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A comprehensive study guide for nurs 629 peds exam 2, covering key concepts and clinical scenarios related to pediatric eye and ear conditions. It includes detailed explanations of various conditions, assessment techniques, treatment options, and differential diagnoses. The document also features a series of questions and answers, allowing students to test their knowledge and prepare for the exam.
Typology: Exams
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VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Strabismus - correct answer Misalignment of the eyes. Lazy eye or cross-eyed. Results in loss of depth perception and double vision. Assessment techniques to detect strabismus - correct answer Red light reflex Cover-uncover test Deviation of the weak eye outward - correct answer Exotropia Deviation of the weak eye inward - correct answer Esotropia Visual axis of one eye is higher than the fellow fixating eye - correct answer Hordeolum - correct answer Sty; an acute infection of a sebaceous gland of the eyelid Obstruction of the sebaceous glands or eyelid. Staphylococcal aureus is the most common causative organism. What might a patient with a hordeolum complain of - correct answer Swollen, red, painful lesion on the lid margin Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Internal - under eyelid Painful swelling Typically develops suddenly Treatment for a hordeolum - correct answer Warm compresses-20 minutes qid Antimicrobial ointment or drops Good eye hygiene and hand washing
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Chalzion - correct answer Chronic inflammation of the eyelid. Blocked meibomian gland - may result from internal hordeolum. Often not painful but sensation of pressure. Develop over weeks to months. Clinical finding of chalzion - correct answer Mild erythema and edema of the eyelid that resolves and results in a painless, non-pigmented mass Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Treatment of chalzion - correct answer Erythromycin drops or ointment if hordeolum is present Cellulitis develops - treat with erythromycin or cephalexin Most important vital sign for a patient with an eye complaint - correct answer Visual acuity Peritonsillar abscess (PTA) - correct answer Collection of pus or fluid around the tonsil Symptoms of PTA - correct answer Increased fever Anorexia Drooling Dyspnea Restless & irritable Muffled voice Stridor
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Respiratory distress Physical exam findings of PTA - correct answer Fiery red asymmetric swelling of one tonsil Uvula is often displaced and often forward Large, tender lymphadenopathy Management of PTA - correct answer Aspiration of the abscess may be performed for accurate diagnosis and treatment. CT scan of the head and neck Monitor airway at all times ENT consult is essential Usual Management
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Children of smokers Acute otitis media epidemiology - correct answer 75% of cases are viral Pathogens are most likely S. pneumoniae, H. influenzae, M. catarrhalis H. influenzae - must treat with Augmentin (conjunctivitis + AOM) must treat with a topical antibiotic for the eye Symptoms of otitis media - correct answer Fever Pain Discharge from the ear Tugging or batting at the ear - can be a teething or a comfort thing Irritability, crying, lethargy Decreased appetitie - chewing & swallowing can increase pressure in the inner ear Decreased sleep Recent URI Signs of otitis media - correct answer Red, bulging TM Retracted with pus Decreased translucency of TM No movement of the TM Inability to see normal landmarks Occasionally - hole in the TM May not see TM if it has ruptured & there is pus & fluid Acute Otitis Media (AOM) - correct answer effusion in the middle ear that occurs suddenly and is associated with other signs of illness Otitis Media with Effusion (OME) - correct answer An amber-yellow drum suggests serum in middle ear that transudates to relieve negative pressure from the blocked eustachian tube. You may note an air/fluid level with fine black dividing line or air bubbles visible behind drum. Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also called serous otitis media (glue ear)
