NR511 Midterm Questions and Answers Rated A+

NR511 Midterm Questions and Answers Rated A+ Appendicitis -Risk: 10-30yo, men, low fiber, high fat/sugar/carb diet -S: Mild to severe colicky epigastric or periumbilical pain, but in 24 hours, moves to RLQ and exacerbated by walking or coughing.May radiate to testicles. maybe vomiting, sensation of constipation, but diarrhea present. low grade temp. chills & sudden cessation of pain=perforation -O: HTN/Tachy, flex R knee up to relieve pain when recumbent, guarding, rebound tenderness. -Dx: + Rovsing, Psoas, Obturator, McBurney's sign -Tx: Appendectomy -Edu: avoid lifting for 2 weeks. Celiac Disease -Risk:family hx, downs syndrome, HLA-DQ2(or 8), turners syndrome, type 2 DM or thyroiditis -S:asymptomatic OR diarrhea, wt loss, dyspepsia, flatulence, fatigue, joint pain, depressed mood, amenorrhea, difficulty getting pregnant, early menopause -O: may be normal, OR muscle wasting, pallow, reduced sub q fat, ataxia, peripheral neuropathy -Dx: Serologic testing for anti-tTG IgA antibodies, Total IgA, Upper GI scope (look at damage). or no Dx- just try diet changes -Tx: gluten free diet cholelithiasis (gallstones) -Risk: Female, obese, pregnant, incr age, drug induced, rapid wt loss, spinal cord injury, DM, Sickle cell anemia. Pigmented stones: hemolytic disease, icr age, hyperalimentation, cirrhosis, biliary stasis -S:indigestion, n/v, colicky-type pain, RUQ or epigastric pain, referred pain to middle back, r shoulder, or infrascapular area, pain incr by movement (breathing) -O: + murphy's sign (hold deep breath, palpate R subcostal area), low fever, mild jaundice, edema, dim BS -Dx: ABD ultrasound -Tx: low fat diet, cholecystectomy, lithotripsy -Edu:wt loss, avoid fatty food, avoid OCs and estrogen Crohn's disease -Risk: family hx, smoking, genetics, early adulthood -S:Abd cramping, tenderness, fever, anorexia, wt loss, flatulence, RLQ pain or mass. Semi liquid stools (may have blood), steatorrhea, gradual onset -O: LLQ or entire abd tenderness, duarding, distentionanal gissures, skin tags -Dx:stool analysis & culture (to r/o other cause), barium upper GI series (aphthous and linear ulcers. Late- "string sign"), Colonoscopy, Ct scan -Tx: sulfasalazine (but not beneficial). glucocorticoids (prednisone), metronidazole, immunosuppressants -Edu: low-residue diet when obstructive symptoms present, avoid all fiber. eat what they want when no attack Diverticulitis -risk: >40yo, low fiber diet, chronic constipation, straining, irregular BMs, diverticula in the colon -S: Fever, chills, tachycardia, LLQ pain,n/v,anorexia, pain is relieved with BM, constipation & diarrhea, abd tenderness & distention. **may present with bleeding not associated with pain** -O: LLQ pain, firm, fixed mass in the area of the diverticula. rebound tenderness, guarding, tender rectum, + blood in BM -dx:mild leukocytosis, low H&H, ABD X-ray if perforation or peritonitis suspected. CT scan most accurate -tx: no routine ATB (but augmentin or metronidazole when needed), -edu: high fiber diet Peptic Ulcer Disease -risk: H.pylori, NSAIDs, ASA, stress, 55-70yo, blood type, genetics, smoking, COPD, cirrhosis, renal failure & transplant, caffeine, ETOH, spicy foods -S: epigastric burning or gnawing pain relieved by food or antacids. nocturnal pain, -O:not useful. epigastric pain 2.5cm to the R of midline -dx: CBC, BMP, urea breath test, stool test, EGD biopsy, -tx: PPI (-prazole) 4-8 weeks. H2-RA x 8 weeks. Clarithromycin & amoxicillin or metronidazole and a PPI BID x 14 days. -edu: change in fecal color when taking bismuth preparations. Sucralfate cannot be taken at the same time as other medications or dig, cipro or phenytoin. GERD -Risk: incr with age, obesity, relaxation of the LES, ETOH, coffee, chocolate, hiatal hernia, delayed gastric emptying -S:heartburn, regurgitation, sour taste in mouth in morning, belching, coughing, hoarseness, wheezing usually at night. substernal pain. dysphagia -O: normal. may have positive blood in BM -dx: Hx, EGD -tx: 8 weeks of PPI, lifestyle changes, Long term PPI for Barrett's esophagus, -edu: lose weight, no large meals, tight clothes, bending or straining. small frequent meals, eat less 4 hours before bed, elevated HOB, quit smoking, no supplemental nicotine, stress reduction. Ulcerative colitis -Risk:family hx, early adulthood