Western Governors University D118 Quizlet PDF

BACK TO SET Done Title D118 Add a description... Course name Western Governers University · Salt Lake City, UT Import Add diagram Create from notes 1 Schizophrenia Diagnosis: TERM Schizophrenia and psychotic disorders lack definitive diagnostic tests, necessitating the exclusion of organic causes of psychosis. Essential diagnostics encompass blood chemistries, hepatic and renal studies, thyroid function tests, complete blood count, syphilis, HIV screening, and substance testing. Imaging like CT or MRI aids in ruling out structural causes. Additional tests like EEG and heavy metal panels may be indicated. Hospitalization referral is necessary for exacerbations of negative or psychotic symptoms and increased agitation. Positive symptoms should persist for at least 1 month, with social and occupational dysfunction for 6 months. Psychiatric differentials include bipolar disorder and severe depression with psychotic features, distinguished by the temporal relationship between mood disturbance and delusions. Substance use disorders are common in schizophrenia. In older adults, acute illnesses like UTIs and dementia can mimic psychosis. NP nurses must understand diagnostic pathways, including medical, psychiatric, and IMAGE substance-related factors, ensuring comprehensive care for patients. Medications such as antipsychotics (e.g., risperidone, olanzapine) are fundamental in managing symptoms. DEFINITION 2 Anxiety Symptoms: TERM Anxiety Disorders necessitate immediate referral to the emergency room for individuals posing a risk to themselves or others. These disorders, affecting a third of the population during their lifetime, manifest through excessive and persistent worry, fear, and disabling anxiety. Women are more susceptible than men, with various disorders emerging at different life stages. The DSM-5 classifies anxiety disorders into several categories including Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, and Generalized Anxiety Disorder (GAD). Neurobiologically, anxiety involves the amygdala, HPA axis, and neurotransmitter systems like serotonin and GABA. Gene-environment interactions also contribute to vulnerability. In clinical practice, anxiety disorders present with physical symptoms alongside psychological distress, often leading individuals to seek help in primary care settings. Generalized Anxiety Disorder, marked by persistent worry and associated symptoms, typifies chronicity. Specific Phobias, Panic Disorder, and OCD entail distinct symptomatology and impairment. The DSM-5 revisions emphasize the categorization and diagnosis of anxietyrelated conditions, facilitating more accurate assessment and intervention by healthcare providers, including nurse practitioners, who play a vital role in recognizing, diagnosing, and managing anxiety disorders, integrating pharmacological and non-pharmacological interventions for optimal patient outcomes. DEFINITION 3 IMAGE Unipolar Depression Symptoms: TERM Unipolar Depression, a prevalent mental health condition, often goes undiagnosed IMAGE due to patients' reluctance to report symptoms and the primary responsibility of primary care providers to identify and manage it. Left untreated, depression can lead to severe complications including coronary artery disease, diabetes mellitus, stroke, and even suicidal ideations. Recognizing its signs such as persistent sadness, disinterest, and changes in weight is crucial. Screening tools like the Patient Health Questionnaire-9 (PHQ-9) aid in diagnosis, especially in primary care settings where depression is frequently encountered. Risk factors for depression encompass various life circumstances like chronic illness, stress, and substance use. Specific considerations for older adults include the use of the Geriatric Depression Scale (GDS) alongside the PHQ-2 and PHQ-9. Beyond screening, a comprehensive patient history and physical examination, coupled with a trusting patient-provider relationship, help in evaluating depressive symptoms and suicidal tendencies. Nurse practitioners must assess suicidal risk diligently, considering factors such as thoughts of suicide, plans, means, and intentions. Any recent life changes or stressors warrant heightened vigilance for depression. Effective management involves not only medication but also lifestyle modifications and psychotherapy, emphasizing the importance of holistic care in addressing this pervasive condition. DEFINITION 4 Referral Guidelines for Mental Health Specialists: Immediate intervention is warranted if: TERM - Patients pose a risk of self-harm or harm to others. - Symptom severity significantly compromises patient well-being. - Symptoms indicate serotonin syndrome, withdrawal, neuroleptic malignant syndrome, or lithium toxicity. IMAGE - Uncertainty persists regarding patient risks. Urgent intervention is necessary within a week if: - High suicide risk exists, but the patient is presently safe. - Coexisting psychiatric conditions, like substance use disorders, are present. - Electroconvulsive therapy (ECT) is indicated. Follow-up with a specialist is needed within a month if: - Symptoms persist despite initial treatment. - Medication management issues require frequent monitoring. - Dementia is concurrent. - Psychotherapy, family education, or group support could benefit the patient. DEFINITION 5 Substance Use Referral: TERM Substance Use Disorders require immediate attention and referral for specific conditions. Withdrawal seizures, often from benzodiazepine or alcohol cessation, necessitate urgent intervention. Delirium tremens, characterized by severe symptoms such as tachycardia, tremors, hallucinations, and seizures, emerges 72-96 hours post-alcohol cessation. Overdose, especially opioids, manifests as unresponsiveness, pinpoint pupils, and respiratory depression, mandating naloxone administration and supervised observation. Any substance ingestion leading to unstable vital signs mandates ER referral. Suicidality, homicidality, and psychosis, common in substance use disorders, demand prompt stabilization. Patients seeking treatment for moderate to severe substance use disorders warrant immediate referral for evidence-based pharmacotherapy, including medications like naloxone, and initiation without delay. Primary care providers should offer pharmacotherapy for alcohol and opioid use disorders promptly. Nurse practitioners should be vigilant for these conditions and act swiftly to ensure patient safety and treatment initiation. IMAGE DEFINITION 6 Chronic Pancreatitis Symptoms: TERM Chronic pancreatitis, marked by pancreatic inflammation, leads to permanent exocrine IMAGE and endocrine insufficiency, contrasting with acute pancreatitis. Major causes include alcoholism, duct obstruction, genetic mutations, autoimmune factors, and idiopathic origins. Alcohol misuse triggers 50-70% of cases, with duration and volume influencing risk. Hereditary factors, including mutations in PRSS-1, SPINK, and CFTR genes, play a role. Notably, recurrent acute pancreatitis or unexplained chronic cases should prompt genetic testing. Clinical signs include epigastric pain, nausea, vomiting, and weight loss, worsened by fatty foods and alcohol. Malabsorption symptoms like diarrhea and steatorrhea suggest advanced disease. Glucose intolerance often precedes diabetes onset. Physical exams may show little beyond abdominal tenderness or weight loss. Severe complications, including pancreatic cancer, can arise. Marseilles-Rome classification categorizes the condition by morphology, epidemiology, and molecular biology, aiding diagnosis and management. Early detection and intervention are crucial in reducing mortality rates. DEFINITION 7 Bell's Palsy Treatment: TERM Interprofessional collaboration is essential in managing Bell palsy. Specialists should be consulted for cases presenting atypically, during pregnancy, or showing signs of corneal abrasion. Additionally, persistent facial weakness beyond two weeks or when surgery or botulinum toxin injections are being considered warrants specialist input. Protecting the eye is crucial to prevent blindness, with measures such as using protective IMAGE eyewear, moisture chambers, and careful eyelid taping. While surgical decompression is rarely necessary due to high recovery rates with steroids, it may be considered in specific cases. Pharmacologically, corticosteroids should be initiated within 72 hours of onset, with antivirals offering modest benefits. Lubricating eye drops help maintain eye moisture, and pain management includes acetaminophen or NSAIDs if not contraindicated. Referral criteria encompass various scenarios, including ocular symptoms, suspected CNS involvement, and persistent paralysis, ensuring appropriate management and care for patients. Education plays a vital role in informing patients about potential complications, eye protection, medication management, and rehabilitation exercises for optimal recovery. DEFINITION 8 Infections of the central nervous system Symptoms CHAPTER 178 TERM Ce Vigilance is crucial for patients presenting with fever, headache, stiff neck, and altered mental status, warranting immediate referral to an experienced healthcare provider for suspected central nervous system (CNS) infections. These infections, encompassing meningitis and encephalitis, stem from various pathogens and exhibit significant morbidity and mortality rates, with bacterial meningitis posing particular urgency. While bacterial meningitis primarily affects infants and older adults, encephalitis, commonly caused by herpesviruses, arboviruses, and enteroviruses, is increasingly observed due to immunocompromised states. Diagnosis relies on clinical suspicion, noting agespecific pathogen prevalence. Risk factors for bacterial meningitis include diverse medical conditions and recent travel. Pathophysiology involves bacterial entry into cerebrospinal fluid, triggering inflammatory responses leading to cerebral complications. Clinical presentation varies widely, emphasizing the need for a IMAGE comprehensive physical exam to distinguish these serious conditions promptly. DEFINITION 9 chronic lipid disorders Symptoms: TERM Immediate referral to the emergency department is crucial for patients with IMAGE severe hypertriglyceridemia and associated complications like chest pain, respiratory distress, or rhabdomyolysis. Lipid disorders, significant risk factors for atherosclerotic cardiovascular disease (ASCVD), affect a majority of adults in the United States. Lowering LDL-C, primarily with statins, remains a primary focus for ASCVD prevention. Lifestyle changes, including diet and exercise, are pivotal in managing dyslipidemia. Lipoproteins, such as LDL and HDL, play key roles in ASCVD development. Lifestyle modifications, such as increased physical activity and improved nutrition, contribute to better lipid profiles and reduced ASCVD risk. Lipid disorders arise from a complex interplay of genetic and environmental factors. A comprehensive evaluation, including medical history and physical examination, is essential for diagnosing and managing lipid disorders and ASCVD risk effectively. Detection of xanthomas or corneal arcus may indicate severe dyslipidemia and prompt further evaluation. DEFINITION 10 Normocytic Anemia Symptoms: TERM Normocytic anemia, specifically Anemia of Chronic Disease (ACD), is typically mild to moderate and commonly arises from inflammatory conditions, infections, or malignancies. It often manifests as normocytic, normochromic RBCs with hemoglobin levels usually above 9 g/dL. ACD has a gradual onset and is prevalent among older hospitalized patients. Its pathophysiology involves low serum iron levels despite normal or elevated iron IMAGE stores, often due to increased hepcidin levels inhibiting iron transport. Another mechanism, ACKD, implicates relative erythropoietin deficiency, where erythropoietin response to anemia may be blunted. Symptoms of ACD are usually mild and related to underlying diseases rather than the anemia itself, including fatigue, pallor, tachycardia, and dyspnea upon exertion. Clinicians should conduct a thorough physical examination to explore underlying chronic conditions. DEFINITION 11 