FNP I HEENT Flashcards
How is NPH diagnosed?
With CT or MRI
The only real way to tell is to slowly drain CSF & c if Sx’s gradually improve
Normal Pressure Hydrocephalus
Affects >60
Gradual (insidious onset)
What symptom triad is associated with NPH?
Magnetic Gait
Dementia
Urinary incontinence
(Wet, Wobbly, Wacky)
Bacterial Conjunctivitis
When does it occur?
Purulent discharge
Normal vision
Gritty/ Crusted lids
Occurs in the fall/winter
Treatment for Bacterial Conjunctivitis
Oral and topical abx
(erythromycin or azithromycin ung; gentamicin or Tobramycin gtts)
Sulfcetamid (>2yrs)
Flurooquinolone gtts (>1yr)
Treatment for Viral Conjunctivitis
Warm Compresses
Artificial Tears QID
NSAIDS
Viral Conjunctivitis
When does it occur?
Watery discharge Normal Vision Itchy, burning, tearing Eyes R really red Pre-auricular Lymph node Palpable
Occurs after URI
Allergic Conjunctivitis
When does it occur?
Stringy Mucoid discharge
Normal Vision
Itching/ burning
Occurs in fall/spring
Treatment for Allergic Conjunctivitis
Oral/Topical antihistamines
(topical vasoconstrictors)
Cool compresses
Giant Papillary
What causes this?
Watery Discharge
Blurry Vision
Itchy/ gritty
Drooping eyelid
Characterized by bumps under the eyelids
Contact wear or contact solution
Treatment for Giant Papillary
D/C contacts
Bacterial conjunctivitis of the new born is ____
Ophthalmia neonatorum
Ophthalmia neonatorum is usually caused by
Gonorrhea or Chlamydia
How is ophthalmic neonatorum treated?
By erythromycin; given @ birth
C. Trachomatis (chlamydia) in adults…
You need to Cx it
Treat sexual partners as well
Herpes Zoster Eye Infections treatment
Start antiviral if early dx is made
Cool compresses
Refer to Ophthalmologist Immediately
Signs & Symptoms of Herpes Zoster Opthalmicus
Pain Tearing Photophobia Mucoid discharge Moderate conjunctival hyperemia
Signs & Symptoms of Corneal Abrasions
Pain Tearing Photophobia Foreign Body Sensation (FOS) Conjunctival Hyperemia Decreased vision
What should the clinician do to inspect the eye for foreign objects or scratches related to corneal abrasion?
stain the eye with fluorescein dye and use cobalt blue filter light or slit lamp
May use tetracaine for evaluation but not for Rx for treatment
Treatment for Corneal Abrasion
Abx gtts or ung (ointments) for 5 days
w/ follow up daily until symptoms resolve
Tetanus
Eye rest
Patient education with corneal abrasion
Avoid wearing contacts until eye has healed
Hordeolum
Stye
swelling of the edge
erythamotus tender lump with in the eye
Subjunctival Hemorrhage
Caused by trauma and excessive straining such as with coughing
Sudden onset of painless red eye
Will resolve on its on within 2-4 weeks (does not require treatment – observe patient)
Treatment of hordeolum
Eye hygiene
Warm Moist Compresses QID
Topical ung
What is seborrhea?
inflammatory skin condition that causes flaky, white to yellowish scales
Blepharitis
Lid crusting and seborrhea
Treatment for Blepharitis
Eye hygiene Abx ung (erythromycin) @HS
tx for blepharitis of the scalp - anti-dandruff shampoos
Chalazion
Mid eyelid swelling and erythema
Treatment for Chalazion
Warm compresses (up to 6 weeks)
Abx-steroid ung
Excision
Lid Cellulitis
Can be related to recent URI, trauma to lid or lid infection
Characterized with painful lid edema
Plan for lid cellulitis
Refer to ophthalmologist
CT scan to RO orbital cellulitis
Red Flag
Orbital Cellulitis Symptoms
Lid edema
H/A
Fever
Plan for orbital cellulitis
Send to ER for IV abx to prevent vision loss
Ophthalmology consult ASAP
Restrict EOM
Dacryocytitis
Erythema
Tearing
Swelling over lacrimal sac
Treatment for Dacryocytitis
Eye Hygiene
Warm moist compresses
Topical opthalmic ung
Uveitis
Inflammation of the uveal tract
What are the two types of uveitis
- Anterior (effects the iris aka Iritis)
2. Posterior (effects choroids, retinitis)
Iritis
Aka Anterior Uveitis
Uveitis inflammation of the iris or anterior chamber of the eye
What is anterior uveitis associated with
Juvenile Rheumatoid Arthritis TB Herpes simplex Trauma Kawasaki disease
S/S of anterior uveitis (Iritis)
Decreased vision Pain Photophobia Pupil size decrease b/c iris crown the puli Cilliary Flush (no discharge or tearing) Refer immediately to ophthalmologist
Treatment for Iritis
Topical NSAIDs/ Corticosteroids
What is the leading cars of blindness in African Americans?
