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116 Cards in this Set
- Front
- Back
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What are chalazia and hordeolas?
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inflammatory processes involving tissue of eyelid, usually upper eyelid
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What is another name for hordelum?
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stye
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What is blepharitis?
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inflammatory condition of eyelid margins
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What is a common cause of blephartis?
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contaminated eye make-up
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What is most common organism causing a hordeolum?
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s. aureus
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Does infection accompany a chalazion?
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no usually just chronically inflammed meibomian gland
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Which are tender to palpation, hordeolum or chalazia?
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hordeolum
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How should a hordeolum or stye be intially treated?
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warm, moist compresses and may need topical antibiotics (Tobramycin)
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How do you treat recurrent eyelid lesions?
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daily lid scrubs with diluted baby shampoo
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What is more common in children hordeola or chalazion?
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hordeola and chalazion more common in adults
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Which type of conjuctivitis is most common?
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viral - adenovirus, herpes simplex and herpes zoster
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Is lymphadenopathy seen with conjuctivitis?
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Yes sometimes usually preauricular of submandibular
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What are sings of conjuctivitis?
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red sclera, photophobia, acute onset, mucopurulent drainage, tearing, swelling
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What is seen on everted eyelids when having an allergic response?
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cobblestone appearance
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What OTC med can be used for allergic conjuctivities?
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Naphcon-A - decongest/antihistamine or Vasocon-A
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What non-med measures can be used with allergic conjuctivitis?
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cold compresses
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Conjuctivitis is usually self-limiting and will heal itself?
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True, but with bacterial drops can hasten resolution
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What increases risk of corneal abrasions?
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extended wear contacts - 5 fold over daily wear
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What can cause a corneal abrasion?
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chemical or mechanical debridement - trauma or UV radiation exposure
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Is pain associated with corneal abrasions?
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yes - intense pain, ocular redness, tearing, and photophobia
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How to treat corneal abrasions?
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antibiotic ointments - tobramycin or eryc
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Is patching indicated for corneal abrasions?
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no
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Should steriod solutions be used with corneal abrasions?
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No steriods can slow healing and promote infection
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What abnormality is seen in the auricule with arthritis?
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hard nodules
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What can cause a hematoma of the auricule?
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blood disorders or trauma and should be drained can result in deformity of ear
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What 2 skin cancers can be found in the auricule?
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basal cell - most common and least deadly, shiny lesion on top of ear that is irregular and painless. Squamous cell - lesion raised, crusted border around center ulcer - can cause death
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Define otitis externa
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superficial inflammation or infection of the external ear - can be called swimmers ear
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What causes otitis externa?
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cerumen impaction, trauma from cleaning with q-tips, swimming in unclean pools, lakes, river, and ocean
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What organism causes otitis externa?
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S. aureaus, candida and aspergillus - oftne CA-MRSA
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What clinical s/s are seen with otititis externa?
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unilateral pain, tenderness, red and edematous - typanic membrane poorly visualized
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How do you treat otitis externa?
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antibiotic-hydrocortison drops
Use 1:2 vinegar/alcohol drops in each ear after swimming or 2% acetic acid |
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Define otitis media
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Infection of middle ear
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What is otitis media associated with?
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upper respiratory infection or allergies that result in edema & dysfunction of eustachian tube or reflux of nasopharyngeal fluid into eustachin tube
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What is otitis media with effusion?
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infection with accumulation of serous fluid behind ear drum
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What can predispose someone to otitis media
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cigarette smoke
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What bacteria causes otitis media?
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strep or Heamophilus influenzae
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What s/s can accompany otitis media?
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painful ear, warm ,enlarged posterior auricular nad cervical lymph nodes, rhinorrhea, vomiting, diarrhea, fever, vertigo, hearing loss
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What percentage of otitis media is bacterial?
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75%, 25% may resolve on own
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How to treat otitis media?
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Amoxicillian
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When would you use prophalytic antibiotics for otitis media?
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if more than 2 episodes in 6 months or 3 episodes in 12 months - give amoxicillin 20 mg daily during winter months
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What are predisposing factors to nosebleeds?
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nasal trauma, rhinitis, drying of nasal mucosa in low humidity, deviated septum, alcohol use and antiplatlet meds
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Where do most nosebleeds come from?
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anterior nasal septum. Posterior bleeds hard to control and associated wtih vascular disease
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How should a patient sit with a nose bleed?
