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96 Cards in this Set
- Front
- Back
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What are the 6 conditions of the upper respiratory tract we are concerned with? |
Viral rhinitis allergic rhinitis otitis eye disorders Sinusitis pharyngitis |
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Which 2 of those 6 are we going to have the most difficulty in tx and why? |
sinusitis: not seen as often; inflammation of the sinus cavities and inability to get the inflammation down enough to get the ABX into it pharyngitis: we need to figure out if it is viral or bacterial in order to tx |
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What is viral rhinitis and what are the common pathogens? |
what it is: the common cold common pathogens: rhinovirus, coronavirus, influenza viruses, adenoviruses |
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What is the incubation period for viral rhinitis and what are the sx? |
incubation: 1 to 4 days so most pt developing sx have been exposed to this a while ago sx: rhinorrhea, sore throat, cough, low grade fever & chills, muscle aches, headache |
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What is important to remember about a cough when trying to determine if this is viral rhinitis? |
Q: where is the cough coming from? post nasal drainage can cause a cough but that doesn't mean the infection is lower respiratory |
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What are the typical results of physical exam for viral rhinitis, and how should we proceed with a pt who exhibits no real sx? |
results: usually unimpressive how to proceed: look hard for something bc the pt is probably going to feel embarrassed |
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what sort of tx are we going to prescribe for the pt dx with viral rhinitis? |
decongestants expectorants = 7-8 glasses H2O/day w/o caffeine antitussives antipyretics antihistamines (2nd gen, not Benadryl) rest & fluids |
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How are we going to know if this is allergic rhinitis? |
presence of sneezing and post-nasal drip |
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Which immunoglobin is going to mediate the response to allergens in allergic rhinnitis? |
IgE |
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With what frequency will allergic rhinnitis sx present? |
seasonally perennially/chronic = year round |
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what allergens correlate to seasonal and perennial allergies? |
seasonal: ragweed, tree pollen, grass pollen, etc perennial: animal dander, molds, dust mites |
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why does a thorough hx need to be taken when suspecting allergic rhinitis? |
we need to get a good idea of the environment the pt is living in |
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what should we be asking with regards to complaints, timing, self tx, family hx, and associated sx when taking the subjective hx? |
complaints: sneezing, pruritis of eyes, nose, & soft palate, watery nasal discharge, tearing, post-nasal drip, cough timing: months of the year, time of day, in response to contact with known or suspected allergen self tx: what are they taking to relieve sx bc there could be an issue of rebound congestion family hx: associated sx: if a fever or purulent drainage is present then we may suspect infectious etiology |
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What should we be looking for in the objective assessment with regards to nasal mucosa, eyes, mouth, allergic shiners, and Dennies lines? |
nasal mucosa: clear/watery discharge, turbinates pale or blue, boggy, and edematous eyes: conjunctival redness, tearing, and possible edema of upper lids mouth: dryness from mouth breathing allergic shiners: darkness around the eyes bc of blood pooling r/t sinus and nasal congestion Dennies lines: fold/line in skin under eyelid caused by edema |
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what are the types of diagnostic testing we can do for allergic rhinnitis and who will this be done for? |
types: serum IgE or skin testing by specialist who: only serious sufferers bc this is done by a specialist |
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what are tx for allergic rhinnitis? |
allergy avoidance antihistamines decongestants topical nasal steroids: budesonide (Rhinocort), Triamcinolone (Nasacort) referral when sx persist after tx |
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How should we instruct the pt to apply topical nasal steroids? |
pt should spray laterally |
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what education should we provide to the pt with allergic rhinnitis caused by a dust mite allergy? |
vacuum weekly oil based furniture polish no feather pillows mattress and pillow covers change air filters regularly |
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what are pt education points we should provide with respect to medications and hydration? |
meds: proper use, what is misuse, possible SE hydration: benefits of hydration to relieve mucus buildup |
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What is the etiology of vasomotor rhinitis and how does vasomotor rhinitis present with respect to allergies & IgE levels? |
etiology: autonomic response leads to vascular dilation or submucosal vessels in the nose presentation: non allergic & IgE levels are normal but it looks just like allergic rhinitis |
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what are factors affecting autonomic response? |
change in temp or humidity i.e. going from warm house to cold air and you get a runny nose exposure to hot or cold foods psychological stimulation drug tx body positioning cocaine abuse |
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what are common sx complaints from the subjective interview of vasomotor rhinitis, and is the onset of sx gradual or abrupt? |
