Nurs 629 Exam 3 (Maryville) question and answer with rated solution

Nurs 629 Exam 3 (Maryville) question and answer with rated solution Otitis media pathogens Caused by: S. Pneumoniae (most common); H. Influenzae, M. Catarrhils Otitis media Symptoms: Fever, Pain, discharge from ear, tugging at ear, irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI Objective findings in otitis media 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 Amoxicillin-clavulanate 80-90 mg/kg/day BID x 10 days Treatment for AOM d/t S. Pneumoniae (most common): Amoxicillin 80-90 mg/kg/day BID x 10 days (high dose) Treatment for AOM with PCN Allergy: Non-Type 1: Cefdinir, Cefuroxime Treatment for AOM with PCN Allergy: Type 1: Azithromycin, clarithromycin OR Ceftriaxone 1-3 days Predisposing factors of otitis externa: Frequent moisture, local trauma, aggressive cleaning, Allergies/skin conditions Causative organisms for otitis externa: Psuedomonas aeruginosa (20-60%); Staphylococcus Aureus (10-70%); 10% fungal infection Symptoms of otitis externa: 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: Otalgia ( inner or outer ear pain), discharge, fullness, itching, pain with movement of tragus, redness around ear, decreased hearing. Treatment of pain and therapeutic management of otitis externa: Warm compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick ) When to wick with otitis externa: If lumen is reduced to >50%, wicks can help ensure delivery of topical abx to medial canal. Treatment of otitis externa: Topical fluroquinolones (Ciprofloxacin, Ofloxacin), ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid) Hallmark sign of otitis externa: Traction of pinna elicits pain When do we begin hearing tests in clinic for children 4 years old What is a normal audiology test result and how are results read Normal -10 to +15 The higher the number, the greater the loss, Severe loss 71-90 (learning disability, limited vocabulary), Profound loss 90 Risk factors related to elevated cholesterol Obesity, Diabetes, Hypertension, Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes Clinical findings for tetralogy of Fallot: Cyanosis: caused by blood low 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 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 intake, 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 • Vision is 20/400 • Fix and follow objects Viral conjunctivitis etiology (causative agent): Adenovirus is the most common cause. Other causes: HSV, herpes zoster, and varicella Viral conjunctivitis symptoms: 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 o Normal visual acuity, PERRLA, EOMI, Fundus normal o Mucoid-profuse watery discharge o Mild, diffuse injection and itching o *Preauricular lymphadenopathy Viral conjunctivitis Treatment: Symptomatic Only - Warm or cool compresses, Strict hand hygiene Pharyngitis Typically viral Causative organism for bacterial pharyngitis Group A Beta Hemolytic strep Subjective findings for strep pharyngitis: Rapid onset of sore throat, abdominal pain, headache, dysphasiay Objective findings for strep pharyngitis: Fever >103, Swollen glands, anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry tongue, anterior cervical lymphadenopathy Treatment for strep pharyngitis Amoxicillin 5mg/kg/day x10 days If allergy to first line tx for strep pharyngitis, what do you prescribe? Cephalosporin or macrolide (azithromycin) Therapeutic tx for strep pharyngitis (in addition to abx) Warm water gargle/apap/ibu Education re strep pharyngitis: Discard toothbrush after 24hs on an abx and after treatment completion When may pt return to school with strep pharyngitis: This is contagious. May return to school after 24 hours on abx Scarlet fever: Occurs secondary to strep throat and progresses to acute rheumatic fever if no intervention Is scarlet fever common or rare? Rare Subjective/Objective findings of scarlet fever: Scarlatina begins on face and spreads down and out/strawberry tongue/Fever/pharyngitis Treatment of scarlet fever: amoxicillin 50-80 mg/kg/day x7 days Classic triad of mononucleosis Pharyngitis: Fever, equative pharyngitis POSTERIOR cervical lymphadenopathy Subjective sx of mononucleosis: malaise, fatigue, headache, anorexia, Objective s/sx of mononucleosis: Abnormal LFTs, splenic enlargement, CBC c diff- lymphocytosis c atypical cells, monospot positive, EBV virus specifics - VCA-IgM, VCA AgG, EA, EBNA, negative rapid strep c culture Treatment for mononucleosis: Symptomatic unless severe Treatment for mononucleosis with strep Macrolide to avoid pcn rash (azithromycin, erythromycin, clarithromycin) Education for mononucleosis: F/u in 1-2 weeks, Avoid contact sports until 1 month after symptoms subside - concern for rupture Is impetigo contagious? Yes- very - spreads by contact - frequently resides in nasopharynx Causative organisms for impetigo Staph (most common), strep Subjective findings for impetigo: Rash that does not go away/pruritus Objective findings for impetigo: Small vesicle that erupts with "honey-colored crust" that begin in a small area and spreads; if crust is removed underlying skin