NR 602 MIDTERM STUDY GUIDE:

CHALAZIONS /BLEPHARITIS /OTITIS MEDIAAny child with moderate/severe bulging TM with otorrhea not associated with AOM Yes Any child with mild bulging of the TM with recent (102.2° F [39° C], otalgia for ≥48 hours) ...

CHALAZIONS /BLEPHARITIS /OTITIS MEDIAAny child with moderate/severe bulging TM with otorrhea not associated with AOM Yes Any child with mild bulging of the TM with recent (<48 hours) onset pain (holding, tugging, and so on) or intensely erythematous TM Yes Babies ≥6 months of age with severe signs of AOM (fever >102.2° F [39° C], otalgia for ≥48 hours) Yes Any child 6 to 23 months old with acute bilateral otitis media without severe symptoms, without fever, and sick less than 48 hours Yes Young children with unilateral AOM without severe symptoms and fever <102.2° F [39° C] Provide prescription and/or wait Close follow-up Children ≥24 months old without severe symptoms Provide prescription and/or wait Close follow-up Children not treated and no improvement in 48 to 72 hours See the patient again5 Diagnosis Treat Clinician discretion whether or not to treat 4. CONJUCTIVITIS – inflammation or irritation of conjunctiva Bacterial (PINK EYE) – in peds bacteria is the most common cause, contact lens, rubbing eyes, trauma, S&S – purulent exudate, initially unilateral, then bilateral Sensation of having foreign body in the eye is common Key findings – redness, yellow green, purulent discharge, crust and matted eyelids in am Self-limiting 5-7 days. Eye drops – polytrim, erythromycin, tobramycin or cipro Improvement 2-4 days Most common organism H. influenza <7 Viral – adenovirus, coxsackie virus, herpes, molluscum  S&S – profuse tearing, mucous discharge, burning, concurrent URI, enlarged or tender preauricular noseVERRUCA VULGARIS - WART painless, benign skin tumors which are viral and can be transmitted by touch HPV 6 or 11 Common wart – rough surface, elevated, flesh-colored papules  Avoid contact with wart exudate from self  Treatment- paring and debridement of wart prior to any treatment  Soak in warm water, occlude with waterproof tape for 1 week and leave open to air for 8- 12 hours,  then reocclude for 1 week  Topical Duofil, Oclussal Hp must be applied up to 12 weeks  CRYOTHERAPY with liquid nitrogen ( 5 second freeze until an ice ball forms  Warts resistant to treatment - biopsy Herpetic Whitlow  occurring on a finger or thumb, is a swollen, painful lesion with an erythematous base and ulceration resembling a paronychia.  It occurs on fingers of thumb-sucking children with gingivostomatitis or adolescents with genital HSV infection.  Lesions occur in children of all ages, are contagious as long as they are present, and have an incubation period of 2 to 12 days.  Primary lesions usually occur before 5 years old, are more painful and extensive, and last longer. S&S  primary herpes, fever, malaise, sore throat, and decreased fluid intake  Deep-appearing vesicles on fingers Diagnostic Studies  A Tzanck smear can be done on fluid from the lesions to identify epidermal giant cells, but does not distinguish HSV-1 from HSV-2.  Viral cultures are the gold standard for defini CERVICAL CAP o Currently, a non-latex cervical cap (FemCap) is available in the U.S. o reusable, flexible, domed cap o The cervical cap comes in 3 sizes to fit most women (fitting required).  The device should be used with spermicide. Fertility Awareness o Fertility awareness methods use physical signs, symptoms, and cycle data to determine when ovulation occurs. o The Standard Days Method (SDM), on which CycleBeads are based, helps the woman track her cycle days and know when she is fertile.  avoid unprotected intercourse on days 8–19 of the menstrual cycle, as these are the fertile days. o These methods are suitable for women with menstrual cycles between 26 and 32 days long.  Users who have 2 or more cycles outside the 26–32-day range within any 1 year of use should be advised that the method may not be appropriate because of a higher risk of pregnancy o Films and suppositories spermicide require 10–15 minutes for activation  Nonoxynol-9 spermicides increase a woman’s risk of HIV-1 infection. Emergency contraception42 o For most the instructions are to take 1 tablet within 72 hours (3