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Signs of OME - correct answer Bulgining TM Decreased or absent mobility of TM Amber fluid or appearance of TM Otorrhea AOM in patients < 6 months of age - correct answer Antibacterial therapy Criteria for antibacterial therapy for tx of AOM in patients 6 months - 2 years - correct answer Fever over 102F Bilateral infection Severe otalgia Longer than 7 days Criteria for antibacterial therapy for tx of AOM in patients > 2 years - correct answer Fever over 102F Bilateral infection Severe otalgia Longer than 7 days Treatment options for otalgia in AOM - correct answer Tylenol or ibuprofen Benzocaine (Auralgan, Americaine otic) Warm compresses Is it okay to not prescribe antibiotics for AOM in children? - correct answer Yes - in children with uncomplicated AOM (no fever or less than 102, unilateral, less than 7 days). Must teach parents what signs and symptoms to return for How to manage otalgia at home Follow-up plan in place Differential diagnosis for AOM - correct answer OME Mastoiditis
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Dental abscess Sinusitis Lymphadenitis Parotitis PTA Trauma TMJ 1st principal of management of AOM - correct answer Pain management Ibuprofen or tylenol Benzocaine Warm/cold compress of ears 1st line of treatment for AOM - correct answer Amoxicillin 80 - 90 mg/kg/day BID for 10 days If use of antibiotics for AOM in last 3 monthsm, antibiotic of choice? - correct answer Augmentin 80 - 90 mg/kg/day BID for 10 days If either Amoxicillin or Augmentin fail, referal to ENT Alternative antibiotic management of AOM if PCN allergy - correct answer 1st line: Cefdinir, cefuroxime 2nd line: Azithromycin, clarithromycin 3rd line: Rocephin 1 or 3 days IM Bullous Myringitis - correct answer Mycoplasma pneumonia
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) AOM in which bullae form between the inner and middle layers of the TM and bulge outward Intensely painful Treat with a macrolide When do you refer a pt for tympanostomy tubes? - correct answer Over 3 confirmed ear infections in 6 months OR 4 or more episodes in 12 months Treatment of children with AOM and tympanostomy tubes - correct answer Oral antibiotics + topical: Floxin otic (Ofloxacin) [1 yr - 12 yr] 0.3% - 5 gtts BID x 10 days Ciprodex (Cipro) [>6 months] 4 gtts BID x 7 days perforated tympanic membrane - correct answer Hole in eardrum Occurs in association with AOM Trauma - blow to ear, blasts, ear cleaning, FB insertion Perforated Tympanic Membrane s/s - correct answer Loss of hearing Blood drainage from the ear Pain Whistling sound when blowing nose or sneezing Spontaneous relief of pain w/ AOM What medications are NOT safe to give with a perforated tympanic membrane? - correct answer Gentamycin Neomycin Tobramycin What medications are SAFE to give with a perforated tympanic membrane? - correct answer Fluoroquinolones
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Cholsteatoma - correct answer Result of chronic ear infections Involves the formation of an epidermal inclusion cyst of the middle ear or mastoid As it grows, destroys the surrounding structures Acquired or congenital S/S vertigo, hearing loss,pearly white lesion on or behind TM Mastoiditis - correct answer Suppurative infection of the mastoid cells Most common in children < 2 y.o. Accompanies AOM Antibiotics for AOM may mask mastoiditis w/ normal TM S/S: fever, otalgia, concurrent AOM unresponsive to antibiotics, postauricular swelling Urgent ENT referral At what age should visual screening begin? - correct answer 4 Can use the objects chart or E chart If strabismus is still present at what age should they ber refered for intervention? - correct answer 6 months At what age:
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Sees and responds to change in light, fixes on contrasts, jerky eye movements, pupillary reflex present - correct answer Birth to 2 weeks At what age: Recognizes parent's smile, looks from near to far, focuses close again, beginning depth perception, follows 180 degrees, reaches towards toy, few exodeviations, esotropia abnormal - correct answer 3 - 4 months At what age: Color vision near that of an adult, tears present - correct answer 4 months At what age: Vision is close to fully developed - correct answer 12 months How to differentiate a hordeolum from a chalzion - correct answer Hordeolum - PAINFUL, ACUTE Chalzion - not painful, chronic What is ophthalmia neonatorum? - correct answer Conjunctivitis in the first month of life Neisseria: Occurs 3-4 days, copious discharge, marked chemosis, and can ulcerate and perforate cornea. Rx IM ceftriaxone w/ copious irrigation Chlamydia: 1 week, mild swelling, hyperemia, and papillary rxn (follicular later in life). Oral erythromycin HSV: Rare, presents in 2nd week of life Chemical: Mild self-limited irritation within 24h Most common cause of viral conjunctivitis - correct answer Adenovirus
