Nursing 620 Exam 1 WITH COMPLETE SOLUTION 2022

Dry Eye Is a common syndrome affecting mostly those > 40 yo More prevalent in Hispanics and Asians Affects both eyes - usually How do patients describe Dry Eye? Feels like sand in the eye Eyes feel hot Irrit ...

Dry Eye Is a common syndrome affecting mostly those > 40 yo More prevalent in Hispanics and Asians Affects both eyes - usually How do patients describe Dry Eye? Feels like sand in the eye Eyes feel hot Irritated and red Burning Itching Excessive tearing Photophobia Is worse in smoky and dry environments Dry Eye occurs as a result of: 1) Mechanical Abnormality such as eye ball protrusion, eyelid abnormalities and misuse of contact lenses 2) Lacrimal Gland Dysfunction 3) Mucin Deficiency Differential Diagnosis of Dry Eye Include: Conjunctivitis Blepharitis Contact lens complications Exophthalmos Bell's Palsy Medicamentosa Sjogrens Syndrome Age-related changes Hormonal changes Systemic vitamin A deficiency Drug Action What is Epiphora? Excessive tearing Differential Diagnosis for Epiphora include: Allergens Dry eye syndrome Viral or Bacterial Conjunctivitis Blocked Lacrimal Duct Ectropion Trauma (foreign body or corneal abrasion) Environmental pollutants Glaucoma What is the most important thing for the clinician to know when dealing with eye pain? When to refer to an ophthalmologist Conditions requiring immediate referral include: Sudden vision loss Sudden non-traumatic eye pain When the physical exam reveals: corneal abrasion suspected herpes zoster ophthalmicus hazy cornea irregular pupils elevation of fundus on exam papilledema limbal flush muscle paresis Management Issues: steroid therapy no improvement in pt condition after treatment Recommendation #1 to begin empiric therapy is guided by the following three typical presentations. These are made to help distinguish between Acute Bacterial Rhinosinusitis and uncomplicated Viral URI. Once the diagnosis has been made treatment should not be delayed. The three typical presentations are: 1. Onset with persistent symptoms that last > 10 days and not improving 2. Onset with severe symptoms, characterized by high fever of at least 39 C or 102 F and purulent nasal discharge for at least 3-4 consecutive days at the beginning of the illness. 3. Onset with worsening symptoms characterized by typical viral URI symptoms that appear to improve followed by the sudden onset of worsening symptoms after 5-6 days (double-sickening) What is the typical triad of symptoms for Acute Bacterial Rhinosinusitis in Adults? 1. Headache 2. Facial Pain 3. Fever ----Onset with persistent symptoms is far more frequent In children with Acute Bacterial Rhinosinusitis, what is the usual presenting condition? 1. The most common is a cough (80%) 2. Nasal discharge (76%) 3. Fever (63%) Parents of preschoolers often report malodorous breath Differential Diagnosis for Mouth Sores: • Food or drug allergies • Chemical irritation • Dry mouth • Mechanical or Thermal injury • Infections (fungal, viral or bacterial) • Host Immunosupression • Nutritional deficiency Differential Diagnosis for Hoarseness: • Infection • Inflammation • Overuse • Vocal cord pathology • Vocal cord paralysis • Muscle atrophy (aging) • Gastroesophageal reflux • Chronic Allergies Differential Diagnosis for Sore Throat: • Streptococcal pharyngitis • Tonsillitis • HSV • Gonococcus • Candidiasis • Aphthous ulceration • Rhinovirus, adenovirus, Epstein-Barr virus, Coxsackievirus • Mycoplasma What are Common Eye Complaints? • Redness • Dry eye • Watery or purulent eye discharge • Eye pain • Impaired vision • Ocular itching • Swelling of the eyelid What conditions require immediate referral? • Severe or sudden vision loss • Eye pain • Corneal ulceration • Trauma • Foreign body • Herpetic Infection of the eye What is Blepharitis? • Is an inflammation of the eyelids and eyelid margins What forms of Blepharitis are there? • Nonulcerative form associated with seborrhea • Ulcerative Describe Non-ulcerative Blepharitis: • Tends to affect people with psoriasis, seborrhea, eczema, allergies, and lice infestations • Contributing factors: exposure to chemical or environmental irritants, use of eye makeup and contact lenses • Non-Ulcerative Blephritis may present with scales along the lid margins that are easily removed What are contributing factors to Non-Ulcerative Blepharitis? • Exposure to chemical or environmental irritants • Use of eye makeup • Contact lenses Describe Ulcerative Blepharitis: • Involves the lash follicle and the meibomian glands of the eyelid • Lashes become thin and break easily • Ulcerative Blephritis may have pustules at the base of the hair follicles that may crust and bleed. What is the clinical presentation of Blephritis (both forms)? Subjective: • Itching and burning • Foreign body sensation • Sensitivity to bright lights • Excessive tearing • May be unilateral or bilateral Objective: • Lid margins are edematous and erythematous in both cases • Palpate for preauricular lymphadenopathy