NURS 545 LATEST UPLOAED EXAM 2025

NURS 545 LATEST UPLOAED EXAM 2025 Allergic conjunctivitis: - -IgE mediated disease in response to triggers. Common triggers can be seasonal such as grass, pollens, and mold. Persistent allergic triggers include dust mites and animal dander. Bilateral, itchy red eyes with rope like discharge and clear nasal discharge Bilateral injected conjunctiva, clear discharge Treatment based on identification and limiting exposure to allergen. Medications include cromolyn ophthalmic drops, oral antihistamines, antihistamine eye drops Viral conjunctivitis: - -Most commonly caused by the adenovirus. Unilateral or bilateral red eyes, reports of current or recent viral infection, such as a UTI Unilateral or bilateral injected conjunctiva, watery discharge No antibacterial therapy needed. Virus resolves in 2-3 weeks Bacterial conjunctivitis: - -Common bacteria include: Staphylococci, streptococci, chlamydial organisms and gonococci. Some bacterial causes can be quite serious. Gonococcal conjunctivitis can result in blindness and can indicate underlying systemic infection. Usually unilateral, red and irritated Eyelids are "stuck together" upon awakening. Injected palpebral and bulbar conjunctiva, purulent drainage Treatment is provided to decrease spread of contagion and shorten course of illness. Eye drop treatments include Polymixin B plus trimethoprim or azithromycin. Otitis Externa - -inflammation of the externa ear canal, is also known commonly as swimmer's ear. Occurring in both children and adults, otitis externa can present as a range of physical symptoms from a minor inflammation to reports of intense pain. Otitis Externa Risk Factors Swimming Impacted cerumen Use of hearing aids/ear plugs Trauma from cotton tip applicators or other items used to clean ear canal Nurs 545 Nurs 545 Nurs 545 Foreign bodies Anatomic causes: narrow ear canals, sharp angles in the ear canal or excessive hair in the canal The normally acidic pH of the ear canal tends to inhibit microorganism growth. Swimming in a pool where the pH is usually alkaline can result in altered pH of the ear canal. It is thought that it is this alteration in pH creates a favorable environment for bacteria or fungal growth. The most common causative agent is P. aeruginosa, other causes include Candida or Aspergillus species. Common complaints (subjective findings): Children: irritability, crying, disrupted sleep. Unilateral ear tugging, unilateral otalgia Adults: unilateral otalgia Physical exam (objective findings): Ear pain is increased upon palpation of tragus. The external ear canal epithelium edema may extend from the pinna all the way to the tympanic membrane. Purulent or serous discharge is noted in the canal. Medication management depends upon the causative factors: Pain management: OTC analgesics include ibuprofen or acetaminophen as appropriate for age and weight Bacterial Otitis externa can be treated with antimicrobial otic drops, which include polymyxin B plus neomycin with or without hydrocortisone, ofloxacin, and ciprofloxacin HC otic drops In cases of severe inflammation, insertion of an ear wick may be required to ensure medication instillation to affected areas. Otitis Media (AOM) - -Middle ear inflammation which results from and obstruction of the Eustachian tube. The Eustachian tube dysfunction results in negative pressure within the middle ear, enabling pharyngeal pathogens to be aspirated into the middle ear. The causes can be viral, bacterial or allergy mediated. Viral Most common cause of otitis which often occurs in association with an upper respiratory tract infection. Most common organisms include respiratory syntactical virus, human rhinovirus, andenovirus and influenza virus. Bacterial Colonization is a most often the result of fluid stasis from a respiratory virus. Streptococcus pneumoniae and H. fluenzae are the most common bacterial pathogens found in middle ear fluid. Allergic Responses resulting in inflammation can lead to obstruction of the Eustachian tube Common complaints (subjective findings): Otalgia, malaise, irritability, fever and vomiting, unilateral hearing loss, recent or current URI. Can report itching or crackling noises in the ear. Ear tugging or rubbing in infants and toddlers. Nurs 545 Nurs 545 Physical exam (objective findings): The outer ear may appear red. The tympanic membrane is erythematous and possibly bulging or retracted. Bony landmarks and light reflex absent. Tympanic membrane may be ruptured