Chamberlain College of Nursing - NR 602NR 602 Midterm Study Notes and Guide (85 Pages)

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Chalazion Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma Management • Acute lesions are treated with hot compresses. Blepharitis Blepharitis is an a... cute or chronic inflammation of the eyelash follicles or meibomian sebaceous glands of the eyelids (or both). It is usually bilateral. Clinical Findings • Swelling and erythema of the eyelid margins and palpebral conjunctiva Acute Otitis Media AOM is an acute infection of the middle ear (Fig. 30-4). The AAP Clinical Practice Guideline requires the presence of the following three components to diagnose AOM (Lieberthal et al, 2013): Diagnostic Studies Pneumatic otoscopy is the simplest and most efficient way to diagnose AOM. Management Many changes have been made in the treatment of AOM because of the increasing rate of antibiotic-resistant bacteria related to the injudicious use of antibiotics. Prevention and Education The following interventions, shown to be helpful in preventing AOM, should be encouraged: Conjunctivitis An estimated 6 million cases of bacterial conjunctivitis occur in the United States annually, at an estimated cost of $377 million to $857 million (Azari and Barney, 2013). Types of Conjunctivitis Types of Conjunctivitis Type Incidence/Etiology Clinical Findings Diagnosis Management* Ophthalmia neonatorum Neonates: Chlamydia trachomatis, Staphylococcus aureus, Neisseria gonorrhoeae, HSV (silver nitrate reaction occurs in 10% of neonates) Erythema, chemosis, purulent exudate with N. gonorrhoeae; clear to mucoid exudate with chlamydia Culture (ELISA, PCR), Gram stain, R/O N. gonorrhoeae,chlamydia Saline irrigation to eyes until exudate gone; follow with erythromycin ointment For N. gonorrhoeae:ceftriaxone or IM or IV For chlamydia: erythromycin or possibly azithromycin PO For HSV: antivirals IV or PO Bacterial conjunctivitis In neonates 5 to 14 days old, preschoolers, and sexually active teens: Haemophilus influenzae(nontypeable), Streptococcus pneumoniae, S. aureus, N. gonorrhoeae Erythema, chemosis, itching, burning, mucopurulent exudate, matter in eyelashes; ↑ in winter Cultures (required in neonate); Gram stain (optional); chocolate agar (for N. gonorrhoeae) R/O pharyngitis, N. gonorrhoeae, AOM, URI, seborrhea Neonates: Erythromycin 0.5% ophthalmic ointment ≥1 year old: Fourth-generation fluoroquinolone For concurrent AOM: Treat accordingly for AOM Warm soaks to eyes three times a day until clear No sharing towels, pillows No school until treatment begins Chronic bacterial conjunctivitis (unresponsive conjunctivitis previously treated as bacterial in etiology) School-age children and teens: Bacteria, viruses, C. trachomatis Same as above; foreign body sensation Cultures, Gram stain; R/O dacryostenosis, blepharitis, corneal ulcers, trachoma Depends on prior treatment, laboratory results, and differential diagnoses Review compliance and prior drug choices of conjunctivitis treatment Consult with ophthalmologist Inclusion conjunctivitis Neonates 5 to 14 days old and sexually active teens: C. trachomatis Erythema, chemosis, clear or mucoid exudate, palpebral follicles Cultures (ELISA, PCR), R/O sexual activity Neonates: Erythromycin or azithromycin PO Adolescents: Doxycycline, azithromycin, EES, erythromycin base, levofloxacin PO Viral conjunctivitis Adenovirus 3, 4, 7; HSV, herpes zoster, varicella Erythema, chemosis, tearing (bilateral); HSV and herpes zoster: unilateral with photophobia, fever; zoster: nose lesion; spring and fall Cultures, R/O corneal infiltration Refer to ophthalmologist if HSV or photophobia present Cool compresses three or four times a day Allergic and vernal conjunctivitis Atopy sufferers, seasonal Stringy, mucoid exudate, swollen eyelids and conjunctivae, itching (key finding), tearing, palpebral follicles, headache, rhinitis Eosinophils in conjunctival scrapings Naphazoline/pheniramine, naphazoline/antazoline ophthalmic solution (see text) Mast cell stabilizer (see text) Refer to allergist if needed Otitis Externa Otitis externa (OE), commonly called swimmer's ear, is a diffuse inflammation of the EAC and can involve the pinna or TM. Inflammation is evidenced as (1) simple infection with edema, discharge, and erythema; (2) furuncles or small abscesses that form in hair follicles; or (3) impetigo or infection of the superficial layers of the epidermis. Streptococcal Disease Streptococci are gram-positive spherical cocci that are broadly classified based on their ability to hemolyze RBCs. Complete hemolysis is known as beta-hemolytic. Partial hemolysis is alpha-hemolytic; non-hemolysis is gamma-hemolytic. Cell wall carbohydrate differences further subdivide the streptococci. Differential Diagnosis, Management, and Complications Many viral pathogens are on the differential for acute pharyngitis, including influenza, parainfluenza, rhinovirus, coronavirus, adenovirus, and respiratory syncytial virus. EBV Kawasaki Disease KD (also known as mucocutaneous lymph node syndrome or infantile polyarteritis) is the second most common 563childhood vasculitis with a varying incidence from country to country, with Japan having the highest incidence of 239.6 per 100,000. Stage 1: Acute Phase Stage 2: Subacute Phase Stage 3: Convalescent Phase Diagnostic Studies Differential Diagnosis Management Complications and Prognosis The acute disease is self-limited; however, during the initial stage (acute phase), inflammation of the arterioles, venules, and capillaries of the heart occurs and can later progress to coronary artery aneurysm in 15% to 25% of untreated children (less than 5% when treated appropriately). [Show More]

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