Disorders Flashcards
Dry eye: Symptoms
Gritty feeling as if something is in the eye, with or without mild redness
Dry eye: non pharm treatment
Avoiding environments that are dry, dusty, and cause evaporation of tears, humidifiers, point AC and heaters away from eyes, wear sunglasses in windy environments. Limit time spent looking at screens (or take frequent breaks). Eyelid hygiene. Warm compresses.
Dry eye: Pharm treatment
Ocular lubricants are the first line treatment. Eye drops like artificial tears are more commonly recommended.(Patient should also seek the advice of an eye care professional)
Dry eye
Common disorder of the eye. Often associated with aging. Common in patients with rheumatoid arthritis, thyroid disease and those taking certain medications (such as anticholinergics). (may also be caused by Sjogren’s Syndrome or female gender androgen deficiency)
Conjunctivitis
Inflammation of the conjunctiva. Types: allergic, viral, bacterial. Most cases are self limiting.
Allergic conjunctivitis: symptoms
occurs bilaterally. pink/red/clear, ITCHY, watery eyes.
Allergic conjunctivitis: non pharm treatment
Most effective non pharm is allergen avoidance. Cold compresses (3-4 daily). Contacts should not be worn.
Allergic conjunctivitis: pharm treatment
First line treatment: artificial tears as needed. If symptoms persist: topical antihistamine (AH)/ mast cell stabilizer.
Topical treatments: Ophthalmic Decongestants/Alpha-Adrenergic Agonists, Ophthalmic Antihistamines, Ophthalmic Antihistamine/Mast Cell Stabilizer
Oral treatments: Antihistamines (2nd generation)
Agent selection:
Viral conjunctivitis: symptoms
Pink eyes with large amounts of watery discharge. Abrupt onset. No itching usually. Can have crusting of the affected eye. Typically begins in one eye and progresses to the other. Contagious for about a week. Self limiting within 1 to 3 weeks.
Viral conjunctivitis: non pharm treatment
Hand washing. Cold compresses. Do not share towels or other objects that come into contact with eye. Avoid using contacts.
Viral conjunctivitis: pharm treatment
No effective treatment for viral conjunctivitis. Artificial tears and ocular antihistamines can provide some relief. Referral is warranted if no improvements within 7 to 10 days.
Bacterial conjunctivitis: symptoms
Can be unilateral or bilateral, mucopurulent discharge. Matting or crusting of the eyelids that is dark brown/green in color. Self limiting.
Bacterial conjunctivitis: non pharm treatment
? Hand washing, cold compresses
Bacterial conjunctivitis: pharm treatment
Antibiotics are not necessary, but they do reduce symptom duration from 6-10 day to 2-5 days.
Glaucoma
Common eye disorder that causes irreversible blindness if left undiagnosed and untreated. 2nd leading cause of blindness. 6 times more likely in African americans.
Glaucoma types:
Open angle: primary and secondary Closed angle: chronic and acute Open angle primary: most common acute- medical emergency ?
Glaucoma treatment:
Treatment of Closed angle glaucoma:
1st line- iridectomy (laser or surgery)
Treatment of open angle glaucoma:
1st line- Prostaglandin analogs and beta blockers
Oral medications are last line treatment because of the many side effects
Otic disorders
self treatment should be restricted to external disorders.
Excessive/impacted cerumen: symptoms
Clinical presentation: fullness or pressure, gradual hearing loss, sometimes a dull pain is present, vertigo and/or tinnitus can also be present, chronic cough, mild pain
Excessive/impacted cerumen: non pharm treatment
Remove cerumen when it has migrated to the outermost portion of the EAC by using a wet, wrung-out washcloth draped over a finger. (not effective when cerumen is already impacted, but can prevent impactation)
Excessive/impacted cerumen: pharm treatment
Carbamide peroxide 6.5% in anhydrous glycerin for cerumen softening (use twice daily but for no more than 4 consecutive days)
Water-clogged ears: symptoms
Clinical presentation of water clogged ears: feeling of wetness or fullness, gradual hearing loss, can cause tissue maceration that can lead to itching, pain, inflammation, or infection
Water-clogged ears: non pharm treatment
Gentle manipulation of the auricle while tilting the affected ear downward (helps removed excess water)
Water-clogged ears: pharm treatment
Isopropyl alcohol 95% in anhydrous glycerin 5%.
Acetic acid 5% in a 50:50 mixture of isopropyl alcohol 95% (needs to be compounded)
Tooth hypersensitivity: symptoms
short, sharp pain in response to a stimulus (thermal, chemical, or physical) that cannot be attributed to any other dental issue. The pain is caused by exposed dentin.
Tooth hypersensitivity: Non pharm treatment
Identify and eliminate predisposing factors that may contribute to tooth hypersensitivity. Use a soft bristle toothbrush and brush less vigorously using standard fluoride containing toothpaste.
Tooth hypersensitivity: pharm treatment
Toothpastes (dentifrices) containing a potassium salt decreases the nerve excitability….
