Otitis Media
what is otitis media?
ear infection
clinical manifestations of otitis media
decrease hearing, hemotympanum, dizziness
snapping or popping sound, pain, tinnitus
discharge, bulging, increased temp, pus
kids: diarrhea, vomiting, fever, pulling at ears, irritability
what is fifths disease?
which population is it common in?
erythema infectiosum
face rash, looks like you have been slapped
typical in school aged children
what is ADHD and ADD?
ADHD: attention deficit hyperactivity disorder
-inattention, hyperactivity, impulsivity and hyperkinesis
ADD: attention deficit disorder
-individuals who experience inattentiveness and difficulty concentrating without hyperactivity
prevention for ADHD
avoid drugs, smoking and alcohol during pregnancy
good prenatal care
true or false: upper respiratory infections can cause otitis media
true
true or false: when examining an adults ear you should pull down and back.
false, you should pull up and back for anyone over the age of. you will pull down and back for those under 3 years old.
causes of fifths disease?
parovirus B19, spread through infected respiratory secretions
can be passed through birth canal
adults who have ADHD are at risk for?
antisocial behavior, substance abuse
serious accidents, academic underachievement
low occupational success
clinical manifestations for ADHD
decreased attention span, increased motor activity, difficulty with social relationships
impulsiveness, fidgeting, difficulty completing tasks, sleep disturbances
girls show less aggression and impulsiveness but more anxiety, mood swings, social withdrawal, rejection, cognitive and language problems
what are the three different types of otitis media?
serous: obstruction of eustachian tube (prolonged)
acute: follows upper respiratory infection, edema, fluid accumulates
chronic: permanent perforation of tympanic membrane, recurrent acute otitis media, cholesteatoma, can cause hearing loss
diagnostic tests for otitis media
tympanometry, CBC, tympanocentesis or myringotomy
spectral gradient acoustic reflectometry
culture and sensitivity, audiologic testing
true or false: once the rash appears you are contagious.
true or false: incubation period is 4-14 days.
false, once the rash appears you are no longer contagious.
true
what symptoms do adults with ADHD typically have?
inattention more than hyperactivity and impulsiveness
women display inattentiveness, depression and stress
how is ADHD diagnosed?
abnormal patterns in 2 settings for 6 months or longer in 2 areas of life (home, school, daycare)
risk factors for otitis media?
-exposure to poor air quality, pacifier use
-exposure to smoke, enlarged adenoids, eustachian tube dysfunction
pharm therapy for otitis media
5-10 days of antibiotics
analgesics, antipyretics, antihistamines (if sinuses blocked)
decongestants, steroids (for serous otitis media)
children: amoxicillin (1st line) and clavulanate (2nd line)
-if penicillin allergy use cephalosporin, trimethoprim-sulfamethoxazole or macrolides)
signs and symptoms of fifths disease
fever, runny nose, sore throat, headache, joint pain
nausea, rash (lace appearance)
severe symptoms: sickle cell anemia, aplastic anemia, HF (hydrops fetalis)
what hormones do people with ADHD have a deficit of?
dopamine and norepinephrine
what CNS stimulants are used for ADHD?
-side effects of CNS stimulants
-youngest age you can start each
Amphetamine-dextroamphetamine (Adderall) (3 years and older)
Methylphenidate (Ritalin, Concerta) (4 years and older)
Dextroamphetamine (Dexedine) (6 years and older)
Kusdexanfetamine (Vyvanse) (6 years and older)
Side effects of CNS stimulants: headache, insomnia, anorexia, stunt growth and development
prevention for otitis media
breastfeeding, bottle feeding in upright position
immunizations, avoiding smoke/pollution
HIB vaccine (at 2 months old)
surgery for otitis media and criteria for surgery
myringotomy (tympanocentesis): relieves excess pressure in middle ear and prevents rupture of eardrum
- greater than 3 episodes within 6 months or greater than 4 episodes in 12 months
how is fifths disease diagnosed and treated?
prevention?
diagnosed by exam and blood test
treatment: goes away on its own, relieve symptoms
prevention: wash hands, cover mouth and nose, avoid sick people, wear mask and gloves
risk factors for ADHD
family stress, poverty, poor nutrition
preterm birth, head injuries, seizures,
prenatal: poor fetal growth, impaired placental functioning, impaired oxygenation
nonstimulants used for ADHD
-side effects
-what you have to monitor for with each?
Atomoxetine (Strattera) (monitor liver function, AST and ALT)
Clonidine (Kapvay) (check BP)
Guanfacine (Intuniv) (check BP)
Side Effects: cardiac function and psychosis