ANCC AGACNP Barkley Review | Adult-Gerontology Acute Care Nurse Practitioner Exam Prep
Labs for Hepatitis A,B,C UA: proteinuria, bilirubinuria
Elevated AST, ALT**
Serologies: pending the hep you're testing
Divirticulitis Higher incidence in ppl w/ low dietary fiber **highlight.
LLQ pain to palpation
Sigmoidoscopy, CT for abscess eval.
**Plain abdominal films are obtained to look for evidence of free air ** =
pneumoperitoneum (air under diaphragm)
Diet: NPO!!!! , IVF, surgery (20-30% of pts)
Choleystitis Inflammation of the gallbladder. Gallstones >90% of all cases. Often c/b fatty
meal.
**Murphy's Sign: deep pain on inspiration while fingers under right ribcage
**Gold standard: Ultrasound
**ERCP- common adverse effect of ERCP is pancreatitis
Management: NPO, NGT decompress, IVF, Surg consult
Acute Pancreatitis Autodigestive state of the pancreas s/t inflammation.
#1 cause other than ETOH: gallbladder disease
Sudden, abrupt epigastric pain, N,V, improvement leaning forward
If hemorrhagic:
**Cullen's sign: umbilical discoloration
*Grey Turner's: flank discoloration * recognize pictures of these
Amylase and lipase elevated. Low Ca+- look for Chvostek and Troussea's sign.
RANSON's CRITERIA: eval this pt.
Ranson's Criteria For acute pancreatitis
on admission:
G: greater than 55 y.o
W: wbc's >16,000
G: glucose >200
L: LDH >350
A: AST >250
"George Washington Got Lazy After"
Then 48hrs after:
H: hct drop >10
B: bun rises >5
C: calcium <8
A: arterial O2 <60
B: base deficit >4
E: estimated fluid sequestration >6,000ml
"He Broke CABE"
Bowel Obstruction C/b adhessions, tumors, etc. Vomiting w/in minutes of pain=proximal, w/in 2
hours of pain=distal
**High pitched, tinkling bowel sounds
**Unable to pass stool/gas
**Films show dilated loops of bowel and air fluid levels
**Horizontal patterns= SBO
**Frame pattern= LBO
,ANCC AGACNP Barkley Review | Adult-Gerontology Acute Care Nurse Practitioner Exam Prep
Ulcerative Colitis Idiopathic inflam. condition
**Bloody diarrhea- hallmark
*Sigmoidoscopy
**Mesalamine (Canasa) suppositories for 3-12weeks
** Hydrocort. enemas
AE: toxic megacolon- life threatening
Crohn's: an ulcerative disease however upper in the bowel, while UC is lower
Mesenteric Infarct A disruption in blood flow to the mesenteric circulation causing ischemia. 60%
mortality rate. Cx: smoking, atherosclerosis, recent surgery (AAA, Cards),
thrombosis.
**Writhing in pain, but abdomen looks fine
** Acute onset, crampy, colicky feeling.
Hyperactive to no BS.
Abd films and CT (r/u free air)
Tx: emergent surgery
Appendicitis inflammation of the appendix, becomes gangrenous within 36hrs. Cx: left over
food, foreign body, neoplasms, etc. S/S: colicky vague umbilical pain.
*McBurney's Point
*Psoas Sign: pain with right thigh extension
*Obturator sign: pain w/ internal rotation of right thigh
*Positive Rovsing's sign: RLQ pain when pressure applied to the LLQ (opp. side)
Gold standard: CT or ultrasound
S1 v. S2 S1: Semilunar valves are OPEN (aortic/ pulmonic)
S2: AV valves are OPEN (mitral/tricuspid)
When one set is open, the other is closed!!!!
SO in S1, the AV valves are closed. In S2, the semilunar valves are closed.
S3 and S4 S3: Ken-Tuck-Y sounding
(increased fluid volume, abnormal, HF... but normal in pregnancy)
S4: Tennessee sounding
(MI, LVH, chronic HTN... stiff ventricular wall)
Ms. Ard & Mr. Ass Mitral Stenosis & Aortic regurg= DIASTOLIC
Mitral regurg & Aortic Stenosis= SYSTOLIC
, ANCC AGACNP Barkley Review | Adult-Gerontology Acute Care Nurse Practitioner Exam Prep
mitral stenosis & mitral regurg Mitral Stenosis: crescendo rumble, low pitched, loud S1 murmur, diastolic
Mitral Regurg: 5th ICS MCL, musical, blowing *****may radiate to the base or
left axilla, systolic
Aortic Stenosis & Aortic Regurg AS: systolic blowing, radiating to the neck ****
AR: diastolic, blowing murmur 2nd left ICS
5th ICS and 2nd/3rd ICS 5th= mitral
2nd/3rd= aortic
Holo or pan both mean throughout
i.e. pansystolic murmur- throughout systole murmur
Murmur- III v. IV IV has a THRILL, III doesn't
New York Heart Association (NYHA) Functional I: no physical activity limitations
Classification of Heart Failure
II: slight activity limitations BUT comfy at rest
III: marked limitations physically, but still comfy at rest
IV: severe, can't for activities w/o s/s; s/s at rest
HF non-pharm interventions always do this first before adding meds.
- Sodium restriction
- Weight loss
- Exercise
- Activity/rest balance
HF pharm interventions 1st always: diuretic, in all types of HF
THEN
HFrEF: ACE, ARBS, ANRI (Entresto)
others: SGLT2 inhibitors (Jardiance), Beta blockers, MRAs (Spironolactone)
** ACE not used in HFpEF
Labs for Hepatitis A,B,C UA: proteinuria, bilirubinuria
Elevated AST, ALT**
Serologies: pending the hep you're testing
Divirticulitis Higher incidence in ppl w/ low dietary fiber **highlight.