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Symptoms of viral conjunctivitis - correct answer **Watery discharge - profuse & clear FB sensation Redness **URI symptoms common - sore throat & fever, preauricular lymphadenopathy Itchy conjuctiva Swollen eye lids **Often bilateral Treatment for viral conjunctivitis - correct answer Warm or cool compresses Strict eye hygiene Comfort Common causes of bacterial conjunctivitis (pink eye) - correct answer staph strep haemophilus neisseria Symptoms of bacterial conjunctivitis (pink eye) - correct answer **Purulent discharge Redness Swelling **Itching **No URI symptoms before hand **Unilateral at onset Treatment of bacterial conjunctivitis (pink eye) - correct answer Topical antimicrobials x 5- 7 days Warm compresses QID x 10 - 20 minutes Strict eye hygiene Close observation and f/u can develop into periorbital cellulitis, iritis, cyclitis, or choroiditis Medications used for treatment of bacterial conjuctivitis (pink eye) - correct answer Trimethoprim/Polymyxin (Polytrim) 4 gtts QID x 7 days Tobramycin 0.3% 1 - 2 gtts Q4 x 7 days
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Cipro 0.3% 1 - 2 gtts w/a x 2D then Q4 x 5 days What are the 4 types of allergic conjunctivitis - correct answer 1. Hay fever (mild injection & swelling)
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) prevents tears from flowing into the nasal mucosa opening dacryocystitis - correct answer inflammation of the nasolacrimal duct => can result in infection Symptoms of dacryostenosis - correct answer Continuous or intermittent tearing, stickiness, and mucoid d/c at inner canthus Blepharitis in lids & lashes Expression of thin mucopurulent exudate from punctum lacrimale Tenderness & swelling over lacrimal duct Eyelids stuck hut on awakening Fever Management of dacryostenosis - correct answer Warm compresses Use cotton balls w/ warm water & rub from inside of eye to out Daily massage of the lacrimal sac Resulting bacterial conjunctivitis - erythromycin ointment or fluroquinolones When to refer dacryostenosis? - correct answer If persists over 1 - 2 weeks w/ interventions What is blepharoptosis? - correct answer Drooping of the upper eyelids affecting one or both eyes Congenital or acquired What is nystagmus? - correct answer Involuntary, rhythmic movements of one or both eyes Movement can be horizontal, vertical, rotary, or mixed Congenital or acquired Present 6 wks - 3 months if congenital Pediatric Cataract - correct answer Partial or complete opacity of the lens - 1 eye or both Most common cause of abnormal pupillary reflex Congenital - genetic i.e. down syndrome or albinism, family hx Acquired - use of systemic or ocular corticosteroids, prematurity, CNS anomalies Retinopathy of Prematurity (ROP) - correct answer Primarily caused by early gestaional age w/ LBW
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Abnormal growth of the retinal vessels in incompletely vascularized retinas of premies Incompletely vascularized retina in state of hypoxia - > stimulates production of vascular endothelial growth factor (VEGF) Higher supplemental O2 causes slowed VEGF = slowed vessel growth What is blepharitis? - correct answer Acute or chronic inflammation of eyelash follicles or meibomian sebaceous glands Bilateral Contaminated makeup or contact lens solution Corenal abrasion and symptoms - correct answer Damage to or loss of epithelial cells of cornea Severe pain and photophobia Tearing Decreased vision Conjunctival erythema Sensation of FB Management of corneal abrasion - correct answer Minor abrasions heal spontaneously w/o scarring; topical anti-infectives; compresses Refer severe corneal injuries Otitis externa - correct answer Swimmer's ear- infection of outer ear Can involve the pinna or TM Most common pathogens of otitis externa - correct answer Pseudomonas & Staph