is erythematous and edematous Diagnosis of impetigo: wound culture - MRSA Treatment of impetigo: Topical mupirocin/bactroban t.i.d., x 7-14 days and Cephalexin (Keflex) 40mg/kg/day x10 days (alternative: erythromycin 30-50mg/g/day x10 days) - If failure use Bactrim/Septra Education for impetigo: Wash face BID with soap/water / Wash sheets and pillow cases /No school for 48 hours after starting treatment This virus usually affects mucus membranes (oral or genital) HSV How is HSV spread? Via droplets, contact with active lesions, contact with saliva Subjective findings for HSV Tenderness, pain, paresthesia, burning, malaise, irritability, anorexia, drooling - PAINFUL NOT PRURITIC Objective findings for HSV Adenopathy, fever, grouped vesicles on an erythematous base, gingivostomatitis, yellow/white plaques, halatosis Treatment for HSV Self limiting, Resolves in 2-3 weeks, Symptomatic tx, Oral antivirals to shorten course (20-40mg/kg/day x5 days (begin c/in 48-72 hours of onset), Topical acyclovir 5% 5x/day This disease process occurs in clusters, has a peak incidence in late winter/early spring, is common in ages 5-15, is communicable between exposure and onset of rash, has an incubation period of 5-15 days and has a causative organism of Human parvovirus B19 Fifth Disease "Slapped Cheek" Subjective findings for Fifth Disease Fatigue, nausea, headache, pruritus Objective findings for Fifth Disease Characteristic "slapped cheek", low grade fever, injected conjunctiva What are the 3 distinct phases of Fifth Disease? 1. Phase 1: Facial redness < or equal to 4 days 2. Phase 2: Fishnet-like Lacey rash winton 2 days of facial redness. 3. Phase 3: Fever, pruritus, petechiae of hands and feet How is Fifth Disease diagnosed? Parvovirus IgG & IgM - CBC with decreased WBCs What is the clinical presentation of Fifth Disease? Low grade fever, malaise, sore throat What is the treatment for Fifth Disease? Symptomatic - Educate pt about hand washing to prevent spread. No school/daycare while infectious Fiery red, maculopapular facial rash concentrated on the cheeks (giving a slapped cheek appearance) Fifth Disease Pustular, ulcerating lesions on the hands and feet with oral lesions Hand-foot-and-mouth disease Vesicles and honey-colored crusted lesions Impetigo Scaly, hyper-pigmented lesions in a fir tree distribution usually found on the trunk Pityriasis roses What is the treatment for Kawasaki disease? IV immunoglobulin, ASA, ECG and cardiac consult When can a patient return to school after starting treatment for impetigo? 48 hours Lesions that have ruptured with yellow serous fluid that crusts easily Bullous impetigo This disease mainly affects children younger than 10 years of age. It is caused by the coxsackievirus A16 Hand foot and mouth How is Hand Foot and Mouth disease spread? Direct contact with nasal discharge, saliva, blister, fluid, or stool. Most contagious during 1st week of illness What are the s/s of Hand Foot Mouth Disease? Low grade fever, pharyngitis, malaise, lymphadenopathy, anorexia, PETECHIAL-TYPE RASH THAT PRECEDES VESICLES, Multiple small vesicles on hands, feet, diaper area, and inside of the mouth, ulcers present in the mouth, throat, tonsils, and tongue, 3-7 mm red macular lesions that rapidly become pale white a red halo Are adults able to get HFMD? Yes What is the typical incubation period for HFMD? 3-6 days What is the causative organism for HFMD? Coxsackievirus A16 What is the tx for HFMD? Treatment is symptomatic as this is a self-limited disease. How long does it take for HFMD to go away? Spontaneous recovery typically in 5-7 days Should you give ASA to a child with HFMD? NO NO! What are some symptomatic treatments for HFMD? apap/ibu, oracle, benadryl/maalox mixture (magic mouthwash), salt-water gargle, cool/cold fluids, avoid sugary and acidic drinks Which rash has a characteristic pink, scaly, rash with a round raised border and central clearing Tinea Corporis What is the treatment for Tinea Corporis Topical antifungals: Ketoconazole, nystatin for 2-6 weeks Education for Tinea Corporis: Avoid contact with skin lesion. No contact sports for 48 hours after treatment This rash has a characteristic "herald patch" on the trunk that is slightly pruritic and erupts into Christmas tree pattern rash? Pityriasis Rosea What is thought to be the causative organism for Pityriasis Rosea? Viral (common in winter months), Females >males Prodome of fever, malaise, and pharyngitis and herald patch: 2-10 cm oval round lesion is indicative of what? Pityriasis Rosea What is the tx for Pityriasis Rosea? Antihistamines, topical steroids, avoid sun exposure, moisturize How long can it take for Pityriasis Rosea to resolve? Can take up to three months to resolve Annular lesions with a scaly border and central clearing? Tinea Corporis Improper alignment of the eyes: strabismus This disorder is caused by an IgE mediated inflammatory reaction to an allergy, chemical, or other unidentified etiology; with high likelihood of family history - has an unknown link to asthma Atopic Dermatitis "Eczema" Early onset (<2 years old) xerosis occurs Atopic