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177 Cards in this Set
- Front
- Back
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What are some common associated sx of acute otitis media?
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fever (60%), URIsx, sore throat, swollen lymph nodes, drainage, ear pulling
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in AOM, describe the TM.
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red, bulging, decreased mobility.
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Rx factors for AOM?
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exposure to others in day care/school setting, smoking, bottle propping.
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Population most affected in AOM?
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children <8 yrs, family hx, with frequent ear infections, and cleft palate
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Where does client c/o pain/discomfort?
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ear to jaw, usually on one side but can be both
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What relieves discomfort for AOM?
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warmth, analgeisics, perfortion of ear drum often causes LESS pain for client!!!
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What is the onset/timing of AOM?
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hours to days, with a steady increase.
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In otitis externa, what clients are at risk?
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adults and swimmers, previous hx, DM, and seborrhea
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Where does client c/o discomfort?
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ear, canal is swollen, pinna displaced.
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What is the timing of discomfort?
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hours to days
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what is the setting in which the client was before c/o pain/discomfort?
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water exposure, trauma
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How does client c/o pain in acute otitis externa?
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aching, throbbing. severe, pain on moving pina
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How is discomfort relieved?
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warmth/analgesics
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What are associated sx?
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itching
lymphadenopathy |
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What does clinician find on exam?
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swollen canal w/ drainage
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Serous otitis media, what client population is most affected?
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children with past PMI of OM.
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What is the onset?
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days---weeks
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In which setting does it occur?
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pre/post OM
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How does the client describe the discomfort in serous otitis?
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popping/crackling
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What releives this for the client?
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decongestants.
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What are some assoc'ed sx with serous otitis?
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decreased hearing
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Describe exam findings of serous otitis?
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TM is retracted, clear fluid behind TM, decreased mobility
test w/ audiometry for decreased hearing. |
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what population is most affected by cerumen impaction?
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elderly
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what is the PMH of cerumen impaction?
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frequent impactions and hearing aid use
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What are some rx factors for cerumen impaction?
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infrequent showers, foreign bodys inside, using q tips
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How does client w/ cerumen impaction describe discomfort?
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stuffing/blockage, worse after q tip usage
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What are some assoc'ed sx with cerumen impaction?
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decreased hearing, itching, dizziness
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What does exam reveal about cerumen impaction?
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impaction of canal, varying from yellow to orange to BLACK.
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In which cause of cough, does client have a low grade fever, chills, and chest burning?
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acute bronchitis?
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in which cause of cough, doe shte client have a brassy cough, and dry to yellow/green or bloody sputum?
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TB
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in which cause of cough does the client have decreaed breath sounds, and dullness to percussion?
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pneumonia
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in which cause of cough does the client c/o of previous URI (winter)?
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acute bronchitis
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in which cause of cough, does client c/o previous UR in the spring or fall?
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pneumonia
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what dx tests are done for a client w/ pneumonia?
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chest xray
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what dx tests are done for a client with TB?
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chest xray, PPD, sputum cx diagnostic!
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In which type of cough, is the onset worst in the morning, and after exposure to another infected individual?
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TB
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In which type of cogh, does the client complain of anorexia?
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pneumonia
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in which type of cough, does the client have a red pharynx?
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acute bronchitis
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in acute bronchitis, what are the lung sounds like?
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rales, ronchi, wheezing
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what are the lung sounds like for a TB patient?
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crackles?
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In asthma, what is the population most affected?
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less than 10 years- boys,
b/w 16-40, girls |
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What is the pmh of clients w/ asthma?
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viral infections during infancy
allergies GERDD sinusitis |
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What is the onset of cough or dyspnea for a client w/ asthma?
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can be any time, usually worse during evenins and an illness, trigered by environmental and emotiona condtions, stress, and exercise
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what relieves dyspnea in an asthma pt commonly?
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albuterol to relieve bronchospasm.
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What are some associated sx that a client w/ asthma c/o?
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chest tightness, dyspnea, cough, wheezing.
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What are exam findings for client w/ asthma? (expiratoryvs inspiratory phase, breath sounds, etc)
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prolonged expiratory phase, wheezes maybe, tachycardia, spirometry and peak airflow indicating OBSTRUCTIVE...less than .7 with lower ratio.
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What is the typical client picture for someone w/ COPD?
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over age 40, men more than fms, smoker,
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What are rx factors for a client to have COPD?
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smoke, environmental exposure, alpha-1 antitrpsin deficiency
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What is the sputum like in asthma patients?
