NUR 676 Final
Otitis externa - answeris cellulitis of the external canal that may extend to the auricle
(swimmer's ear). p391
otitis externa risks factors - answercomprise the integrity of the inherent defense
mechanism against infection, including; removal of protective cerumen w damage to
fragile skin from vigorous cleaning, accumulation of moisture from swimming, and
alterations to the tissues that result from wearing devices such as headphones or
earplugs. p391
Otitis Externa Expected findings - answerpain of the affected ear and auricle developing
over the course of 48 hours or less, feeling of fullness or itching. S&S that may be
present drainage and hearing loss. Chronic Otitis externa- pruritus
Otitis Externa bacterial cause - answermost common pseudonomas aeruginosa and
staphyloccocus aureus. Uncommon candida, and aspergillus organisms.
otitis externa diagnostics - answerusually unnecessary, culture of canal if symptoms
persist with antibiotic sensitivity if no improvement after 14 days of antibiotic therapy
(C&S, and potassium hydroxide preparation of drainage).
otitis externa Oral antimicrobial therapy - answerFluoroquinolone antibiotics- effective
against s aureus and P. aeruginosa (ofloxacin, ciproflaxin). antibiotic-corticosteroids
(Cipro Hc) for infection and inflammation. Improvement should occur within 48 to 72
hours, and resolution occurs usually at 7 to 10 days. p392
Meniere's disease - answerchronic condition of the inner ear S&S recurrent vertigo and
hearing loss. symptoms may or may not occur simultaneously dizziness describe as
spinning vertigo, low frequency sensorineural hearing loss, tinnitus, and feeling of
fullness in the affected ear p388
Meniere's disease pathophysiology - answerexcess fluid and pressure in the labyrinth of
the inner ear that episodically distends the structure of the labyrinth and damages the
vestibular system (Involved in balance) & cochlear cells (involve in hearing). Unknown
etiology p388
Meniere's disease clinical presentation - answerPCP should ask patient about history of
recurrent symptoms. Early-patients have intermittent attacks of vertigo that last from
minutes to hours often associated with nausea and vomiting. these symptoms usually
are accompanied by ear pressure, low-pitched tinnitus, fluctuating intensity, and
unilateral hearing loss
, Meniere's disease diagnostics - answeressential diagnostics- 2 episodes of
spontaneous vertigo lasting at least 20 minutes
Audiogram- documented hearing loss
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
Meniere's disease pharmacological management - answershould refer to
otolaryngologist for testing and management.
Goals of therapy-managing the episodes of vertigo and arresting the disease process
drug therapy- short term oral steroid course, IM on affected ear may last longer.
symptom relief- Meclizine and antiemetics(least sedating), Benzodiazepines prescribe
for GABA agonist effect but not commonly used. Lorazepam has a quick onset may be
appropriate for infrequent use.
P.389
Oropharynx Pharyngitis - answerStreptococcus pyogenes. GAS can cause rheumatic
fever. Infection with GAS peaks in late winter. Group C is the most common in college
students. p438
Oropharynx Pharyngitis clinical presentation Allergies - answervaries on the offending
agent.
non-infectious- sore throat and dryness, if allergens are the cause S&S rhinorrhea,
postnasal drip, and watery eyes
Oropharynx Pharyngitis clinical presentation Viral - answermost common, self limiting-
sore throat, fever, malaise, headache, myalgias, and fatigue, rhinitis, and conjuctivitis,
congestion, and cough with sputum. p438
Oropharynx Strep throat clinical presentation bacterial - answermost prevalent in
children under 15 y.o incubation period of 2 to 5 days. S&S onset of sore throat, painful
swallowing, fever (higher than 101.3F), chill, headache, vomiting, and abdominal pain.
GAS may present with erythema of the throat and tonsils, patchy, discrete white or
yellowish exudate, pharyngeal petechiae, and tender anterior cervical adenopathy. p439
Oropharynx Strep throat diagnostics - answerthroat culture, a rapid antigen detection
test (RADT), and sometimes an antistreptolysin (ASO) titer.
Oropharynx Strep throat treatment - answerantibiotics: penicillin or amoxicillin for 10
days, penicillin is low cost, safe, and efficacy. If allergic to PCN clindamycin or
Clarithromycin for 10 days is given. Another option is Azithromycin for 5 days.
Mononucleosis clinical presentation - answermore common in adolescents and young
adults. S&S headache, malaise, fatigue, and anorexia before the sore throat occurs.