resulting in otorrhea. Most cases of acute otitis media resolve spontaneously and do not require treatment. Viral cases of AOM resolve in 7-10 days with supportive care alone. Recommend PRN OTC analgesics and antipyretics. Pain management OTC analgesics are offered for symptomatic relief Acetaminophen or Ibuprofen as appropriate for age and weight. Topical otic analgesics such as Auralgan Otic Solutions Antibiotic therapy should be avoided in mild to moderate cases. Antibiotics are prescribed for those with symptoms persisting for more than 2- 3 days, children under two years with bi Rhinitis - -an inflammation of the nasal mucosa that is usually accompanied by edema and a profuse nasal discharge. Whether allergic or viral in nature, the rhinorrhea will be watery, speech will sound nasal and there will be noted mouth breathing due to nasal edema. Bacterial rhinitis is discussed within sinusitis, which is commonly referred to as rhinosinusitis. Allergic Rhinitis - -IgE mediated diseases in response to triggers. Common triggers can be seasonal such as grass, pollens, and mold. Persistent allergic triggers include dust mites and animal dander Subjective: pruritis of nasal passages, conjunctiva, and roof of mouth, sneezing coughing, sore throat, seasonal presentation, usually pollen related Objective: nasal turbinates edematous OTC: Antihistamines - PO or Nasal spray Diphenhydramine, loratidine, cetirizine, fexofenadine Anticholinergic nasal spray: Ipratropium bromide Nasal saline flush post exposure Allergic exposure avoidance Viral Rhinitis - -Most commonly caused by the adenovirus Subjective: Headache, occasional fever, sneezing, coughing, sore throat Objective: nasal turbinates edematous, tonsillar edema; Laryngopharynx: erythema OTC: Treat symptoms: Nurs 545 Nurs 545 Fever and headache: acetaminophen or ibuprofen 3-4 days nasal decongestant for rhinorrhea. Sinusitis - -Sinusitis is an inflammation of the lining of the membranes of one or more of the paranasal sinuses. We will focus on acute sinusitis, which is the abrupt onset of pain. Sinusitis is a result of any condition that alters the normal sinus cleansing mechanisms. Common causes include tobacco smoke allergies and anatomy of the sinuses. Viral: 98% of cases are viral, usually caused by the common cold. Common agents include human rhinovirus and adenovirus Acute bacterial rhinosinusitis: occurs with URI symptoms persisting 7 days. Common complaints (subjective findings): Reports of a gradual onset, recurrent or chronic dull, constant pain over the affected sinuses. Can report retro orbital pain or tooth pain. Pain described as throbbing and worsens with coughing or sudden head movements, especially bending forward. Complaints can include nasal congestion, mucopurulent rhinorrhea, cough, pharyngitis and fatigue. May report cough due to pharyngeal drainage. Physical exam (objective findings): Tenderness elicited over affected sinus Highly erythematous nasal mucosa Purulent nasal secretions is noted on exam. Differentiating features include: Viral sinusitis: afebrile, length of symptoms 7 days, symptoms are consistent or improving Acute bacterial sinusitis symptoms are more severe and include fever 102, symptom length 10 days or reports of worsening symptoms after 3-4 days such as new onset fever after initial symptom improvement Viral sinusitis: treatment is OTC symptom relief Fever and headache: acetaminophen or ibuprofen Rhinorrhea: 3-4 days nasal decongestant Acute bacterial sinusitis is treated for 10-14 days First line: Amoxicillin-clavulanate Second line/penicillin allergy: Doxycycline Pharyngitis - -Pharyngitis is an inflammatory processes involving the pharynx (pharyngitis) and pharyngeal tonsils (tonsillitis). They may occur independently of one another but often co-occur. Allergic pharyngitis: IgE mediated diseases in response to triggers. Common triggers can be seasonal such as grass, pollens, and mold. Persistent allergic triggers include dust mites and animal dander Viral pharyngitis: Common agents include human rhinovirus and andenovirus Bacterial pharyngitis: known as group A beta-hemolytic streptococcus, is caused by S. pyogenes. This bacterium is transmitted primarily via saliva and droplets, making it highly contagious. Allergic pharyngitis - -postnasal drip Nurs 545 Sneezing Itchy, watery eyes Sore throat Bilateral injected conjunctiva, clear discharge Pharynx: edema with minimal redness, clear exudate Viral pharyngitis (laryngitis) - -Conjunctivit