HEENT Flashcards
What is a primary headache?
It has no underlying cause → consists of tension headaches, cluster headaches, and migraines
What is a secondary headache?
It is associated with an underlying illness such as an infection, trauma, stroke, or hypertensive crisis
What are some facts about tension headaches?
- most common type of headache
- women get it more than men
- incidence decreases with age
- unclear pathophysiology
- caused by stress, anxiety, and head/neck movements
- episodic or chronic (occurs at least 15 days/month)
What are the symptoms of a tension headache?
- constant, dull pressure → not pulsating
- bilateral tightness pain → hatband pattern
- photophobia and phonophobia could be present (sensitive to light and sound)
What are some facts about migraine headaches?
- second most common primary headache
- women get it more than men
- peaks between 18-54 years of age
- duration can last from 4 hours-3 days
- caused by neuronal or vascular changes
What are the symptoms of a migraine headache?
- throbbing/pulsating pain → is unilateral
- nausea and vomiting
- photophobia and phonophobia (sensitivity to light and sound)
What are the symptoms of aura?
- tingling of extremities
- flashes of light or blind spots
- sensory changes
What are some common characteristics of aura?
- is a neurologic symptom that can last from 5-60 minutes
- starts before or at the onset of a migraine
- affects half of the visual field
What are some facts about cluster headaches?
- less common but is the most severe primary headache
- men have it more than women
- can last 15 minutes - 3 hours that occur in series that can last weeks to months
- caused by hypoxia or histamine/serotonin release
What are the symptoms of cluster headaches?
- circadian rhythm of painful attacks
- unilateral and usually centered around or behind the eye
- constant/severe pain
- nausea and vomiting
- photophobia and phonophobia
- nasal stiffness, rhinorrhea (thin clear nasal discharge), eyelid swelling
What are the most common treatments for a tension headache?
analgesics, caffeine, stress management
What are the most common treatments for a migraine headache?
lying down in a dark room, botulism toxin, triptans
What is the most common treatment for a cluster headache?
oxygen
What are non-pharmacologic treatments for headaches?
- avoid triggers
- stress management and relaxation training
- heat/cold packs
- massage
- exercise and stretching
- sleep hygiene
What are some OTCs to treat headaches?
- acetaminophen
- NSAIDS (ibuprofen, naproxen)
- Excedrin (acetaminophen, aspirin, caffeine)
What is an important counseling tip for OTC analgesics?
they can cause a rebound headache → don’t take for more than 15 days per month
When do you refer a patient for a headache/head condition?
- uncontrolled hypertension
- recent trauma
- neck stiffness
- signs of infection/fever
- signs of stroke
- excessive drowsiness
- confusion
- having more than 15 tension headaches per month
- new onset of headaches if older than 50 years old
- standard treatments are ineffective
- migraine or cluster headaches
When do you refer a patient for a headache/head condition?
- uncontrolled hypertension
- recent trauma
- neck stiffness
- signs of infection/fever
- signs of stroke
- excessive drowsiness
- confusion
- having more than 15 tension headaches per month
- new onset of headaches if older than 50 years old
- standard treatments are ineffective
- migraine or cluster headaches
What does SCHOLAR stand for?
S - scholar C - characteristics H - history O - onset L - location A - aggravating factors R - remitting factors
What are some SCHOLAR questions for head conditions?
S - What symptoms are you experiencing? Any smells, visual changes, sensitivities or light/sound, aura, nausea, vomiting?
C - Describe the pain. What does it feel like? Throbbing vs pressure vs sharp/severe
H - How often do the symptoms happen? Has this happened before? Have any life changes occurred recently?
O - When did the pain/symptoms begin? Was it gradual or sudden?
L - Where is the pain located? Is it one side of the face, across the forehead, around the eye?
A - What makes the pain worse?
R - What makes the pain better? What have you tried to help the pain?
What is conjunctivitis?
