Primary Care The Art and Science of Advanced
Practice Nursing – an Interprofessional
Approach 6th Edition Test Bank
1). Blepharitis pathophysiology
Ans: Inflammation of the eyelids. Two categories are anterior and posterior. Anterior
involves anterior it later margin surrounding lid margin and usually associated with staff
infection or seborrhea. Posterior involves posterior lid margin associated with
meibomian gland dysfunction and rosacea.
2). Blepharitis history and clinical presentation
Ans: Inflammation and erythema of the eyelids. Burning, tearing or foreign body
sensation. Itching, redness, discharge. Absent lashes or lashes crusted with meibum.
Seborrheic blepharitis may have a greasy scales along the lid margins with foamy tears,
diffuse seborrhea of the scalp and years. Rosacea is related to meibomian Gland
dysfunction. Patients may have erythema or telangiectasia Over cheeks and nose or
pustular rash. Rosacea of the eye equals a referral.
3). Blepharitis management
Ans: Lid hygiene: warm, moist compresses for 5 to 10 minutes; lid scrubs with a Q-tip
and diluted baby shampoo. Antibiotic ointment such as erythromycin or bacitracin.
Gentle lid massage. Oral flaxseed oil. Referral to ophthalmology for corticosteroids or
long-term use of oral antibiotics usually doxycycline.
4). Hordeolum
Ans: An Acute infection of gland in eyelid. Focal inflamed Focal inflamed area of
eyelid where the eyelash meets the eyelid
• Bacteria (usually staphylococcus) gets into the oil glands that
lubricates the eye.
• Similar process to a pimple.
History and Clinical Presentation:
• Swollen single gradually emerging red bump on the eyelid
• Gritty scratchy sensation
• Sensitivity to light, tearing, tenderness Management
• Usually self limited
PaperStoc.com Page 1 of 34
, • Spontaneous improvement in 1-2 weeks with conservative
treatment
• Frequent warm, moist compresses 3-4 times a day
• Teaching: Light and gentle massage
Lid Hygiene with lid scrubs
• Refer to Ophthalmologist if incision and drainage needed
5). Viral conjunctivitis
Ans: Pathophysiology
• Inflammation of the conjunctiva or the transparent mucosal tissue
than lines the eye and inner surface of the eyelids.
• Generally caused by adenovirus type 3
• Frequently associated with a URI
• Highly contagious
History and Clinical Presentation
• Red eye (from corners inward)
• Excessive watering
• Itching
• Watery discharge
• Photophobia
• Foreign body or "gritty" sensation
• Begins in one eye and spreads to the other
• Abrupt onset
• 50% may have tender preauricular lymph nodes
• Generally self limiting with symptoms worsening for 3-5 days and
resolution by 14 days
Management
• Self limiting and usually lasts 5-14 days
• Treatment is supportive for symptoms relief
• Artificial tears q 4-6 hours [throw bottle away after resolution]
• Cool compresses
• Teaching: Good hand hygiene, don't share towels
Avoid contact lens use until resolved and discard
used lenses and previously used eye makeup
6). Chalazia
Ans: Pathophysiology
• Chronic, sterile lipogranulomatous inflammatory lesion of the
meibomian gland
• Lipogranuloma caused by a blockage in the Meibomian gland or
oil gland that lubricates the eye. A gradually localized enlarging
nodule where glands are located near the eyelashes.
History and Clinical Presentation
PaperStoc.com Page 2 of 34
, • Hard, non tender module found on the mid portion of the eyelid
away from the lid border.
• May develop on lid margin with lid tenderness, pain and swelling.
• Eyelid tenderness, increased tearing
• Gradually enlarging nodule on the eyelid , sensitivity to light pain
or pressure if pressing against the cornea
Management
• Usually self limited in 25-50% of cases
• Spontaneous improvement in 1-3 months with conservative
treatment
• Frequent warm, moist compresses to liquify glandular secretions
• Teaching: Gentle massage to express impacted secretions
• Referral to Ophthalmologist for corticosteroid injections or incision
and drainage if necessary
• Antibiotics not indicated
7). Allergic conjunctivitis
Ans: Pathophysiology
• Eye is the most common target organ for IgE/mast cell hypersensitivity
reactions
• Airborne allergen comes in direct contact with the ocular surface
• Inflammatory response occurs
• Seasonal allergic conjunctivitis (SAC) due to tree pollen and ragweed is
more common and more acute
• Perennial allergic conjunctivitis (PAC) is less severe and year round
secondary to animal dander, house mite feces, mold and dust
History and Clinical Presentation
• Associated with Allergic Rhinitis and Allergic Pharyngitis
• Headache
• Fatigue
• Often have a positive family history of hay fever or atopy
• Generally begins simultaneously in both eyes
• Itching, watery eyes
• Periocular skin discoloration, thickening, erythema
Management
• Cool compresses
• Teaching: Remove irritants / avoid allergens
• Oral/Systemic antihistamines
• Ophthalmic antihistamines
Naphcon A Vasocon (otc)
8). Bacterial conjunctivitis
PaperStoc.com Page 3 of 34
, Ans: Pathophysiology
• Bacterial infection of the conjunctiva-membrane lining the eyelid by a
wide range of gram-positive and gram negative organisms.
