EENT Nursing Study Guide: Comprehensive Review of Eye, Ear, Nose, and Throat Disorders, Exams of Nursing

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EENT NURS 5433 MODULE 1

COMPLETE STUDY GUIDE ALL

CHAPTERS INCLUDED.

id OTC vasoconstric-

elid)

tching, tearing,

czema, allergies, lice

borrhea, immuno-

anterior eyelid, loss

if d/t meibomian

may fill with pus

ase of eyelash

gin; attects hair

1. Glaucoma management -prevention (first) CORRECT ANSWERS IOP measured in yearly eye exams, avo tive ocular agents and anticholinergic agents
2. Blephatitis definition CORRECT ANSWERS inflammation of the eyelid
3. Blepharitis Ulcerative form s/s CORRECT ANSWERS (lash follicle in the meibomian glands of the ey s/s CORRECT ANSWERS pustules base of hair follicles that crust and bleed, lashes can become thick and break easily, i chalazia, recurrent styes, photophobia, small ulcerations at the eyelid margin
4. Blepharitis Non-ulcerative form associated with CORRECT ANSWERS psoriasis seborrhea, e infestations, trisomy 21, chemical or environmental irritants, eye makeup, contact lenses
5. blepharitis risk factors CORRECT ANSWERS dry eye, frequent hordeolum or chalazium, facial or scalp se compromised state, acne, diabetes, and use of retin-A
6. Blepharitis Seborrheic s/s CORRECT ANSWERS chronic inflammation eyelid, erythema, greasy scaling of of lashes, and sebborrheic dermatitis of eybrows and scalp
7. Blepharitis treatment CORRECT ANSWERS warm moist compresses and lid scrubs with baby shampoo, ( glands) massage gland, no contacts
8. Blepharitis pharm CORRECT ANSWERS antibiotic ointments CORRECT ANSWERS (start with) bacitracin, erythromycin, and quinolone

(no results or resistant infections) oral antibiotics CORRECT ANSWERS (First line) doxycycline 100mg PO BID or Tetracycline 250 mg 4 times daily

9. Hordeolum Definition & s/s CORRECT ANSWERS (stye) small glands that line the eyelid get plugged & s/s CORRECT ANSWERS erythema, tenderness and sometimes exudate. pearl- inflammation of sebaceous glands at b
10. External hordeolum (stye) cause CORRECT ANSWERS inflammation and infection of the eyelid mar follicles and eyelashes.

-can cause blindness -fluorescein stain w/ positive dendrites -referred immediately to an ophthalmologist

st

arl- ocular

uorescein

ve object

sation, corneal

onal CORRECT

ANSWERS IgE

mediated/

ulfacetamide 10%,

ompresses, discard

20. Patient presents with eye problems, first action is CORRECT ANSWERS visual acuity test CORRECT ANSWERS Snellin te

-if there's any visual acuity changes at all, these patients need to be referred out to an ophthalmologist. pe foreign body assessment CORRECT ANSWERS visual acuity both eyes, next exam w/ slit lamp or binocular loupe or pen light, next fl stain (last part of exam to assess corneal defect); lid eversion foreign body CORRECT ANSWERS flip eyelid w/ cotton swab, remo w/ wet cotton swab

21. Conjunctivitis CORRECT ANSWERS Red flags CORRECT ANSWERS diminished visual acuity, photophobia, foreign body sen

opacity, fixed pupil, severe headache -pear (all above, referral)

22. Allergic Conjunctivitis pharm and management CORRECT ANSWERS -decongestant antihistamine drops CORRECT

ANSWERS Naphcon -A, Vasocon-A -mast cell stabilizers CORRECT ANSWERS Palatal or Optivar -(first line) prevention, avoid allergen triggering conjunctivitis Pearl-plan of care; Intermittent/seas triggers CORRECT ANSWERS April/may- tree pollens; June/July- grass pollens; July/august- mold spores and weed pol (perennial) CORRECT ANSWERS IgE mediated/ common trigger CORRECT ANSWERS house/dust mites

23. Bacterial Conjunctivitis pharm and management CORRECT ANSWERS -antibiotic drops CORRECT ANSWERS S

Tobramycin, Ciprofloxacin, Ofloxacin, Moxifloxacin, Gatifloxacin pearl-plan of care