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sit straight up, tile head forward and apply firm continusous pressue to affected nostril
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What can be used besides pressure to stop a nosebleed?
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topical nasal decongestant sprays
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What is allergic rhinitis?
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sneezing, rhinorrha, congseiton, pruritis of nose and eyes, popping of ears, postnasal drip, throat clearing and coughing
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when should you refer eye problems?
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When eyeball affected
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What do you see with blepharitis?
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scaly, crusty more seborreic
redness more likey infectious Treat with lid washes and antibiotic ointment |
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How to treat blephaitis?
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scrub with diluted baby shampoo then antibiotic ointment
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Where aer chalazia found?
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midway up lid, not on lid margins
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How do warm compresses help hordeolums?
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hasten pointing and drainage
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When to use antibiotic ointment for hordelum?
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helps prevent secondary infection r/t drainage of stye
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How to treat chalazion?
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warm compresses to liquify secretions, then massage of gland toward tear duct no antibiotics indicatid - block meibomian gland
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What is meibomian gland
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produces oil into tears along lid
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What are clinical s/s seen with viral conjuctivitis?
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red eye, pre-auricular lymphadenopathy
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What are clinical s/s seen with allergic conjuctivitis?
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cobbblestoning in conjuctivia
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When is crustying or drainage seen with pink-eye
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mostly with bacterial conjuctitivis
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what meds for allergic conjuctivitis?
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naphcon A or Vasocon A - topical antihistamine/decongestant
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What meds for bacterial conjuctivitis?
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Suamyd or Tobrex
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What type of compresses for conjuctivitis?
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cool compresses help with itching
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S/S with conjuctivitis?
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tearing, photophobia, crusting, itching, burning
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How to find corneal abrasions?
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need to use florescein stain/UV light
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What are some emergent eye condiditons that shoudl be refered
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loss of vision, angle-closure glaucoma, foreign body, ulcer, abrasion, scleritis, iritis or uveitis, retinal detachment
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What meds used for rhinitis
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1st removed environmental irritants, intranasal steriods,decongestants and antihistmines
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Other help with rhinitis
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saline nasal spray, high does guaifenesin
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What meds to use in pregnancy with rhinitis?
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chlorpheniramine and nasal cromolyn or intranasal beclomethasone - no decongestants 1st trimester d/t can cause fetal abnormalities
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Where is sinusitis seen?
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usually maxillary & anterior ethmoidal - mostly bacterial
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What other c/o seen with sinusitis?
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teeth, throat nad ears, increased pain when bending head forward
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How to treat sinusitis?
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for s/s greater than 1 week or4 unilaternal symptoms - decongestant & antitiobic augmentin or levaquin, saline nose drops or rinse
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What disorders can be seen with the auricular?
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rheumatoid nodules - also seen hands, elbows, knees, feet. Tophi - uric acid nodules painless, hematoma - cauliflower or boxers ear
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What cancers can be seen on auricles?
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basal cell carcinoma, - slow growing, common, squamous cell carcinoma - can metastatize to lympn node
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What is best med for otitis media?
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amoxicillian
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If otitis media not responding to antibiotic what shoudl be suspected?
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beta lactimase producing bacteria- then prescribe Augmentin
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What are causes of aphthous ulcer or cankers?
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vitamin deficiency, stress, famiily predispostion - more females than males - more in adolescents
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What causes stomatitis or glossitis?
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nutritional defienceis, drug rx, irritants like dentures
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What rinses can be used for stomatis/glossitis or ulcers?
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baking soda/salt water rinse or mylanta/benadrly rinse
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What see with viral pharangitis?
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dry, scratchy thoat with rhinorrhea - nasal congestion
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Waht see with bacterial pharangitis?
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sore throat, painful swallow, fever, chills, N&V no nasal congestions - treat with PCN
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What is mono caused from?
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Epstein Barr of CMV
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S/s of Mono
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malaise, anorexia before sore throat, then fever up to 104, sore throat, lymphadenopahty triad
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Education for mono
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no strenuous exercise for 2-4 weeks d/t can rupture spleen
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Where is pulmanry TB infection seen?
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apex of lung
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S/S of TB
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faigue, anorexia, weight loss, night sweats, low grade diuranal fever, cough, chest pain r/t cough, hemoptysis, irreg menses
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Exam for TB
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maybe rales in upper posterior area, maybe plueral effusion, lymphadenopathy
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When can isonozid be given for TB?
