NR 509 FINAL EXAM STUDY GUIDE PART 3

NR 509 FINAL EXAM STUDY GUIDE PART 3 1. Candida vaginitis a. Discharge is a white and curdy, may be thin by typically thick, NOT malodorous. Often accompanied by pruritis, vaginal soreness, pain on urination (From skin inflammation) and dyspareunia. b. Vulva and surrounding skin are often inflamed and sometimes swollen to a variable extent. The vaginal mucosa is often reddened with tenacious patches of white discharge. 2. Mental Health screening a. Unexplained conditions lasting more than 6 weeks are increasingly recognized as chronic disorders that should prompt screening for depression, anxiety, or both. b. The following patient indications for mental health screening: i. Medically unexplained physical symptoms- more than half have depression or anxiety ii. Multiple physical or somatic symptoms, or high symptom count iii. High severity of the presenting somatic symptom iv. Chronic pain v. Symptoms for more than 6 weeks vi. Physician rating as "difficult encounter" vii. Recent stress viii. Low self-rating of overall health ix. Substance abuse x. Frequent use of health care providers 2. Ankle-brachial Index (ABI) a. Peripheral artery disease (PAD) can be diagnosed noninvasively using the ABI. b. ABI is a ratio of blood pressure measurements in the foot and arm i. Values 0.9 are considered ABNORMAL b. Risk factors for lower extremity PAD: i. Age greater than or equal to 50 with a hx of DM or smoking ii. Leg symptoms with exertion iii. Nonhealing wounds 2. Lymph node group most involved with breast cancer a. Central nodes (axillary) 2. Risk factors for PAD a. Smoking/ diabetes/ obesity BMI 30 / HTN / high cholesterol / increasing age (over 50 yrs) / family Hx of PAD, stoke or heart disease. 2. Condylamata Acuminata a. Genital warts single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower like verrucous. b. Caused by HPV, usually strains 6 and 11 c. Incubation usually weeks to months d. Infected contact ma have had no visible warts e. Occasionally cause itching and pain f. May disappear w/o tx g. Can arise on penis, scrotum, groin highs or anus 2. Differentials for epigastric pain a. GERD/ pancreatitis/ perforated ulcers/ MI 2. Grading of pulses a. Bounding carotid, radial, and femoral pulses are present in aortic regurgitation; asymmetric diminished pulses point to arterial occlusion from atherosclerosis or embolism. i. 3+ bounding ii. 2+ brisk, expected (normal) iii. 1+ diminished, weaker than expected iv. 0 absent, unable to palpate 9. Developmental mile stones a. 8-month old should be able to: pull up to stand, say mama and dada, and indicates wants by vocalizing and pointing. 2. Memory assessment a. Serial 7s: poor performance may result from delirium, the late stages of dementia, intellectual disability, anxiety or depression. Also need to consider educational level. b. Spelling backwards c. New learning activity: 3-4 word recall- give the pt 3 word and have them repeat them so that you know they heard them. And to recall the word 3-5 mins later. 2. Delirium VS Dementia 52. Ulcer due to venous insufficiency a. Usually appears over the medical and sometimes lateral malleolus (toes). b. Ulcer contains small, painful granulation tissue and fibrin, necrosis or exposed tendons are rare. c. Borders are irregular, flat or slightly steep. d. Pain effects QOL in 75% of patients e. Associated findings include edema, reddish pigmentation and purpura, the eczematous changes of stasis dermatitis (redness, scaling, and prutitis) and at times cyanosis of the foot when dependent. Gangrene is rare. 2. Edema, swelling and ulceration due to venous insufficiency a. It arises from chronic obstruction and incompetent valves in the deep venous system 2. Increased jugular venous pressure a. Highly correlated with both acute and chronic heart failure. Also seen in tricuspid stenosis, chronic pulmonary HTN, superior vena cava obstruction, cardiac tamponade, and constrictive pericarditis. 2. Retracted tympanic membrane with effusion 56. Ectopic pregnancy a. Clinical presentations of ectopic pregnancy range from subacute, approx. 80- 89% to shock from rupture and intraperitoneal hemorrhage (10-30# of cases). b. Most common clinical features: abdominal pain, adnexal tenderness, and abnormal uterine bleeding. c. In more than half there is a palpable adnexal mass that is typically large, fixed, and ill-denied at times with adherent omentum or small or large bowel. d. In mild cases, there may be a prior hx of amenorrhea or other symptoms of pregnancy. 2. Prostatitis a. Acute bacterial prostatitis: presents with fever, UTI symptoms such as frequency, urgency, dysuria, incomplete voiding and sometimes lower back pain. The gland feels tender, swollen, boggy and warm. b. Chronic bacterial prostatitis: is associated with recurrent UTIs, usually from the same organism. Men may be asymptomatic or have symptoms of dysuria or mild pelvic pain. The prostate gland may feel normal w/o tenderness or swelling. 2. Atopic dermatitis a. Eczema: erythema, scaling, dry skin, and intense itching 2. Signs of depression a. Early signs: low self-esteem, loss of pleasure in daily activities (anhedonia), sleep disorders and difficulty concentrating or making decisions. b. Vulnerable populations: young, female, single, divorced, separated, or chronically ill, bereaved, or have other psychiatric disorders including substance abuse. 2. Tetanus vaccine a. All adults age 19 or older who have not received Tdap should received a single dose regardless of the time interval since last td. After receiving tdap they should receive TD boosters at 10 year intervals. b. For adults over 65 and older, this will reduce the likelihood of transmission to infants under 12 months.