NR511 Midterm Study Guide
Disease Risk Worksheet
Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common -Dx made clinically, -May have HTN\ -Labs are -Surgical; preoperative -F\U with surgeon
between 10-30yrs; based primarily on tachy proportional not care, NPO, correction of -Ambulation
but can occur at any H&P exam to pain\symptoms diagnostic fluid\electrolyte after surgery
age; rare in infants - Classic -When lying flat, and imbalances -Adv diet when
and older adults presentation may flex R knee to nonspecific -Avoid narcotics bowel sounds
-men more at risk includes acute relieve tension in -Women should -Atb with 3rd gen return
- Diets low in fiber, onset of mild to abd muscle have urine human cephalosporin; Ex: -Return to hosp
high in fat, refined severe colicky, -Pain with chorionic ampicillin, with s\s of
sugars, & other epigastric, or palpation in abd, gonadotrophin to r\ gentamycin, flagyl infection
carbs at increased periumbilical pain diffuse in early o ectopic -Avoid heavy
risk. - Pain is vague at stages. Localized pregnancy lifting for at
- Obstruction of first then localizes to RLQ later - +Rovsing’s Sign- least 2 wks
appendix is cause within 24hrs to -Positive for deep palpation &
of majority of RLQ rebound pain; ask release in LLQ
appendicitis - Pain exacerbated pt to cough to causes rebound
- contributing by walking\ localize pain pain in RLQ
factors: Intra- coughing location - +Psoas Sign- lift R
abdominal tumors, - Men may feel -Sudden cessation leg against gentle
positive family hx radiated pain in of pain means pressure causes
- Recent testes perforation and is pain
roundworm - Abd muscle ER - +Obturator Sign-
infection or viral rigidity, N\V, flex R hip & knee
GI infection anorexia and slowly rotate
- Mildly elevated internally causes
temp 99-100F pain
common - +McBurney’s
- If RLQ Sign- pain with
accompanied by pressure applied
shaking chills, to point between
perforation should umbilicus & ilium
be suspected - x-ray\CT helpful
- Older adults may when paired with
present with positive H&P
weakness, anorexia, findings
abd distention, mild
pain leading to
delayed dx and
increased morbidity.
, NR511 Midterm Study Guide
Celiac disease ** Mostly diagnosed Many Worksheet
Muscle wasting Serologic testing lifelong adherence teaching related
(autoimmune in adulthood. asymptomatic. (anemia), reduces for anti-tTG IgA to a strict gluten- to gluten free
disorder caused by May complain of subcutaneous fat, antibody free diet. diet.
an immunologic A family member diarrhea, gas, ataxia, & peripheral Some people with
response to gluten) with celiac disease dyspepsia, wt. neuropathy Total IgA (2% of Referral to a celiac disease
or dermatitis loss. Atypical (vitamin B12 pts have IgA dietician to help. have vitamin or
herpetiformis symptoms: deficiencies) deficiency and nutrient
fatigue, osteoporosis or will falsely test Some pts may need deficiencies that
Type 1 diabetes bone or joint osteopenia (bone negative) treatment with do not cause them
pain, arthritis, loss) immunomodulating to feel ill, such as
Down syndrome osteoporosis, hypothyroidism duodenal biopsies agents. anemia due to
or Turner or iron deficiency or
syndrome osteopenia (bone Pts with dermatitis Test for nutritional bone loss due to
loss) liver and biliary herpetiformis deficiencies vitamin D
Autoimmune tract disorders found to have associated with deficiency.
thyroid disease (transaminitis, fatty signs of celiac malabsorption of However, these
liver, primary disease on C.D. (hemoglobin, deficiencies can
Microscopic sclerosing intestinal biopsy. iron, folate, vit cause problems
colitis cholangitis, B12, Calcium, and over the long
(lymphocytic or depression or Vitamin D.) term. Untreated
collagenous anxiety peripheral celiac/developing
colitis) neuropathy certain types of
seizures or gastrointestinal
Addison's disease migraines missed cancer. This risk
menstrual periods can be reduced by
infertility or eating a gluten-
recurrent free diet.
