EENT Study Guide for Module 4 PDF

**Study Guide for Module 4** **EENT** **Emergent Eye Conditions: Floaters associated with flashing lights, a black curtain covering part of the visual field, or decreased vision could represent serious disease, such as a retinal detachment, and should be urgently evaluated by an ophthalmologist.**...

**Study Guide for Module 4** **EENT** **Emergent Eye Conditions: Floaters associated with flashing lights, a black curtain covering part of the visual field, or decreased vision could represent serious disease, such as a retinal detachment, and should be urgently evaluated by an ophthalmologist.** **Scleritis is a more serious condition that can be vision threatening and is often related to an underlying autoimmune disorder. Scleritis produces a boring sensation of pain, and the eye is exquisitely tender to palpation. Patients with possible scleritis should be promptly referred to an ophthalmologist.** **\*\*\*\*treatment of bacterial conjunctivitis with steroids may exacerbate the infection, and steroid use with a corneal abrasion or ulcer may lead to corneal melting and serious visual consequences. Similarly, treatment of herpetic keratitis with an antibacterial may delay appropriate therapy and lead to potentially serious consequences** **\*\*\*\*The health care provider should not hesitate to refer patients to an ophthalmologist when treatment does not produce the expected result or when the diagnosis remains obscure.** **\*\*\*\*** **Any patient reporting new-onset visual distortion or a change in previously noted metamorphopsia should be referred to an ophthalmologist** **\*\*\*\*** **If floaters occur suddenly or increase in frequency or quantity, urgent referral to an ophthalmologist is necessary. These symptoms may indicate the presence of a posterior vitreous detachment, primary vitreous hemorrhage, retinal tear, or retinal detachment.** **[Eyes]** 1. **Based on clinical presentation, distinguish between blepharitis and conjunctivitis.** Blepharitis and conjunctivitis are similar, but they affect different parts of the eye. Blepharitis affects the oil glands, eyelashes and eyelids. Conjunctivitis affects the conjunctiva, thin membrane that covers the white of the eye, and the inside of the eyelid. **Blepharitis --** **Subjective:** Ocular burning, pain, foreign body sensation (Gritty), tearing, photophobia, itching, redness, discharge, and swollen erythematous eyelids, often worse in the morning. Remission and exacerbations **Conjunctivitis: Pink eye -- Viral, Bacterial, Allergic** - Viral -- self-limited lasting 5-14 days. Supportive treatment with artificial tears. Contagious if they are tearing. - Bacterial -- High risk patients may require treatment with trimethoprim polymyxin B or fluroquinolone drops. - Allergic -- supportive care, preservative artificial tears, eliminate allergen. 2. **List pharmacological and non-pharmacological management of a patient with blepharitis.** **Non pharm:** Warm compresses; daily lid scrubs; erythromycin or bacitracin ophthalmic ointment for anterior blepharitis. Lid hygiene is the mainstay of all blepharitis treatments. Warm compresses over both eyelid margins for 5 to 10 minutes loosen lid margin debris and remove secretions. After use of the compresses, patients may use commercially available lid scrub kits or warm water with diluted baby shampoo on a cotton tip applicator at the lid margin to decrease bacterial colonization. **Pharm:** Antibiotic ointment, erythromycin or bacitracin or 0.3 tobrex BID 3. **Discuss patient teaching to be included for a patient with a hordeolum.** Hordeolum: acute infection and inflammation of one of the glands in the eyelid (stye) hordeolum is often acute, tender, warm, and erythematous. Chalazion -- chronic, sterile, nontender lipogranulomatosis inflammatory lesion of the meibomian gland (stye) 4. **Discuss the evidence-based treatment for treating hordeola with steroids/antibiotics.** Not indicated for hordeola unless the hordeola becomes a chalazion then antibiotic is not indicated but Intralesional corticosteroid injection is effective. 5. **Name 3 types of conjunctivitis.** Viral -- Adenovirus Allergic -- Hay fever Bacterial -- Staph aureus most common in adults. H influenza, strep pneumoniae, gonococcal and chlamydia. 6. **What is the most common causative organism in bacterial conjunctivitis?** Staph aureus in adults. H. Influenza and strep pneumonia in children 7. **Discuss common risk factors of conjunctivitis.** 8. **Discuss various scenarios when an APRN should consider referral for a patient diagnosed with conjunctivitis.** Vison loss Culture grows out MRSA or STI Refer contact wearers Immunocompromised Ciliary flush -- red ring around cornea 9. **What if any diagnostics are included in the management of a patient with suspected conjunctivitis?** If STI or MRSA suspected culture and sensitivity or PCR Through PE and medical history **[Ears]** 1. **Discuss the management of a patient diagnosed with mild to moderately infected piercings.** 2. **What are common risk factors for otitis externa?** Too much cleaning Immunocompromised Swimmers Warmer weather 3. **List objective data for the patient with suspected otitis externa. -- 90% are bacterial pseudomonas and staph / 10% fungal** Pain with tragus palpation and on repositioning the auricle Canal red and swollen, filled with debris and slough Enlargement of per auricular lymph nodes TM may be red 4. **Discuss patient teaching for the patient diagnosed with otitis externa.