for 10 days -Levofloxacin 500mg daily for 10 days (not in elderly and last option) Macular Degeneration - Central vision loss worse over several months - Disease of aging and the leading cause of blindness in those over 60 yrs old slow, progressive atrophy and degeneration of the retina. - Caused by the macula breaking down, central vision and fine detail perception deteriorates. (p.286-288) How long should one avoid contact sports after a mono diagnosis? - 21 days Signs and Symptoms of Peritonsillar Abcess o a collection of pus located between the capsule of the palatine tonsil and the pharyngeal muscles o severe sore throat, fever, a "hot potato" or muffled voice, drooling, and trismus o enlarged and fluctuant tonsil with deviation of the uvula to the opposite side. There may be fullness or bulging of the posterior soft palate near the tonsil with palpable fluctuance (up to date) Allergic Rhinitis Treatment -Oral antihistamines