common sx: nasal congestions, watery discharge, sneezing speed of sx onset: abrupt |
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what does the physical exam usually turn up with vasomotor rhinitis? |
turbinates pale or hyperemic (redness) congested nasal passages watery nasal discharge |
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how is vasomotor rhinitis tx with pharm and w/o? |
nonpharm: avoid the thing precipitating a rxn pharm: topical nasal steroids & topical antihistamines |
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what is the function of the paranadsal sinuses, what happens to them during sinusitis, and what sort of rhinitis does it follow? |
function: warm and humidify air what happens: inflammation of one or more paranasal sinuses follows: nasal obstruction from viral/allergic rhinits |
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how are acute and chronic sinusitis differentiated from one another? |
acute: often precipitated by rhinnitis and resolves promptly w/tx chronic: episodes of prolonged inflammation or repeat infections follow tx & sx persist for > 3 months |
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how long does tx w/abx look like for both acute and chronic sinusitis? |
acute: 24 - 48 hrs chronic: 3 - 4 wks |
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what are the 3 clinical features of acute sinusitis? |
1. onset w/persistent sx lasting > 10 days & not improving 2. onset w/severe sx high fever (100-101)and purulent nasal drainage for at least 3-4 days at beginning of illness 3. double-sickness (onset w/worsening sx) typical viral URI appear to improve followed by sudden onset of worsening sx after 5-6 days |
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rank h. flu, staph aureus, moraxella catarrhalis, & strep pneumoniae, as the most common pathogens of acute sinusitis from most common to least. |
HIGH strep pneumoniae h. flu moraxella catarrhalis staph aureus LOW |
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What are the 2 common pathogens for chronic sinusitis? |
staph aureus anaerobic organisms |
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what are the clinical presentations for sinusitis and how can we get the pt's help in IDing the sx? |
fever: unilateral pain in teeth: this is a typical sx sinus tenderness: facial palpation and tenderness in lymph nodes headache: have them point to where it hurts sore throat: look for halitosis cough: we don't need to see ALL these sx to dx |
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how do finding multiple sx help us to rule out strep throat? |
strep throat is sore throat w/o presence of other sx |
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what are objective findings helping us dx sinusitis? |
halitosis purulent nasal drainage red, edematous nasal membranes injected pharynx (red & inflammed) w/post-nasal drip |
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where is the pain do frontal, maxillary, ethmoid, and sphenoid sinuses present w/respect to sinusitis? |
frontal: pain over lower forehead maxillary: pain in cheeks referred to teeth that worsens when leaning forward ethmoid: pain over bridge of nose and behind eye sphenoid: retro-orbital pain |
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what cases is diagnostic testing indicated for and what are the diagnostic tests? |
indicated: only w/someone who is a frequent flier, NOT acute tests: Water's view x-ray, allergy testing, CT |
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what are examples of nonpharm tx of sinusitis so long as the pt is not an active or passive smoker? |
increase fluids steam inhalation allergen avoidance avoid swimming |
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which abx will we use to tx sinusitis and how long is the tx for acute and chronic? |
abx: augmentin, doxycycline, eythromycin, bactrim, ceftin acute: 10 - 14 days chronic: 3 -4 wks |
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at what point in the disease process can we conclude that the pt's sinusitis is not viral? |
virus should run its course in 5-7 days so if not getting better then we should give an abx |
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should we rx an abx in for mild sinusitis in smokers and why or why not? |
should we: yes why: bc they tend to go south quickly |
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what other pharm tx should be rx for sinusitis, when should we do them, and what warning should we provide? |
PO decongestants: warn about rebound antihistamines: only if there is an allergy component bc it will slow movement of secretions and we don't want that |
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what are some complications that can arise from sinusitis? |
periorbital edema cellulitis osteomylitis carvernous sinus thrombus brain abcess |
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what is otitis externa also known as, when is it most common, and what are the causative pathogens? |
aka: swimmer's ear common: in summer causative pathogens: pseudomonas = copious or green (#1), fungal = white to black, fluffy |
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what are subjective sx of otitis externa? |
pain w/ touch = crying out if you barely touch it pain w/ jaw movement vague dizziness some degree of hearing loss |
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what are objective findings for otitis externa? |
+/- Tragus sign +/- Pinna sign redness or edema of ear canal exudate = white, yellow, green |
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which pt are we going to most concerned about otitis externa and cellulitis? |
immunocompromised pt DM pt |
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what are the non pharm and pharm tx for otitis externa? |
nonpahrm: prevention through hygeine, protect ears during H2O activity, no foreign objects pharm: abx/steroid combo |
