Nurs 629 Exam 3 (Maryville) Questions With Verified Answers Otitis media pathogens - Answer Caused by: S. Pneumoniae (most common); H. Influenzae, M. Catarrhils Otitis media Symptoms: - Answer Fever, Pain, discharge from ear, tugging at ear, irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI Objective findings in otitis media - Answer Red, 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 - Answer Amoxicill in-clavulanate 80-90 mg/kg/day BID x 10 days Treatment for AOM d/t S. Pneumoniae (most common): - Answer Amoxicillin 80- 90 mg/kg/day BID x 10 days (high dose) Treatment for AOM with PCN Allergy: Non-Type 1: - Answer Cefdinir, Cefuroxime Treatment for AOM with PCN Allergy: Type 1: - Answer Azithromycin, clarithromycin OR Ceftriaxone 1-3 days Predisposing factors of otitis externa: - Answer Frequent moisture, local trauma, aggressive cleaning, Allergies/skin conditions Causative organisms for otitis externa: - Answer Psuedomonas aeruginosa (20-60%); Staphylococcus Aureus (10-70%); 10% fungal infection Symptoms of otitis externa: - Answer Discharge 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: - Answer Otalgia ( inner or outer ear pa in), discharge, fullness, itching, pain with movement of tragus, redness around ear, decreased heari ng. Treatment of pain and therapeutic management of otitis externa: - Answer Warm compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick ) When to wick with otitis externa: - Answer If lumen is reduced to >50%, wick s can help ensure delivery of topical abx to medial canal. Treatment of otitis externa: - Answer Topical fluroquinolones (Ciprofloxacin, Of loxacin), ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid) Hallmark sign of otitis externa: - Answer Traction of pinna elicits pai n When do we begin hearing tests in clinic for children - Answer 4 years old What is a normal audiology test result and how are results read - Answer Normal - 10 to +15 The higher the number, the greater the loss, Severe loss 71-90 (learning disabil ity, limited vocabulary), Profound loss 90 Risk factors related to elevated cholesterol - Answer Obesity, Diabetes, Hypert ension, Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes Clinical findings for tetralogy of Fallot: - Answer Cyanosis: caused by blood l ow 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 - Answer Infants less than 4 months old, Infant with poor feeding, grunting, O2 saturation <92%, respiratory rate >70 , Older child with grunting, inability to tolerate oral i ntake, 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): - Answer Adenovirus is the most co mmon cause. Other causes: HSV, herpes zoster, and varicella Viral conjunctivitis symptoms: - Answer o 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 - Answer o Normal visual acuity, P ERRLA, EOMI, Fundus normal o Mucoid-profuse watery discharge o Mild, diffuse injection an d itching o *Preauricular lymphadenopathy Viral conjunctivitis Treatment: - Answer Symptomatic Only - Warm or cool compresses , Strict hand hygiene Pharyngitis - Answer Typically viral Causative organism for bacterial pharyngitis - Answer Group A Beta Hemolytic strep Subjective findings for strep pharyngitis: - Answer Rapid onset of sore throat, abdominal pain, headache, dysphasiay Objective findings for strep pharyngitis: - Answer Fever >103, Swollen glands, ano rexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawbe rry tongue, anterior cervical lymphadenopathy Treatment for strep pharyngitis - Answer Amoxicillin 5mg/kg/day x10 days If allergy to first line tx for strep pharyngitis, what do you prescribe? - Answer Cephalosporin or macrolide (azithromycin) Therapeutic tx for strep pharyngitis (in addition to abx) - Answer Warm water gargle/apap/ibu Education re strep pharyngitis: - Answer Discard toothbrush after 24hs on an abx and after treatment completion