Dermatitis "Eczema" Subjective findings for atopic dermatitis (Eczema) Intensely pruritic red rash, burning/stinging, dryness Objective findings for atopic dermatitis (Eczema) Pruritic papulovesicular rash that oozes and crusts over, lichenification occurs secondary to itching/physical trauma, indistinct borders, excoriations of lesions Atopic Dermatitis (Eczema) Management of Atopic Dermatitis (Eczema) Avoid harsh soaps. Low potency topical steroids. Immunomodulator (elide/Protopic). AAbx if secondary infection. Bleach bath. What is the most common cause of sore throat? Viral pharyngitis What are the most common viruses that cause viral pharyngitis? Rhinovirus, adenovirus, EBV, RSV What are the sx of viral pharyngitis Rhinorrhea, low-grade fever, conjunctivitis, cough, tonsillar exudate and/or enlarged tonsils, malaise Treatment for viral pharyngitis Gargle with warm salt water, increase fluid intake, ibu or apap for fever/throat pain Fluid accumulation in middle ear without evidence of infection Otitis media with effusion (OME) Is OME viral or bacterial? It can be either What are the most common bacterial etiologic agents that cause OME streptococcus pneumonia, H influenza, Moraxella catarrhalis What is the incubation period for mono? 2-5 weeks What virus causes Mono? Epstein-Barr Virus How do you treat a patient with elevated BP (stage 1) during initial visit? Repeat in 1-2 weeks and average the BP over 3 visits How do you treat a child with asthma when it is disruptive several times during the night/interrupting sleep at least 3 times a week. What do you prescribe? Inhaled steroid (Flovent, Asmanex, etc.) Risk factors related to elevated cholesterol Obesity, Diabetes, HTN, Fm Hx: CAD prior to age 55, HLD, Diabetes What are the clinical findings of tetralogy of Fallot? Cyanosis caused by blood low in oxygen/SOB and rapid breathing, especially during feeding or exercise/LOC/Clubbing of fingers and toes/Poor weight gain, delayed growth/Polycythemia, metabolic acidosis/Systolic murmur at 2nd left ICS & holosystolic murmur at LLSB How to treat a patient with elevated BP (stage 1) during initial visit Repeat in 1-2 weeks and average the BP over 3 visits How to treat a patient with asthma that is disruptive several times during the night, interrupting sleep at least 3 times a week Prescribe an inhaled steroid (Flovent, Asmanex, etc.) Causative organism of bronchiolitis Respiratory syncytial virus (RSV) most likely cause Treatment for prehypertension seen in a patient on initial visit Monitor BP over the next 3 visits, Encourage healthy lifestyle choices What is a murmur with a decrease in intensity when patient moves from supine to standing position? Innocent (benign) murmur Characteristics of innocent (benign) murmur Heard in up to 50% of children/No radiation/Systolic/Grade <III/Does not interfere with S1 & S2/Decreases with sitting and standing/Equal femoral and radial pulses/Normal PMI Symptoms of Croup Barking cough/Fever/URI sx Symptoms of Bronchiolitis Inspiratory and expiratory wheezing accompanied by: Fever, URI symptoms including profuse clear nasal discharge When do you use inhaler to treat exercise induced asthma? Use resume inhaler 15-30 min prior to activity What is Kawasaki Disease? Idipathic multi system disease characterized by vasculitis of small and medium blood vessels including coronary arteries Who typically gets Kawasaki Disease? 75% of diagnose are <5 years old. More common in boys. More common in winter and early spring. What is the etiology of Kawasaki Disease? Viral Is Kawasaki Disease contagious? Nope Clinical findings of Kawasaki Disease? Fever for at least 5 days (102-104) and at least 4 of the 5 following features: 1.Changes in extremities (edema, erythema, desquamation (peeling of hands) 2. Conjunctival injection 3. Cervical lymphadenopathy 4. Cracking of lips and oral cavity 5. Polymorphous exanthema, usually truncal At what age do we always treat with abx for AOM? Under 6 months If a patient is 6months - 24 months old with AOM, a high fever, bilateral involvement, severe otalgia, and longe than 7-day presentation, how do we treat? High dose amoxicillin (80-90mg/kg/day) in two divided doses - If allergic use Cefdinir ALSO oral analgesics If a patient is 6 months - 24 months and presents with unilateral non-severe illness of AOM, how do we treat? Watchful waiting for 48-72 hours If a patient is greater than 2 years old and presents with AOM, when do we treat w ABX? High grade fever/bilateral ear involvement/severe otalgia/longer than 7 days What is a non pharmacologic treatment for AOM? Local heat application What virus causes mono? Epstein-Barr virus Signs and symptoms of mono? Malaise, fatigue, fever, chills, headache, pharyngitis (may be painful, severe, and exudative), POSTERIOR cervical adenopathy, spenomegaly, palatal petechiae Treatment for mono Rest, no vigorous exercise, contact sports, or heavy lifting for abs 6-8 weeks or until spleen is no longer enlarged, warm salt-water gargles, avoid stress, apap for fever, aches Is it normal for eyes to briefly cross in a newborn until about 2 months of age YEP