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when would we refer to ENT? |
if mastoiditis is suspected for immunocompromised pt or DM pt |
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what is otitis media, which population is it most common in, when is it most common, and what illness is it often preceded by? |
what: inflammation/infection of middle ear population: kids peak: winter preceded: upper resp infection |
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what are the common causative pathogens in OM? |
strep pneumoniae* H. flu M catarrhalis |
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what are the subjective sx of OM? |
fever pain headache hearing loss dizziness fullness |
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what are the objective findings of OM? |
decrease TM mobility = introduce air to ear canal and observe movement redness full/bulging TM = tells us we don't really need air absent/obscured landmarks = healthy looking TM has pink to grey bone distored light reflex |
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what are indications of chronic OM and what needs to be done in the case of a ruptured TM? |
chronic sx: opaque or white TM r/t scar tissue ruptured TM: refer to ENT |
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what is the non pharm and pharm tx for OM? |
nonpharm: avoid smoke pharm: DOC, bactrim, tylenol/NSAID, auralgan (topic analgesic) |
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what are complications of OM? |
matoiditis, bacterial meningitis, breain abcess, subdural empyema |
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what might we do w/ a mild OM? |
leave it be bc they are going to want an abx let virus ru nits course and watch out for 2ndary bacterial infection |
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what is serous OM and what are the common causes? |
what: accumulation of serous fluid in middle ear causes: adenoidal hypertrophy, URI, allergies, deviated septum |
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what are subjective sx of serous OM? |
often aymptomatic may feel fullness, stuffiness, popping sound w/chewing & yawning |
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what are objective findings of serous OM? |
bubble or fluid level behind the TM decreased TM mobility |
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what are the nonpharm and pharm tx of serous OM? |
nonpharm: avoid smoke pharm: amoxixillin, erythromycin, bactrim, topical nasal steroid * f/u in 10 days * |
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what is pharyngitis and what are the 2 categories? |
what: inflammation of pharynx and surrounding lymph tissue categories: bacterial, viral |
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what are the bacterial pathogens associated with bacterial pharyngitis? |
group A beta-hemolytic strep mycoplasma pneumoniae chlamydia cornyebacterium haemolyticum neisseria gonorrhoeae c. diphteriae |
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what are subjective sx of strep pharyngitis? |
sore throat ear pain fever (102- 104) malaise dysphagia abdominal pain nausea & vomiting |
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what are objective findings of strep pharyngitis? |
red pharynx, tonsils, uvula exudate on tonsillar pillars tender & enlarged cervical lymph nodes fever petechiae or soft palate halitosis - very distinct |
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what are the diagnostic tests for strep pharyngitis? |
rapid strep test throat culture CBC |
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what are possible complications of strep pharyngitis? |
scarlet fever peritonsillar abcess glomerularnephritis rheumatic fever |
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what are the nonpharm tx for strep pharyngitis? |
wash hands increase fluids warm salt water gargle throat lozenges new toothbrush no work/school x 24 hrs |
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what is the pharm tx for strep pharyngitis? |
ABX: benzatine penicillin (IM) oral penicillin azithromycin antipyretics/analgesics: tylenol NSAIDs |
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what is the presentation on the membranes of nasal, pharynx, tonsilar, and uvula in of c. diptheriae pharyngitis, what happens when the membrane is removed, and where should this pt be referred to? |
membranes: gray & adherent removal: bleeds referral: infectious disease |
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what is the transmission method, the presentation, the tx, and the method of diagnosis for N. Gonorrhea pharyngitis? |
transmission: oral-genital route presentation: chronic sore throat diagnosis: culture for gonorrhea tx: rocephin |
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what are the subjective sx of viral pharyngitis? |
sore throat fever headache malaise tonsillar adenopathy |
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what is the tx of viral pharyngitis? |
symptomatic only with increased fluids, warm salt water gargles, throat lozenges, tylenol or NSAIDs |
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what is a peritonsillar abcess, who does is affect, what does it usually follow, what are sx, and how should this be tx by the NP? |
what: abscess on the tonsil who: older kids and adults when: after tonsillitis sx: unilateral throat pain but may say ear pain, dysphagia, dysphonia, drooling tx: immediate referral to ED |
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what are the objective findings for a peritonsillar abscess? |
fever increase oral secretions uvula displaced to one side affected tonsil is grossly enlarged enlarged & tender lymph nodes on affected side |
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what is infectious mononucleosis, what is the causative agent, how is it spread, and what is the incubation period? |
what it is: acute infection of B lymphocytes causative agent: epstein-barr virus spread: usually saliva incubation: 4-6 wks |
