- Eye assessment—Adult
Medical History (Specific to eyes):
- “Defects” added between Eye diseases or injuries
Rationale: adding ‘defects’ alerts nurse to assess for the specifics of eye anomalies that are most pertinent. Inclusion of defects promotes identification of individuals that present with corneal defects, who are predisposed to recurrent erosions and issues with the surface of the eye.
Symptoms Requiring Urgent Referral:
- “or bilateral eye pain” added to first bullet
- “Ocular pain” added as second bullet
Rationale: expand to provide better descriptor, as patients may present with
either unilateral or bilateral eye pain that prompts referral as they may indicate pathology.
- “recent onset” added to sixth bullet to describe floaters
Rationale: alerts nurse to assess for the specific chronicity of floaters: floaters of new onset may indicate acute pathology versus the presence of floaters.
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- Conjunctivitis—Adult
Common Findings:
- Streamlined description of pupillary reaction
- “Papillary reaction normal” deleted
Rationale: applicability. Papillary reaction may be an indicator of viral conjunctivitis, but was misaligned with this DST; term describes conjunctival surface finding and is not described as ‘normal’.
- Wording added to include ‘known’ and ‘environmental’
Rationale: alerts nurse to consider common allergens when performing history related to conjunctiva
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- Eye Assessment—Pediatric
Cardinal Signs and Symptoms (Other Associated Symptoms):
- “squinting or keeping one eye closed in younger children” added as a descriptor for diplopia
- “observed” added at beginning of above statement
Rationale: addition of content provides age appropriated symptom cues.
Medical History (Specific to eyes):
- “Defects” added between Eye diseases or injuries
Rationale: alerts nurse to assess for the specific of eye anomalies that are pertinent. Inclusion of defects promotes identification of individuals that present with corneal defects, whom are predisposed to recurrent erosions and issues with the surface of the eye.
Symptoms Requiring Urgent Referral:
- “or bilateral eye [pain]” added to second bullet
- “Ocular pain” added
- “recent onset” added to sixth bullet to describe floaters
Rationale: alerts nurse to assess for the specific chronicity of floaters: floaters of new onset may indicate acute pathology versus the presence of floaters.
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- Conjunctivitis—Pediatric
History (Bacterial and Viral):
- Revised to include timing of red eye/unilateral or bilateral presentation
Rationale: Improved recognition of the sequencing of presentation for history taking.
Common Findings:
- Streamlined description of pupillary reaction
- “Papillary reaction normal” deleted
Rationale: applicability. Papillary reaction may be an indicator of viral conjunctivitis, but seems misaligned with this DST; term describes conjunctival surface finding and is not described as ‘normal’.
Allergic, History:
- Alternate wording added to include ‘known’ and ‘environmental’
Rationale: alerts nurse to consider common allergens when performing history related to conjunctiva
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Potential Causes:
- “contact lens use” added to bracketed content
Rationale: alerts nurse to consider the most pertinent causes for corneal abrasion. Improper contact lens use may include incorrectly fitting or soiled contact lenses – that introduce sources of trauma, infection or small foreign bodies.
Non-pharmacologic Intervention:
- “to promote removal” added to first bullet
Rationale: intent of irrigation is the removal of the foreign body – not explicit as an intervention related to corneal abrasion – for clarification of direction, rationale
Client/Caregiver Education and Discharge Information:
- “Or participating in contact sports” added to fifth bullet
Rationale: provides health teaching relevant to corneal abrasion prevention
Consultation and/or Referral:
- “There is significant worsening of vision” added
Rationale: vision that worsens is a sign of potentially serious complications and requires referral to a physician or nurse practitioner.
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- Ear Nose and Throat Assessment—Adult
Medical History (Specific to ENT):
- New bullet: chronic cough
Rationale: Chronic cough is noted to be a part of history taking and may be associated with ceruminosis, and ENT infections.
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- Acute Otitis Media—Adult
Client Information and Discharge Education:
- Expanded 4th bullet, include reference to scuba diving
Rationale: Providing most common causes of barotrauma to include as relevant history for ENT - Added new bullet: counsel to stop smoking
Rationale: Preventive education to decrease risk of ENT infections, specifically AOM.
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- Ear Nose and Throat Assessment—Pediatric
Inspection:
- Expanded 2nd bullet to add guidance to inspect tissue for local findings of infection or malignancy
Rationale: Added inspection detail may promote assessment of mastoid area changes associated with infection or malignancy- may be complications of acute otitis media
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- Acute Otitis Media—Pediatric
History:
- Added new bullet: anorexia
Rationale: Significant history element in pediatric assessment for dental abscess; dental issues are associated with anorexia
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- Pharyngitis Sore Throat—Pediatric
Potential Complications:
- Added to current content: 1. Pneumonia, 2. Bacterial meningitis
Rationale: Significant complications of pharyngitis, cited in several sources
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- Dental Abscess—Adult
Physical Assessment:
- Added to current content: 1. Breath odour, 2. Fever
Rationale: Additional assessment elements for dental abscess, signs of dental infection, therefore value add. Note, repetition in Hx and Physical Assess. Section, but key finding.
Pharmacologic Interventions
Potential Complications:
Rationale: Significant complication of untreated dental abscess
Client Education and Discharge Information:
- Expanded 2nd bullet, add the extension to limit sugary drinks
Rationale: Provides targeted guidance regarding the type of recommended dietary modifications that will impact the risk of developing a dental abscess
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