Glaucoma
2 types of glaucoma are
- Primary open angle (slow)
2. Primary angle closure (emergent) Intraocular pressure >22 mm Hg = glaucoma
Primary Open Angle Glaucoma
Most common
Slow process with central vision affected late
Usually bilateral
Increase interocular pressure
Symptoms of Primary Open Angle Glaucoma
blurred vision nausea headache halos around bright lights Increase cup-disc ratio difference between eyes
Treatment for Primary Open Angle Glaucoma
Refer
Symptoms Primary Angle Closure Glaucoma
Sudden eye pain Brow aching Corneal edema Decrease vision Sensation of seeing halos around light Photophobia Sudden loss of vision
Treatment for Primary Angle Closure Glaucoma
Referral: EMERGENT
Iridortomy laser hole in iris relieve pressure & damage
Beta blocker eye gtts Timoptic decreases aqueous humor production by ciliary body
Alpha agonists Alphagan dcrease aqueus prod. and increase ductal outflow
Marajuana decreases IOP
PE for Glaucoma
Visual acuity, visual fields ophthalmic exam, IOP if equipped
Macular Degeneration Dry
Develops slowly causing loss of central vision
No Tx. Affects both eyes, one before other
Risk Factors for Macular Degeneration
Fhx, smoker (past or present), light skin light eyes, excessive sun exposure, obesity, female, dietary deficiencies in zeaxanthin and Lutein
Wet Age Related Macular Degeneration (AMD)
new blood vessel growth behind retina causes bleeding and scarring 10% can be Tx’d with laser
S/S of Macular Degeneration
Decrease in macula function: blurriness, dark cloud, difficult to read, straight line distorted
Peripheral Vision okay.
Retinal Detachment S/S
SS increase floaters
Curtain like over field of vision
SS Depends where tear
Treatment for Retinal Detachment
Surgery
DM Retinopathy
develops from blood vessels that supply the retina and is the leading cause of blindness in adults age 20-64.Affects90% of Diabetics who have had DM >15 yrs.
What causes Proliferative DM?
Proliferative DM retinopathy most severe and threatening to sight. Caused by a lack of O2 to retina stimulates abnormal blood vessel growth which tightens and pulls on retina which detaches from inner wall. No pain, severe sight loss or blindness
Tx fro Proliferative DM
Laser surgery to reduce blood vessel growth, vitrectomy to remove blood in vitreous replace with saline
Cataract
Cloudy lens to the degree vision is disturbed
Causes of cataracts
Smoking Sun exposure Poor diet DM Steroids
S/S of cataracts
Gradual loss of vision: cloudy foggy vision
Light glare a problem reduces visual acuity: night driving
Cataract treatment
Surgery
Refer for evaluation
Further evaluation of visual acuity is necessary when
Adults & children ,>5yr: with visual acuity of 20/30 or worse
> 5y 20/50
Infants failing gross visual acuity (follow object or social response)
All who demonstrate more than one line difference between eyes
Myopia
light focuses in front of retina ; sees near objects best (nearsightedness)
Hyperopia
ight focuses behind the retina; sees far objects best (farsightedness)
Presbyopia
lens less resilient; poor near vision (aging)
Astigmatism
cornea or lens curvature causing unequal light refraction
Anisometropia
different refractive error in each eye
Amblyopia
Marked decrease in visual acuity in one eye due to interrutpion of normal visual development
Blinkin excessively, frowns, behavior closing or covering one eye
Refer
Strabismus
one eye not working with the other
Pseudostrbismus
Cross eyed
Genetic
Eso
inwards
Exo
outwards
Tropia
constant turned eye
Phoria
Both eyes are straight until coveredmisalignment of Visual axis revealed by the disassociation of the eyes
Advice for healthy eye aging
Avoid cigarette smoke
Regular eye exams
Healthy eating
Wear UV protection outdoors