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thick, tenacious, clear, like jello.
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What is th sputum like for a client w/ COPD?
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variable
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What relieves dyspnea in a client w/ COPD?
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rest
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What are some common sx's for a client w/ COPD?
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dyspnea, cough, barrel chest, prolonged expiration
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what are breath sounds like for a COPD client?
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normal to rhonici
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what dx tests are done on a copd client?
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PFT, chest xray
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name some rx factors for a client with a corneal abrasion?
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sudden trauma to eyeball, contact lens usage
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What are tests done on a client to dx corneal abrasion?
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evert the eyelid, perform a fluorescein stain, check for visual acuity, and hyphema
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What does the client w/ a corenal abrasion present with? (symptoms)
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frequent blinking, pain burning, blurred vision, tearing, photophobia
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In which eye disorder, does the client complain of a hal, blurred vision, and headache, nausea, or vomiting?
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glaucoma
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exam findings for client w/ glaucoma?
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decreased visual acuity, dilated oval pupil, a steamy cornea, a shallow anterior chamber
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what tool is used to test pressure in eye for client w/ glaucoma?
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tonometry or slit lamp
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in a client w/ iritis, what does the client complain of?
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blurred vision, soreness, aching, photophobia, decreased visual acuity
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what are the findings of an eye exam for a client w/ iritis?
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affected pupil may react weakly, hazy anterior chamber
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what dx test is preformed in a client with iritis?
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a ciliary flush.
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What causes iritis?
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conjuctivitis or trauma
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in bacterial conjunctivitis, name some rx factors.
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kids, exposure to family or group
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Name some sx of client w/ conjunctivitis.
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burning, itching 'sandy', blurred vision, drainage, photophobia, red sclera and conjuctiva, preauricular lymph nodes inflamed
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testing for a client w/ conjunctivitis?
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MAYBE perform a fluorescein stain??
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Which cuase of nasal congestion frequently is from spring or fall exposure?
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allergic rhinitis
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in which cause of nasal congestion, are associated symptoms such as red itchy eyes, clear drainage from eyes, itchyness, and wheezing?
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allergic rhinitis
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In which type of nasal congestion, are the turbinates pale and boggy, with a red clera and conjuctiva, shiny face?
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allergic rhinitis
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in which type of nasal congestion,a re the turbinates red and swollen, client c/o sinus tenderness, drainage may NOT be present, c/o being sick for days to weeks?
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sinusitis
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in which type of nasal congestion, does the client c/o sneezing, headache, and ear or throat pain, post nasal drip, and noisy breathing, with onset 1-3 days?
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URI
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Which sore throat, does the client have a fever over 104, a cough, nasal congestion, and muscle aches?
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flu
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what tests are done to dx flu?
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rapid flu test
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what tets are done to dx mono?
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mono spot, looking for more than 50% atypical lymph nodes (CBC)
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What are some associated sx for a client with mono?
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low grade fever PRECEDES sore throat, malaise, abdominal pain, GRADAL onset
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what are some findings upon exam on a client w/ mono?
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splenomegaly, cervical adenopathy, palatine petchiae
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in which type of sore throat, is there uvula deviation, unilateral swollen soft palate?
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peritonsillar abscess
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in which type of sore throat, does the client have difficulty eating?
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peritonsillar abscess
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in which type of sore throat, does the client have 'lock jaw' (trismus)?
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peritonscillar abscess
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in which type of sore throat, does the client also have a cough, and laryngitis?
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viral pharyngitis
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in which type of sore throat, does the client have a fever more than 101?
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strep
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in which type of sore throat, is the onset FAST?
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strep
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in which type of sore throat, does the client c/o previous cold?
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viral
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in which type of sore throat, does the client c/o worse pain in the morning, because of PND?
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viral cause
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in which type of sore throat, does the client have a scarlitina rash, exudate on the tonsils, halitosis, a straberry tongue?
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strep
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how is strep dx'ed?
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rapid strep test, throat culture, aso titer 1-6 month after
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in which type of sore throat, does the client have a cobblestone appearance in their throat, nasal dischrage, and swollen turbinates?
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viral pharyngitis.
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what are the most common resp complaints in primary care setting? (name 3 and rank)
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1. cough
2. dyspnea 3. wheezing |
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what are the three processes that lead to respiratory pathology?
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1. irritation of the airways.
2. mucosal edmea/excessive secretions. 3. airflow obsturciton/bronchospasm |
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what is the timing for an acute cough?