miscarriage
canker sores inside
the mouth
, NR511 Midterm Study Guide
dermatitis Worksheet
herpetiformis
(itchy skin rash)
Cholelithiasis is the formation of Patient complaint of Right side Mild elevation of a. Initial management-- Nonsurgical
gallstones and is indigestion, nausea, involuntary WBC up to 15, 000 begins with definitive intervention:
found in 90% of vomiting (after guarding of Abdominal Xray: diagnosis. When weight loss,
patients with consuming meal abdominal muscles, Quick, noninvasive, asymptomatic (normally an avoidance of
cholecystitis. high in fat), and pain Positive Murphy's reliable, and cost- incidental finding while fatty foods to
--Risk factors--2 types in RUG or sign, possible effective means of exploring another problem) decrease attacks,
of stones (cholesterol epigastrium that palpable identifying the require no further treatment alternative birth
and pigmented) may radiate to the gallbladder, Low presence of except teaching s/sx of control for
a. Cholesterol (most middle of the back, grade fever cholelithiasis. "gallbladder attack". persons taking
common form): infrascapular area or between 99-101 Nonsurgical candidate can oral
female, obesity, right shoulder. degrees. Possible be treated with dissolution contraceptives,
pregnancy, jaundice from therapy or lithotripsy. Acute menopausal
increased age, drug- common bile duct includes hydration (IV women taking
induced (oral edema and fluids), antibiotics, estrogen
contraceptives and diminished bowel analgesics, GI rest. informed about
clofibrates: sounds. b. Treatment of choice for alternative
cholesterol lowering Acute cholecystitis is early sources of
agent), cystic surgical intervention after phytoestrogens
fibrosis, rapid weight stabilization. Poor surgical (soy products).
loss, spinal cord risk may benefit from
injury, Ileal disease cholecystectomy
with extensive operatively or
resection, Diabetes percutaneously.
mellitus, sickle cell
anemia.
b. Pigmented:
hemolytic diseases,
increasing age,
hyperalimentation
(artificial supply of
nutrients, typically
IV), cirrhosis, biliary
stasis, chronic biliary
infections.
Crohn’s ** Ages 15-25 of onset Mild-Four or fewer Tenderness in LLQ Stool analysis to Glucocorticoids, there Pt educated on
and then again at 50- loose bowel or across entire abd r/o bacterial, is no cure for CD and disease process,
80. movements per day, with guarding and fungal, or treatment is aimed at diet and lifestyle
Familial can have small abd distension. DRE parasitic infection suppressing changes. Stress
tendency, amounts of blood performed to look for cause of inflammation and reduction,
smoker and mucus in the for anal and diarrhea. symptomatic relief of adequate rest to
Carcinoma less stool, and cramping perianal CBC to check for complications. Initially decrease bowel
common in patients in the rectum. inflammation, rectal anemia, eval for oral prednisone 40-60 motility and
with CD due to Moderate-4-6 loose tenderness, and hypocalcemia, vit D mg/d, tapered over 2-4 promote healing.
treatment sometimes bowel movements blood in stool. S/Sx deficiency., months, then can have Low residue diet
colectomy per day containing of peritonitis and hypoalbuminemia, daily maintenance dose when obstructive
more blood and ileus may be found and steatorrhea. of 5- 10mg/d. sx present such
mucus and other sx depending on LFT to screen for Sulfasalazine for mild as canned fruits,
such as tachycardia, severity of crohns. primary sclerosis to moderate CD 500 vegetables and
weight loss, fever, Tender mass in cholangitis, and mg BID, increased to 3- white bread
mild edema. Severe- RLQ, anal fissure, other liver 4 g/d. Clinical
frequent bloody perianal fissure, problems assoc improvement in 3-4
bowel movements edematous pale with IBD. Check wks, and then tapered
(6- 10), abd pain skin tags. Extra fluid and to 2-3 g/d for 3-6
and tenderness, sx intestinal finding electrolytes. May months, this
of anemia, may be episcleritis, have elevated WBC medication interferes
, NR511 Midterm Study Guide
Worksheet
impaired nutrition. nondeforming and prolonged absorption and patient
Most common sx are peripheral arthritis, prothrombin time. must take
abd and axial Barium upper GI supplements.