24. Viral Conjunctivitis pharm and management (Chlamydial and gonococcal) CORRECT ANSWERS -

-systemically and topically -Systemic CORRECT ANSWERS penicillin and doxycycline -Occular CORRECT ANSWERS managed by ophtomologist (Gentamicin, Ofloxacin, Norofloxacin, tetracycline)

-hand hygiene, clean washcloth every time, change the pillowcases, warm compresses alt w/ cool c old contacts and eye makeup (discard q30 days) pearl- plan of care; common outbreaks are d/t S. pneumonia (most are resistant to tobramycin & gentamicin); "pink eye" caused by adenovirus

32. Corneal abrasion and erosion diagnostics CORRECT ANSWERS -visual acuity (first)

-fluorescein stain (in oflce)

ells after trauma or

thelial defect

ockers, Oxybutynin)

-culture and sensitivity (suspected infection) -intraoccular pressure (in oflce, prior to referring out) -ophthalmology referral

33. Corneal abrasion definition CORRECT ANSWERS partial or complete defect in epithelial layer of the c sun exposure

34. Corneal erosion diagnostic CORRECT ANSWERS involves underlying stromal layer in addition to epi

35. Corneal abrasion and erosion management & pharm CORRECT ANSWERS -prevention CORRECT ANSWERS protective eye

wear -smaller corneal abrasion is smaller managed in a primary care setting. -(Infected) antibiotics CORRECT ANSWERS (start with) Ciprofloxacin drops ofloxacin drops, tobramycin oint., erythromycin oint -if not healed within one or two days or erosion= referral -superficial corneal and conjunctival foreign bodies can be removed by PCP -patches no longer used

36. corneal complication chart CORRECT ANSWERS

37. Dry eye causes CORRECT ANSWERS -acquired or congenital

-acquired disorders CORRECT ANSWERS Sjogren's syndrome, infection (form of conjunctivitis) and trauma (facial nerve or palsy) -Bell's palsy (damage facial nerve and cannot close eyelid) -medications cause decrease tear production CORRECT ANSWERS anticholinergic (antihistamines, beta-adrenergic bl -Menopausal (lack of estrogen)

• long time computer usage (decreases blink rate-> decrease tear production)

38. Dry eye management & pharm CORRECT ANSWERS -Level one CORRECT ANSWERS avoid cause/irritant; artificial tear substitutes, lubricants,

10 / 32

by ophthalmologist

wn, causing vision

ment of health

es, red eye, acute

lete cure)

teroids, or topical systemic omega-3 fatty acids), restasis for chronic (cyclosporine)

-Level three CORRECT ANSWERS autologous serum, special contact lenses, impermanent punctual occlusion, managed

-Level 4 may require surgical intervention CORRECT ANSWERS grafting mucous membrane or transplant of salivary gland ducts

39. Cataracts definition & causes CORRECT ANSWERS -Proteins and fibers in the lens begin to break do to become hazy

or cloudy -90% age related, excess exposure to sun (UVB), congenital, metabolic, traumatic

40. Cataract s/s CORRECT ANSWERS -opacification of the lens decreases visual acuity -pearl

-diminished red reflex -Leukocoria (white reflex) -blurred vision, halo around lights, diminished night vision, diminished visual acuity, glare

41. Cataract management CORRECT ANSWERS -prevention CORRECT ANSWERS UV protective eye wear, control diabetes,

manage conditions, decrease alcohol intake, and smoking -ophthalmologist referral -most common medicare covered surgery in US

42. Dacryostenosis definition & cause CORRECT ANSWERS -obstruction in the nasolacrimal duct

-most common cause of epiphora and ocular discharge in a newborn -congenital or infection -congenital CORRECT ANSWERS inferior turbinate fails to completely canalize in a newborn infant -infection CORRECT ANSWERS staph or strep

43. Dacryostenosis s/s CORRECT ANSWERS -epiphora (persistent overflow of tears in lower lid), crusting lash distention and

inflammation of lacrimal sack region -mucus reflux through punctum when the when pressure's applied

44. Dacryostenosis management CORRECT ANSWERS -(first choice) massaging lacrimal duct BID

-Antibiotic drops(infecion) -Usually in a new born you can clear this up with the lacrimal duct massage

-If it does not clear, referral ophthalmologist (duct probing- open duct and insert a catheter, comp

