HEENT

Health Science/Nursing

This week’s pocket guide blog focuses on HEENT. Reviewed here are head, eyes, ears Nose and throat complications commonly seen in primary care.
-I need common diagnosis of problems involving this systems
-treatmnets with common medications.
-Please look at the example provided. its from my classmate. basically sam idea, just look for different common diagnosis.

HEENT
Sinuses: frontal, maxillary (only two palpable), ethmoid, sphenoid
Acute Bacterial Rhinosinusitis-
• sinus pain pressure, nasal congestion, purulent nasal drainage, fever, headache, ear pressure, cough fatigue, halitosis
• head cold- symptoms not improving beyond 10 days, double sickening, or severe symptoms for 3-4 days
• Exam includes- nasal passages, URI and resp exam, teeth and gum exams, palpations of sinuses, transillumination of sinses
• S. pneumo, H. flu, M. catarrhalis
• Tx: Augmentin/Amoxicillin, PCN allergy: doxy for adults, cefixime/clindamycin for kids, levofloxacin
• Treat adults 5-7 days, children 101-14 days, if no better after switch abx and referral +CT
Risk for antibiotic resistance
• Age <2 or >65
• Antibiotics in past month
• Hospitalization past 5 days
• Comorbidities
• immunocompromised
Benadryl is 1st generation; Claritin is 2nd a better side effect profile- less drowsy
Hayfever- runny nose, sneezing, runny eyes,
Acute Otitis Media:
– white bulging tympanic membrane, erythema
– membrane can rupture
– risks- swimming, hot tubes, immunocompromised, diabetics, hearing aids, headphones, bottle feeders, smokers
– common organisms: staph, pseudonymous, fungus
– Tx: polymyxin B and neomycin ear drops, steroids, maybe oral meds – amox, Augmentin
Hearing Loss: can be conductive or sensorineural, weber and rinne test to assess, could be med induced
– Sensorineural is when there is an inner ear nerve issue
– Conductive: sound is not reaching inner ear
Pharyngitis: inflammation of the pharynx caused group a beta hemolytic strep or mycoplasma pneumoniae, or chlamydia pneumoniae
– Cough, sore throat, difficulty swallowing, enlarged lymph nodes, inflamed tonsils
EBV (mono)- young adult, prodrome of fatigue, malaise, headache, fever, sore throat, adenopathy, petechiae, splenomegaly/hepatomegaly
Lab testing that can be done: rapid stress, cultures, mono spot, HIV viral load, GC culture, KOH prep
Sensitivity: high means few false negs
Specificity: high means few false positives

Eye Disorders:
– Subjective: itching, pain, anyone else symptomatic? Sick contacts, fever, chills, allergies, pregnant
– Objective: Snellen, ophthalmic exam, visual acuity, staining, PERLA
Fluorescein is an ophthalmic dye used for diagnostic purposes. The dye will settle into defects in the corneal epithelium or illuminate a foreign body that might not be seen with the naked eye
Conjunctivitis:
– Could be from staph or h flu
– Tx with arithromycin ointment, wear glasses and avoid contacts, cover for pseudonymous if a contact wearer, ocular fluroquinolones, wash hands, throw away makeup, warm compress, bacitracin, refer to ophthalmology
Red Eye: could be dry eye, trauma, blepharitis, conjunctivitis, abrasion, contacts, keratitis, glaucoma
Subconjunctival Hemorrhage: eye blood vessel bleeding into the eye, normally from straining, not a medical emergency, will go away on its own
Foreign Body: eye pain, photophobia, excessive tearing, sensation of something in their eye, red eye. Need a fluorescein exam to assess. Removal of foreign body needs to be done by a specialist
Corneal Abrasion: a disruption to the corneal epithelium due to trauma- presents with foreign body sensations (hallmark), eye pain, photophobia, visual disturbances, also needs a fluorescein exam, referral if damage is bad enough, otherwise abx ointment in the PCP office, erythromycin or fluoroquinolone to cover pseudomonas for contact wearers
Keratitis: sight threatening infection/inflammation of the cornea- bacterial, viral, med induced- p/w photophobia, erythema, foreign body sensation, vision change, possible drainage- emergent referral to ophthalmology
Iritis/uveitis: inflamed uveal tract- infectious, idiopathic, inflammatory- eye pain, extreme photophobia, visual changes, no foreign body sensation, minimal discharge, ciliary flush and constricted pupil- non urgent ophthalmology referral
Hyphema- bleeding into the anterior chamber from trauma- wine glass*- same day referral to ophthalmology
Hypopyon- similar to hyphema but with WBCs/pus- infectious process
Pinguecula/pterygium- common, benign growths of the tissue in the eye, from sun exposure, typically harmless lesions, artificial tears can help if they become bothersome, surgery to remove if needed
Scleritis- painful, sight threatening eye condition, worse at night, causes a HA and eye pain- refer to ophthalmologist
Glaucoma
– Acute Angle Closure- ocular emergency, caused by an abrupt and complete block of aqueous flow, sudden with dramatic onset, blurred vision, red eye, pain, HA, N/V, loss of vision- emergent treatment needed to reduce intraocular pressure
– Open Angle Closure – chronic condition, not emergent, aqueous flow is altered resulting in damage to optic nerve, could have no symptoms, genetic, management is to lower intraocular pressure with meds

Always assess head, eyes, ear, nose, throat- both subjective and objective data, refer when in doubt, ask colleagues, use up to date for medication/prescription questions, always ask patients about allergies or other times they were treated for something, always follow up after treatment course