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Signs/Symptoms of otitis externa - correct answer Pain, severe, esp. w/ movement of the tragus (pushed) or pinna (pulled) Swollen EAC - may not be able to see TM which may be perf'd Red, crusty, or pustular speading lesions **Unilateral Low-grade fever Fullness Decreased hearing Differentials for otitis externa - correct answer AOM w/ perforation Chronic suppurative otitis media Necrotizing OE Mastoiditis Dental infection Eczema Herpes Zoster FB Treatment of otitis externa - correct answer Antibiotic ear drops; aminoglycoside or fluorquinolone +/- corticosteroid Avoid further moisture or ear injury Warm compresses NSAIDs/Tylenol Wick - if greater than 50% obstructed Auralgan - OTC benzocaine
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Diabetic or immunocompromised patients may develop malignant otitis externa (necrotizing infection extending into blood vessels, bone and cartilage) requiring hospitalization and IV ABX Prevention of Otitis Externa - correct answer Avoid prolonged exposure to moisture Eliminate self-inflecting trauma to canal w/ cotton swabs & other foreign objects Use ear plugs when swimming Mixing 1 drop of alcohol w/ 1 drop of white vinegar - after ears get wet. Good tip for surfers Blow dryer to ears after getting them wet What factors should be considered when choosing the otic drop for otitis externa - correct answer - efficacy
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025)
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025)
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) What stage of tonsilar swelling are most children at? - correct answer 3 Should a patient who is drooling, having difficulty breathing, and exhibiting stridor be examined? - correct answer No, send directly to the ER w/o an exam Pharyngitis - correct answer inflammation of the throat or pharynx Most common cause is viral or group A beta hemolytic strep Usually has URI symptoms Complications of pharygnitis - correct answer PTA RF Post-streptococcal glomerulonephritis How does mono differ from strep? - correct answer Usually no URI symptoms Fever N/V Rash Exposure to someone with mono Abd exam - check for liver or splenic enlargement Diagnostic tests for pharyngitis - correct answer Rapid antigen strep and culture for strep Mono spot if suspected & strep negative CBC w/ diff & LFTs if suspect mono Exudative pharyngitis - correct answer the white stuff! common in strep S/S of exudative pharyngitis - correct answer Rapid onset of sore throat Fever 103 - 104 Swollen anterior glands Children c/o abd pain, dec. appetitie, & vomiting
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) HA No URI symptoms Dysphagia Irritability Physical exam findings of exudative pharyngitis - correct answer Strawberry tounge Rash Exudate on tonsils Anterior cervical lymphadenopathy Management of exudative pharyngitis - correct answer Throat culture -- gold standard Quick strep Mono spot if suspect mono - usually more exudate then strep 50% of kids w/ mono also have strep Treatment of strep pharyngitis - correct answer Amoxicillin 50 - 80 mg/kg/day x 10 days If PCN allergy - cephalosporin or macrolide (1st choice) Warm water gargles Tylenol/NSAIDs Contagious! No school until on antibiotic for full 24 hrs What is the classic triad for the acute viral syndrome of Mono? - correct answer Fever Exudative pharyngitis Adenopathy (posterior cervical) S/S of mononucleosis - correct answer Fever, sore throat, swollen lymph glands, increased WBC, atypical lymphocytes, splenomegaly, enlarged liver