Microcytic Anemia Symptoms: Microcytic anemia (MCV 5.5cm usually needs surgical repair Terrell Suggs #55 DEFINITION 57 Breast cancer TERM Every other year 50-74. Self exam not examined. IMAGE The next step. If a woman self exams and finds a lump. If under 30 Ultrasound Under 30 If over 30 Mammogram More than 30 DEFINITION 58 High Blood Pressure TERM Screening a. Adults 40+ with risk factors Yearly b. Adults 18-39 WITHOUT risk factors Q3-5 years Clinical Scenario. A patient has a BP of 158/98 in the office, now what? Ambulatory Monitoring Goals of Treatment: a. Age 60+ 150/90 b. Age 100,000 CFU/mL of a single uropathogen or >10,000 CFU/mL if the pathogen is group B streptococcus indicates treatment. DEFINITION Describe the USPSTF recommendations for Grade B. Pregnant women, new breastfeeding. mothers, and their children. The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding. Clinicians should, as with any preventive service, respect the autonomy of women and their families to make decisions that fit their specific situation, values, and preferences. Describe the USPSTF recommendations for depression screening in adults. Grade B: Population Adults aged ≥18 y Recommendation Screen for depression, with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Commonly used depression screening instruments include the Patient Health Questionnaire in various forms and the Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in postpartum and pregnant women. Positive screening results should lead to additional assessment that considers severity of depression and comorbid psychological IMAGE problems, alternate diagnoses, and medical conditions. The optimal timing and interval for screening for depression is not known. Describe the USPSTF recommendations for the prevention of neural tube defects. Grade A. Persons who plan to or could become pregnantThe USPSTF recommends that all persons planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. Describe the USPSTF recommendations for Grade B. Asymptomatic pregnant gestational diabetes screening. persons at 24 weeks of gestation or after. The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. Asymptomatic pregnant persons before 24 weeks of gestation. Grade I. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. Describe the USPSTF recommendations for Grade A. Pregnant womenThe hepatitis B screening in adults and pregnant women. USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit. A test for HBsAg should be ordered at the first prenatal visit. Women with unknown HBsAg status or with new or continuing risk factors for HBV infection (eg, injection drug use or a sexually transmitted infection) should be screened at the time of admission to a hospital or other delivery setting. Describe the USPSTF recommendations for Grade B: Women of reproductive intimate partner violence screening. ageThe USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services. See the Clinical Considerations section for more information on effective ongoing support services for IPV and for information on IPV in men. Grade I: Older or vulnerable adultsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults. See the Clinical Considerations section for suggestions for practice regarding the I statement. Describe the USPSTF recommendations for Grade B. Blood pressure prevention in women at high risk for measurements should be obtained preeclampsia. during each prenatal care visit throughout pregnancy. If a patient has an elevated blood pressure reading, the reading should be confirmed with repeated measurements. To achieve the benefit of screening, it is important that persons who screen positive receive evidence-based management of hypertensive disorders of pregnancy. The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in persons at high risk for preeclampsia. Describe the USPSTF recommendations for **USPSTF Recommendation:** lung cancer screening. - **Grade:** Grade B - **Screening Timeframe:** Annually with low-dose computed tomography (CT) - **Implementation:** 1. Assess risk based on age (50-80 years) and 20 pack-year smoking history. 2. Engage in shared decision making about screening. 3. If decision is to screen, refer for low-dose CT, preferably to an experienced center. 4. Provide smoking cessation interventions for current smokers. 5. Discontinue screening if the person hasn't smoked for 15 years or has a health problem limiting life expectancy or the ability for lung surgery. Describe the USPSTF recommendations for syphilis screening in pregnant women. Grade A. Pregnant women. The USPSTF recommends early screening for syphilis infection in all pregnant women. Describe the USPSTF recommendations for Grade A. Pregnant women, during the Rh(D) incompatibility screening in pregnant first pregnancy-related care visit. The women. USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. Grade B: Unsensitized Rh(D)-negative pregnant women. The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative. Describe the USPSTF recommendations for Grade B: Adults aged 40 to 75 years statin use for the primary prevention of CVD. who have 1 or more cardiovascular risk factors and an estimated 10-year cardiovascular disease (CVD) risk of 10% or greater. The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (i.e. dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater. Grade C: Adults aged 40 to 75 years who have 1 or more cardiovascular risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (i.e dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. Grade I: Adults 76 years or older. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. Describe the dietary guidelines for Americans. **Dietary Guidelines for Americans:** 1. **Eating Pattern:** - Include fruits, vegetables, whole grains, lean proteins, and low-fat dairy. 2. **Limit Sugars:** - Reduce added sugars; prefer natural sugars in fruits and dairy. 3. **Manage Sodium:** - Choose lower-sodium foods; use herbs and spices for flavor. 4. **Healthy Fats:** - Replace saturated fats with healthier fats from oils, nuts, and fish. 5. **Portion Control:** - Be mindful of portion sizes for a balanced calorie intake. 6. **Hydration:** - Opt for water over sugary and alcoholic beverages. 7. **Individual Needs:** - Customize based on health, preferences, and culture. 8. **Food Safety:** - Follow safe food handling practices. 9. **Physical Activity:** - Combine a healthy diet with regular exercise for overall well-being. How much food from protein is needed daily in Recommended Dietary Allowance adults by age group (ages 19 years and up)? (RDA) for protein intake in adults (ages 19 years and up) is generally set at 0.8 grams of protein per kilogram of body weight per day. It's important to note that individual protein needs may vary based on factors such as age, sex, activity level, and health status. How much food from dairy is needed daily in 3 cups equivalent daily adults by age group (ages 19 years and up)? What nutrients does the dairy food group Dairy products are rich in essential provide? nutrients, including calcium, vitamin D, protein, potassium, and other vitamins and minerals. These nutrients play crucial roles in bone health, maintaining a healthy immune system, and overall well-being. Consuming dairy as part of a balanced diet can contribute to meeting these nutritional needs. How much food from grains is needed daily in adults by age group (ages 19 years and up)? Daily intake of grains is typically around 6 ounce-equivalents per day, according to dietary guidelines. This includes a balance of whole grains and refined grains. Which nutrients are provided in the grain food Grains are a good source of essential group? nutrients, including: 1. **Dietary Fiber:** Important for digestive health and helps regulate blood sugar levels. 2. **B Vitamins:** Including B vitamins like thiamin, niacin, and folate, which are vital for energy metabolism. 3. **Iron:** Essential for transporting oxygen in the blood. 4. **Magnesium:** Important for muscle and nerve function, blood glucose control, and bone health. 5. **Phosphorus:** Critical for bone and teeth formation. 6. **Selenium:** Acts as an antioxidant and supports the immune system. Choosing whole grains over refined grains is encouraged as they retain more of their natural nutrients and fiber. How much fruit is needed in the daily adult diet The recommended daily intake of by age group? fruits for adults can vary, but a general guideline is around 2 cup-equivalents per day for adults Which nutrients are provided from the fruit food group? Fruits are rich in various essential nutrients, including: 1. **Vitamin C:** Important for the immune system and skin health. 2. **Potassium:** Helps regulate blood pressure and fluid balance. 3. **Dietary Fiber:** Aids in digestion and helps maintain a healthy weight. 4. **Folate (B9):** Important for cell division and DNA synthesis. 5. **Antioxidants:** Such as flavonoids and carotenoids, which help protect cells from damage. 6. **Vitamins A and K:** Contribute to vision health and blood clotting, respectively. 7. **Natural Sugars:** Provide a quick source of energy. Incorporating a variety of fruits into the diet ensures a diverse range of these essential nutrients. How many vegetables are needed in the daily adult diet by age group? The recommended daily intake of vegetables for adults can vary, but a general guideline is around 2.5 cupequivalents per day for adults aged 19 years and up, according to dietary guidelines. This includes a variety of vegetables, whether raw, cooked, fresh, frozen, or canned. Individual needs may differ based on factors like age, gender, and health conditions, so it's advisable to consult with a healthcare professional or a registered dietitian for personalized recommendations. Which nutrients are provided from the Vegetables are rich in a variety of vegetable food group? essential nutrients, including: 1. **Dietary Fiber:** Supports digestive health and helps maintain a healthy weight. 2. **Vitamins:** Vegetables are excellent sources of various vitamins such as vitamin A, vitamin C, vitamin K, and several B vitamins, which play crucial roles in overall health. 3. **Minerals:** Important minerals found in vegetables include potassium, magnesium, and folate, which contribute to various bodily functions. 4. **Antioxidants:** Vegetables contain a wide range of antioxidants, such as flavonoids and carotenoids, which help protect cells from damage. 5. **Phytonutrients:** Natural compounds that contribute to the color and flavor of vegetables and may have health benefits. 6. **Low-Calorie Source:** Vegetables are generally low in calories but high in nutrients, making them a healthy choice for weight management. Consuming a diverse range of vegetables ensures a broad spectrum of these nutrients in your diet. Describe the physical activity guidelines for **Physical Activity Guidelines for Americans. Americans:** **For Adults (18-64):** - Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week. - Include muscle-strengthening activities on 2 or more days. **For Older Adults (65+):** - Follow adult guidelines with an emphasis on activities to enhance balance. **For Children and Adolescents (617):** - Engage in at least 60 minutes of moderate-to-vigorous aerobic activity daily. - Include muscle-strengthening and bone-strengthening activities on at least 3 days per week. **Additional Tips:** - Minimize sedentary behavior. - Choose activities you enjoy and can sustain. These time recommendations provide a simple overview of the guidelines for different age groups. Always consider individual health conditions and consult with healthcare professionals for personalized advice. Meningococcal Vaccine 2 Dose series 8 weeks apart with certain conditions. First year college and military recruits get one dose HPV Vaccine Adults through age 26 years. Start at 15 years. 