** Treatment includes -- Acetic acid (inhibits growth of pathogens) and Hydrocortisone 1% drops Bacterial -- otic drops -- TM not intact fluroquinolones / aminoglycosides (cortisporin) in TM intact 5. **Discuss complications of otitis externa.** Invasive osteomyelitis - immunocompromised Facial paralysis cranial nerve abnormalities Malignant otitis externa 6. **What are the 2 most common causative organisms for otitis media?** Strep pneumonia H influenza 7. **List the subjective data in a patient with otitis media.** Rapid onset otalgia worse in prone position Vertigo Mild stuffiness Fullness or popping Fever Tinnitus Recent URI 8. **Describe the ear exam of a patient with otitis media. This is objective data.** Bulging red TM / Cream (puss) to grey or red 9. **Discuss the pharmacological management for a patient with otitis media.** Amox 500mg q12 5-7 days or Augmentin Z pack - Azithro 500 mg of clarithromycin 500mg 10. **What are the complications of otitis media?** Perforated ear drum Otitis media with effusion -- pain free watch and wait / noninfectious 11. **Discuss various scenarios that would prompt an APRN to consider transfer of care in the patient with otitis media.** 12. **What patient education is essential for the patient with otitis media?** **[Nose]** 1. **Discuss the pathophysiology of rhinitis.** Allergen triggers the production of antibody IgE 2. **What differential diagnoses are essential when considering rhinitis in a patient?** Nasal-septal trauma Substance abuse Masses or tumors 3. **List subjective and objective data for the patient with rhinitis.** Subjective: Clear rhinorrhea Itchy watery eyes Nasal congestion Sneezing Afebrile Hx may include "allergies" Objective: Eyelid swelling Lower lid venous stasis Pale, boggy, nasal mucosa Swollen nasal turbinates 4. **List the pharmacological management for the patient diagnosed with rhinitis.** Intranasal steroids 5. **What patient teaching is essential for the patient with rhinitis?** Avoid triggers Saline spray Environmental control factors Use of nasal inhaler 6. **Are there complications for the patient with rhinitis?** Increase asthma Sleep apnea sinusitis 7. **Discuss pathophysiology and risk factors for epistaxis.** 8. **Discuss the management of a patient with epistaxis.** Tilt head forward, apply pressure to anterior portion of nose, referral if still bleeding in 15 minutes. 9. **Discuss patient education for the patient with frequent epistaxis episodes.** 10. **Are there complications associated with chronic epistaxis?** Anemia 11. **Differentiate between a patient with rhinitis and one with sinusitis.** Sinusitis is usually febrile Rhinitis is typically allergen Sinusitis is infection 12. **What element is key in making the diagnosis of sinusitis?** ABRS has three cardinal symptoms: mucopurulent discharge, nasal obstruction, and facial pain or pressure. Four cardinal signs for CRS; purulent nasal discharge, nasal obstruction, facial pain, and loss of smell lasting more than 12 weeks. 13. **Provide education to a patient on the proper way to use nasal steroids.** Shake the bottle, bend the neck forward slightly, point nozzle away from septum, avoid hard sniffing **[Throat]** 1. **What differential diagnoses should we consider when caring for a patient with suspected pharyngitis?** Infectious mono Tonsilitis Allergies Thrush Peritonsillar cellulitis/abscess Pharyngeal abscess Epiglottitis URI STI HIV 2. **Discuss key findings that assist the APRN in distinguishing between bacterial and viral pharyngitis.** Viral: Sudden onset Fever Malaise & myalgias Cough Headache Fatigue May have rhinitis, conjunctivitis, congestion & sputum w/cough Negative rapid Group A strep Bacterial Acute onset sore throat Painful swallowing Fever w/chills Headache Nausea/vomiting May have abdominal pain Positive rapid Group A strep 3. **Discuss the pharmacological management of caring for a patient with viral and bacterial pharyngitis.** Viral NSAIDS Throat lozenges Corticosteroids Bacterial PCN x10 days PCN allergy Azithromycin, clarithro or clinda 4. **What diagnostics are available for use when suspecting pharyngitis in a patient?** Group a strep swab and culture 5. **List the common complications with pharyngitis.** 6. **Discuss scenarios that would prompt a referral for a patient with pharyngitis. To whom should they be referred?** 7. **List subjective and objective data present in a patient with infectious mononucleosis.** Gradual onset Anorexia Marked fatigue Malaise Fever, Pharyngitis Lymphadenopathy White to gray or green exudate diffuse Petechiae on hard-soft palate junction Mono is more generalized in tonsils Kissing tonsils NO COUGH Gargle with lidocaine, fluid and rest 8. **List complications of infectious mononucleosis.** Liver and spleen injury 9. **Discuss the pathophysiology of aphthous ulcers.** Canker sores Viral in nature Herpes simplex is most common Can be bacterial in form of gingivitis May be candidiasis. May be autoimmune in nature 10. **List factors that put a patient at risk for aphthous ulcers.** Stress Trauma Vit B 12 deficiency Poor oral hygiene Oral thrush Ill-fitting dentures Underlying disease 11. **Discuss the clinical presentation in the patient with aphthous ulcers. This would be our subjective and objective data.** Subjective: Painful ulcerations Difficulty chewing Objective: Round or oval ulcers White, yellow or gray membrane Located on buccal mucosa, lateral and ventral tongue. Can be on the floor of the mouth, soft palate, or oropharynx 12. **Discuss the recommended treatment for patients with aphthous ulcers.** 13. **Discuss patient teaching essential for patients diagnosed with aphthous ulcers.**