Maryville 612 Exam 1
Assessment and dx of otitis media? - correct answer-Middle ear with fluid or pus, red,
bulging tympanic membrane, loss of red reflex, inability to visualize bone structures,
conductive hearing loss, pain, loud abnormal sounds, rupture, foul smelling drainage. Otitis
media with effusion-fluid in ear. Acute otitis media fluid becomes infected, pus.
Describe murmurs? - correct answer-Heart murmurs are relatively prolonged extra sounds
heard during systole and diastole. Murmurs are caused by some disruption in the flow of
blood into, through, or out of the heart.
Ear congestion assessment and dx: - correct answer-Assessment: examine the external ear
structures. Manipulate the external ear to identify any tenderness before inserting the
otoscope. Examine the canal for masses or swelling. Observe the TM for dullness,
decreased light reflect, bulging, retraction, or inflammation, which may indicate fluid or
infection.
Dx: Meniere's dx (AOM, otitis externa), OM with effusion, allergies, cerumen impaction of
foreign body.
Eustachian tube malfunction assessment and diagnosis: - correct answer-The Eustachian
tub drain into the posterior aspect of the inferior turbinate of the nose. The tubes help the
ears drain fluid. They also keep air pressure in the ears at the right level. When you swallow
or yawn, the tubes open briefly to let air in to make the pressure in the middle ears equal to
the pressure outside of the ears. Sometimes fluid or negative pressure gets stuck in the
middle ear. The pressure outside the ear gets to high. This causes ear pain and sometimes
trouble hearing.
How are they treated? - correct answer-Blocked Eustachian tubes often get better on their
own. You may be able to open the blocked tubes with a simple exercise. Close your mouth,
hold your nose, and gently blow as if you are blowing your nose. Yawning and chewing gum
also may help. You may hear or feel a pop when the tubes open to make the pressure equal
between the inside and outside of your ears.
How do you assess extra ocular movements and determine what's normal? - correct
answer-Movement of eyes controlled by cranial nerves III, IV, and VI and the six extra ocular
muscles. Six cardinal fields of gaze: hold pts chin in place, ask to watch your finger as you
move them through the 6 cardinal fields of gaze. Normal- movement should be
accomplished smoothly with out exposure of the sclera. Abnormal- observe for nystagmus
and lid lag.
How do you assess for presbyopia? What is it? - correct answer-Presbyopia-the major
physiologic eye change that occurs with aging is a progressive weakening of
accommodation (focusing power).
Assessment-visual acuity, refraction and accommodation.
, Symptoms- most people notice are difficulty reading fine print, particularly in low light
condition, eye strain when reading for long periods, blur at near or momentarily blurred
vision when transitioning between viewing distances.
How do you assess peripheral vision? - correct answer-Confrontation test- tests nasal,
temporal, superior and inferior visual fields. Cover and uncover test. Stand opposite side of
patient and they cover their right eye and you cover your left eye. Open eyes are opposite of
each other. Fully extend your arm slowly centrally. Have the patient tell you when fingers are
seen.
How do you assess pupillary response and document it? - correct answer-Dim lights in room
so pupil dilate. Shine a penlight directly into one eye and note whether the pupil constricts
simultaneously with the tested pupil. Repeat in other eye. Evaluate optic nerve/swinging
flashlight test: Shine the light into one eye and then rapidly swing to the other. There should
be a slight dilation in the second eye while the light is crossing the bridge of the nose but it
should constrict equally to the first eye when the light enters the pupil. Contraction and
accommodation-ask pt to look at a distant object and then at a test object (finger) held 10 cm
from the bridge of the nose. Expect pupils to constrict when the eyes focus on the near
object. Documentation: PERRLA.
How do you document bounding arterial pulses? - correct answer-Pulse amplitude on a
scale from 0-4.
0- Absent, not palpable
1- Diminished, barely palpable
2- Expected
3- Full, increased
4- Bounding, aneurysmal
How do you use an ophthalmoscope? - correct answer-Inspect interior of the eye. Allows
visualization of the optic disc, arteries, veins, and retina. Adequate papillary dilation is
necessary. Examine the patients right eye with your right eye and the patients left eye with
your left eye. A lesion in the eye is described in relation to the disk diameter. For example,
two disk diameters from the optic disc at the 2 o'clock position. Papilledema-lost of definition
of the optic disk margin that usually occurs due to increased intraocular pressure. Glaucoma
with head cupping. Disk margins are raised with a lower central area. Corneal abrasion
cannot be seen without staining the eye.
In a carotid exam what do you do or not do? - correct answer-Do not palpate both sides
simultaneously. This can cause a drop in heart rate and blood pressure resulting in a
syncope and decreasing blood flow to the brain.
Know the oral cancer assessment, screening. - correct answer-Inspecting the oral cavity,
have pt lift tongue, move side to side, up and stick out, palpate with gloved hand.
Sinuses- How do you assess the sinuses? Anatomical location of the sinuses on the face.
Name the sinus cavities. - correct answer-Assessment: inspect for swelling, tenderness, and
pain by palpating, frontal with thumbs, and either side of the nose, zygomatic processes, and
maxillary sinus, with thumbs or index finger-positive findings indicate obstruction or infection.
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