3 Dose series similar to Hep V schedule Pneumococcal Vaccine Give at 65. If given before 65 then they will receive a dose 5 years later. Influenza Vaccine Annual shot given. Egg allergy ok. Can be given in clinic with allergy emergency relief supplies ready. Do not give to immune compromised patients or history of anaphylaxis. Zoster Vaccine Age 50+ Receive 2 dose 2-6 months apart (wait at least 4 weeks between). If too soon, give another. Tdap Vaccine If no Tdap received 11 years and older, start a dose and then every 10 years after. Why is knowledge of international travel important for health and wellness and where can the practitioner find resources for patients So you can help prepare the patient appropriately for travel. who are planning international travel? Discuss the role of vaccines in disease They prep the body in fighting off prevention. viral infections Which vaccines are recommended for adults Flu 1 dose 19+ Flu live 19-50 ages 19 years and older? Tetanus MMR Describe the vaccines that are recommended First dose MenACWY (Menactra, for college students. Menveo) cultural competence Understanding practices can help direct care without being assumptive in your assessment Explain how health literacy influences health care outcomes. The patients ability to understand what is being presented will affect their compliance to treatment. Explain how health care disparities impact Certainly, here's a concise version certain populations. suitable for Quizlet: **Healthcare Disparities Impact on Populations:** 1. **Access to Healthcare:** - *Financial Barriers:* Limited access due to affordability issues. - *Geographic Barriers:* Challenges for those in underserved or rural areas. 2. **Quality of Care:** - *Cultural and Language Barriers:* Miscommunication affecting care. - *Implicit Bias:* Biases influencing provider decisions. 3. **Preventive Care and Screening:** - *Unequal Utilization:* Disparities in accessing preventive services. 4. **Chronic Disease Management:** - *Unequal Treatment:* Varied care quality for chronic conditions. 5. **Maternal and Child Health:** - *Disparities in Mortality:* Higher rates in certain racial/ethnic groups. 6. **Mental Health:** - *Stigma and Access Issues:* Limited mental health access due to stigma. 7. **Health Disparities among Minorities:** - *Racial and Ethnic Disparities:* Higher rates in minority communities. Addressing disparities requires policy changes, improved access, cultural competency training, and tackling social determinants of health for health equity. What is culturally responsive care? Culturally Responsive Care: Definition: Tailoring healthcare to respect and meet the cultural needs of diverse individuals. Key Components: Cultural Awareness: Understanding diverse cultural backgrounds and their impact on health. Communication: Using culturally appropriate language and addressing language barriers. Respect for Diversity: Recognizing differences in race, ethnicity, religion, etc. Cultural Sensitivity: Being attuned to cultural norms and practices. Inclusivity: Creating a welcoming environment for all patients. Patient-Centered Care: Customizing care plans based on cultural preferences. Training and Education: Continuous learning for cultural competence. Collaboration: Working with interpreters and community resources. Importance: Enhances patient-provider communication. Promotes health equity and better health outcomes. Fosters a welcoming and inclusive healthcare environment. Implementation: Ongoing provider training. Collaboration with interpreters and cultural resources. Patient-centered care planning based on cultural understanding. Phases of emergency management [LOCATED in the Unit 3 Cohorts and Other Resources Four Phases of Emergency Management: folder in the Course Tips Mitigation: Actions to prevent or reduce the impact of disasters. Preparedness: Planning, training, and educational activities for unpreventable events. Response: Immediate actions taken during and after a disaster. Recovery: Restoration efforts concurrent with regular activities, aiming to reduce vulnerabilities. Identify the most commonly encountered office emergencies. Identify the recommended Anaphylaxis, epinephrine emergency supplies (equipment and medications) for family practice offices. What are the key components of an emergency plan?.Mitigation: Actions to prevent or reduce the impact of disasters. Preparedness: Planning, training, and educational activities for unpreventable events. Response: Immediate actions taken during and after a disaster. Recovery: Restoration efforts concurrent with regular activities, aiming to reduce vulnerabilities. Describe the clinical presentation, physical examination, and treatment of patients with anaphylaxis. Describe the clinical presentation, physical examination, and treatment of patients with various types of bites and stings: animal bites, tick bites, spider bites, mosquito-borne diseases, parasitic infestations, bee stings... 5. Animal Bite ### Animal Bites: **Clinical Presentation:** - Animal bites may present with localized pain, swelling, redness, and possible puncture wounds. - Risk of infection, including tetanus and rabies, is a concern. **Physical Examination:** - Assess the bite site for signs of infection, such as redness, warmth, and purulent discharge. - Evaluate for any damage to underlying structures (tendons, nerves) and the possibility of foreign bodies. **Treatment:** - Clean the wound thoroughly with soap and water. - Administer tetanus prophylaxis if indicated. - Prescribe antibiotics for bacterial prophylaxis if the risk of infection is high. - Rabies prophylaxis may be necessary based on the animal involved and exposure circumstances. Tick bite Tick Bites: Clinical Presentation: Tick bites may present with local redness and itching. Concerns about tick-borne diseases like Lyme disease, Rocky Mountain spotted fever, etc. Physical Examination: Identify and remove the tick carefully. Observe for the characteristic "bull'seye" rash associated with Lyme disease. Treatment: Use blunt, angled, medium-tipped forceps or a specific tick-removal instrument. Grasp the tick close to the mouth, flip it, and pull straight up for removal. Inspect the bite area for retained mouth parts; remove if possible. Clean the area with an antiseptic. Consider antibiotic prophylaxis in Lyme disease-endemic areas or unknown tick attachment time (needs >36 hours for Lyme disease transmission). Insect bites General Local Wound Care for Insect Bites and Stings: Apply local wound care for all insect bites and stings. Remove the stinger if present. Clean the area with soap and water. Use ice packs for swelling. Administer antihistamines (H1 and H2 blockers) for itching. Apply topical steroids for inflammation. Prescribe topical or systemic antibiotics for secondary infection. Nonsteroidal anti-inflammatory drugs can be used for discomfort. Specific Insect Eradication and Treatment: Flea Infestation:Vacuum thoroughly, treat pets, wash rugs and beds, and use insecticide. Lice Eradication:Shampoo with lindane, rinse, and use a comb to remove lice.Permethrin (Nix, Elimite) is an effective scabies treatment.Crusted scabies may require oral Ivermectin (off-label use). Bedbugs:Difficult to eradicate; cause psychological and economic distress.Focus on thorough cleaning in institutional settings. Anaphylaxis Anaphylaxis Management: Any evidence of a systemic reaction should be immediately treated as anaphylaxis. Administer IM (preferably lateral thigh) or subcutaneous epinephrine. Adult dosing: 0.3 to 0.5 mg (0.3 to 0.5 mL of 1:1000 concentration [1 mg/mL]). Pediatric dosing: 0.01 mg/kg (up to 0.3 mg). Transfer the patient to the nearest emergency room for further evaluation. Describe the clinical presentation, physical Title: Cardiac Arrhythmias: examination, and management of patients with cardiac arrhythmias, including tachyarrhythmias Presentation and Management ## Definition and bradyarrhythmias. Cardiac arrhythmias include tachyarrhythmias (HR >100 bpm) and bradyarrhythmias (HR 37.2°C, rectal >37.5°C in elderly) - Tachycardia, tachypnea - Ill appearance - Hypotension - Leukocytosis, neutrophilia (poor specificity) - Thrombocytopenia - Biomarkers (e.g., C-reactive protein, interleukin-6) **Management:** 1. **Expedited Evaluation:** Prompt assessment for severe sepsis or septic shock with infection source, ill appearance, or hypotension. 2. **Lab Studies:** CBC, chemistry panel, lactate, coagulation studies. Look for Döhle's bodies, toxic granules, vacuoles, and thrombocytopenia. 3. **Biomarkers:** Investigational (e.g., procalcitonin, TREM-1). Caution in routine use pending further clinical investigations. 4. **Microbial Cause Identification:** Cultures before antimicrobial treatment. Blood cultures positive in 50% of severe sepsis cases. 5. **Culture Sites:** Identify infection sites (pulmonary, genitourinary, intraabdominal, skin, indwelling lines). 6. **Catheter Removal:** Prompt removal in suspected indwelling line infection. 7. **Fluid Resuscitation:** Address hemoconcentration with significant hypovolemia. 8. **Antibiotic Therapy:** Target identified pathogens. Regular evaluations and adjustments. 9. **Monitoring:** Regular assessments for response to therapy. Caution in using non-culture based microbiologic testing. *Note: Ongoing clinical investigations for biomarkers. Caution in routine use.* SIRS 1. SIRS (systemic inflammatory response syndrome) defined as the presence of two or more of the following 1) temperature greater than 38.3℃ or less than 35.5℃ 2) pulse rate greater than 90 beats/min 3) respiratory rate greater than 20 breaths/min or PaCO2 less than 32 torr 4) a WBC count greater than 12000/mm3 or less than 4000/mm3 2. Sepsis SIRS and presumed existence of an infection 3. Severe sepsis Sepsis and organ dysfunction* 4. Septic shock Sepsis and refractory hypotension** Identify the phases of Emergency Management (see document in course tips under "Recorded Cohorts and Additional Resources"). Blepharitis Definition: Inflammation of the eyelids, categorized into anterior and posterior types. Types: Anterior blepharitis (front lid margin) and posterior blepharitis (back lid margin). Etiology: Can be infectious or inflammatory, associated with staphylococcal infection, seborrhea, or meibomian gland dysfunction. Clinical Presentation: Symptoms include burning, foreign body sensation, tearing, photophobia, itching, redness, discharge, and swollen eyelids. May lead to the development of hordeola or chalazia. Management: Lid hygiene, warm compresses, and pharmacologic interventions. Stye (Hordeolum) Definition: An acute infection and inflammation of one of the glands in the eyelid. Etiology: Often associated with staphylococcal infection. Clinical Presentation: Usually painful, characterized by erythema, edema, and a localized nodule. Can lead to cosmetic disfigurement and mechanical ptosis. Diagnostics: Usually diagnosed clinically, no specific tests indicated. Management: Typically selflimited, treated with warm compresses, lid scrubs, and rarely with antibiotics. Spontaneously improves in 1 to 2 weeks. Chalazion Definition: A chronic, sterile, nontender bump lipogranulomatous inflammatory lesion of the meibomian gland. Etiology: Often associated with meibomian gland dysfunction. Clinical Presentation: Painless, often described as a "lump" along the eyelid, gradually enlarging. May cause cosmetic disfigurement and mechanical ptosis. Diagnostics: Usually diagnosed clinically, no specific tests indicated. Management: Conservative treatment with warm compresses, lid scrubs, and steroid injections. Surgical incision and removal may be required for chronic cases. Conjunctivitis **Definition and Epidemiology:** - Inflammation of the bulbar or palpebral conjunctiva. - 1% of primary care visits related to conjunctivitis. - Causes: viruses, bacteria, allergies, toxins. **Clinical Presentation:** - Viral conjunctivitis: Red eye, watery discharge, follicles. - Bacterial conjunctivitis: Thick, purulent discharge. - Allergic conjunctivitis: Itching, clear discharge, boggy appearance. - Vernal/atopic conjunctivitis: Severe symptoms, corneal complications. **Diagnostics:** - Physical exam and medical history crucial for differentiation. - Consider herpetic eye disease, gonococcal or chlamydia-related conjunctivitis. **Pharmacologic Management:** - Viral conjunctivitis: Supportive care with artificial tears, cool compresses. - Bacterial conjunctivitis: Topical antibiotics, especially in high-risk patients. - Allergic