• Staphylococcus aureus is the most common
• Tears contain enzymes and antibodies that kill bacteria
History and Clinical Presentation
• Red eye (corners inward) and more abrupt than viral
• Generally begins in one eye and spreads to the other within 48 hours
• Blurred vision, crust or matted discharge forming on eyelid overnight
• Early morning glued eyes
• Thick mucoid discharge
• Absence of itching
Management
• Antibiotic drops or ointment
- Tobramycin, fluoroquinolone trimethoprim-polymixin B
• Warm compresses frequently
• Teaching should include-changing pillowcases daily,
dispose of eye cosmetics. Do not share towels or
handkerchiefs. Good hand hygiene. Contact lens cleaning
and/or disposal.
9). Corneal abrasion
Ans: Pathophysiology
Cornea is comprised of 3 layers: Epithelium or outer layer, stroma or
middle layer and the endothelium or inner layer.
• A cut, scratch or abrading of the thin, clear, protective coat of the
anterior portion of the ocular epithelium often the result of trauma
Clinical Presentation
[Subjective]
• Pain (sand or grit) due to rich innervation of of sensory fibers from
the trigeminal nerve and increases with blinking
• Tearing, history of some traumatic event, contact lenses?
• Photophobia
• Known or suspected foreign body
Examine [Objective]
• Visualize Eye structures
• Observe for foreign body
• Perform a Visual acuity
• EOM
• Fluorescein staining-visualize with cobalt blue light
Management [Plan]
• Do not patch
• Oral analgesics
PaperStoc.com Page 4 of 34
Practice Nursing – an Interprofessional
Approach 6th Edition Test Bank
1). Blepharitis pathophysiology
Ans: Inflammation of the eyelids. Two categories are anterior and posterior. Anterior
involves anterior it later margin surrounding lid margin and usually associated with staff
infection or seborrhea. Posterior involves posterior lid margin associated with
meibomian gland dysfunction and rosacea.
2). Blepharitis history and clinical presentation
Ans: Inflammation and erythema of the eyelids. Burning, tearing or foreign body
sensation. Itching, redness, discharge. Absent lashes or lashes crusted with meibum.
Seborrheic blepharitis may have a greasy scales along the lid margins with foamy tears,
diffuse seborrhea of the scalp and years. Rosacea is related to meibomian Gland
dysfunction. Patients may have erythema or telangiectasia Over cheeks and nose or
pustular rash. Rosacea of the eye equals a referral.
3). Blepharitis management
Ans: Lid hygiene: warm, moist compresses for 5 to 10 minutes; lid scrubs with a Q-tip
and diluted baby shampoo. Antibiotic ointment such as erythromycin or bacitracin.
Gentle lid massage. Oral flaxseed oil. Referral to ophthalmology for corticosteroids or
long-term use of oral antibiotics usually doxycycline.
4). Hordeolum
Ans: An Acute infection of gland in eyelid. Focal inflamed Focal inflamed area of
eyelid where the eyelash meets the eyelid
• Bacteria (usually staphylococcus) gets into the oil glands that
lubricates the eye.
• Similar process to a pimple.
History and Clinical Presentation:
• Swollen single gradually emerging red bump on the eyelid
• Gritty scratchy sensation
• Sensitivity to light, tearing, tenderness Management
• Usually self limited
PaperStoc.com Page 1 of 34
, • Spontaneous improvement in 1-2 weeks with conservative
treatment
• Frequent warm, moist compresses 3-4 times a day
• Teaching: Light and gentle massage
Lid Hygiene with lid scrubs
• Refer to Ophthalmologist if incision and drainage needed
5). Viral conjunctivitis
Ans: Pathophysiology
• Inflammation of the conjunctiva or the transparent mucosal tissue
than lines the eye and inner surface of the eyelids.
