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NURS 629 Exam 3 STUDY GUIDE
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NURS 629 Exam 3 STUDY GUIDEOtitis media ANS - #1 diagnosis is among healthcare providers caring for
children
-By the age of 3, 2/3 of all children will have had an OM: ½ will have >3
occurrences
OM is most common in ANS - boys, first born, winter months, bottle fed
babies, preemies, daycare children, children of smokers
Reason for OM ANS - ■ Eustachian tube is shorter. By the ages 7-12 the
eustachian tube resembles that of an adult
■ Adenoids can be enlarged. If the adenoid that is enlarged d/t smaller nasal
canals & respiratory tract, that can easily block the eustachian tube & not
allow for drainage
Common bacterial causes for OM? ANS - ● S. pneumoniae: most common
● H. influenzae: child presents with conjunctivitis with OM, treat with
Augmentin and topical antibiotic for conjunctivitis
● M. catarrhalis
Symptoms of OM? ANS - ■ Fever, pain, discharge from the ear, tugging or
batting at the ear, irritability, crying, lethargy, decreased appetite,
decreased sleep, recent URI
Clinical Signs of OM? ANS - ■ Red, bulging TM, retracted with pus,
decreased translucency of TM, no movement of the TM, inability to see
normal landmarks, occasionally: hole in the TM
Diagnosis of OM requirements? ANS - ■ History of acute onset
■ Identify presence of middle ear effusion: bulging TM, decreased or absent
mobility of TM, amber fluid or appearance of TM, otorrhea
■ Identify signs of middle ear inflammation: erythematous TM, otalgia
(which interferes with function/sleep)
Tx of OM? ages:
>6m
6m-2yrs
>2yrs ANS - <6m: abx if certain or not
6-12m: abx if : fever >102, bilateral infection, severe otalgia, longer than 7
days (observe if not severe)
>2 yrs: abx if severe ^ observe if not
,Symptoms relief for OM? (non-abx) ANS - ● Acetaminophen or ibuprofen:
mild to moderate pain
● Benzocaine (Auralgan, Amerciaine otic): mild to moderate pain
● Warm compress
ABX tx for OM? ANS - ● Clinically defined treatment failure at 48-72 hours
after initial management with observation or at diagnosis for patients being
initially with antibacterial agents
ABX:
Amoxicillin 80-90 mg/kg/day BID for 10 days
OR IF PCN ALLERGY:
Non-Type 1: Cefdinir, cefuroxime
Type 1: Azithromycin, clarithromycin
OR: SEVERE OM:
Augmentin (Amoxicillin-clavulanate) 80-90 mg/kg/day for 10 days or
PCN alg: Ceftriaxone 1 or 3 days
Signs of bacterial AOM? ANS - • Bulging TM with decreased mobility, acute
onset pain and fever
when do you not 'watch and wait' on AOM? ANS - o Kids younger than 6
months
o \Children 6 mo - 2 years with moderate to severe pain (concerned bc of
speech development during this time)
o 2 and older with high fever
o All children with comorbidities such as heart disease etc
How do you treat AOM in kid who has ear tubes? ANS - Ofloxacin/cipro gtt
If pt develops rash after taking amox for ear infection what do you do? ANS
- stop and start cephalosporin
What are the predisposing factors for otitis externa? ANS - ■ Frequent
exposure to moisture of the ear
■ Aggressive cleaning of the ear canal (do not use Q-tips because that can
cause little micro tears in the skin which can lead to inflammation and
infection)
■ Local trauma to the ear
■ Allergies & skin conditions
■ Eczema
t/f otitis externa is typically bilateral? ANS - F usually unilateral
, symptoms of otitis externa? ANS - ■ Discharge from the ear (especially if
the TM has rupture), low grade fever, recent history of swimming or placing
something in ear, pain with movement of the tragus, redness around ear,
decreased hearing
tx of otitis externa? ANS - ■ Topical antimicrobial for initial therapy of
diffuse AOE should be based upon efficacy, low incidence of adverse events,
likelihood of adherence to therapy, and cost.
■ Pain management: analgesic treatment based on the severity of pain
■ Therapeutic
● Warm compresses, NSAIDs/Tylenol, prednisone, auralgan, OTC benzocaine
drops and then wicking
when should pt with otitis externa return if therapy has failed? ANS - ■ If
the patient fails to respond to the initial therapeutic option within 48-72
hours, the clinician should reassess the patient to confirm the diagnosis of
diffuse AOE and to exclude other causes of illness
what are red flag symptoms of throat pain? ANS - drooling, stridor, or
trouble breathing
Do NOT examine
What type of rash is associated with strep? ANS - sandpaper rash
what are common complications of pharyngitis? ANS - peritonsillar
abscesses, rheumatic fever, post-streptococcal, glomerulonephritis
What are the common signs/symptoms of Group AB strep? ANS - ■
Symptoms: rapid onset of sore throat, fever 103-104, swollen glands,
children often complain of abdominal pain, usually no URI symptoms,
headache, decreased appetite, dysphagia, irritability
■ Signs: exudate tonsils, anterior cervical lymphadenopathy, strawberry
tongue, rash
Diagnostic for strep? ANS - ■ Throat culture: 24 hr is the gold standard,
must swab both tonsils for best results
■ Remember 50% of kids with mono also have strep
what is the common abx for strep? ANS - ■ Amoxicillin (50-80 mg/kg/day)
x 10 days (PCN allergy: cephalosporin or macrolide)
■ Warm water gargles
■ Tylenol/NSAIDs
What causes Mono? ANS - Epstein-Barr virus
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