NURS 5461 Gastroenteritis Test Questions with Correct Answers Latest Update

NURS 5461 Gastroenteritis Test Questions with Correct Answers Latest Update Gastroenteritis - Answers caused by bacterial food toxins in food- "food poisoning" In healthy adults—the s/sx usually self-limited CDC says that 1 in 6 Americans affected q yr. Can be acute or chronic (food allergy) The most common players - Answers —**Norovirus (1/3), Hep A, Rotavirus most common V nontyphoid Salmonella, Clostridium perfringens, Campylobacter, Staphylococcus aureus, Toxoplasma gondii, Listeria monocytogenes, Yersinia, and ***Shiga toxin-producing E. coli [aka know as STEC E. coli 0157 ] Non-Shiga toxin producing—enteropathogenic E. coli; enteroinvasive E. coli; enteroaggregative E coli and diffusely adherent E. c Epidemiology and Causes - Answers Acute gastroenteritis is most often from an infectious agent— food and waterborne outbreaks are important causes, fecal-oral route -Person-to-person transfer is more common in hospitals and day care centers **Those at high risk—anyone traveling to a developing country, immunosuppressed, those engaging in anal intercourse, residents of LTAC, those consuming raw shellfish and seafood Pathophysiology - Answers ⚫ Most forms of gastroenteritis manifest with diarrhea—which is not considered an emergency unless it affects an older adult who cannot regulate their fluid intake With *viral FBD it is usually transmitted through infected food handlers, in a given setting [café, banquet, etc.] Most states require reporting of - Answers Hepatitis A - Botulinum - Salmonella - STEC 0157 - Listeria - Shigella - Vibrio Parasites - Answers Parasitic protozoa do multiply in food—but can live on moist food for months in a cool, damp environment, most common transmission is contaminated water⚫ Cryptosporidium, Cyclospora, Giardia and Toxoplasma gondii are the big players Overview of the Common FB Pathogens—the Big Picture - Answers 60 and older—Salmonella and Campylobacter are the most common bacteria in FBD - Noroviruses are the leading cause of food related illness in the US - In the US, parasitic FBD is not common— Cryptosporidium is the most common parasite seen, but according to CDC—Toxoplasma gondii is the 2nd leading cause of FB illness-related death and hospitalizations in the US - Listeria is the pathogen most likely to cause death Overview of the Common FB Pathogens—the Big Picture 2 - Answers - Raw foods and beverages—because they have not been processed, cooked or refrigerated/frozen - Fruits and vegetables can be contaminated in the field or from contaminated water—with Salmonella, STEC 0157, Cyclospora, Hepatitis A - If not pasteurized, milk or fruit juices can be a source of Listeria and Salmonella - Campylobacter, E. coli, Yersinia and Toxoplasma gondii live in the intestines of animals—causing contaminated raw meats and poultry General Ancillary Testing - Answers ⚫ Stools culture—positive in <40 percent of cases ⚫ PCR testing may be available for the pathogen you are suspicious of (have to specify pathogen) ⚫ ?CRP, CBC, blood cultures, UA, abdominal x-rays, anoscope, endoscopy—based on severity⚫ Toxic megacolon can be identified on abdominal x-rays ⚫ Severe inflammation changes can be seen on CT ⚫ BC in those with fever and diarrhea—as 1% of these patients have nontyphoidal Salmonella bacteremia General Ancillary Testing 2 - Answers ⚫ Stool microscopy for C. difficile ⚫ Stools with RBCs, WBCs suggest colonic source ⚫ Stool microscopy is done to identify ova, cysts, parasites [antigen test for Giardia is more sensitive] ⚫ Microscopic evaluation of the stool for fecal leukocytes or lactoferrin suggest inflammatory etiology ⚫ Flexible sigmoidoscopy is reserved for those with colitis that is unresponsive to antimicrobial therapy and for those with persistent diarrhea Symptomatic Treatment - Answers ⚫ Oral rehydration therapy [Pedialyte or Gatorade] to prevent and treat dehydration⚫ Intake should exceed output by at least 500 cc every 24 hours ⚫ These solutions contain electrolytes and CHO - Sports drinks and soft drinks have a high CHO-tosodium ratio and total osmolality, and can make diarrhea worse ⚫ Those with severe dehydration or who have chronic disease or low BP—should be hospitalized for IV hydration ⚫ If IV hydration needed, 1-2 liters of IV NS or RL over 4-6 hours Empiric antimicrobials should be considered if - Answers the patient is febrile and has signs of invasive disease—hematochezia, fecal leukocytes; if symptoms have been present >1week or they are severe [>8 stools per day] - Stool testing SHOULD still be performed ⚫ Empiric treatment decreases duration in those with traveler's diarrhea Enterotoxigenic E. coli - Answers the most common cause of traveler's diarrhea worldwide and is usually susceptible to Cipro, but Zithromax is equally effective and a better choice— especially since fluoroquinolone-resistant C. jejuni is present Cipro is NO longer DOC—Azithromycin or Erythromycin Giardiasis - Answers Diarrhea >10 days duration associated with fatty or foul-smelling stools, cramps, bloating and weight loss—treat for Giardiasis Inflammatory diarrhea - Answers mucosal invasion [usually of LB] causes stools to be bloody and be + for fecal leukocytes; this patient usually has fever, belly pain or tenderness, headache, n/v, malaise and myalgias Noninflammatory diarrhea - Answers mild dehydration, watery stool [sometimes severe], fever and systemic symptoms are absent—this type of diarrhea is from mucosal hypersecretion or decreased absorption without mucosal destruction—and usually SB is involved Four clues - Answers Incubation; Duration of Illness; Predominant Clinical Symptoms; Location of the patient or the ingested food Incubation Period - Answers Hours-Toxin, One day-Virus, Several days Bacteria Duration of Illness - Answers Short Virus or toxin, Long Bacteria Predominant Clinical Symptoms - Answers Diarrhea-Virus or bacteria, Vomiting-Toxin, Severe illness-Bacteria