45. Hyphema definitions & causes CORRECT ANSWERS -hemorrhaging to interior chamber of eye, iris or cililary body rupture

mmHg; 25 or greater

ence)

umor outflow; side

ngle rarely have

around light,

50. Glaucoma definitions & causes CORRECT ANSWERS -progressive damage to optic nerve-> atrophy and blindness pearl- optic neuropathy; second

leading cause blindness (after cataracts) -elevated intraocular pressure Pearl-characterized by IOP, but does not have to be accompanied by IOP -forms CORRECT ANSWERS open angle or angle-closure, primary or secondary, congenital is primarily a problem with -Risk factors Open angle CORRECT ANSWERS DM, African American, family history -age, Incr IOP, positive FH -Risk factors close angle CORRECT ANSWERS hyperopia (near objects blurry-farsighted), small corneas pearl- family, age >60, female, antihistamines, phenylephrine, HCTZ, TMPS, TCA, BB *Caution w/ anticholinergic eye drops (can increase interocular pressure)

51. Glaucoma ocular pressure diagnostics CORRECT ANSWERS -open angle and angle closure glaucoma problem w/ excessive interocular

pressure above 25mmHg -angle closure CORRECT ANSWERS abnormal measurement is usually documented on more than one occasion -fundoscopic exam CORRECT ANSWERS optic disc and cup are pushed in; ratio will be greater than 0. **If papilledema is present= ocular emergency -tonometer (measure intraocular pressure) CORRECT ANSWERS average three readings; normal pressure is 10 to 23 is close angled glaucoma pearl- normal IOP= 9-23mmHg; inadequate drainage of aqueous humor lead to incr IOP; rapid rise pressure s/s CORRECT ANSWERS red conjunctiva, corneal cloudiness, shallow anterior chamber, mid-dilated pupil (4-6mm, react poor to light)

52. Open angle Glaucoma Pharm CORRECT ANSWERS -beta blocker drops CORRECT ANSWERS betaxolol, carteolol, livobunolol, metipranolol,

timolol (decreasing aqueous humor; few side ettects but if enough systemic absorbed can experi -prostaglandin analogs CORRECT ANSWERS latanoprost, travoprost, bimatoprost, and tafluprost (increasing aqueous h ettects brown pigmentation of iris) -Laser surgery CORRECT ANSWERS (if meds don't work; attective only in first several years after surgery) pearl- open a symptoms

53. Angle-closure glaucoma pharm CORRECT ANSWERS -Acute attack to lower intraoccqular pressure CORRECT ANSWERS Diamox and IV

mannitol w/ topical biotic (pilocarpine) -ophthalmologist management -Surgical CORRECT ANSWERS laser iridotomy or peripheral iridectomy -bed rest until this is taken care of pearl- closed angle have acute symptoms; s/s CORRECT ANSWERS decr vision, halo headache, eye pain, N/V

ght loss, manage BP

t

der than 60

istortion or loss of

sion corrects is un-

spots)

a

ategies for prevent-

e, and is the second

54. diabetic retinopathy CORRECT ANSWERS -uncontrolled DM; 3 stages

-stage 1 CORRECT ANSWERS background -stage 2 CORRECT ANSWERS preproliferative -stage 3 CORRECT ANSWERS Proliferative -visual changes -fundoscopic exam CORRECT ANSWERS microaneurysms, intra-retinal hemorrhage, macular edema, and lipid deposits; Nerve fiber layer infarctions ("cotton wool spots"), venous beading and dilation, edema, sometimes retinal hemorrhage

55. diabetic retinopathy management CORRECT ANSWERS -Prevention (first goal) CORRECT ANSWERS maintain BS, wei

-(only agent found to slow progression) lisinopril -Laser surgery (main treatment) w/ proliferated or significant macular edema is the main treatmen

56. Macular degeneration CORRECT ANSWERS wet vs dry CORRECT ANSWERS -leading cause of blindness in patients ol

-Dry CORRECT ANSWERS slow progressive atrophy and degeneration of retina -Wet CORRECT ANSWERS age related; new blood vessels develop under the retina in the macula, and causes sudden d central vision; referral needed; progressive, usually end up blind

57. macular degeneration diagnostics CORRECT ANSWERS -pinhole test (vision less than 20/20) CORRECT ANSWERS vi

corrected refractive error. -Fundoscopic exam CORRECT ANSWERS normal w/ refractive error