Hepatosplenomegaly may be noted during examination. p439
Mononucleosis clinical diagnostics - answerCBC reveals leukocytosis with a right shift
of atypical lymphocytes. A positive monospot test reveals heterophil antibodies, this test
Otitis externa - answeris cellulitis of the external canal that may extend to the auricle
(swimmer's ear). p391
otitis externa risks factors - answercomprise the integrity of the inherent defense
mechanism against infection, including; removal of protective cerumen w damage to
fragile skin from vigorous cleaning, accumulation of moisture from swimming, and
alterations to the tissues that result from wearing devices such as headphones or
earplugs. p391
Otitis Externa Expected findings - answerpain of the affected ear and auricle developing
over the course of 48 hours or less, feeling of fullness or itching. S&S that may be
present drainage and hearing loss. Chronic Otitis externa- pruritus
Otitis Externa bacterial cause - answermost common pseudonomas aeruginosa and
staphyloccocus aureus. Uncommon candida, and aspergillus organisms.
otitis externa diagnostics - answerusually unnecessary, culture of canal if symptoms
persist with antibiotic sensitivity if no improvement after 14 days of antibiotic therapy
(C&S, and potassium hydroxide preparation of drainage).
otitis externa Oral antimicrobial therapy - answerFluoroquinolone antibiotics- effective
against s aureus and P. aeruginosa (ofloxacin, ciproflaxin). antibiotic-corticosteroids
(Cipro Hc) for infection and inflammation. Improvement should occur within 48 to 72
hours, and resolution occurs usually at 7 to 10 days. p392
Meniere's disease - answerchronic condition of the inner ear S&S recurrent vertigo and
hearing loss. symptoms may or may not occur simultaneously dizziness describe as
spinning vertigo, low frequency sensorineural hearing loss, tinnitus, and feeling of
fullness in the affected ear p388
Meniere's disease pathophysiology - answerexcess fluid and pressure in the labyrinth of
the inner ear that episodically distends the structure of the labyrinth and damages the
vestibular system (Involved in balance) & cochlear cells (involve in hearing). Unknown
etiology p388
Meniere's disease clinical presentation - answerPCP should ask patient about history of
recurrent symptoms. Early-patients have intermittent attacks of vertigo that last from
minutes to hours often associated with nausea and vomiting. these symptoms usually
are accompanied by ear pressure, low-pitched tinnitus, fluctuating intensity, and
unilateral hearing loss
, Meniere's disease diagnostics - answeressential diagnostics- 2 episodes of
spontaneous vertigo lasting at least 20 minutes
Audiogram- documented hearing loss
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
Meniere's disease pharmacological management - answershould refer to
otolaryngologist for testing and management.
Goals of therapy-managing the episodes of vertigo and arresting the disease process
drug therapy- short term oral steroid course, IM on affected ear may last longer.
symptom relief- Meclizine and antiemetics(least sedating), Benzodiazepines prescribe
for GABA agonist effect but not commonly used. Lorazepam has a quick onset may be
appropriate for infrequent use.
P.389
Oropharynx Pharyngitis - answerStreptococcus pyogenes. GAS can cause rheumatic
fever. Infection with GAS peaks in late winter. Group C is the most common in college
students. p438
Oropharynx Pharyngitis clinical presentation Allergies - answervaries on the offending
agent.
non-infectious- sore throat and dryness, if allergens are the cause S&S rhinorrhea,
postnasal drip, and watery eyes
Oropharynx Pharyngitis clinical presentation Viral - answermost common, self limiting-
sore throat, fever, malaise, headache, myalgias, and fatigue, rhinitis, and conjuctivitis,
congestion, and cough with sputum. p438
Oropharynx Strep throat clinical presentation bacterial - answermost prevalent in
children under 15 y.o incubation period of 2 to 5 days. S&S onset of sore throat, painful
swallowing, fever (higher than 101.3F), chill, headache, vomiting, and abdominal pain.
GAS may present with erythema of the throat and tonsils, patchy, discrete white or
yellowish exudate, pharyngeal petechiae, and tender anterior cervical adenopathy. p439
Oropharynx Strep throat diagnostics - answerthroat culture, a rapid antigen detection
test (RADT), and sometimes an antistreptolysin (ASO) titer.
Oropharynx Strep throat treatment - answerantibiotics: penicillin or amoxicillin for 10
days, penicillin is low cost, safe, and efficacy. If allergic to PCN clindamycin or
Clarithromycin for 10 days is given. Another option is Azithromycin for 5 days.
Mononucleosis clinical presentation - answermore common in adolescents and young
adults. S&S headache, malaise, fatigue, and anorexia before the sore throat occurs.
Hepatosplenomegaly may be noted during examination. p439
Mononucleosis clinical diagnostics - answerCBC reveals leukocytosis with a right shift
of atypical lymphocytes. A positive monospot test reveals heterophil antibodies, this test