conjunctivitis: Identify/eliminate allergens, antihistamines, supportive care. **Referral Indications:** - Sight-threatening diseases, recent trauma, surgery, contact lens use. - Non-ocular symptoms, corneal involvement, severe symptoms require ophthalmology referral. **Patient Education:** - Noninfectious conjunctivitis is chronic; understand the condition. - Interrupt transmission cycle for infectious conjunctivitis (hand hygiene, avoid touching eyes). This condensed summary focuses on critical information for an NP in adult care, emphasizing key aspects of conjunctivitis diagnosis, management, referral criteria, and patient education. If you have specific questions or need further details, feel free to ask. Eustachian Tube Dysfunction Eustachian tube dysfunction involves difficulties in equalizing pressure across the tympanic membrane, often caused by factors like colds, allergies, or structural issues. Symptoms include pain, muffled hearing, and potential balance problems. Treatment addresses underlying causes, such as viral infections or allergies, and may include medications or tympanostomy tube placement for pressure equalization. Acute Otitis Media with Effusion A. Causes: high-altitude activity, URI, allergies, orthodontic malocclusion with mouth breathing, or eustachian tube dysfunction B. Signs and symptoms do not have acute onset 1. Decreased hearing 2. Feeling of fullness or pressure in the ear(s) 3. "Popping" sensation with yawning, swallowing, or nose blowing 4. TM retracted with clear to yellowish or bluish colored fluid; decreased mobility and poor visibility of landmarks C. Treatment 1. With mild symptoms, the condition often spontaneously resolves in 2 to 3 wk but can take up to 12 wk 2. Medications to consider a) Pseudoephedrine 30 mg tid b) Oxymetazoline (Afrin) 1 to 2 sprays q12h (Note: this should be used only for 3 to 5 days because of nasal rebound congestion) c) Loratadine 10 mg or cetirizine 10 mg or fexofenadine 180 mg qd d) Azelastine (Astelin) nasal spray 2 sprays each nostril bid e) Azelastine/fluticasone propionate (Dymista) 1 spray each nostril bid f) Consider nasal steroids (e.g., fluticasone, mometasone) 1 to 2 sprays each nostril qd 3. Consider chewing gum or frequent autoinsufflation (trying to gently "pop ears," pinch nose closed and swallow or blow out with lips closed, or blow up balloons) 4. Use hypertonic saline nasal spray often (e.g., 8 to 10 ×d) or neti pot/nasal rinse 2 to 3 ×d 5. Follow-up in 3 wk and consider hearing testing if still symptomatic after 8 to 12 wk D. Refer to ENT or allergist if needed Allergic Rhinitis Certainly! Here's a general breakdown of key points that a Nurse Practitioner (NP) should know about Rhinitis: **Definition and Types:** - Rhinitis is an inflammation of the sinus nasal cavity. - Types include allergic rhinitis (AR) and nonallergic rhinitis (idiopathic rhinitis). **Epidemiology:** - AR is an inflammatory response affecting the paranasal and sinus mucosa. - Nonallergic rhinitis is not immunerelated; symptoms are provoked by environmental stimuli. **Pathophysiology:** - AR involves immunoglobulin E (IgE)mediated mast cell hypersensitivity to allergens. - Nonallergic rhinitis is neurogenic, involving an abnormal balance favoring parasympathetic control over sympathetic control. **Clinical Presentation and Examination:** - AR symptoms include sneezing, rhinorrhea, mucosal swelling, obstruction, conjunctivitis, and itching. - Nonallergic rhinitis presents with perennial nasal congestion, little discharge, and watery discharge; triggered by environmental factors. **Diagnostics:** - Diagnosis of AR is clinically based; nasal cytology, scratch/patch tests, and radioallergosorbent tests (RASTs) may be used. - Nonallergic rhinitis may have positive nasal eosinophils; skin testing can be done. **Management:** - AR management includes environmental control, pharmacotherapy (intranasal steroids, antihistamines), and immunotherapy. - Nonallergic rhinitis is managed by avoiding stimuli, using oral decongestants, saline irrigation, and intranasal steroids. **Complications and Referral:** - Complications of AR include increased asthma exacerbations. - Referral for both AR and nonallergic rhinitis may be needed for unresponsive cases or if anatomic causes are suspected. **Patient Education:** - Patients should be educated on environmental triggers and correct use of medications. - Idiopathic rhinitis is chronic, and Laryngitis Usually caused by a virus but can be bacterial. Infection causes goblet cells to increase in larynx. Can also be allergy or smoking related too. Dysphonia, dysphagia and dyspnea. Which eye conditions warrant referral to an ophthalmologist? Urgent with acute onset eye pain, diminished visual acuity, and photophobia Nonurgent referral with chronic conditions such as red eyes and scratchy feelings that aren't controlled with current medications Bacterial Conjunctivitis: Redness, discharge; Refer if not improved in 4 days or suspected herpetic infection. Viral Conjunctivitis: Burning, tearing; Refer if symptoms persist past 7 days or suspected herpetic infection. Allergic Conjunctivitis: Itching, redness, watery discharge; Refer if no improvement in 5 to 7 days. II. Corneal Injuries/Abnormalities Corneal Abrasions: Unilateral pain, photophobia; Urgent referral for large abrasions, persistent discharge, or vision issues. Pinguecula: Yellowish growth near cornea; Refer if vision is affected. III. Tear Duct Abnormalities Dry Eye Syndrome: Redness, dryness; Refer if not controlled and affecting QOL. IV. Eyelid Abnormalities Blepharitis: Redness, itching; Refer for severe symptoms, light sensitivity, impaired vision, or poor response. Hordeolum: Painful red bump; Refer if poor response, frequent occurrences, or hardening into chalazion. Chalazion: Painless eyelid nodule; Refer if not resolved or affecting visual fields. Xanthelasma: Yellow plaques on eyelids; Consider referral for cosmetic reasons. Periorbital Cellulitis: Eyelid swelling, redness; Refer for severe symptoms, light sensitivity, or poor response. V. Other Eye Conditions of Importance Angle-Closure Glaucoma: Severe eye pain, vision issues; Immediate referral. Iritis (Uveitis): Ciliary flush, photophobia; Immediate referral. Cataracts: Gradual vision changes; Refer for further evaluation and surgical options. Compare and contrast the following eye disorders: hordeolum, blepharitis, and chalazion. **Hordeolum (Stye):** - **Definition:** Infected eyelid gland. - **Features:** Painful, red bump, pusfilled. - **Management:** Warm compresses, antibiotics.term-0 **Blepharitis:** - **Definition:** Eyelid margin inflammation. - **Features:** Red, swollen, itchy. - **Management:** Warm compresses, lid hygiene, antibiotics. **Chalazion:** - **Definition:** Non-infectious eyelid nodule. - **Features:** Painless, slow-growing lump. - **Management:** Warm compresses, lid massage, corticosteroids. **Comparison:** - **Pain:** Hordeolum painful, blepharitis and chalazion usually painless. - **Location:** Hordeolum at eyelash base, blepharitis on margins, chalazion from meibomian gland. - **Symptoms:** Blepharitis itchy, hordeolum and chalazion swelling. - **Management:** Hordeolum antibiotics, blepharitis lid hygiene, chalazion compresses, massage, corticosteroids. Describe clinical presentation, physical **Clinical Presentation:** examination, and treatment of conjunctivitis. 1. **Bacterial Conjunctivitis:** - *Symptoms:* Itching, tearing, redness, mucopurulent discharge. - *Referral Criteria:* Not markedly better in 4 days or suspected herpetic infection. 2. **Viral Conjunctivitis:** - *Symptoms:* Burning, itching, tearing, watery discharge. - *Referral Criteria:* Symptoms persist past 7 days, worsen within 24 hr, or suspected herpetic infection. 3. **Allergic Conjunctivitis:** - *Symptoms:* Itching, redness, watery discharge, conjunctival edema. - *Referral Criteria:* Not improving in 5 to 7 days. **Physical Examination:** 1. **External Examination:** - Check for redness, swelling, or signs of irritation around the eyes. 2. **Visual Acuity:** - Assess visual acuity, especially if there are reported vision changes. 3. **Conjunctival Examination:** - Look for signs of inflammation, such as redness and chemosis. - Assess discharge—mucopurulent in bacterial, watery in viral, and clear in allergic conjunctivitis. **Treatment:** 1. **Bacterial Conjunctivitis:** - *Referral Criteria:* Not markedly better in 4 days or suspected herpetic infection. 2. **Viral Conjunctivitis:** - *Referral Criteria:* Symptoms persist past 7 days, worsen within 24 hr, or suspected herpetic infection. 3. **Allergic Conjunctivitis:** - *Referral Criteria:* Not improving in 5 to 7 days. Describe the epidemiology, pathophysiology, clinical presentation, and diagnostics for Epidemiology: Causes: Trauma (foreign objects, Corneal surface defects and ocular surface foreign bodies. airbags), contact lens use, occupational exposure (particles, chemicals). At-risk Groups: Workers (particles, dust, metal grinding), contact lens wearers. Prevention: Eye protection. Pathophysiology: Mechanism: Interruption of corneal epithelium (trauma, chemicals, UV radiation). Abrasion/Erosion: Disruption of Bowman layer, fluid layer formation, microbial invasion. Clinical Presentation: Symptoms: Sudden severe eye pain, foreign body sensation, blurred vision, redness, tearing, light sensitivity, eyelid swelling, blepharospasm. Examination: Limited vision, normal pupil reaction, unaffected eye pressure, swollen eyelids, injected conjunctiva, cornea with mild haze. Diagnostics: Fluorescein Staining: Abrasions (bright green, polygonal), foreign bodies (linear, vertical), herpetic causes (branching, dendritic), full-thickness laceration (irregular iris, shallow anterior chamber). Immediate Referral: Hypopyon, nonhealing epithelial defects, metallic foreign bodies, chemical injuries, infectious keratitis, full-thickness corneal laceration, elevated eye pressure (>30). Describe the components of a general eye examination.... 15. Identify the signs and symptoms and treatment Common Eye Conditions: Signs, for common eye conditions: bacterial conjunctivitis, viral conjunctivitis, allergic conjunctivitis. Pterygium, subconjunctival Symptoms, and Treatment DisorderSigns and SymptomsPainManagementBacterial hemorrhage, pinguecula, dry eye syndrome, dacryostenosis, xanthelasma, periorbital ConjunctivitisPhotophobia with blepharospasm; mucopurulent cellulitis, iritis, angle closure glaucoma, and cataracts. discharge with eyelash mattering; edema, hyperemia; preauricular adenopathy only with hyperacute disorder±Topical antibiotic drops; systemic antibiotics necessary for gonococcal or chlamydial cause; see Chapter 55Viral ConjunctivitisAcute onset often associated with systemic illness; photophobia or foreign body sensation; preauricular adenopathy; hyperemia; chemosis; watery discharge; classic dendritic corneal lesion present with herpes simplex; periocular lesions present with herpes zoster ophthalmicus±Supportive treatment, including cool compresses, topical artificial tears; referral to ophthalmologist for herpetic conjunctivitis; see Chapter 55Allergic ConjunctivitisPruritus; conjunctival hyperemia, chemosis; watery or stringy dischargeNoAvoidance of allergens; cold compresses; topical and/or systemic medication; see Chapter 55PterygiumOcular irritation or pain when inflamed; dry eye symptoms; fleshy lesion medial on conjunctiva; with pterygium, lesion extending onto corneaYesOcular lubricants; topical NSAIDs; with pterygium, routine referral to ophthalmologist; see Chapter 60Subconjunctival HemorrhageNo subjective symptoms; bright red spot of blood visible under overlying conjunctiva; remainder of conjunctiva whiteNoReassurance; no treatment necessaryPingueculaOcular irritation or pain when inflamed; dry eye symptoms; fleshy lesion medial on conjunctivaYesOcular lubricants; topical NSAIDs; routine referral to ophthalmologist; see Chapter 60Dry Eye SyndromeSandy, gritty, foreign body sensation; burning; pruritus; conjunctival hyperemia; decreased visual acuity±Topical artificial tears; lubricating ointments at night; warm compresses; gentle eyelid massa Identify the clinical manifestations