NURS 5335 family 2 Study Guide EENT Family Nursing II Modules 1&2 (spring 2022)

NURS 5335 family 2 Study Guide EENT Family Nursing II Modules 1&2 Non-Ulcerative: A/W seborrhea; seen commonly with trisomy 21; affects those with psoriasis, seborrhea, eczema, allergies and lice. Chemical and environmental irritants contribute Ulcerative:Involves the lash follicle & the Meibomian glands of the eyelid.May be pustules at the base of the hair follicle that crust & bleed.Lashes break easy. - Blepharitis Blepharitis treatment - TX: Warm compress; daily lid scrubs; erythromycin, quinolone or bacitracin ophthalmic ointment for anterior blepharitis. Consider oral ABX for resistance (Doxycycline or Tetracycline) Disinfect contacts Lid massages hordeolum age group? - More common in children and adolescents hordeolum s/s? - Localized tenderness, erythema, edema of eyelids; internal lesions pointing to external or internal eyelid surface; external lesions pointing to eyelid margin Pain Ocular rosacea Contact dermatitis, Atopic Kerato-conjunctivitis, Herpes simplex infection, Preseptal cellulitis, Acute dacryocystitis, - differentials of hordeolum differentials of hordeolum - blepharitis Sebaceous carcinoma, Basal cell carcinoma, Squamous cell carcinoma, Dry eye syndrome, Conjunctivitis, blepharitis - Ocular burning, eyelid margins red w/ scaling or crusting Pain Itching, tearing, chalazia, recurrent styes, photophobia, small ulceration at eyelid margin, broken or absent eyelashes hordeolum - (stye) red, painful pustule that is a localized infection of hair follicle at eyelid margin. The most common associated organism is Staphylococcus aureus TX: Warm compress; lid scrubs for recurrent lesions - Hordeolum tx chalazion - a nodule or cyst, usually on the upper eyelid, caused by an obstruction in a sebaceous gland A granulomatous infection of a Meibomian gland Nontender chronic lesions; bump - Chalazion is More common in adults and S?S TX: Warm compress; daily lid scrubs; lid message; intralesional steroid injection - Chalazion Conjunctivitis - Refer to ophthalmology for viral herpetic conjunctivitis w/RED FLAGS Inflammation of the conjunctiva covering the front of the eye from a causative agent (bacteria, virus, allergen) - Conjunctivitis Conjunctivitis - Allergic conjunctivitis is seen more in Spring and Summer. Bacterial is seen more in pediatric population. Conjunctivitis - ALLERGIC: Pruritus; conjunctival hyperemia, chemosis; a watery or stringy discharge BACTERIAL: Photophobia w/ blepharospasm; mucopurulent discharge w/ eyelash mattering; edema; hyperemia; preauricular adenopathy only w/ hyperacute disorder VIRAL: Acute onset often A/W systemic illness; photophobia or foreign body sensation; preauricular adenopathy; hyperemia; chemosis; watery discharge; classic dendritic corneal lesion present w/ herpes simplex; periocular lesions present w/ herpes zoster opthalmicus ALLERGIC: Conjunctivitis - Pruritus; conjunctival hyperemia, chemosis; watery or stringy discharge Topical antihistamine/oral antihistamine or topical vasoconstrictor decongestant antihistamine (OTC) drops: o Naphazoline hydrochloride 0.025% (Naphcon-A) o Naphazoline- antazoline 0.3% (Vasocon-A) o Levocabastine hydrochloride 0.05% (Livostin) o Emedastine 0.05% (Emadine) mast cell stabilizers: o Olopatadine 0.1% (Palatal) o Azelastine 0.05% (Optivar) 1st line = prevention; avoid whatever allergen is triggering conjunctivitis BACTERIAL:Conjunctivitis - Photophobia w/ blepharospasm; mucopurulent discharge w/ eyelash mattering; edema; hyperemia; preauricular adenopathy only w/ hyperacute disorder Caused by staph, strep, h flu, and m catarrhalis, Pseudomonas (contact lens wearers), gonorrhea ****Staph aureus (more common in adults) Eye drops or ointment: o Polytrim/trimethoprim/polymyxin o Erythromycin o Tobramycin o Gentamicin o Sodium sulfacetamide o Ciprofloxacin o Fluoroquinolones-(**1st line for contact users) o Ointment over drops for children VIRAL:conjunctivitis - the second eye usually infected after 24-48 hrs itchy eyes. Tearing. Redness. Discharge. Sandy, gritty Light sensitivity (when corneal involvement is present) TX: Antihistamine/decongestant drops o Trifluridine (herpes conjunctivitis) enlarged or tender preauricular node; initially unilateral, then bilateral caused from adenoviruses, coxsackie virus, varicella, herpes, and herpes zoster § fluorescein stain= dendrites-----****Referral to opthamologist Red flags in conjunctivitis: - Diminished visual acuity, photophobia, severe foreign body sensation preventing pt from keeping eye open, corneal opacity, fixed pupil, or severe HA with nausea corneal abrasion - Partial or complete defect in the epithelial layer of cells after traumatic event or overexposure to sunlight Corneal Abrasion Fluorescein stain, C&S for - Overexposure to sunlight, sports, failure to wear eye protection Urgent referral to ophthalmology for erosions and emergent for ulcers corneal abrasion tx - Pain, redness, tearing, photophobia, foreign body sensation Abx ointment or drops for 5-7 days -Traumatic/foreign body/recurrent abrasions= erythromycin ointment OR sulfacetamide o Contact lens abrasion= ofloxacin, cipro OR tobramycin drops/ointment -Oral analgesics o Tetanus prophylaxis ***ointment preferred due to lubrication to help facilitate regeneration of epithelium periorbital edema - swelling of the tissues surrounding the eye or eyes Hordeola, Chalazia, Bug bites, trauma-related lesions, lesions caused by recent surgical procedures near the eyelids, lesions caused by oral procedures, dacryocystitis, filler injections around cheeks and forehead Caused by Staph, group A strep, strep pneumonia, H influenza, fungal Bacterial infections may result from local spread of an adjacent sinusitis or dacryocystitis, from an external ocular infection, or following trauma to the eyelids. The most common organisms are Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, and anaerobes, reflecting the organisms that commonly cause upper respiratory tract infections and external eyelid infections. - What can cause periorbital edema? Allergic Contact Dermatitis, Bacterial Conjunctivitis (Pink Eye), Carotid-Cavernous Fistula (CCF), Dacryoadenitis, Dacryocystitis, Herpes Simplex, Herpes Zoster, Hordeolum, Orbital Cellulitis, Viral Conjunctivitis (Pink Eye) - Periorbital Edema differentials PE & TX for periorbital edema - PE: Be alert for signs of systemic illness (esp. in peds). Look for signs of trauma. VA test & pupillary reaction as well as EOM. Funduscopic exam. TX: Broad-spectrum ABX (Cephalosporin, Ampicillin-Clavulanic acid) periorbital edema F/U exam within #-#? hours Refer to Opthalmology or otolaryngology if no response to treatment (for IV ABX) - 12-24 Broad-spectrum ABX for sinusitis caused periorbital edema: (Cephalosporin, Ampicillin-Clavulanic acid) - cause the sinus may have let it spread..the bacteria may be broadly from the body so in periorbital edema tx is? periorbital edema from sinusitis: YOu follow up with pt 12-24 hours later and there is no resolve? - Refer to opthalmologyor otolaryngology if no response to treatment (for IV ABX) Pterygium of the eye looks like "the more you know stardust pic." - A vascularized lesion that extends from the conjunctiva of the nasal palpebral fissure onto the nasal cornea horizontal meridian at 3 or 9 o'clock position, more nasally than temporal Pingueculas: - Degenerative lesions of the conjunctiva resulting from epithelial hyperplasia elevated yellowish growth in the nasal aspect of the palpebral conjunctiva Pingueculas: - Pt x, 20-50 years old, reports on and off again irritation, dry eye, itchy...pain when ted yellowish growth in nasal aspect of the palpebral conjunctiva Pterygium - (Jill, 20-50 years old, reports on and off again irritation, dry eye, itchy...pain when inflamed. The eye has a "the more you know" stardust pattern with, a Vascularized lesion that extends from the conjunctiva of the nasal palpebral