• Generally caused by adenovirus type 3
• Frequently associated with a URI
• Highly contagious
History and Clinical Presentation
• Red eye (from corners inward)
• Excessive watering
• Itching
• Watery discharge
• Photophobia
• Foreign body or "gritty" sensation
• Begins in one eye and spreads to the other
• Abrupt onset
• 50% may have tender preauricular lymph nodes
• Generally self limiting with symptoms worsening for 3-5 days and
resolution by 14 days
Management
• Self limiting and usually lasts 5-14 days
• Treatment is supportive for symptoms relief
• Artificial tears q 4-6 hours [throw bottle away after resolution]
• Cool compresses
• Teaching: Good hand hygiene, don't share towels
Avoid contact lens use until resolved and discard
used lenses and previously used eye makeup
6). Chalazia
Ans: Pathophysiology
• Chronic, sterile lipogranulomatous inflammatory lesion of the
meibomian gland
• Lipogranuloma caused by a blockage in the Meibomian gland or
oil gland that lubricates the eye. A gradually localized enlarging
nodule where glands are located near the eyelashes.
History and Clinical Presentation
PaperStoc.com Page 2 of 34
, • Hard, non tender module found on the mid portion of the eyelid
away from the lid border.
• May develop on lid margin with lid tenderness, pain and swelling.
• Eyelid tenderness, increased tearing
• Gradually enlarging nodule on the eyelid , sensitivity to light pain
or pressure if pressing against the cornea
Management
• Usually self limited in 25-50% of cases
• Spontaneous improvement in 1-3 months with conservative
treatment
• Frequent warm, moist compresses to liquify glandular secretions
• Teaching: Gentle massage to express impacted secretions
• Referral to Ophthalmologist for corticosteroid injections or incision
and drainage if necessary
• Antibiotics not indicated
7). Allergic conjunctivitis
Ans: Pathophysiology
• Eye is the most common target organ for IgE/mast cell hypersensitivity
reactions
• Airborne allergen comes in direct contact with the ocular surface
• Inflammatory response occurs
• Seasonal allergic conjunctivitis (SAC) due to tree pollen and ragweed is
more common and more acute
• Perennial allergic conjunctivitis (PAC) is less severe and year round
secondary to animal dander, house mite feces, mold and dust
History and Clinical Presentation
• Associated with Allergic Rhinitis and Allergic Pharyngitis
• Headache
• Fatigue
• Often have a positive family history of hay fever or atopy
• Generally begins simultaneously in both eyes
• Itching, watery eyes
• Periocular skin discoloration, thickening, erythema
Management
• Cool compresses
• Teaching: Remove irritants / avoid allergens
• Oral/Systemic antihistamines
• Ophthalmic antihistamines
Naphcon A Vasocon (otc)
8). Bacterial conjunctivitis
PaperStoc.com Page 3 of 34
, Ans: Pathophysiology
• Bacterial infection of the conjunctiva-membrane lining the eyelid by a
wide range of gram-positive and gram negative organisms.
• Staphylococcus aureus is the most common
• Tears contain enzymes and antibodies that kill bacteria
History and Clinical Presentation
• Red eye (corners inward) and more abrupt than viral
• Generally begins in one eye and spreads to the other within 48 hours
• Blurred vision, crust or matted discharge forming on eyelid overnight
• Early morning glued eyes
• Thick mucoid discharge
• Absence of itching
Management
• Antibiotic drops or ointment
- Tobramycin, fluoroquinolone trimethoprim-polymixin B
• Warm compresses frequently
• Teaching should include-changing pillowcases daily,
dispose of eye cosmetics. Do not share towels or
handkerchiefs. Good hand hygiene. Contact lens cleaning
and/or disposal.
9). Corneal abrasion
Ans: Pathophysiology
Cornea is comprised of 3 layers: Epithelium or outer layer, stroma or
middle layer and the endothelium or inner layer.
• A cut, scratch or abrading of the thin, clear, protective coat of the
anterior portion of the ocular epithelium often the result of trauma
Clinical Presentation
[Subjective]
• Pain (sand or grit) due to rich innervation of of sensory fibers from
the trigeminal nerve and increases with blinking
• Tearing, history of some traumatic event, contact lenses?
• Photophobia
• Known or suspected foreign body
Examine [Objective]
• Visualize Eye structures
• Observe for foreign body
• Perform a Visual acuity
• EOM
• Fluorescein staining-visualize with cobalt blue light
Management [Plan]
• Do not patch
• Oral analgesics
PaperStoc.com Page 4 of 34