and treatments for common ENT conditions: tinnitus, otitis externa, otitis media, otitis media with **ENT Conditions: Manifestations and Treatments** 1. **Tinnitus** effusion, allergic rhinitis, acute bacterial - Definition: Perception of sound without external source rhinosinusitis, chronic rhinosinusitis, pharyngitis, influenza, aphthous ulcers, gingivitis. - Epidemiology: 10-25% prevalence; increases with age - Pathophysiology: Nervous system activity; various causes - Clinical Presentation: Chronic ringing, buzzing, hissing; may indicate serious disorders - Physical Examination: Ear, nose, throat, head, neck, TMJ examination; audiologic evaluation - Diagnostics: Audiology evaluation; additional tests guided by clinical impression - Management: - Pharmacologic: Antidepressants, sleeping medications, melatonin; eliminate ototoxic medications, noise exposure - Nonpharmacologic: Treat local pathologies; hearing aids, sound masking, cognitive behavioral therapy - Referral: Otolaryngologist or neurologist if needed 2. **Otitis Externa** - Definition: Inflammation of external ear canal - Epidemiology: Common; frequent in swimmers - Clinical Manifestations: Ear pain, discharge, hearing loss; exacerbated by movement of pinna/tragus - Treatment: Topical antibiotics (usually fluoroquinolones), avoid moisture, analgesics 3. **Otitis Media** - Definition: Middle ear inflammation - Clinical Manifestations: Ear pain, hearing loss, fever; effusion may lead to temporary hearing loss - Treatment: Antibiotics (amoxicillin), pain management; myringotomy or tubes in chronic cases 4. **Otitis Media with Effusion** - Definition: Fluid in middle ear without infection - Clinical Manifestations: Hearing loss, feeling of fullness - Treatment: Observation, hearing aids; tubes if persistent 5. **Allergic Rhinitis** - Definition: Inflammation of nasal mucosa due to allergens - Clinical Manifestations: Sneezing, rhinorrhea, nasal congestion, itching - Treatment: Allergen avoidance, antihistamines, intr Identify ophthalmology problems that require... same-day care. 19. Identify the indications, contraindications, precautions, and patient preparation involved in ocular foreign body removal procedures.... 20. Describe the steps involved in the procedure. Identify the indications, contraindications, Certainly, I can provide you with precautions, and patient preparation involved in the removal of a foreign body from the ear. information on the indications, contraindications, precautions, and Describe the steps involved in the procedure. patient preparation for ocular foreign body removal procedures, as well as the steps involved in the procedure. **Indications:** - Presence of a foreign body in the eye causing discomfort, pain, or vision disturbances. - Suspected metallic or sharp objects in the eye. - Foreign bodies that are easily accessible and can be safely removed. **Contraindications:** - Inability to visualize or locate the foreign body. - Suspected penetrating injury to the eye. - Presence of a foreign body embedded deep within the eye. - Cases where removal might cause more harm than leaving the object in place. **Precautions:** - Extreme care should be taken to avoid causing additional damage to the eye. - Consideration of potential complications, such as infection or damage to surrounding structures. - Adequate lighting and magnification tools should be used for better visualization. - The patient's cooperation and ability to remain still during the procedure are crucial. **Patient Preparation:** - Explanation of the procedure and obtaining informed consent. - Topical anesthesia may be applied to numb the eye and reduce discomfort. - Proper positioning of the patient to ensure stability during the procedure. - Use of a speculum to keep the eyelids open and improve visibility. - Administration of a topical anesthetic, such as tetracaine eye drops. **Procedure:** 1. **Examination:** Begin by examining the eye thoroughly to locate and assess the foreign body. 2. **Anesthesia:** Apply a topical anesthetic to numb the eye and reduce pain. 3. **Eye Fixation:** Use a speculum to keep the eyelids open and improve visibility. 4. **Fluorescein Staining:** If necessary, use fluorescein staining to enhance the visibility of the foreign body. 5. **Forei Identify the indications, contraindications, precautions, and patient preparation involved in Certainly, I can provide you with information on the indications, cerumen disimpaction. Describe the steps involved in the procedure. contraindications, precautions, and patient preparation for cerumen disimpaction, as well as the steps involved in the procedure. **Indications:** - Symptoms of impacted cerumen (earwax) causing hearing loss, earache, dizziness, tinnitus, or a sensation of fullness in the ear. - Presence of visible cerumen obstructing the ear canal during examination. **Contraindications:** - Suspected perforated eardrum: Cerumen removal is contraindicated if there is suspicion or evidence of a perforated eardrum. - Recent ear surgery or injury: Recent trauma or surgery to the ear may contraindicate cerumen removal until the ear has healed. - Presence of a foreign body in the ear canal: If a foreign body is present, it may need to be addressed before cerumen removal. **Precautions:** - Caution should be exercised to avoid injury to the ear canal, especially in individuals with narrow or tortuous ear canals. - If the patient has a history of recurrent impacted cerumen, preventive measures and routine ear hygiene should be discussed. **Patient Preparation:** - Explanation of the procedure and obtaining informed consent. - Inspection of the ear to assess the extent of cerumen impaction. - Evaluation of the patient's medical history, especially any history of ear surgery or ear problems. **Procedure:** 1. **Examination:** Begin by visually inspecting the ear canal using an otoscope to assess the cerumen impaction and the condition of the ear canal. 2. **Softening Agents (optional):** If the cerumen is hard or impacted, the use of cerumen softening agents (e.g., over-the-counter drops with carbamide peroxide) may be recommended. These drops are typically applied for a few days before the procedure. 3. **Irrigation:** Cerumen removal is commonly performed using irrigation. War Identify the indications, contraindications, Certainly, I can provide information precautions, and patient preparation involved in tympanometry. Describe the steps involved in on the indications, contraindications, precautions, and patient preparation the procedure. for tympanometry, along with the steps involved in the procedure. **Tympanometry:** **Indications:** 1. **Hearing Assessment:** Tympanometry is commonly used as part of a hearing assessment to evaluate the middle ear function and the mobility of the eardrum. 2. **Diagnosis of Middle Ear Disorders:** It is used to assess conditions such as otitis media (middle ear infection), eustachian tube dysfunction, and the presence of middle ear effusion (fluid). 3. **Monitoring Ear Health:** Tympanometry may be used to monitor changes in middle ear function over time or during treatment. **Contraindications:** 1. **Perforated Eardrum:** Tympanometry is contraindicated if there is a perforation (hole) in the eardrum, as it involves changes in air pressure that could be harmful in such cases. 2. **Presence of Otorrhea:** If there is active drainage (otorrhea) from the ear, tympanometry may be contraindicated. **Precautions:** 1. **Ear Infections:** If there is suspicion of an active ear infection, caution should be exercised, and the decision to proceed with tympanometry may depend on the severity and nature of the infection. 2. **Recent Ear Surgery:** Tympanometry should be approached with caution in individuals who have undergone recent ear surgery, and the timing of the procedure may need to be adjusted based on the healing process. **Patient Preparation:** 1. **Explanation of the Procedure:** Inform the patient about the purpose of tympanometry, the procedure itself, and its importance in assessing middle ear function. 2. **Informed Consent:** Obtain informed consent from the patient, explaining the nature of the procedure and any potential discomfort. **Procedure:** 1. **Positioning:** The patient is usually seated Identify the indications, contraindications, Certainly, I can provide information precautions, and patient preparation involved in audiometry. Describe the steps involved in the on the indications, contraindications, precautions, and patient preparation procedure. for audiometry, along with the steps involved in the procedure. **Audiometry:** **Indications:** 1. **Hearing Assessment:** Audiometry is primarily used to assess a person's hearing ability across different frequencies (pitches) and intensities (loudness). 2. **Diagnosis of Hearing Loss:** It helps in diagnosing the type and degree of hearing loss, whether conductive, sensorineural, or mixed. 3. **Monitoring Hearing Changes:** Audiometry is used to monitor changes in hearing over time, especially for individuals with known hearing conditions or those at risk of hearing loss. **Contraindications:** 1. **Severe Ear Infections:** Audiometry may be contraindicated if there is an active, severe ear infection, as inserting earphones or ear inserts could exacerbate the condition. 2. **Ear Surgery Recovery:** If a person has recently undergone ear surgery, it may be contraindicated until the ear has sufficiently healed. **Precautions:** 1. **Cerumen (Earwax) Buildup:** Cerumen impaction can affect the accuracy of the audiometric results. Cerumen removal may be necessary before conducting the test. 2. **Tinnitus:** Individuals with severe tinnitus may find the procedure challenging, and additional considerations may be needed. **Patient Preparation:** 1. **Explanation of the Procedure:** Explain the purpose of the audiometry test, the types of sounds they will hear, and the importance of providing accurate responses. 2. **Informed Consent:** Obtain informed consent from the patient, explaining the nature of the procedure and any potential discomfort. 3. **Cerumen Check:** Check for excessive cerumen, and if present, consider cerumen removal before proceeding with the test. 4. **Comfortable Clothing:** Ensure the pati Identify nasal procedure concerns that warrant emergency evaluation or emergent ear, nose, Certain nasal procedure concerns may require emergency evaluation or and throat (ENT) consult. an emergent Ear, Nose, and Throat (ENT) consultation. These concerns indicate the need for prompt attention to address potential complications or adverse events. Here are some nasal procedure concerns that warrant emergency evaluation or an emergent ENT consult: 1. **Uncontrolled Bleeding:** - Excessive or uncontrolled bleeding during or after a nasal procedure may require urgent evaluation. Hemorrhage can lead to complications such as hematoma formation, airway compromise, or hypovolemic shock. 2. **Severe Pain or Discomfort:** - Intense or worsening pain beyond the expected discomfort may indicate complications such as infection, nerve injury, or inadequate anesthesia. Prompt evaluation is necessary to address the underlying issue. 3. **Signs of Infection:** - Symptoms of infection, including increasing redness, swelling, warmth, and purulent discharge, require urgent attention. Infection can lead to systemic complications if not addressed promptly. 4. **Respiratory Distress:** - Any signs of respiratory distress, such as difficulty breathing, stridor, or persistent nasal obstruction, should be considered an emergency. These symptoms may indicate airway compromise or obstruction. 5. **Allergic Reactions:** - Severe allergic reactions, such as anaphylaxis, characterized by symptoms like swelling, difficulty breathing, or systemic manifestations, require immediate medical attention. 6. **Foreign Body Complications:** - Complications arising from the presence of a foreign body in the nasal passages, such as migration or embedding, may necessitate urgent removal or intervention. 