58. macular degeneration early vs late phase CORRECT ANSWERS -Early CORRECT ANSWERS drusen (yellow round

-Late CORRECT ANSWERS clumps of pigment and irregularly interspace w/ depigment areas of atrophy in the macul

59. macular degeneration management and pharm CORRECT ANSWERS -Initial CORRECT ANSWERS

noproven str ing, and no treatments -intermediate stages CORRECT ANSWERS high dose antioxidant, vitamins, zinc -Thermal laser photocoagulation for certain forms of wet AMD but studies show limited value

60. Otitis Media definition & types CORRECT ANSWERS -inflammation of the middle ear due to any caus most common

disease diagnosed in young children -acute otitis media and otitis media with ettusion.

drainage (if the

een behind the

s pneumoniae), or

ns

rhinitis or any

n

62. otits media diagnostic CORRECT ANSWERS -Pneumatic otoscopy CORRECT ANSWERS decreased tympanic membrane mobility, distorted land-

marks, displacement of light reflex and a cloudy, dull, opaque or erythematous tympanic membrane

63. otitis media causes CORRECT ANSWERS -Strep pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. (These pathogens are also the

three most common causes of sinusitis as well)

64. Otitis media w/ purulent material CORRECT ANSWERS -otitis media with the purulent material s tympanic

membrane -otitis media with ettusion CORRECT ANSWERS fluid collection w/o infection -no antibiotics

65. Myrintitis during acute otitis media CORRECT ANSWERS -viral, bacterial (particularly Streptococcu mycoplasmal

otitis media. -Pain occurs suddenly and persists for 24 to 48 hours. -Hearing loss and fever (bacterial) -Diagnosis CORRECT ANSWERS otoscopic visualization of vesicles on the tympanic membrane

66. Acute Otitis Media w/ Perforation Drainage CORRECT ANSWERS

67. Acute Otitis Media causes & prevention CORRECT ANSWERS -breastfeeding and immunizatio

-exposure to tobacco smoke, daycare attendance, younger siblings in the home, poverty, allergic condition that causes mucous or congestion in the nasal passages, bottle feeding while lying dow

68. Otitis media CORRECT ANSWERS -observation for about 48-72 hrs

-About 75% of cases resolve spontaneously in about seven days. -If child is symptomatic 48-72 hrs, or they are getting worse, antibiotics -Amoxicillin, 80-90 mg/kg/day (first) -amoxicillin/clavulanate -2nd cephalosporins CORRECT ANSWERS Cefuroxime

-3rd cephalosporin CORRECT ANSWERS Cefpodoxime, Cefdinir, IM Rocephin 50mg/kg (up to 1g single dose) -use azithromycin or clindamycin- penicillin allergy -high incidence of resistance with macrolides

-gentamycin opthlamic (1mo +) 1-2 drops q4hr

s, ataxia, vertigo.

eripheral vestibular

rinthitis, obstructed

ertebrae disorders,

75. peripheral vertigo causes CORRECT ANSWERS -90% of cases

-Otogenic CORRECT ANSWERS Meniere's Disease, infections of the inner ear or mediated inner ear infections, otitis, laby eustachian tubes or benign paroxysmal positional vertigo (BPPV) -Toxic CORRECT ANSWERS excessive alcohol ingestion, potent diuretics and autotoxic drugs

76. Environmental vertigo causes CORRECT ANSWERS noise, bright lights, and also motion sickness

77. Central Vertigo causes CORRECT ANSWERS -migraine (most common), TIA, or postural hypotension

78. Neurologic Vertigo causes CORRECT ANSWERS -multiple sclerosis, temporal lobe seizures, cervical v syphilis, acoustic

tumors, and brainstem or cerebellar vascular lesions

79. Other Ideologies Vertigo causes CORRECT ANSWERS hypothyroidism and psychiatric illness

80. Vertigo diagnostics CORRECT ANSWERS -H&P, neurologic exam, check hearing

-Lab CORRECT ANSWERS CBC (rule out anemia), TSH (rule out hypothyroidism), syphilis serology, fasting glucose (rule out hypoglycemia) -Bithermal caloric testing (evaluating unilateral vestibular deficits) -auditory brainstem response (rule out acoustic neuroma) -CT/MRI (rule out central lesions) -Dix Hallpike maneuver (diagnose BPPV) -ENG (ditterentiate center and peripheral lesions)