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Final Exam; NR511 Differential
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NR511 Final Exam Review
Diagnosis and Management of Common Gastrointestinal Disorders and
Anemia
Ulcerative colitis - a disease only of the colon
o Inflammatory bowel disease-the mucosal surface of the colon is inflamed-
most often occurs in the rectosigmoid areas and must involve the entire
colon
o Results in friability, erosions, and bleeding
o Occurs in the rectum and sigmoid colon
o Characterized by bloody and purulent diarrhea
o While it is not the first treatment choice, total colectomy is a treatment
option that can completely resolve this problem.
Diverticulitis
o Patients with diverticulitis may present with bleeding not associated with
pain or discomfort.
o Is associated with obesity-these patients are at higher risk
o When the diverticula become inflamed, there are usual signs and
symptoms of infection-fever, chills, and tachycardia, painless bloody stools
o Patients typically present with localized pain and tenderness in the LLQ of
the abdomen with associated anorexia, nausea, and vomiting.
o CT scan with contrast (esp. with females) may sometimes be done to r/o if
the gynecologic etiology (such as ovarian cyst or tumor) as well as bowel
pathology such as abdominal abscess
o A high-fiber diet is the best management
Clostridium difficile
o Infection of the large intestine
o Exists in air, water, soil, processed food and human feces
o Causes profuse, watery, mucoid diarrhea
o Certain types can be dangerous or life-threatening if not treated
o Risk factors:
Working in a healthcare facility
Long duration hospitalization
Long-term use of antibiotics that affects normal GI flora
Long-term use of medications that reduce GI acidity (PPIs)
Consumption of contaminated food or water
Touching infected soil, objects, and surfaces
Older adults will become dehydrated quickly
o Patient may be asymptomatic
o Generally profuse, watery, mucoid diarrhea
o Mild to moderate infection:
Watery diarrhea three or more times/day for two or more days
Mild abdominal cramping and tenderness
o Severe infection:
Watery diarrhea (10-15 stools/day)
Strong foul odor
Acute abdomen secondary to toxic megacolon with perforation
Abdominal distention
Fever
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Final Exam; NR511 Differential
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Nausea/vomiting/dehydration requiring hospitalization
Blood or pus in the stools (severe cases)
o Dx
CBC: elevated WBC count
Enzyme-linked immunodeficiency assay (ELISA): identifies toxins
that produce C. diff bacteria
Cell cytotoxicity assay: identifies the effects of bacterial toxins on
human cells
Polymerase chain reaction (PCR): detects bacterial genes
Endoscopy: if the patient is unresponsive to treatment; will show
pseudomembranes that suggest c-diff infection
o Tx
Metronidazole (Flagyl)
Probiotics- to restore the healthy growth of normal GI bacteria
Colectomy in severe cases
Supportive care
Maintain fluids
Clear liquid diet
Eat starchy foods to prevent diarrhea
Avoid caffeine, spicy foods, milk, and greasy foods
May require a GI consult
GERD
o Symptoms occur at night with regurgitation; heartburn is classic for GERD
(mild to severe). Dysphagia is frequently a prominent symptom of GERD. It
is usually associated with other symptoms, including regurgitation, water
brash (reflex salivation), sour taste in the mouth in the morning,
odynophagia, belching, coughing, hoarseness, or wheezing, usually at
night.
o If the patient has been treated with diet modifications and 6 weeks of
omeprazole without improvement of symptoms, the next step is an
endoscopy; a biopsy can be done during endoscopy and sent for H pylori
at that time.
o Patients should be instructed to avoid coffee, alcohol, chocolate,
peppermint, and spicy foods; eat smaller meals; stop smoking; remain
upright for 2 hours after meals; elevate the head of the bed on 6- to 8-in
blocks; and refrain from eating for 3 hours before retiring.
Rotavirus
o Rotavirus is common in children younger than age 3.
o Symptoms include low-grade fever and copious watery diarrhea.
o Treatment: needs fluids and electrolytes, supportive care, and antiemetics
Appendicitis
o Constant periumbilical pain shifting to the right lower quadrant; vomiting
following the pain; a small volume of diarrhea; may not always vomit
o Fecalith: most common cause—stone made of feces typically found in the
colon
o Symptoms: pain (dull, sharp, mild or severe); fever, chills, loss of appetite,
malaise, diarrhea, nausea, or vomiting
o No systemic symptoms, such as a headache, malaise, or myalgia;
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Final Exam; NR511 Differential
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Diagnosis & Primary
https://www.stuvia.com/user/filwe1099salmin
Care Practicumhttps://www.stuvia.com/user/fil
NR511 Final Exam Review
Diagnosis and Management of Common Gastrointestinal Disorders and
Anemia
Ulcerative colitis - a disease only of the colon
o Inflammatory bowel disease-the mucosal surface of the colon is inflamed-
most often occurs in the rectosigmoid areas and must involve the entire
colon
o Results in friability, erosions, and bleeding
o Occurs in the rectum and sigmoid colon
o Characterized by bloody and purulent diarrhea
o While it is not the first treatment choice, total colectomy is a treatment
option that can completely resolve this problem.