7. **CSF Leak:** - Cerebrospinal fluid (CSF) leakage, identified by clear fluid drainage from the nose, may occur after certain nasal procedures. This requi Identify the indications, contraindications, **Indications for Nasal Packing for precautions, and patient preparation involved in nasal packing for epistaxis. Describe the steps Epistaxis:** 1. **Recurrent Epistaxis:** Nasal involved in the procedure. packing is indicated for recurrent or persistent epistaxis that does not respond to initial conservative measures. 2. **Posterior Bleeding:** In cases of posterior epistaxis, where bleeding originates from deeper areas of the nasal cavity. 3. **Failure of Other Interventions:** When other methods such as cauterization, topical hemostatic agents, or anterior packing have failed to control bleeding. **Contraindications:** 1. **Septal Perforation:** Nasal packing is contraindicated in cases of septal perforation, as it may worsen the perforation and lead to complications. 2. **Facial Fractures:** Avoid nasal packing in the presence of facial fractures, as it may exacerbate swelling and hinder proper fracture management. **Precautions:** 1. **Anticoagulant Use:** Caution is needed in patients on anticoagulant medications, as nasal packing may increase the risk of hematoma formation. The decision to use nasal packing in such cases should be individualized based on the patient's overall health and risk factors. 2. **Cardiovascular Conditions:** Patients with cardiovascular conditions should be monitored closely during the procedure due to the potential for increased blood pressure and heart rate. **Patient Preparation:** 1. **Informed Consent:** Obtain informed consent from the patient or a legal representative, explaining the procedure, its purpose, potential risks, and alternatives. 2. **Baseline Assessment:** Perform a baseline assessment of the patient's general health, vital signs, and any coexisting conditions. 3. **Topical Anesthesia:** Administer topical anesthesia to the nasal passages using lidocaine or a similar agent to enhance patient comfort during the procedure. 4. **Patient Positioning:** Place the patient in a comfortable posi Identify the indications, contraindications, precautions, and patient preparation involved in **Indications for Foreign Body Removal from the Nose:** foreign body removal from the nose. Describe the steps involved in the procedure. 1. **Presence of Foreign Body:** The primary indication is the confirmed or suspected presence of a foreign body within the nasal cavity. 2. **Symptoms:** Patients presenting with symptoms such as nasal pain, obstruction, bleeding, or unilateral nasal discharge suggestive of a nasal foreign body. **Contraindications:** 1. **Sharp or Penetrating Objects:** Caution is needed when dealing with sharp or penetrating objects, as attempts at removal may cause injury or complications. 2. **Uncooperative Patient:** In cases where the patient is uncooperative, frightened, or unable to tolerate the procedure, especially in pediatric patients. **Precautions:** 1. **Caution with Live Insects:** If the foreign body is a live insect, special care is needed to avoid causing the insect to move deeper into the nasal passages or causing further distress to the patient. 2. **Avoid Blind Instrumentation:** Avoid blind instrumentation, especially in cases where the nature or location of the foreign body is unclear. **Patient Preparation:** 1. **Informed Consent:** Obtain informed consent from the patient or a legal representative, explaining the procedure, its purpose, potential risks, and alternatives. 2. **Topical Anesthesia:** Administer topical anesthesia to the nasal passages using lidocaine or a similar agent to enhance patient comfort during the procedure. 3. **Positioning:** Position the patient appropriately, often in a seated or semi-reclined position, with the head stabilized to facilitate the procedure. 4. **Equipment Readiness:** Ensure that all necessary equipment for foreign body removal, such as specialized instruments, a light source, and nasal specula, is readily available. **Procedure Steps:** 1. **Examination:** Conduct a thorough examination of the nasal cavity usi Describe the management for post tooth Take History and Assess avulsion or fracture. $ Give mild analgesics til see's Dentist If fracture, Refer to specialist *If under 1 hour 1: Inspect tooth 2: Gently rinse 3: Irrigate tooth root w/ saline 4:Gently set tooth in socket *If unable place in transport medium 5: Consult Dentist *Contact Endodontist ASAP if unable to set tooth back Education: -Do not dislodge tooth -Clench teeth if support needed -Avoid talk, drink and chew -Seek Dentist ASAP Acute Bronchitis Symptoms: Cough, sputum, fever Acute Bronchitis Diagnosis: Tests generally not necessary Acute Bronchitis Treatment: Mainstay is symptom reduction. 1. Reassure and educate about treatment. 2. Explain 10-14 day cough duration. 3. Rest, hydrate, use humidifier or warm shower. 4. Advise smoking cessation, avoid pollutants, irritants. 5. Use face mask in chemical, dusty environments. 6. Call healthcare provider if symptoms worsen. 7. Promote awareness of symptom severity changes. Common culprit is influenza Avoid antibiotics unless pertussis is suspected (then use Macrolide, Azithromycin). Send to physician if 2 weeks no improvement Pneumonia Symptoms: Fever, chills, malaise, cough, hemoptysis, dyspnea, pleuritic chest symptoms. Pneumonia Diagnosis: Chest Radiography or CT with History/Physical Culture and Gram stain to identify Agent testing not needed for diagnosis. Usually S. pneumoniae. Pneumonia Treatment: Use macrolide if healthy patient then doxycycline 2nd 1. Moxifloxacin 400 mg qd 2. Gemifloxacin 320 mg qd 3. Levofloxacin 750 mg qd Outpatient: Macrolide or doxycycline. Inpatient non-ICU: Respiratory fluoroquinolone or β-lactam plus macrolide. Inpatient ICU: β-lactam plus azithromycin or respiratory fluoroquinolone. Penicillin-allergic patients: Consider alternatives. CA-MRSA treatment: Vancomycin, linezolid. Early: Oseltamivir, zanamivir. Pleural Effusion Symptoms: Dyspnea, nonproductive cough, chest pain, and activity intolerance. Pleural Effusion Diagnosis: Chest radiograph smaller can be ultrasound Pleural Effusion Treatment: Indomethacin for Pain Thoracentesis Refer to ED for distress ARDS (Acute Respiratory Distress Syndrome) Symptoms: NOT IN TEXT BOOK Symptoms: low blood oxygen, rapid breathing, and clicking, bubbling, or rattling sounds in the lungs when breathing. ARDS (Acute Respiratory Distress Syndrome) Diagnosis: NOT IN TEXT BOOK Diagnosis: the doctor will do a physical exam, review your medical history, measure blood oxygen levels, and order a chest X-ray. Identify the clinical presentation, physical examination, and management of patients with acute respiratory conditions: acute bronchitis, DONE pneumonia, pleural effusions, pleurisy, acute respiratory syndrome. What is the criteria for hospitalization vs outpatient management for patients with Patients at low risk for death and who are treated appropriately in the pneumonia? outpatient setting do not require hospitalization. In outpatient settings, for previously healthy individuals with no use of antimicrobial therapy within the previous 3 months, a macrolide antibiotic is recommended. Doxycycline is a secondary recommendation. Appendicitis Symptoms: Pain starting near the belly button and moving to the lower right abdomen. Anorexia, nausea, vomiting. McBurney's Point / Rovsing sign (same thing) Appendicitis Diagnosis: History/Physical If pregnant: Serum β-hCG human gonadotropin Appendicitis Treatment: Acute needs appendectomy within 24 hours of onset. If surgery NPO and IV fluids only Constipation Symptoms: Symptoms: Infrequent bowel movements, hard stools, straining, incomplete evacuation, abdominal discomfort, bloating, rectal bleeding, anal fissures, and rectal prolapse Constipation Diagnosis: Diagnosis: abdominal discomfort, nausea, or vomiting with abdominal xray or CT scan, CBC with differential CBC (for anemia), CMP B. TSH (for hypothyroidism) C. Stool for FOBT Constipation Treatment: Treatment: Stop all medications (OTC or prescription) that may contribute to constipation Give Fiber for IDIOPATHIC D. Colonoscopy criteria: 1. Patient 45 yr or older (may screen earlier with FH colon cancer). 2. Rectal bleeding or iron deficiency 3. Weight loss 4. Recent or sudden onset of constipation 5. IBD (Crohn or UC) Hemorrhoids Symptoms: External may be asymptomatic until thrombosis develops, causing acute perianal pain, anal irritation, pruritus, and edema. Internal are devoid of somatic sensory nerves, are typically painless bright red blood per rectum with bowel movements, occasionally with intermittent, reducible prolapse. The blood may be seen on the toilet paper. Hemorrhoids Diagnosis: Almost always a clinical one. If heavy bleeding, get a CBC for anemia check. Anoscopy plays a critical role. Hemorrhoids Treatment: Fluids and high fiber diet. Elliptical excision can be done with anesthetic. Send home with 12 h gauze. Sitz bath. Educate on sitting too long and footstool. Cream 2-4 x daily If symptoms persist refer to in-office band ligation procedure. Gallstones Symptoms: Most are asymptomatic, if pain, upper right radiates to shoulder with N/V. Can be cholesterol, pigmented, and mixed. right upper quadrant pain, vomiting, fever, jaundice, and presence of Murphy sign. Gallstones Diagnosis: Ultrasound is the most practical imaging study for evaluation. Should be individualized, but a complete blood count (CBC) with differential, urinalysis, liver function tests (LFTs), and serum pancreatic enzymes are usually indicated. Chorionic gonadotropin (hCG) is essential in women in childbearing. Gallstones Treatment: Asymptomatic do not require surgical intervention. Reassure patient. Dissolve stones, surgical removal Counsel on dietary changes. Celiac Disease Symptoms: Symptoms include chronic diarrhea, bloating, abdominal pain, weight loss, fatigue, anemia, skin rash (dermatitis herpetiformis), and nutrient deficiencies. Testing for celiac disease involves blood tests for specific antibodies and, if necessary, a biopsy of the small intestine for confirmation. Celiac Disease Diagnosis: IgA Blood Test 98% sensitive Carbohydrate malabsorption Celiac Disease Treatment: Gluten-free diet no wheat Gastritis Heavy alcohol use associated with malnutrition and atrophic ___________ both may result in low vitamin B12 absorption into the small intestine, causing pernicious anemia along with secretory diarrhea. NSAIDs inhibit cyclooxygenase, decreasing the synthesis of protective prostaglandins, and may have direct effects on the gastric mucosa, causing both irritation and superficial lesions. Gastroenteritis Symptoms: Norovirus causes sudden onset of vomiting, diarrhea, and low-grade or no fever, lasting 1 to 3 days. Gastroenteritis Diagnosis: Norovirus and rotavirus infections are typically diagnosed based on symptoms and confirmed through laboratory tests on stool samples. Gastroenteritis Treatment: Treatment for both viruses primarily involves oral rehydration therapy (ORT), as antibiotics are not effective against viral gastroenteritis. Vaccines like RotaTeq and Rotarix are available to prevent severe rotavirus infections in infants. Cholecystitis Diagnosis: Right upper quadrant abdominal pain, nausea, vomiting, and occasionally fever and jaundice. Cholecystitis Diagnosis: Diagnosis complete blood count, liver function tests, and imaging studies such as ultrasound, CT scan, or MRI. Cholecystitis Treatment: Isotonic intravenous rehydration and correction of electrolyte abnormalities. NPO, chenodeoxycholic acid, injectable nonsteroidal antiinflammatory prostaglandin inhibitor (e.g., ketorolac tromethamine) is also an effective pain reliever. Diabetes or asymptomatic disease or who are not candidates for surgery should have a consultation with a gastroenterologist or surgeon. 