(NR 602 Week 4 Midterm)
NR 602 Week 4 Midterm Study Guide
Signs of pregnancy
presumptive (subjective signs) Amenorrhea, nausea, vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18–20 weeks
probable (objective signs) Goodell sign (softening of cervix)
Chadwick sign (cervix is blue/purple)
Hegar’s sign (softening of lower uterine segment)
Uterine enlargement
Braxton Hicks contractions (may be palpated by 28 weeks)
Uterine soufflé (soft blowing sound due to blood pulsating through the placenta)
Integumentary pigment changes
Ballottement, fetal outline definable, positive pregnancy test (could be hydatidiform mole, choriocarcinoma, increased pituitary gonadotropins at menopause)
positive (diagnostic signs) Fetal heart rate auscultated by fetoscope at 17–20 weeks or by Doppler at 10–12 weeks
Palpable fetal outline and fetal movement after 20 weeks
Visualization of fetus with cardiac activity by ultrasound (fetal parts visible by 8 weeks)
Pregnancy and fundal height measurement
Signs of pregnancy (presumptive, probable, positive) ……. Continue
NR 602 Week 4 Midterm Study Guide (Pediatrics)
1. Chalazions: chronic inflammatory lesion that develops from meibomian tear gland obstruction. Causes: sebaceous cell, basal cell, or Meibomian gland cancer.
Signs and symptoms: eyelid swelling and erythema evolving into painless, rubbery nodule at at eyelid margin.
Treatment: warm moist compress. Resolves without treatment in several weeks. Not an infection. Referral to ophthalmology if does not resolve or if visual fields affected.
2. Blepharitis: Inflammation of the eyelid margin. Can be acute or chronic.
Causes: Inflammation at the base of the eyelash by staph aureus, which alters meibomian eye secretion. Contact dermatitis, eczema, psoriasis, contact lens, or smoke exposure.
Signs and symptoms: Redness, itching, irritation, gritty feeling, pink eyes, tearing, crusting or matting of eyelashes in the morning, scaling of eyelids, blurred vision that can be blinked away, and light sensitivity.
Treatment: Nonpharmacological consists of warm moist compresses 1 to 2 X D fallowed by lid washing with baby shampoo. Artificial tears.
Mild to moderate: Pharmacological includes erythromycin ointment (Ilotycin) 7-10 day. Bacitracin HS for 1-2 weeks. Azithromycin (Azasite) 1gtt bid X2d then qd for 5 days.
Moderate to severe: Doxycycline 100mg bid for 2 to 4 weeks or Azithromycin 500mg qd X 3d
Referral: severe eye redness and pain, light sensitivity, impaired vision, or poor response to treatment.
3. Otitis media: Inflammation or infection (bacterial or viral) of the middle ear with purulent effusion.
Causes: strep pneumoniae, Hemophilus influenzae, Moraxella catarrhalis for bacterial. For viral adenovirus, RSV, or influenza. Environmental exposure to sick children (i.e, daycare). Pasive exposure to smoke or sleeping with a bottle.
Signs and symptoms:
Mild: Mild otalgia and fever < 102 F in the past 24 hours. Preverbal child may pull at ear or hair near ear to signify pain.
Severe: moderate to severe otalgia or fever > 102 in the past 24 hours. May cry unconsolably or have otorrhea if TM perforated.
TM abnormal in color (red or hemorrhagic) with moderate to severe bulging, impaired mobility, and possible perforation. Fever, sinus congestion, rhinorrhea, hearing loss or decreased.
Diagnostic testing: pneumatic otoscopy for mobility.
Treatment:
Conservative if child > 2 years of age, has mild symptoms, no otorrhea, TM intact, fever <102, patient does not appear ill and has been healthy prior to illness.
Acetaminophen 10-15 mg/kg q4 hours or ibuprofen 10mg/kg q6hor topical analgesic drops (antipyrine/benzocaine (auralgan) if TM intact. If no improvement in 48-72 hours start antibiotics.
First line treatment if no recurrent AOM and no recent antibiotics (within the last 30 days), and no purulent conjunctivitis amoxicillin 90mg/kg/day divide by 2 for BID. 5-7 days for > 2 years old and 10 days if <2 years old.
For recurrent AOM, recent antibiotic use, or purulent conjunctivitis give 10 days of Amoxicillin? Clavulanate 90mg/kg/day divided by 2.
Alternative to PCN Cefdinir 14mg/kg/day divide 2 or ceftriaxone 50mg /kg IM qd for 1-3 days
Allergy to PNC and cephalosporins
Azithromycin 10mg/kgon day one and 5mg/kg on days 2-5
Fallow up: 48-72 hours if not improving (treatment failure switch antibiotics and continue for 10 days i.e Cefdinir). See patient 8-12 weeks after treatment to reassess TM and hearing.
Referral: ENT if unsolved and/or < 2 months of age and noted decreased hearing……. Continue