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less than 3 weeks
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subacute cough?
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3-8 weeks
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chronic cough timing?
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> 8 weeks.
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cough that occurs at night is most often caused by what?
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CHF, asthma
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cough that occurs after eating most likely caused by...
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GERD.
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off white or white sputum is sign of...
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asthma or PND
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a dry cough may be caused by...
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ACE inhibitors, asthma, interstitial lun disease, sacrcoidosis
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a purulent cough may be sign of...
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acute or chronic bronchitits, lung abscess, TB
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what is the most common cause of an acute cough?
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infections- normally viral...
URI sinusitis acute bronchitis pneumonia |
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what are common causes of a subacute cough?
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post-infectious
asthma PND GERD |
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a chronic cough is caused by... (name the 3 most common cuases)
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1. PND
2. Asthma 3. GERD |
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What are some other causes of a chronic cough?
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1. chronic bronchitits
2. unexplained-habit 3. ACE inhibitors 4. broniectasis |
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What are the most common causes of acute dyspnea?
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acute blood loss, asthma, bronchitis, MI, pneumonia, pneumothorax, pulmonary emoblism, psychgenic, and trauma
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what are some common causes of chronic dyspnea?
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ashtma, cardiomyopathy, copd, interstitial pulmonary fibrosis
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what is status asthmaticus?
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NON reversible asthma. an inhaler will NOT help!
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what are some signs of anaphylaxis?
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swelling, edema around lips, acute dyspnea
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a change in unilateral breath sounds could be a sign of...
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pneumothorax
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what is the most common cause of wheezing?
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asthma, followed by copd
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if during a resp exam you find that the trachea is deviated to one side, this could be a sign of...
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pneumothorax.
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during a resp exam, what other systems should you always check?
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cardiac
eent lower extremites nail beds. GI |
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when is a client most likely to contract community acquired MRSA?
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after viral pneumonia w/ flu
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what test is done to differentiate ashtma from bronchitis?
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spirometry (PFT test)
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do differentiate lung cancer from chf, emphsyema, or pneumonia, what test needs to be done?
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chest x/ray
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in a spirometry test, what does FEV1 indicate?
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forced expriatory volume in 1 second, after the client takes the biggest breath possible
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in a spirometry test, what does the FVC indicate?
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forced vital capacity= total amt that the pt can exhale
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what should you make sure of to get an accuate spirometry test/
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clients at least 5 years old.
calibrate tool daily. perform test 3 times to get best results. |
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FEV1 result w/ >80% predicet means...
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NORMAL...however, asthamticus and CPD may all still show as normal
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FEV1 < 80% predicited, with a FEV1/FVC <70% means...
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obstructive...common in asthma or copd
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FEV1 <80% predicted, and an FEV1/FVC ratio that is normal indicates...
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restrictive lung disorder.... sarcodosis?
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FEV1 < 80%, and FVC reduced=
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MIXED--- obstructive and restricive
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to differentiate b/w asthma and COPD in an obstructive disease, what should the clinician do?
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give a short acting Beta 2 agonist....repeat spirometry....if client has improved (at least 12% FEV1), then disease is reversible. if there was no increase in FEV1, then it is a noreversible disease and most likely it is COPD...can also perform a methyline choline test and continue
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CHEST Xray that is radiolucent will appear what color? what does this indicate?
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BLACK.... space or fat.
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Chest Xray that is radiopaque will be what color? what is this?
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WHITE--- bone, metal, or calcium in tumors/deposits
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Chest xray that is mixed will be what color?
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grey--- different density of tissues, such as organs, soft tissues, or muscles.
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if the chest xray is lateral, what side of the chest is against the box? which means that the xray will hit what side of the body first?
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left side against, which means xray will hit right side first... good b/c otherwise heart will appear enlarged.
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CHEST Xray look at first:
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AIRWAY....
trachea, mediastinum, lungs |
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Chest Xray look at second
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BONES...
clavicles...if too lcose together, may indicate a poor inspiratory effort anterior ribs lateral view... spine |
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what is a positive spine sign in an xray?
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may indicate pulmonary patholoy or atelecatsis...appears white
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Chest Xray look at 3rd...
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CIRCULATION
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the cardiothoracic ratio is?
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ratio of diameter of heart to diameter of chest...should be 0.5
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Chest Xray look at 4th....
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DIAPHRAGM...should be dome shaped
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what side of the diaphragm is usually higher and why?