28. Identify the clinical presentation, physical Done examination and management of patients with acute gastrointestinal disorders: abdominal pain and infections, nauseas and vomiting, constipation, diarrhea, anorectal complaints, acute pancreatitis, cholelithiasis, cholecystitis, : Glomerulonephritis Symptoms: Acute kidney infection glomerulus, typically manifests with acute-onset oliguria, gross hematuria, hypertension (HTN), edema of hands and face in the morning and feet and ankles in the evening, malaise, lethargy, back pain, and weight gain. Glomerulonephritis Diagnosis: Diagnostic testing involves dipstick urinalysis which reveals hematuria and proteinuria, along with microscopic examination showing elevated white blood cells (>10/hpf) and red blood cells (>10/hpf), as well as the presence of RBC casts and dysmorphic RBCs. Glomerulonephritis Treatment: Immediate transfer to the Emergency Department (ED) is warranted if glomerulonephritis is suspected, where further evaluation and management, including antibiotic therapy, hydration, and supportive care, can be initiated promptly. Nephrolithiasis Symptoms: Sudden, severe flank pain described as colicky and intermittent, possibly radiating to the testicle in males. Hematuria (gross or microscopic), nausea/vomiting, dysuria, urgency. Inability to find a comfortable position due to pain. Nephrolithiasis Diagnosis: Noncontrast helical CT scan is the gold standard for detection of stones and urinary tract obstruction. Dipstick urinalysis showing blood and protein, with microscopic examination revealing RBCs >3/hpf. CBC and basic metabolic panel may be ordered. Nephrolithiasis Treatment: Urgent referral to ED or urologist for severe pain, fluid intolerance, or signs of infection. Pain management with opioids or NSAIDs. Pharmacotherapy to aid stone passage (e.g., tamsulosin or nifedipine). Increased fluid intake to facilitate stone passage. Dietary modifications and prophylactic pharmacotherapy for stone prevention. Referral to urologist for recurrent stones or specific stone types. Urinary Tract Infection Men always considered complicated Women tend to self diagnose accurately Not all bacteria produce nitrate Assess for more spread of infection Ultrasound is recommended for under 2 yrs and for patients with recurrent UTI history Differential dx. PID cervical infection Hydration. Asymptomatic is NOT TREATED Uncomplicated 3 days Complicated 7 days Treatment for non pregnant women is nitrofurantoin or trimethoprimsulfamethoxazole Treatment if pregnant cephalexin, amoxicillin Treatment for men trimethoprimsulfamethoxazole Alt. therapy can be cipro Hospitalization for complicated pyelonephritis or HX. diabetes, sickle cell anemia, nephrolithiasis Uncomplicated pyelonephritis cephalosporin and fluoroquinolones can be prescribed on outpatient basis with 72 hour clinical response. Urethritis Always treated Empirically! Classified as Gonococcal if caused by Gonorrhea's virus, usually caused by Chlamydia Can be transmitted by sexual contact inoculation of the eyes. Many are asymptomatic Signs and Symptoms: purulent leukorrhea that is odorous. Diagnose: Vaginal swabs women, urine catch for men but also can be for women too. Major cause of PID. In men, epididymitis and blindness. Ceftriaxone is recommended IM Chlamydia Azyrthromycin for pregnancy Pyelonephritis Possible Fever, flank pain, N/V, malaise, several days Urine dipstick positive for nitrate, proteinuria. If pregnant or dehydrated refer to hospital. If patient can maintain hydration and mild symptoms, treat outpatient. Ceftriaxone IM then go to cipro 5-7 days Evaluate after 1-2 days if symptoms not resolved, refer to Emergency Department Genital Herpes Symptoms: Cold sores (herpes labialis) may manifest with tingling, itching, burning, and swelling. Genital herpes (HSV) can cause painful sores, itching, and flu-like symptoms during initial outbreaks. Do not cross the midline. Genital Herpes Diagnosis: Laboratory tests include viral cultures, polymerase chain reaction (PCR), and serologic assays. Diagnosis may be made clinically based on history and physical examination. Genital Herpes Treatment: Topical therapy involves medications like acyclovir 400 mg PO q3d for 7-10 days and hydrocortisone. Oral therapy includes drugs like acyclovir 400 mg, famciclovir 125 mg, and valacyclovir 1 g. Nonpharmacologic management includes OTC treatments docosanol (Abreva) cream and prevention strategies. Referral to specialists, HIV coinfection, and treatment failure. Explain the clinical manifestations, diagnostic... criteria, and treatment for urinary tract infections. 2. urinary tract infection Symptoms: Uncomplicated: Increased frequency, urgency, dysuria, suprapubic pain, odorous urine, and occasionally hematuria. Complicated (pyelonephritis or urosepsis): High fever, chills, flank pain, costovertebral angle tenderness, nausea, and vomiting. Men: Mild and gradual onset of symptoms including dysuria, irritative symptoms, frequency, urethral discharge, and pruritus. Women: Vaginal discharge or bleeding, lower abdominal pain, dysuria, and urinary frequency. urinary tract infection Diagnosis: History: Assess urinary symptoms, medical history, recent instrumentation, sexual history, and risk factors for sexually transmitted infections. Physical Examination: Vital signs, abdominal examination, pelvic examination in females, and assessment for urethral discharge and lesions in males. Diagnostics: Urinalysis, urine culture, microscopy, and renal ultrasound for structural abnormalities. urinary tract infection Treatment: All men are complicated Wipe front to back, avoid spermicidal products Treat with Nitrofurantoin ER 100 bid x5 days TMP-SMZ 1 tab 3 days women Amoxicillin 200 mg 7 days if allergies to first choice cefdinir 300 mg x7 days as last resort Prophylactic Trimethoprim-sulfamethoxazole (TMP-SMZ) 100mg If more than 3 per year refer to nephrologist Explain the clinical manifestations, diagnostic Done criteria, and treatment for urethritis. 3. Urethritis Symptoms: increased frequency, urgency, dysuria, suprapubic pain, odorous urine, and occasionally hematuria. Characterized by an inflammation (mechanical, chemical, viral, or bacterial) of the urethra. Nongonococcal urethritis (NGU) is most common, with Chlamydia being the most frequent causative organism. Urethritis Diagnosis: Urinalysis is the most important initial study and the urine dipstick is a reasonable alternative to urine culture to diagnose. Urine culture is the definitive test; specimens should be obtained from all patients. Urethritis Treatment: Recommended Regimens Ceftriaxone 250 mg IM single dose plus Azithromycin 1 g PO single dose, or Doxycycline 100 mg PO twice daily for 7 days (azithromycin preferred) If Ceftriaxone Not Available replace it with Cefixime 400 mg PO in a single dose Explain the clinical manifestations, diagnostic... criteria, and treatment for pyelonephritis. 4. Pyelonephritis Symptoms: Adults: Fever (>99.9°F, not always present) with chills. Severe flank pain or costovertebral angle tenderness (CVAT), often localized over the affected kidney but may be bilateral. Nausea, vomiting, malaise, and anorexia. Dysuria, frequency, and urgency. Symptoms may persist for several days. Elderly: Fever (less common).Mental status changes (common).Generalized deterioration with an increase in falls. Decompensation in another organ system (e.g., heart failure). Pyelonephritis Diagnosis: Positive leukocyte esterase and nitrites are good indicators of infection. Positive for bacteria, WBCs (>10 to 20/hpf), RBCs (>3/hpf), and presence of RBC/WBC casts. Urine Culture and Sensitivity (C&S) to guide antibiotic treatment. CBC, basic metabolic panel. Plain abdominal films and renal ultrasound may be considered. Pyelonephritis Treatment: IV fluids in office N/V promethazine/ondansetron Ciprofloxacin 500 mg BID 7 days Acetaminophen Repeat U/A after 5 days refer to urologist or ED Refer to urologist for Men w/ 1st episode or women with unresolved. Explain the clinical manifestations, diagnostic criteria, and treatment for nephrolithiasis. Hx. of hyperoxaluria with cystinuria. High salt intake coronary artery disease, waist circumference Obese individuals excrete more stones. Cola and chocolates increase risk. Low citrate contributes too. Allopurinol, laxatives potassium channel blockers. family history. fluid intake. Usually has a soft abdomen to rule out aortic aneurysm. Reduced urinary flow. Calcium oxalate are most common. Fever chills dull pain, flank located, N/V, severe CVA tenderness Colic has sudden onset Elevated creatinine, hematuria Diagnosis with: Physical Exam, U/A to determine ph level to determine ph of stone, imaging X-RAY is FASTEST. NONCONTRAST COMPUTED TOMOGRAPHY IS GOLD STANDARD for DIAGNOSIS. Evaluate metabolic panel. CBC ordered to rule out infection. ultrasound for pregnant women Acne Vulgaris Symptoms: black heads, white heads (comedones), papules, pustules legions face neck upper trunk Acne Vulgaris Diagnosis: Diagnosed by physical examination. Laboratory blood testing is necessary only if adrenal or gonadal dysfunction. Acne Vulgaris Treatment: One frustrating fact of acne therapy is that most treatments require 6 to 12 weeks to take effect. Topical first line tretinoin (Retin-A), benzoyl peroxide, and salicylic acid applied to clean skin once daily, usually before bedtime. Oral antibiotics are effective most commonly used oral antibiotics include erythromycin, tetracycline, doxycycline, and minocycline. Isotretinoin is restricted to the treatment of recalcitrant nodulocystic acne that has been unresponsive to standard therapies. Sexually active women of childbearing age must use two forms of birth control and be monitored for pregnancy monthly. Rosacea Symptoms: There are no comedones (bumps). Occurs bilaterally without comedones; there is very little to no scarring and centrally on the face. Appears as erythema, telangiectasia, inflammatory papules, and/or pustules on central face. Rosacea Diagnosis: 4 Subtypes: 1: Erythematotelangiectatic 2: Papulopustular 3: Phymatous Mild and Severe 4 Ocular Otherwise... NONE Acne is diagnosed primarily through physical examination. Laboratory blood testing is required only if adrenal or gonadal dysfunction is suspected. Other conditions often mistaken for acne include milia, rosacea, adenoma sebaceum lesions of tuberous sclerosis, nevus comedonicus, miliaria of the newborn, flat warts, and molluscum contagiosum. Rosacea Treatment: Metronidazole 1% cream qd or metronidazole 0.75% gel bid a) If severe, may need to add an oral antibiotic (tetracycline) until remission b) May take several weeks for the effects to be seen and the usual course of treatment is up to 2 mo Tetracycline 250 to 500 mg q12h until improvement is seen; then decrease to daily dosing 2. Doxycycline 100 mg bid until improvement is seen; then may need daily dosing 3. Minocycline 50 to 100 mg bid until improvement is seen; then may need daily dosing 4. Metronidazole 250 mg qd for 4 to 6 wk Mild emollient-based cleansers along with light, nongreasy facial moisturizers. Oil-based products are to be avoided. Patients do not need to avoid makeup. 1: Erythematotelangiectatic - Primary: metronidazole topical, doxycyclyne Secondary: erthromycin, metronidazole Tertiary: erythromycin, metronidazole 2: Papulopustular: metronizadole, doxycycline, laser treatment 3: Phymatous Mild: metrronizadole, doxycycline and Severe: electrosurgery, laser surgery 4 Ocular: artificial tears, metronizadole, azithromycin, mycin, trimethoprim/sulfamethoxazole Burns Symptoms: H (Head and neck): 9% A (Arms, both): 18% (9% each) T (Trunk): 36% (18% ant & post) L (Legs): 36% (18% each) P (Perineum): 1% 1st: Glossy red 2nd: dull pink red 3rd: white, brown, black, full thickness, subcutaneous fat insensate Burns Diagnosis: Simple, no testing. More Serious: CBC, Glucose, BUN. Chest X-Ray for inhalation damage Burns Treatment: Minor, reduce heat w/ cool water. Do not rupture blisters. Soap and water. Use silver cream. acetaminophen 500 to 1000 mg tid or ibuprofen 400 to 800 mg tid Referral if greater than minor burn criteria. Circumferential burns; burns involving the face, chest, or neck; Burns of a severity greater than second degree and/or involving the fascia and tendons, ligaments, or muscle, electrical burns Referral if failed healing > 2-3 weeks Varicella Zoster Symptoms: 1. Primary Onset: Initial severe infection, painful lesions, may last 10 to 14 days. 2. Latent Phase: Virus remains dormant in nerves, no active symptoms. 