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what are the subjective sx of infectious mononucleosis? |
headache malaise fatigue arthralgia anorexia fever chills dysphagia |
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what are the classic triad of sx for mononucleosis? |
fever pharyngitis posterios cervical lymphadenopathy |
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what are findings on the physical exam for infectious mononucleosis? |
pharyngeal petechiae pharyngeal exudate splenomegaly = spleen enlargement possible heptomegaly eye lid edema maculopapular rash |
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what are lab findings of infectious mononucleosis? |
positive mono spot test elevated LFT = liver function test leukocytosis thrombocytopenia |
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what is the tx for infectious mononucleosis? |
supportive only isolation is unnecessary bed rest avoid strenuous activity no contact sports analgesics & antipyretics (tylenol, NSAIDs) |
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what is a hordeolum, what is the presentation, what are the findings of a physical exam, how is diagnosis made, what is the tx, and what are education & f/u points for a hordeolum? |
what: infection of a gland surrounding an eyelash follicle presentation: local or diffuse swelling of the eyelid, redness, pain findings: redness & swelling of lid, conjunctiva appear injected, normal cornea, pupil, and visual acuity diagnosis: on hx & physical findings tx: warm moist compresses, abx drops & ointments education: avoid touching & wash hands often, do not touch tip of eye dropper to anything f/u: refer to ophthalmologist if sx not resolved in several days |
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what needs to be done for the pt who is experiencing eye pain and vision changes with a hordeolum? |
immediate referral to ED bc medical emergency |
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what is a chalazion, how does it present, and what sort of pain does the pt experience? |
what: benign & painless bump on eyelid that might be a hordeolum that has healed presents: little redness pain: NONE |
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what corneal/pupil/vision changes result from a chalazion, are how will be examine a chalazion on the conjunctival side of the lid? |
changes: no changes on conjunctival side: invert lid |
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how is chalazion tx, and what are pt education points & f/u? |
tx: warm & moist compresses, abx drops or ointments education: avoid touching eye, wash hands often, teach how to instill eye drops f/u: eval within a few days & refer to ophthalmology if not resolving |
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what is blepharitis, what will we find on physical exam, how will pupil/corneas react, how is dx made, and what is the tx? |
what: eyelid inflammation physical exam: scaling of eyelid margins accompanied by itching, burning, crusting, & redness of eyelid margins pupil/vision: no changes dx: based on hx and physical findings tx: topical antibiotic at first, clean eye margins to remove scales & reduce inflammation, warm compresses |
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how should the eyelid be cleaned during blepharitis? |
use a clean cotton ball soaked w/warm water & drop of baby shampoo/olive oil/hydrogen peroxide gentle scrub of eyelid with eye closed followed by rinsing w/warm water |
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what is the f/u for blepharitis? |
initially within a few days until cleared up, then in one to two weeks |
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what are the 3 types of conjunctivitis? |
viral bacterial allergic |
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what are the sx of viral conjunctivitis? |
watery discharge unilateral swelling rough cobblestone appearance on the palpebral conjunctiva |
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what are sx of bacterial conjunctivitis? |
thick and purulent discharge with crusting of lids worse in the morning upon awakening if eye is matter together in the morning then it is almost certainly bacterial |
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what are the sx of allergic conjunctivitis? |
discharge is often stringy chief complain is pruritis ALWAYS bilateral <== important |
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how is the dx made, what are the changes to cornea and visual, what is the pt's pain look like? |
dx: made upon hx and physical changes: none to corneal sensitivity or vision pain: none |
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what is an important differential for allergic and viral conjunctivitis, how does it present, and what is the tx? |
differential: Herpetic Keratitis presentation: herpetic lesions develop over a couple days, vision decrease, corneal sensitivity decreases, unilateral involvement, no blinking relfex in affected eye tx: refer immediately |
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how are bacterial, viral, and allergic conjunctivitis tx? |
bacterial: abx drops of ointments = aminoglycosides, polymyxin B combinations, flouroquinolones viral: warm compresses and abx if secondary infection starts allergic: oral antihistamines if other sx present, topical antihistamines for continual sx |
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what are pt education points for conjunctivitis? |
eye hygiene & frequent hand washing, stop wearing contacts & eye makeup, advise the pt keep up abx full course even if sx disappear |
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What is a subconjunctival hemorrhage, how does it present, how is the pt's pain, and what sort of changes happen to visual acuity? |
what: unilateral red eye with localized areas presentation: bright red pain: no pain & no discharge visual acuity: no change |
