NURS 629 Exam 3 STUDY GUIDE

NURS 629 Exam 3 STUDY GUIDE Otitis media ANS - #1 diagnosis is among healthcare providers caring for children

-By the age of 3, 2/3 of all children will have had an OM: ½ will have >3

occurrences OM is most common in ANS - boys, first born, winter months, bottle fed babies, preemies, daycare children, children of smokers Reason for OM ANS - ■ Eustachian tube is shorter. By the ages 7-12 the eustachian tube resembles that of an adult ■ Adenoids can be enlarged. If the adenoid that is enlarged d/t smaller nasal canals & respiratory tract, that can easily block the eustachian tube & not allow for drainage

Common bacterial causes for OM? ANS - ● S. pneumoniae: most common

● H. influenzae: child presents with conjunctivitis with OM, treat with

Augmentin and topical antibiotic for conjunctivitis ● M. catarrhalis Symptoms of OM? ANS - ■ Fever, pain, discharge from the ear, tugging or batting at the ear, irritability, crying, lethargy, decreased appetite, decreased sleep, recent URI Clinical Signs of OM? ANS - ■ Red, bulging TM, retracted with pus, decreased translucency of TM, no movement of the TM, inability to see

normal landmarks, occasionally: hole in the TM

Diagnosis of OM requirements? ANS - ■ History of acute onset

■ Identify presence of middle ear effusion: bulging TM, decreased or absent

mobility of TM, amber fluid or appearance of TM, otorrhea

■ Identify signs of middle ear inflammation: erythematous TM, otalgia

(which interferes with function/sleep)

Tx of OM? ages:

>6m 6m-2yrs

>2yrs ANS - <6m: abx if certain or not

6-12m: abx if : fever >102, bilateral infection, severe otalgia, longer than 7 days (observe if not severe)

>2 yrs: abx if severe ^ observe if not 1 / 3

Symptoms relief for OM? (non-abx) ANS - ● Acetaminophen or ibuprofen:

mild to moderate pain

● Benzocaine (Auralgan, Amerciaine otic): mild to moderate pain

● Warm compress ABX tx for OM? ANS - ● Clinically defined treatment failure at 48-72 hours after initial management with observation or at diagnosis for patients being initially with antibacterial agents

ABX:

Amoxicillin 80-90 mg/kg/day BID for 10 days

OR IF PCN ALLERGY:

Non-Type 1: Cefdinir, cefuroxime

Type 1: Azithromycin, clarithromycin

OR: SEVERE OM:

Augmentin (Amoxicillin-clavulanate) 80-90 mg/kg/day for 10 days or

PCN alg: Ceftriaxone 1 or 3 days

Signs of bacterial AOM? ANS - • Bulging TM with decreased mobility, acute onset pain and fever when do you not 'watch and wait' on AOM? ANS - o Kids younger than 6 months

• \Children 6 mo - 2 years with moderate to severe pain (concerned bc of

speech development during this time)

• 2 and older with high fever
• All children with comorbidities such as heart disease etc

How do you treat AOM in kid who has ear tubes? ANS - Ofloxacin/cipro gtt If pt develops rash after taking amox for ear infection what do you do? ANS

• stop and start cephalosporin

What are the predisposing factors for otitis externa? ANS - ■ Frequent exposure to moisture of the ear ■ Aggressive cleaning of the ear canal (do not use Q-tips because that can cause little micro tears in the skin which can lead to inflammation and infection) ■ Local trauma to the ear ■ Allergies & skin conditions ■ Eczema t/f otitis externa is typically bilateral? ANS - F usually unilateral 2 / 3

symptoms of otitis externa? ANS - ■ Discharge from the ear (especially if the TM has rupture), low grade fever, recent history of swimming or placing something in ear, pain with movement of the tragus, redness around ear, decreased hearing tx of otitis externa? ANS - ■ Topical antimicrobial for initial therapy of diffuse AOE should be based upon efficacy, low incidence of adverse events, likelihood of adherence to therapy, and cost.

■ Pain management: analgesic treatment based on the severity of pain

■ Therapeutic ● Warm compresses, NSAIDs/Tylenol, prednisone, auralgan, OTC benzocaine drops and then wicking when should pt with otitis externa return if therapy has failed? ANS - ■ If the patient fails to respond to the initial therapeutic option within 48-72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness what are red flag symptoms of throat pain? ANS - drooling, stridor, or trouble breathing Do NOT examine What type of rash is associated with strep? ANS - sandpaper rash what are common complications of pharyngitis? ANS - peritonsillar abscesses, rheumatic fever, post-streptococcal, glomerulonephritis What are the common signs/symptoms of Group AB strep? ANS - ■

Symptoms: rapid onset of sore throat, fever 103-104, swollen glands,

children often complain of abdominal pain, usually no URI symptoms, headache, decreased appetite, dysphagia, irritability

■ Signs: exudate tonsils, anterior cervical lymphadenopathy, strawberry

tongue, rash

Diagnostic for strep? ANS - ■ Throat culture: 24 hr is the gold standard,

must swab both tonsils for best results ■ Remember 50% of kids with mono also have strep what is the common abx for strep? ANS - ■ Amoxicillin (50-80 mg/kg/day)

x 10 days (PCN allergy: cephalosporin or macrolide)

■ Warm water gargles ■ Tylenol/NSAIDs What causes Mono? ANS - Epstein-Barr virus

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