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under 35 for mautoux test of greater than 10mm, no hx of liver problems or alcohol use - avoid Tylenol or other heptotoxic drugs - take B6 to decrease peripheral neuropathy
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Influenza s/s
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fever by 2-3 day, chlls, HA, malaise, loss of appetite, dry cough, nasal congestion with clear drainage, sore throat - cough most prominient - last 4-8 days with cough longer
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When contagious with influenza?
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24 hours before coming down with symptoms
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What meds can be given for flu?
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Tamiflu or Zanamivir helpful if given w/i 48 hours can reduce severity and duration about 1 day, Vaccine best prevention
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What is Asthma?
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Chronic inflammation of the airways
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What triggers asthma?
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allergens - coachroach, dust mites, cat, tree & grass pollen, infections, exercise, changes in weather, irritants, allergy to ASA
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S/S of asthma
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episodic wheezing with dyspnea, cough (most common symptom), breathlessness, anxiety, sputum production
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When see exercise induced asthma?
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5-10 minutes after the exercise
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What is best test for Asthma lung function
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spirometry, Peak expiratory flow meter should be done each morning
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What should be asked with Asthma F/U visits
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Asthma better or worse since last visit, high and low peak flow, has asthma interfered with daily life, what meds taking and how often
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What see with severe Asthma Attack?
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forces expiration, both inspiratory and expiratory, use of accessory muscles, hyperinflation, RR greater thatn 30 HR greater than 120
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Describe Step 1 - Mild Asthma
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symptoms less than 2 times a week, exacerbations brief nightime symptoms less than 2 times a month
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Describe Step 2 - Mild persistant Asthma
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Symptoms greater than 2x week, but less than 1 time/day, exacerbations affect activity, nighttime > 2x month
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Describe Step 3 - Moderate persistent Asthma
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daily symptoms, daily use of rescue inhaler, exacerbations affect activity > 2 time a week can last days, nighttime > 1x/week
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Step 1 - mild intermittent managment of Asthma
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Long term: no daily med
quick relief: Short acting bronchodilator |
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Step 2 - mild persistant management of Asthma
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One daily med - either inhaled corticosteriod or cromolyn or nedocromil (children start with these), quick relief: Short acting bronchodilator
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Step 3 - moderate persistant managment of Asthma
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daily med: either inhaled antiinflammatory medium or low medium dose and long actiing bronchodilator
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Step 4 - severe persistant Asthma
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daily meds: inhaled corticosteriod high dose & long acting bronchodilator & steriod tablets if necessary
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What daily use Asthma meds are good for peds, exercise induced and pregnancy??
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Cromolyun and Nedocromil
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When is singular effective?
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Takes 1-2 hours for onset - last 10-12 hours good for nightime and before exercise
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S/S of acute bronchitis
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begins with URI, burning in chest, nose and throat s/s, cough, wheezes, rhonchi and rales, substernal pain
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What is most common cuase of pneumonia?
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strep pneumoniae
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Pneumonia is leading cause of death from infectious diesase - T or F
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True
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Gram pos pneumonia s/s
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onset high fever, shaking chills, purulent sputum, chest pain, rust or bloody sputum, egophay over consolidation, fremitus, dullness to percussion
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Gram Neg pneumonia
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Haeophilis influenza - pneumonia in people who are immunocompromised
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Atypical pneumonia
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walking pneumonia - seen in younger adults, no high fever - 100, HA, malaie, dry cough, much less ill, no lung consolidation, macupapular rash on trunk, earache - see blister on eardrum
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Smoking 4 A's
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Ask about smoking every visit, Advise benefit of quitting to smoke, Assist them to stop smoking, Arrange for follow-up visits
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35 million people try to quit smoking each year only 7% succeed
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true
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What is best way to stop smoking
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Cold turkey
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Smoking #1 cause of premature death, 1:5 deaths r/t smoking T or F
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true
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What are 6 phases of change in a smoker?
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1: precontemplation 2: contemplation 3: determination 4: action 5: maintenance 6: relapse
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concern for women who quit smoking?
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weigth gain
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What are some pharmocologic interventions to help stop smoking?
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nictotine replacement - patches, gum, Bupropion - prolong effect ot neuronal uptake of dopamine. Chantix: binds and deactivates nicotine receptors
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