Oral disorders: exclusions for self-care
toothache
mouth soreness associated w/poor fitting dentures
presence of fever or swelling
loose teeth
bleeding gums in absence of trauma
broken or knocked-out teeth
severe tooth pain triggered or worsened by hot, cold or chewing
trauma to the mouth w/ bleeding, swelling, and soreness
Teething discomfort: symptoms
Children may experience reddening, irritation, swelling, mild pain, low grade fever (not over 101), slight gum swelling, or excessive drooling while teething….
Teething discomfort: non pharm treatment
Non pharmacological measures should be used before pharmacological measures. Pharmacological measures should be reserved as much as possible.
Gum massage, cold (not frozen) teething rings, or a cold wet cloth. Dry toast or teething biscuits (depending on patient’s age)
Teething discomfort: pharm treatment
Benzocaine (not for use in children under 2) (do NOT use the 20% in children)
Appropriately dosed systemic analgesics, such as acetaminophen.
Recurrent aphthous stomatitis (RAS): symptoms
(aphthous ulcers or canker sores)
precipitated by stress and local trauma.
Sores located on nonkeratinized mucosa, such as tongue, floor of mouth, soft palate, and inside lining of the lips and cheeks. Usually round or oval, flat or crater-like, gray to yellow in color with an erythematous halo of inflamed tissue surrounding the ulcer. Some patients experience a prodrome (prickling or burning sensation) 24-48 hours prior to when the ulcers appear.
RAS: non pharm treatment
Increased consumption of nutrients
Ice
Stress reduction to prevent additional ulcers
RAS: pharm treatment
Oral debriding and wound cleansing agents
Herpes simplex labialis: symptoms
(fever blisters or cold sores) Primarily associated with oral lesions. Lesions on lips- can be intraoral on keratinized tissue Preceded by a prodrome Small, red papules Erythematous border Crust will form after lesions burst
HSV-1: non pharm treatment
Keep the lesions clean with a gentle wash of warm water and mild soap. Keep hands clean with frequent washing.
HSV-1: pharm treatment
Topical protectants: protect from infection, relieve dryness
Topical analgesics/anesthetics: burning, itching, and pain relief; no reduction in duration
Topical antiviral: Docosanol 10% (Abreva); reduces healing time, Apply during prodromal time (1st sign), Apply 5 times daily until healed (max 10 days)
Topical antibiotics: triple antibiotic ointment, 3-4 times daily, use only is secondary infection may be present
Antivirals: prescription needed
HSV-1: exclusions for self treatment
Lesions present for longer than 14 days increased frequency of outbreaks compromised immunity symptoms of systemic infection (fever, swollen glands, rash) no previous diagnosis of a cold sore
Dry Mouth
Result of limited or arrested salivary flow
also known as xerostomia
Symptoms: difficulty talking or swallowing
Risk factors: diabetes, depression, antihistamines, diuretics
Dry mouth: non pharm treatment
avoid tobacco, avoid alcohol containing products, if medications are the cause of dry mouth-take meds one hour prior to meals, limit sugary or acidic foods, chew gum, increase water intake
Dry mouth: pharm treatment
artificial saliva products as needed
Dry mouth: exclusions for self care
Tooth erosion, decalcification, decay
candidiasis, gingivitis, periodontics
reduced denture-wearing time
mouth soreness associated with poor fitting dentures
presence of fever or swelling
loose teeth
bleeding gums in the absence of trauma
broken or knocked out teeth
severe tooth pain triggered or worsened by hot, cold, or chewing
trauma to the mouth with bleeding, swelling, and soreness
Impacted Cerumen and Water-clogged ears: exclusions for self-care
severe pain signs of infection pain associated with ear discharge bleeding or signs of trauma presence of ruptured tympanic membrane (abrupt hearing loss and sharp pain) ear surgery within prior 6 weeks tympanostomy tube present incapable of following proper instructions hypersensitivity to recommended agents less than 12 years old
Ocular disorders: exclusions for self-treatment
Patients should be referred to a physician if they are experiencing:
eye pain
blurred vision that is not due to the use of eye ointments
light sensitivity
ocular trauma
chemical exposure
untreated symptoms that persist over 72 hrs. (except conjunctivitis)
eye exposure to heat (not sun exposure)
signs and symptoms of eyelid infection, except stye (red, thickened eyelids, scaling)
Hordeolum vs chalazion
Hordeolum: (stye) eyelid gland infection, tender to touch, palpable tender nodule present, eyelid swelling, lid margin redness
Chalazion: noninfectious granuloma located near, but not on the eyelid, not tender to touch, similar appearance
Hordeolum (stye): treatment
warm compresses (which brings blood to surface) should be applied for 5-10 minutes 3-4 times daily. apply gentle pressure by rolling the compress around the stye. External styes may be treated with topical antibiotic ointment.
Chalazion: treatment
May be drained by warm compresses, but may not resolve. If the nodule doesn’t drain after 1 week of treatment, patients should seek medical care.