Diverticulitis
o Patients with diverticulitis may present with bleeding not associated with
pain or discomfort.
o Is associated with obesity-these patients are at higher risk
o When the diverticula become inflamed, there are usual signs and
symptoms of infection-fever, chills, and tachycardia, painless bloody stools
o Patients typically present with localized pain and tenderness in the LLQ of
the abdomen with associated anorexia, nausea, and vomiting.
o CT scan with contrast (esp. with females) may sometimes be done to r/o if
the gynecologic etiology (such as ovarian cyst or tumor) as well as bowel
pathology such as abdominal abscess
o A high-fiber diet is the best management
Clostridium difficile
o Infection of the large intestine
o Exists in air, water, soil, processed food and human feces
o Causes profuse, watery, mucoid diarrhea
o Certain types can be dangerous or life-threatening if not treated
o Risk factors:
Working in a healthcare facility
Long duration hospitalization
Long-term use of antibiotics that affects normal GI flora
Long-term use of medications that reduce GI acidity (PPIs)
Consumption of contaminated food or water
Touching infected soil, objects, and surfaces
Older adults will become dehydrated quickly
o Patient may be asymptomatic
o Generally profuse, watery, mucoid diarrhea
o Mild to moderate infection:
Watery diarrhea three or more times/day for two or more days
Mild abdominal cramping and tenderness
o Severe infection:
Watery diarrhea (10-15 stools/day)
Strong foul odor
Acute abdomen secondary to toxic megacolon with perforation
Abdominal distention
Fever
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by madiba South Africa stuvia ()
, lOMoARcPSD|44532475
Final Exam; NR511 Differential
https://www.stuvia.com/user/filwe1099salmin
Diagnosis & Primary
https://www.stuvia.com/user/filwe1099salmin
Care Practicumhttps://www.stuvia.com/user/fil
Nausea/vomiting/dehydration requiring hospitalization
Blood or pus in the stools (severe cases)
o Dx
CBC: elevated WBC count
Enzyme-linked immunodeficiency assay (ELISA): identifies toxins
that produce C. diff bacteria
Cell cytotoxicity assay: identifies the effects of bacterial toxins on
human cells
Polymerase chain reaction (PCR): detects bacterial genes
Endoscopy: if the patient is unresponsive to treatment; will show
pseudomembranes that suggest c-diff infection
o Tx
Metronidazole (Flagyl)
Probiotics- to restore the healthy growth of normal GI bacteria
Colectomy in severe cases
Supportive care
Maintain fluids
Clear liquid diet
Eat starchy foods to prevent diarrhea
Avoid caffeine, spicy foods, milk, and greasy foods
May require a GI consult
GERD
o Symptoms occur at night with regurgitation; heartburn is classic for GERD
(mild to severe). Dysphagia is frequently a prominent symptom of GERD. It
is usually associated with other symptoms, including regurgitation, water
brash (reflex salivation), sour taste in the mouth in the morning,
odynophagia, belching, coughing, hoarseness, or wheezing, usually at
night.
o If the patient has been treated with diet modifications and 6 weeks of
omeprazole without improvement of symptoms, the next step is an
endoscopy; a biopsy can be done during endoscopy and sent for H pylori
at that time.
o Patients should be instructed to avoid coffee, alcohol, chocolate,
peppermint, and spicy foods; eat smaller meals; stop smoking; remain
upright for 2 hours after meals; elevate the head of the bed on 6- to 8-in
blocks; and refrain from eating for 3 hours before retiring.
Rotavirus
o Rotavirus is common in children younger than age 3.
o Symptoms include low-grade fever and copious watery diarrhea.
o Treatment: needs fluids and electrolytes, supportive care, and antiemetics
Appendicitis
o Constant periumbilical pain shifting to the right lower quadrant; vomiting
following the pain; a small volume of diarrhea; may not always vomit
o Fecalith: most common cause—stone made of feces typically found in the
colon
o Symptoms: pain (dull, sharp, mild or severe); fever, chills, loss of appetite,
malaise, diarrhea, nausea, or vomiting
o No systemic symptoms, such as a headache, malaise, or myalgia;
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