NURS 629 Peds Exam 2 QUESTIONS WITH COMPLETE SOLUTIONS

NURS 629 Peds Exam 2 QUESTIONS WITH COMPLETE SOLUTIONS Strabismus Correct Answer: Misalignment of the eyes. Lazy eye or cross-eyed. Results in loss of depth perception and double vision. Assessment techniques t ...

NURS 629 Peds Exam 2 QUESTIONS WITH COMPLETE SOLUTIONS Strabismus Correct Answer: Misalignment of the eyes. Lazy eye or cross-eyed. Results in loss of depth perception and double vision. Assessment techniques to detect strabismus Correct Answer: Red light reflex Cover-uncover test Deviation of the weak eye outward Correct Answer: Exotropia Deviation of the weak eye inward Correct Answer: Esotropia Visual axis of one eye is higher than the fellow fixating eye Correct Answer: Hordeolum Correct Answer: Sty; an acute infection of a sebaceous gland of the eyelid Obstruction of the sebaceous glands or eyelid. Staphylococcal aureus is the most common causative organism. What might a patient with a hordeolum complain of Correct Answer: Swollen, red, painful lesion on the lid margin Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Internal - under eyelid Painful swelling Typically develops suddenly Treatment for a hordeolum Correct Answer: Warm compresses-20 minutes qid Antimicrobial ointment or drops Good eye hygiene and hand washing Chalzion Correct Answer: Chronic inflammation of the eyelid. Blocked meibomian gland - may result from internal hordeolum. Often not painful but sensation of pressure. Develop over weeks to months. Clinical finding of chalzion Correct Answer: Mild erythema and edema of the eyelid that resolves and results in a painless, non-pigmented mass Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Treatment of chalzion Correct Answer: Erythromycin drops or ointment if hordeolum is present Cellulitis develops - treat with erythromycin or cephalexin Most important vital sign for a patient with an eye complaint Correct Answer: Visual acuity Peritonsillar abscess (PTA) Correct Answer: Collection of pus or fluid around the tonsil Symptoms of PTA Correct Answer: Increased fever Anorexia Drooling Dyspnea Restless & irritable Muffled voice Stridor Respiratory distress Physical exam findings of PTA Correct Answer: Fiery red asymmetric swelling of one tonsil Uvula is often displaced and often forward Large, tender lymphadenopathy Management of PTA Correct Answer: Aspiration of the abscess may be performed for accurate diagnosis and treatment. CT scan of the head and neck Monitor airway at all times ENT consult is essential Usual Management - IV antibiotics - Inpatient management At what age should hearing testing start? Correct Answer: 4 If a child's hearing test results are anything greater than -10 to +15, what is the 1st thing a provider should do? Correct Answer: Check the ear with an otoscope for an obstruction with cerumen or a foreign body Risk factors for otitis media Correct Answer: Boys 1st born Winter months Bottle fed babies Preemies Daycare children Children of smokers Acute otitis media epidemiology Correct Answer: 75% of cases are viral Pathogens are most likely S. pneumoniae, H. influenzae, M. catarrhalis H. influenzae - must treat with Augmentin (conjunctivitis + AOM) must treat with a topical antibiotic for the eye Symptoms of otitis media Correct Answer: Fever Pain Discharge from the ear Tugging or batting at the ear - can be a teething or a comfort thing Irritability, crying, lethargy Decreased appetitie - chewing & swallowing can increase pressure in the inner ear Decreased sleep Recent URI Signs of otitis media Correct Answer: 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 May not see TM if it has ruptured & there is pus & fluid Acute Otitis Media (AOM) Correct Answer: effusion in the middle ear that occurs suddenly and is associated with other signs of illness Otitis Media with Effusion (OME) Correct Answer: An amber-yellow drum suggests serum in middle ear that transudates to relieve negative pressure from the blocked eustachian tube. You may note an air/fluid level with fine black dividing line or air bubbles visible behind drum. Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also called serous otitis media (glue ear) Signs of OME Correct Answer: Bulgining TM Decreased or absent mobility of TM Amber fluid or appearance of TM Otorrhea AOM in patients < 6 months of age Correct Answer: Antibacterial therapy Criteria for antibacterial therapy for tx of AOM in patients 6 months - 2 years Correct Answer: Fever over 102F Bilateral infection Severe otalgia Longer than 7 days