fissure onto the nasal cornea dry eye - May be acquired or congenital. A deficiency in any layer of the tear film or in any component of the lacrimal functional unit can lead to dry eye. Inflammation plays a central role in exacerbating & perpetuating dry eye disease. Inflammatory cytokines affect tear film osmolarity, leading to ↑ tearing film instability & evaporative loss, which in turn leads to further inflammation. Dry Eye: - Sjogrens, cranial nerve palsy, lupus, RA, lymphoma, sarcoidosis ↓tear production: Meds (anticholinergics, beta-adrenergic blockers, antihistamines), aging (esp. women during menopause), sitting at a computer for long periods of time Dry Eye: s/s ↓tear production - Sandy, gritty, foreign body sensation; burning; pruritus; light sensitivity, transient blurred vision that is relieved by blinking; conjunctival hyperemia; ↓ visual acuity, sometimes pain Common after Lasix surgery EYELID DISORDERS of dry eye - Trichiasis, facial nerve palsy, floppy eyelid syndrome CONJUNCTIVAL DISORDERS of dry eye - Viral or allergic conjunctivitis, topical medication toxicity (glaucoma drops), Cicatrizing conjunctivitis (graft-vs-host disease, Stevens-Johnsons syndrome, ocular cicatricial pemphigoid, trachoma) CORNEAL DISORDERS of dry eye - Corneal abrasion, Corneal foreign body, Contact lens intolerance, Thermal or chemical burns, Herpes simplex or Varicella Zoster keratitis, Pterygium, ↓ corneal sensation (neurotrophic keratopathy, PD), Photokeratitis (welding or tanning beds w/o UV protection) DRY EYE SYNDROMES of dry eye - Aqueous-deficient dry eye: lacrimal gland deficiency & Evaporative dry eye:meibomian gland dysfunction PE, VA, fluorescein and cobalt blue-filtered light source, CN exam, Schirmer test, tear breakup time test Level 1: education, environmental & dietary modifications, eliminate offending meds, use of artificial tears, possible eyelid therapy Level 2: ocular lubricants, non preserved first-line: artificial tear substitutes, antiinflammatory agents (cyclosporine A), topical corticosteroids, topical/systemic omega-3 fatty acids, Restasis solution Level 3: Autologous serum, special contacts & permanent punctual occlusion Level 4:Systemic anti-inflammatory agents; surgical interventions - levels of tx for dry eyes dacryostenosis risks: - Brachycephalic heads Female sex Whites or non-African American Infants or adults greater than 40 HX of chronic allergies, inflammatory disease, sarcoidosis, Crohn's, UC, sinusitis, previous nasal or sinus surgeries, prior midfacial fractures or radiation therapy. Dacryostenosis - tx? - PE: signs of inflammation such as telangiectasia-as or erythema. overflow of tears, mucoid or purulent drainage. Fever & leukocytosis may be present. Examine nasal passages for anything that could obstruct the ducts. TX: Definitive treatment usually requires sx. Temporary conservative management includes warm compress and topical broad-spectrum ABX and oral ABX. Infection or inflammation of the nasolacrimal sac, usually accompanied by blockage of the nasolacrimal duct. Dacryocystitis can be acute or chronic and congenital or acquired. - Dacryostenosis from? Chronic tearing, ocular discharge, eyelash crusting, painful swelling below the medial canthus & a mucopurulent discharge from the puntum - Dacryostenosis s/s Conjunctivitis, Blepharitis, Meibomian gland disease, Congenital glaucoma, Dry eye syndrome, Corneal abrasion, Corneal foreign body, Tumor, Foreign body, Eyelid malposition, Punctal stenosis, Bell palsy, Preseptal cellulitis, Orbital abscess, Orbital Cellulitis or it might be - Dacryostenosis differentials Preseptal Cellulitis - absent orbital cellulitis signs and more prominent eyelid symptoms. Tx- outpatient Abx dacryostenosis tx or refer? - Refer to an oculoplastic surgeon Hyphemia - Hemorrhage into the anterior chamber of the eye as a result of iris or ciliary body rupture. May be spontaneous, but usually is a result of blunt trauma. EMERGENCY *********Continues...