- also known as pink eye
- inflammation of the conjunctiva (thin, transparent layers of mucus membrane that lines the inner surface of the eye/eyelid)
- causes include: infectious (bacterial/viral), allergic, nonspecific
What is viral conjunctivitis?
- is the most common infectious cause (up to 80%)
- most commonly caused by adenovirus
- lasts 1-3 weeks
What are the symptoms of viral conjunctivitis?
- begins in one eye and spreads to the other
- blurred vision
- watery discharge
- pink/red eye
- low grade fever
- other respiratory symptoms → rhinitis (stuffy nose), sore throat, cough
What is the treatment for viral conjunctivitis?
- lubricants (artificial tears)
- ocular decongestants or antihistamines (like ketotifen)
- cold compress
What is bacterial conjunctivitis?
- caused by S. aureus, S. pneumonia, H. influenzae
2. lasts 2 weeks
What are the symptoms of bacterial conjunctivitis?
- purulent yellow/green ocular discharge
- begins in one eye and spreads to the other
- blurred vision
- pink/red eye
- eye discomfort/swelling
What is the treatment for bacterial conjunctivitis?
antibiotics
What is allergic conjunctivitis?
- affects up to 40% of the population
2. caused by triggers → animal dander, dust mites, pollen
What are the symptoms of allergic conjunctivitis?
- itchy eyes
- clear watery discharge
- bilateral
- pink/red eye
- eye discomfort/swelling
- sneezing/rhinorrhea
What is the treatment for allergic conjunctivitis?
- allergen avoidance
- topical antihistamine/vasoconstrictor eye drops (Naphcon-A)
- mast cell stabilizers (Cromolyn eyedrops)
What are the causes of dry eye conjunctivitis?
- increased age
- women get it more than men
- allergens
- medications (anticholinergics, diuretics, decongestants, antidepressants, hormone replacement therapy)
- dry air
What are the symptoms of dry eye conjunctivitis?
- sandy, gritty feeling
2. feels like something is stuck in the eye
What are some non-pharmacologic treatments for dry eye conjunctivitis?
- avoid allergens
- avoid prolonged viewing of computer screens
- discontinue topical or systemic medications causing dry eyes
- humidifier
- wear sunglasses when outdoors
What is a pharmacologic treatment for dry eye conjunctivitis?
artificial tears (polyethylene glycol) in liquid, gel, or ointment
What are the causes of irritant conjunctivitis?
- foreign object in the eye
- chlorine
- smoke
What is the treatment for irritant conjunctivitis?
- carefully remove the object
- remove contacts and flush the eye with clean water
- do not rub eyes
What is the cause of blepharitis?
can be allergic or bacterial cause
What are the symptoms of blepharitis?
- inflammation of the eyelid → shows as a lump near the edge of the eyelid
- swollen itchy eyelid
What is the treatment for blepharitis?
- warm compress
- eyelid cleansing
- artificial tears
- can lead to the formation of a stye if left untreated
What eye conditions are self treatable?
dry eye conjunctivitis, allergic conjunctivitis, viral conjunctivitis
When do you refer for an eye condition?
- pain in the eyeball itself
- significant vision changes
- photophobia (light sensitivity)
- severe foreign body sensation
- any corneal irregularity
- eye trauma
- symptoms get worse or do not improve
- soft tissue swelling near the eye
- intense redness in the eyes
- contact lens wearers
- chemical exposure to the eye
How do you administer eyedrops?
- Wash hands before and after use
- Remove glasses or contacts
- Remove the cap and make sure nothing touches the bottle tip
- Tilt head back or lie down → pull lower lid of eye down to form a pocket
- Hold eye drop bottle near eyelid but not touching anything
- look up and away from the top and place one drop into the eye
- hold eyelid to allow solution to spread then close the eye and apply light pressure to nasolacrimal opening on side of nose for 30 seconds to avoid systemic absorption and loss of product
- wipe excess liquid away
- wait 5 minutes before applying another drop