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right side is usually 1-3 cm higher than the left, because the liver is underneath the right side.
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a hyperinflated chest may indicate what disease?
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copd.
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what test is done for near visual acuity?
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rosenbaum
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what sould be done to the room before performing eye exam?
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darken the room!
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why is it important to check the anterior, posterior, and sides of the tongue?
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cancer commonly missed and hides here :-(
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cardinal dx sign of sinusitis?
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lenght of sickness more than 2 weeks...color of drainage has nothin to do with it!
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sx of foreign body present?
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drainage on 1 side only
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what are some sx of trigeminal nueralgia?
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pain and tingling on face, may have nasal discharge
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what causes rhinitis medicamentosa and what can you suggest to your client?
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overuse of nasal spray, such as afran, sugest to client only use BID, and to spray in 1 nostril at a time, giving other side a break.
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infection around the entire area of the eyer or orbit is called...
what should it be treated with? |
periorbital cellulitis... tx w/ IV antibiotics b/c its so close to the brain!
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grading tonsils means...
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can be 1, 2, 3, 4, depending on how close to touching/kissing, that the tonsils are.
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what does a rapid strep test test for?
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Group A Beta Hemoliytic Strep
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the choxsackie virus (herpangina) and apthous culcer/canker sores cause...
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uclerations/sores
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what should you not ask a client w/ epiglotitis to do?
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open mouth b/c swollen epiglottis will occlude airway
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a swollen neck underneath the maxilla , with swelling and infection of midsalivary glands, caused by past dental work, is called...
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ludwig's angina
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why does the client w/ peritonscillar abscess have a swollen soft palate?
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pus underneath! must be drained!!!
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why is a pregnant client two times more likely to have ringing of ears?
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hormonal changes
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what is a cholesteatoma?
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an epithelial growth that is behind the eardrum. sometimes causes hearing difficulties.
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what is acoustic neruoma/schwannoma?
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a tumor on the auditory nerve... it causes tinnitus, dizziness, and hearing troubles innititally.
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what is a sign of mastoiditis?
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the ear appears to stick out because the head swells...it is infection of the mastoid bone.
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what is a common cause of subconjunctival hemmorhage?
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increased pressure from vomitting or doing the valsalva maneuver. no treatment. resolves spontaneously.
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signs/sx of conjunctivitis?
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collbestone appearnce in viral
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an infection of the external gland at the bottom fo the eyelash that often origiantes from a staph infection, is a.... hint...painful!
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STYE (hardeolum)
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an inflamed gland in teh eye which produceds tears and is painless is...
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a chalazion.
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what color does the abrasion turn after performing a fluorescein stain/
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green
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what is the second most common cause of blindness?
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glaucoma
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what is a collection of blood in the anterior chamber called?
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a hyphema.
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in glaucoma, does the pupil dilate or constrict?
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dilate.
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in which eye disorder does the anterior chamber appear hazy and a ciliary flush is performed?
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iritis
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what is a common sign of temporal ateritis?
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pain in the eye
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what is a sign of 3rd nerve palsy?
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drooping (ptosis) of the eye
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what are some symptoms of tic douloureux?
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draining fo the eyes and spasm when touched.
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what population of clients commmonly has gonoccoal or chalmyidal infection?
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mostly newborns.
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in a migraine aura, what is another symptom that occurs sometimes?
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tearing.
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sudden blindness may indiacte...
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glaucoma or trauma
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a toothache could be referred pain from what?
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sinus inflammation
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what are the three most common visits (recurring) in out patient setting?
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1. mental illness
2. trauma 3. back problems |
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what is 80% of the pt's diagnoses?
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the history from the client...will talk for 90 seconds to give the whole story.
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what is a pertinent negative?
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the absence of data or symptoms that would implicate or be positive for a certain system or process. ie. client denies SOB, anusea and diaphroesis if client states that he has chest pain
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what is included in subjective information?
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chief complaint
history of present illness past medical history personal/faily social history Review of systems |
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client's current state of health, including impact of chief complaint and health pi are all part of the client's
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review of systems
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how many generations do you need to go back when asking about the client's family history?
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two
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what is a differntial diagnosis?
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a laundry list of the possible dx'es that the client may have.gives options.
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which minority population has the highest mortality rate?
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african americans?
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which minority group is least likely to have a breast/cervical cancer screen or colorectal cancer screen?
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asians
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which minority group is least likley to try to quit smoking, and to get the pneumococcal vaccine?
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hispanics
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