3. Recurrent Outbreak: Lesions reappear unpredictably, usually shorter and less severe than primary outbreak. Varicella Zoster Diagnosis: History & physical Consider testing for newly diagnosed. Definitive test is culture. Fluid from vesicle for Tzanck or DFA test; less sensitive than culture. Serologic testing may not differentiate HSV-1/HSV-2, reveals previous exposure. Varicella Zoster Treatment: Acyclovir 200 mg 5 times qd for 5 days (adults) Famciclovir 250 to 500 mg q8h for 7 to 10 days (adults only) Valacyclovir 1000 mg q12h for 7 days or 2 gm bid for one day (adults only) Recurrence started at earliest sign of infection Acyclovir 400 mg tid for 5 days or 200 mg 5 times qd for 5 days or 800 mg q12h for 5 days (adults) Valacyclovir 2 g bid for 1 day (adults) or 1 g bid for 7 days Famciclovir 750 mg bid 1 day or 1500 mg as single dose (adults only) Suppression for adults: 1. Acyclovir 400 mg bid 2. Valacyclovir 500 mg or 1 g qd 3. Famciclovir 250 mg bid for 12 mo Intertrigo Symptoms: Inflammatory skin disorder from friction and moisture, presenting as erythema, scaling, plaques, and itching, often in skin folds. Intertrigo Diagnosis: Relies on clinical appearance. Scrapings can confirm Candida with KOH prep. Culture identifies superinfections; Wood lamp detects erythrasma. Biopsy for tougher cases. Intertrigo Treatment: Keep skinfolds cool and dry. fluconazole is 100 to 200 mg PO daily for 7 days, but obese individuals may need an increased dose Impetigo Symptoms: Cutaneous lesions: crusts, vesicles, or pustules with moist base. Bullous lesions common in intertriginous areas. Enlargement, crust formation noted. Impetigo Diagnosis: Patient history and physical exam are commonly the only diagnostics needed. Impetigo Treatment: Interprofessional Care: - Topical Antibiotics: Mupirocin 2% ointment 3 times daily, or retapamulin 1% twice daily. - Oral Antibiotics: Dicloxacillin, cephalexin, azithromycin, amoxicillin/clavulanate for 7-10 days. - Non-Pharmacological: Wet compresses, chlorhexidine gluconate washes. Considerations: - Impetigo affects all ages, worsened by crowded settings. Risk factors include malnutrition, anemia. Complications: - Recurrent infections may need intranasal mupirocin and oral antibiotics like rifampin, doxycycline. Cellulitis Symptoms: Presents with redness, warmth, pain. Diagnosis by clinical recognition, culture, blood tests. Mimics exist. Cellulitis Diagnosis: Gram stain, culture for moderate to severe infections. Blood cultures, biopsy for severe cases. Cellulitis Treatment: - Oral antibiotics: CILLIN MEDS that Cover S. aureus; consider MRSA, adjust dose for obesity and comorbidities. - IV antimicrobials for severe cases, consider vancomycin, daptomycin. - Anti-inflammatory agents accelerate healing, consider NSAIDs, steroids with caution. - In-office incision and drainage for purulent infections. Nonpharmacologic Management: - Postural drainage, compression for cellulitis. - Debridement, daily dressing for ulcerative lesions. - Referral for severe, immunocompromised, or unresponsive cases. Life-Span Considerations: - Monitor diabetes-related complications, prevent secondary infections. - Address underlying dermatoses promptly. - Routine checks to prevent complications. Psoriasis Symptoms: Red scaly papules and plaques form and collect on skin surfaces in welldemarcated lesions. Psoriasis Diagnosis: Psoriasis diagnosis by appearance, biopsy for pustular cases; uric acid levels may rise. Psoriatic arthritis lacks definitive tests, linked to HLA-B27. Psoriasis Treatment: Mild to moderate: Topical corticosteroids are first-line; vitamin D analogues and calcineurin inhibitors are alternatives. Oral retinoids, methotrexate, and biologics are systemic options. Phototherapy and combination therapies are common. Referral is indicated for unresponsive cases. Psoriatic arthritis warrants close monitoring. Tinea Corporis Symptoms: Appears on the skin as erythematous plaques and papules in an annular or arciform pattern. Involves the trunk, extremities, feet, groin, face, or hand. Tinea Corporis Diagnosis: The easiest method of exam is using KOH (Potassium hydroxide) microscopy to diagnose hair, nail, and skin. Wood Lamp. Tinea Corporis Treatment: Fluconazole, aluminum sulfate (Domeboro) soaks, many others products should be continued 1 week after clearing of the lesions to discourage recurrence. Clinical improvement typically occurs soon after treatment initiation. Apply topical treatments twice daily. Treat infections for 2 weeks after resolution. Tinea pedis, unguium, and capitis require at least 6 weeks of treatment. Deep, inflammatory lesions may resist topical therapy. Topicals have no effect on nail tinea. It is imperative that patients keep problem areas as dry as possible and avoid recurrence of tinea infestation. Tinea Versicolor Symptoms: Lesions exhibit varied coloration: white or light pink in hypopigmented versions, tan or brown in hyperpigmented versions. Slightly scaly, round or oval. Tinea Versicolor Diagnosis: Initial diagnosis includes KOH (Potassium hydroxide) examination revealing "spaghetti and meatballs" appearance, Wood's lamp test, and fungal culture if necessary. Tinea Versicolor Treatment: Topical antifungals and medicated shampoos are primary treatments for tinea versicolor. Imidazoles and selenium sulfide or zinc pyrithione shampoos are effective. Apply shampoos to affected areas, let dry, rinse after 10 minutes. Repeat daily for 7-14 days during active infection, then periodically as needed. For extensive or unresponsive cases, systemic antifungals are the second line of treatment. This may involve itraconazole (200 mg daily for 5-7 days) or fluconazole (300 mg weekly for 2-4 weeks). Oral ketoconazole isn't approved due to hepatotoxicity, but topical forms might help. Folliculitis Symptoms: Manifests as erythematous papules and pustules around hair follicles. Types include S. aureus, Gramnegative, P. aeruginosa, fungal, viral, and Demodex folliculitis. Folliculitis Diagnosis: Diagnosed by cultures or scraping. Folliculitis Treatment: Pharmacologic management involves topical benzoyl peroxide as first-line for superficial cases, dicloxacillin for recurrent S. aureus, cephalexin for S. aureus infections, ampicillin for gramnegative cases, ciprofloxacin for P. aeruginosa. Antifungals treat dermatophytic folliculitis. Demodex folliculitis is treated with antiparasitic therapy. Pain can be managed with acetaminophen or NSAIDs. Nonpharmacologic methods include patient education on prevention, laser hair removal, and referral to a dermatologist for severe cases. Atopic Dermatitis (Eczema): Symptoms Atopic dermatitis presents as pruritic, erythematous, dry patches with scales and excoriations. It may appear in various body areas, notably flexural folds and extremities. Atopic Dermatitis (Eczema): Diagnosis Diagnosed clinically via history and examination. No routine imaging or lab tests are needed. Additional tests like KOH (Potassium hydroxide) preparation, biopsy, and patch testing may aid. Differentials include mycosis fungoides, immunodeficiency, scabies, psoriasis, and seborrheic dermatitis. Atopic Dermatitis (Eczema): Treatment Treatment emphasizes patient education, avoiding scratching, continual moisturization, and inflammation control. Antihistamines alleviate itching. Topical corticosteroids alleviate inflammation, while nonsteroidal calcineurin inhibitors and newer drugs target inflammation. Acute and persistent flares of eczema may require stronger topical steroid medications such as triamcinolone 0.1% cream. Typically these medications are applied twice daily for 2 weeks, and then every 3 days as needed for control. Overt infections require appropriate treatment. Referral may be necessary for unresponsive cases or suspected allergies. Onychomycosis Symptoms: The most common nail condition, affects toenails primarily, causing discoloration, thickening, roughness, and sometimes onycholysis. Triggers include age, trauma, diabetes, and immunodeficiency. Trichophyton rubrum and Candida are common pathogens. Subungual hyperkeratosis and discoloration characterize clinical presentation. Physical examination reveals nail discoloration, thickening, onycholysis, and subungual hyperkeratosis. Onychomycosis Diagnosis: Accurate diagnosis is crucial for effective treatment. Microscopic examination of nail scrapings using KOH (Potassium hydroxide) preparation aids in diagnosis, but fungal culture remains the gold standard. Molecular assays may assist. Differential diagnosis includes malignancy and psoriasis, which may coexist with fungal infection. Subungual malignant melanoma warrants urgent referral. Onychomycosis Treatment: Confirmed diagnosis warrants systemic treatment. Terbinafine is effective orally for 12 weeks (toenails) or 6 weeks (fingernails). Topical agents have limited efficacy. Ciclopirox nail lacquer is an alternative. Referral to dermatology is advisable for complex cases or suspected malignancy. Patient education on medication use, recurrence prevention, and foot care is crucial. Avoid tight fitting shoes. Herpetic Whitlow Symptoms: Manifests as painful herpetiform vesicles around the distal finger, often preceded by flulike symptoms. Vesicles persist for 8-12 days, eventually forming crusted fissures. Edema and erythematous streaking may be present, alongside enlarged lymph nodes. Examination includes nail inspection and assessment of lymphadenopathy. Herpetic Whitlow Diagnosis: Relies on clinical evaluation, though confirmation may involve viral culture of vesicular fluid, Tzanck smear, or serum titers. Additional bacterial culture may be necessary if secondary bacterial infection is suspected. Priority differentials include tenosynovitis and bacterial infections. Herpetic Whitlow Treatment: Non-pharmacologic methods like cool compresses and avoiding incision to prevent superinfection. Pharmacologic management involves analgesics for pain and antivirals (e.g., acyclovir) for severe cases or recurrences. Referral to a physician may be necessary for resistant cases, but hospitalization is rare. Patients should be educated about infection risk, medication adherence, and seeking medical help for complications. Furuncles Symptoms: Furuncles, commonly known as boils, originate from infected hair follicles and extend into the dermis, forming abscesses. They present as painful nodules with central pustules and erythematous margins. Treatment involves incision and drainage for larger furuncles, systemic antibiotics targeting Staphylococcus aureus, and referral for severe cases or immunocompromised patients. Furuncles Diagnosis: Is largely by clinical recognition. The causal pathogen may be determined by Gram stain and culturing any existing vesicular fluid, pus, ulcer, or erosions; this is indicated to evaluate bacteriology and susceptibility patterns. Furuncles Treatment: For furuncles, oral antibiotics targeting S. aureus are essential, with consideration for MRSA coverage based on clinical severity and local resistance patterns. Incision and drainage are necessary for larger furuncles, while smaller ones may resolve with moist heat application. Nonpharmacologic management includes postural drainage and compression. Referral is indicated for severe infections, immunocompromised patients, and those with poor outpatient response. Wart (Verruca) Symptoms: Caused by various types of human papillomavirus (HPV). They manifest as skin-colored, hyperkeratotic papules in different forms: common on hands and knees, filiform on the face, on the face and extremities, and verruca plantaris on the soles of the feet. Anogenital, transmitted sexually, range from small, skin-colored papules to large, cauliflower-like growths. Wart (Verruca) Diagnosis: Diagnosis primarily relies on clinical observation. Debridement of thickened epidermis can reveal pinpoint capillaries, distinguishing warts from calluses. Absence of skin lines within the lesion aids in diagnosis. Additional diagnostics, if indicated, may include lesion biopsy, cytology, immunoperoxidase stain, and lesion culture. Differential diagnosis includes seborrheic keratosis, callus, lichen planus, squamous cell carcinoma, molluscum contagiosum, amelanotic melanoma, and foreign body reactions. Genital warts mandate ruling out secondary syphilis, while other pr

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