NRNP 6540 Advanced Practice Care of Frail Elders

NRNP 6540 Advanced Practice Care of Frail Elders NRNP 6540 WEEK 7 Knowledge Check 1. June is a 69-year-old being seen for her GYN exam. She still has her uterus and ovaries. What do you expect to find on bimanual examination? Examining the female genito-reproductive system would be the same in younger and older patients. On a bimanual examination, the ovaries should not be palpable and the uterus should be small and firm. 2. Your 82-year-old patient comes to the clinic with complaints of cramping abdominal pain, nausea, vomiting, and obstipation for the past 4 days. His PMH includes hernia repair, HTN, and atrial fibrillation. Your examination leads you to suspect a small bowel obstruction. What is your diagnostic test of choice to determine the diagnosis? The initial diagnostic test for small bowel obstruction is the plain abdominal x-ray with flat and upright views. This radiologic test identifies multiple air-fluids, distention of small bowel loops and absence of gas in the areas of the colon. If no obstructions are seen in the x-rays but the provider has a high suspicion of the diagnosis, a CT scan is recommended. CT scan is found to be as high as 90% sensitive in identifying the presence of bowel strangulation and can determine the etiology and site of the obstruction. Ultrasonography is often utilized to evaluate acute abdominal pain and can also be used to identify obstruction and what caused it. 3. Sarah is a 68-year-old patient who had a mammogram and biopsy positive for breast cancer. Her breast cancer is staged at T1N0M0. Sarah asks you what this means. Please describe what TNM indicates. TNM Classification of Malignant Tumors by the The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) is a staging system to classify malignant tumors. For breast cancer, it tells about the tumor size and how far it has spread within the breast and to adjacent tissues (T), the extent of spread to nearby lymph nodes (N), presence or absence of distant metastases (spread to distant organs) (M). Upon determining T, N, and M, stages are assigned as 0, I, II, II, or IV, with stage 0 being in situ stage, stage I as early stage invasive cancer, and stage IV as the most advanced disease with organ metastases. Sarah’s T1N0M0 means: TI means that the cancer cells are only growing in the layer of cells where they started, without growing into deeper layers. This may also be called in situ cancer or pre-cancer. N0 means nearby lymph nodes do not contain cancer. M0 means that no distant cancer spread has been found. 4. Harry is an 81-year-old male who complains of increasing urinary frequency, nocturia, weak or intermittent urine stream, and a sensation of incomplete voiding, what would your differential diagnoses consist of? Name at least three. Based on the symptoms presented, Harry's differential diagnoses consist of the following: 1. Benign Prostatic Hyperplasia (or Benign Prostatic Hyperthrophy) - is the benign growth of the prostate that may lead to obstruction of the bladder outlet. Signs and symptoms include urinary frequency, nocturia, urgency hesitancy, weak or intermittent urine stream, straining to void, sensation of incomplete voiding, and dysuria (with infection). Most of the said symptoms were reported by Harry. 2. Prostate Cancer-is a malignant neoplasm of the prostate which may co exist with BPH. Early stages are usually asymptomatic, however, obstructive voiding symptom like intermittent urinary stream which is what Harry reported may indicate an advanced disease. 3. Prostatitis- Acute bacterial prostatitis is an acute bacterial infection of the prostate. Typically, fever, chills, and malaise are present and urinary symptoms of dysuria, frequency, and urgency. There is absence of the first three symptoms mentioned, ho