NR-569 Differential Diagnosis in Acute Care Practicum
Final Exam (Latest Update)
Question:
ROS: EAR
Have you noticed any drainage or blood coming from the ear?
Answer:
Purulent drainage is a commonly reported finding with AOE and cholesteatoma but may not be present.Drainage is not associated with AOM and OME unless the TM has ruptured.
Question:
Otitis media with effusion (OME)
Answer:
Otitis media with effusion (OME) is fluid in the middle ear, without the presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM infection. Mild pain,
conductive hearing loss may be present.Air bubbles are seen behind the TM. 1 / 4
Question:
Ear pain/infection: Management
Answer:
ear pain may be treated with OTC analgesics avoid scratching, tugging, or inserting anything in the ear, including cotton- tipped swabs reinforce water precautions with TM ruptured avoid getting water in the ear during bathing/shower avoid submerging ear under water
Question:
Acute Mastoiditis
Answer:
*Bacterial infection of the mastoid process* presents clinically with the same signs and symptoms as acute otitis medial with the addition of *inflammation and palpatory tenderness over the mastoid*, hearing loss is commonly associated with it, tympanic membrane is red, bulging, and immobile bc associated otitis media, should be suspected when discharge from middle ear is continuous for >10 days
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Question:
TMJ Dysfunction
Answer:
referred ear pain
acute: pain with opening mouth extremely wide
chronic: malocclusion (from enlarged masseter muscles)/arthritis of TMJ
clicking palpable crepitus
Question:
impacted cerumen
Answer:
rarely bilateral recurrent problem normal otologic findings
Question:
Some clients who present with throat pain may be at risk for airway compromise. The following signs/symptoms indicate the need for immediate intervention?
Answer:
respiratory distress drooling 3 / 4
upper airway obstruction stridor
Question:
Mono treatment
Answer:
Serum diagnostics:
Lymphocytosis Possible thrombocytopenia, mild relative and absolute neutropenia Elevated aminotransferases.Consider rapid strep test as symptoms mirror Group A Beta Hemolytic Streptococcus Monospot test will not become positive until symptoms present about 10 days.Heterophile antibody tests or EBV specific antibodies.There is no specific antiviral therapy used to treat the disease.Confirmatory testing is utilized to acknowledge disease and explain symptoms.Risks of splenic rupture are concerning.Educate patient and family on when to seek healthcare.Avoid contact sports.If EBV testing is negative, further evaluation is warranted to rule out HIV, cytomegalovirus, and toxoplasmosis.
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