LLQ pain to palpation
Sigmoidoscopy, CT for abscess eval.
**Plain abdominal films are obtained to look for evidence of free air ** =
pneumoperitoneum (air under diaphragm)
Diet: NPO!!!! , IVF, surgery (20-30% of pts)
Choleystitis Inflammation of the gallbladder. Gallstones >90% of all cases. Often c/b fatty
meal.
**Murphy's Sign: deep pain on inspiration while fingers under right ribcage
**Gold standard: Ultrasound
**ERCP- common adverse effect of ERCP is pancreatitis
Management: NPO, NGT decompress, IVF, Surg consult
Acute Pancreatitis Autodigestive state of the pancreas s/t inflammation.
#1 cause other than ETOH: gallbladder disease
Sudden, abrupt epigastric pain, N,V, improvement leaning forward
If hemorrhagic:
**Cullen's sign: umbilical discoloration
*Grey Turner's: flank discoloration * recognize pictures of these
Amylase and lipase elevated. Low Ca+- look for Chvostek and Troussea's sign.
RANSON's CRITERIA: eval this pt.
Ranson's Criteria For acute pancreatitis
on admission:
G: greater than 55 y.o
W: wbc's >16,000
G: glucose >200
L: LDH >350
A: AST >250
"George Washington Got Lazy After"
Then 48hrs after:
H: hct drop >10
B: bun rises >5
C: calcium <8
A: arterial O2 <60
B: base deficit >4
E: estimated fluid sequestration >6,000ml
"He Broke CABE"
Bowel Obstruction C/b adhessions, tumors, etc. Vomiting w/in minutes of pain=proximal, w/in 2
hours of pain=distal
**High pitched, tinkling bowel sounds
**Unable to pass stool/gas
**Films show dilated loops of bowel and air fluid levels
**Horizontal patterns= SBO
**Frame pattern= LBO
,ANCC AGACNP Barkley Review | Adult-Gerontology Acute Care Nurse Practitioner Exam Prep
Ulcerative Colitis Idiopathic inflam. condition
**Bloody diarrhea- hallmark
*Sigmoidoscopy
**Mesalamine (Canasa) suppositories for 3-12weeks
** Hydrocort. enemas
AE: toxic megacolon- life threatening
Crohn's: an ulcerative disease however upper in the bowel, while UC is lower
Mesenteric Infarct A disruption in blood flow to the mesenteric circulation causing ischemia. 60%
mortality rate. Cx: smoking, atherosclerosis, recent surgery (AAA, Cards),
thrombosis.
**Writhing in pain, but abdomen looks fine
** Acute onset, crampy, colicky feeling.
Hyperactive to no BS.
Abd films and CT (r/u free air)
Tx: emergent surgery
Appendicitis inflammation of the appendix, becomes gangrenous within 36hrs. Cx: left over
food, foreign body, neoplasms, etc. S/S: colicky vague umbilical pain.
*McBurney's Point
*Psoas Sign: pain with right thigh extension
*Obturator sign: pain w/ internal rotation of right thigh
*Positive Rovsing's sign: RLQ pain when pressure applied to the LLQ (opp. side)
Gold standard: CT or ultrasound
S1 v. S2 S1: Semilunar valves are OPEN (aortic/ pulmonic)
S2: AV valves are OPEN (mitral/tricuspid)
When one set is open, the other is closed!!!!
SO in S1, the AV valves are closed. In S2, the semilunar valves are closed.
S3 and S4 S3: Ken-Tuck-Y sounding
(increased fluid volume, abnormal, HF... but normal in pregnancy)
S4: Tennessee sounding
(MI, LVH, chronic HTN... stiff ventricular wall)
Ms. Ard & Mr. Ass Mitral Stenosis & Aortic regurg= DIASTOLIC
Mitral regurg & Aortic Stenosis= SYSTOLIC
, ANCC AGACNP Barkley Review | Adult-Gerontology Acute Care Nurse Practitioner Exam Prep
mitral stenosis & mitral regurg Mitral Stenosis: crescendo rumble, low pitched, loud S1 murmur, diastolic
Mitral Regurg: 5th ICS MCL, musical, blowing *****may radiate to the base or
left axilla, systolic
Aortic Stenosis & Aortic Regurg AS: systolic blowing, radiating to the neck ****
AR: diastolic, blowing murmur 2nd left ICS
5th ICS and 2nd/3rd ICS 5th= mitral
2nd/3rd= aortic
Holo or pan both mean throughout
i.e. pansystolic murmur- throughout systole murmur
Murmur- III v. IV IV has a THRILL, III doesn't
New York Heart Association (NYHA) Functional I: no physical activity limitations
Classification of Heart Failure
II: slight activity limitations BUT comfy at rest
III: marked limitations physically, but still comfy at rest
IV: severe, can't for activities w/o s/s; s/s at rest
HF non-pharm interventions always do this first before adding meds.
- Sodium restriction
- Weight loss
- Exercise
- Activity/rest balance
HF pharm interventions 1st always: diuretic, in all types of HF
THEN
HFrEF: ACE, ARBS, ANRI (Entresto)
others: SGLT2 inhibitors (Jardiance), Beta blockers, MRAs (Spironolactone)
** ACE not used in HFpEF