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Headache is usually the 1st symptom that appears before sore throat How long does mono last? - correct answer 3 - 4 week but can be up to 2 - 3 months Can adolescents go back to playing sports within 24 hours with mono? - correct answer Not if they have spleen enlargement. Must wait until spleen is no longer enlarged. Diagnostics for mono - correct answer Mono spot - 90% positive of cases May need to repeat if initially negative but symptoms persist. CBC LFTs Rapid strep EBV specific antibodies - VCA-IgM, VCA-AgG, EA, & EBNA Should concurrent strep with mono be treated with amoxicillin or PCN? - correct answer No, avoid rash by treating with erythromycin or a macrolide How frequently should a mono patient follow-up? - correct answer Every 1 - 2 weeks until symptoms have resolved. Thrush (oral candidiasis) - correct answer candidiasis of mouth characterized by white, creamy patches of exudate on inflamed oral mucosa and tongue Common in breast fed patients, immunocompromised patients, or patiens who use inhaled corticosteroids Physical exam findings of thrush - correct answer Friable, adherent white plaques that won't scrape away Cracked lips Fissured and inflamed corners of lips Treatment for thrush - correct answer Nystatin suspension QID until patches are gone for 1 - 2 days
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Breastfeeding mother should put solution on nipples to prevent reinfection Ankyloglossia (tongue tie) - correct answer developmental anomaly characterized by a shortened lingual frenum that limits movement of the tongue. Can cause speech problems, periodontal defects, and problems with breast feeding. More common in males Treatment of Ankyloglossia - correct answer frenectomy observation - depending on severity What are the 2 most common keratolytics used in the 1st line treatment of mild acne? - correct answer Benzoyl peroxide Retinoic acid Oral retinoid used to treat nodulocystic acne not responsive to other treatments? - correct answer Isotretinoin (acutane) Topical antibiotics for acne - correct answer Abx (clindamycin, erythromycin, & sufacetamide) ↓ P. acnes and ↓ inflammation; well tolerated, MUST USE WITH BENZOYL PEROXIDE (or else tolerance) Oral antibiotics for acne - correct answer Tetracycline, Amoxicillin/Ampicillin, Doxycycline, Minocycline, Septra, Erythromycin What is impetigo? - correct answer Contagious bacterial infection marked by clusters of small blisters Has 2 forms:
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Signs/Symptoms of impetigo - correct answer Classic signs and symptoms of impetigo:
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025)
than 1 cm Vesicle - correct answer Fluid-filled < 1 cm Pustule - correct answer Raised spot on the skin containing pus < 1 cm Plaque - correct answer Raised, palpable a solid mass greater than 1 cm in diameter and limited to the surface of the skin Bullae - correct answer fluid filled blisters 1 cm Cyst - correct answer Raised, encapsulated, fluid-filled
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Wheal - correct answer raised red skin lesion due to interstitial fluid Circumscribed skin edema Crusts - correct answer Areas of dried pus and blood, commonly called scabs Varied colors Scales - correct answer Thin, flaking layers Lichenification - correct answer Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen). Furrows. Excoriation - correct answer Abraision or removal of epidermis, scratch or abraision Erosion - correct answer Oozing, moist area with loss of superficial epidermis Ulcer - correct answer Deeper than erosion with loss into the dermis What defines a throat infection? - correct answer - Temp >100.9F
3 Infections/yr x 3yrs
VERIFIED SOLUTIONS ( ALREADY GRADED A+)(2024-2025) Virus-specific findings of a common cold - correct answer Mild injection of conjunctiva Red nasal mucosa w/ secretions of varying colors Mild erythema of the throat Anterior cervical lymphadenopathy Clear breath sounds Differentials for URI - correct answer Allergic rhinitis Rhinosinusitis Adenoiditis Treatment for URI - correct answer Symptomatic relief for fever, pain, and nasal congestion Acute Rhinosinusitis (ARS) - correct answer Persistent nasal symptoms for more than 10 days w/ URI, nasal drainage (purulent or discolored), cough Acute presentation w/ high fever, purulent rhinitis Lasts 10-30 days Treatment for ARS - correct answer Amoxicillin or Augmentin x 10 days Should be asymptomatic by day 7 If no change by 48 - 72 hours after start of antibiotics change tx of antibiotic Symptoms of viral pharyngitis - correct answer Pain Myalgia and arthralgia Fever Sore throat and dysphagia Rhinitis, cough, hoarseness, stomatitis, stridor, and conjunctivitis Non-specific rash or diarrhea Physical exam findings for viral pharyngitis - correct answer Erythema of the tonsils and pharynx