cramping/tendernes arthropathy series, Metronidazole effective
s, fever, anorexia, colonoscopy, and in tx perianal disease
wt loss, spasm, CT to determine and in controlling
flatulence, RLQ pain bowel wall crohns colitis, other
or mass thickening or ABT’s such as Cipro,
abscess formation Ampicillin, and
Tetracycline effective in
controlling CD ileitis,
and ileocolitis.
Disease Risk Worksheet
Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common -Dx made clinically, -May have HTN\ -Labs are -Surgical; preoperative -F\U with surgeon
between 10-30yrs; based primarily on tachy proportional not care, NPO, correction of -Ambulation
but can occur at any H&P exam to pain\symptoms diagnostic fluid\electrolyte after surgery
age; rare in infants - Classic -When lying flat, and imbalances -Adv diet when
and older adults presentation may flex R knee to nonspecific -Avoid narcotics bowel sounds
-men more at risk includes acute relieve tension in -Women should -Atb with 3rd gen return
- Diets low in fiber, onset of mild to abd muscle have urine human cephalosporin; Ex: -Return to hosp
high in fat, refined severe colicky, -Pain with chorionic ampicillin, with s\s of
sugars, & other epigastric, or palpation in abd, gonadotrophin to r\ gentamycin, flagyl infection
carbs at increased periumbilical pain diffuse in early o ectopic -Avoid heavy
risk. - Pain is vague at stages. Localized pregnancy lifting for at
- Obstruction of first then localizes to RLQ later - +Rovsing’s Sign- least 2 wks
appendix is cause within 24hrs to -Positive for deep palpation &
of majority of RLQ rebound pain; ask release in LLQ
appendicitis - Pain exacerbated pt to cough to causes rebound
- contributing by walking\ localize pain pain in RLQ
factors: Intra- coughing location - +Psoas Sign- lift R
abdominal tumors, - Men may feel -Sudden cessation leg against gentle
positive family hx radiated pain in of pain means pressure causes
- Recent testes perforation and is pain
roundworm - Abd muscle ER - +Obturator Sign-
infection or viral rigidity, N\V, flex R hip & knee
GI infection anorexia and slowly rotate
- Mildly elevated internally causes
temp 99-100F pain
common - +McBurney’s
- If RLQ Sign- pain with
accompanied by pressure applied
shaking chills, to point between
perforation should umbilicus & ilium
be suspected - x-ray\CT helpful
- Older adults may when paired with
present with positive H&P
weakness, anorexia, findings
abd distention, mild
pain leading to
delayed dx and
increased morbidity.
, NR511 Midterm Study Guide
Celiac disease ** Mostly diagnosed Many Worksheet
Muscle wasting Serologic testing lifelong adherence teaching related
(autoimmune in adulthood. asymptomatic. (anemia), reduces for anti-tTG IgA to a strict gluten- to gluten free
disorder caused by May complain of subcutaneous fat, antibody free diet. diet.
an immunologic A family member diarrhea, gas, ataxia, & peripheral Some people with
response to gluten) with celiac disease dyspepsia, wt. neuropathy Total IgA (2% of Referral to a celiac disease
or dermatitis loss. Atypical (vitamin B12 pts have IgA dietician to help. have vitamin or
herpetiformis symptoms: deficiencies) deficiency and nutrient
fatigue, osteoporosis or will falsely test Some pts may need deficiencies that
Type 1 diabetes bone or joint osteopenia (bone negative) treatment with do not cause them
pain, arthritis, loss) immunomodulating to feel ill, such as
Down syndrome osteoporosis, hypothyroidism duodenal biopsies agents. anemia due to
or Turner or iron deficiency or
syndrome osteopenia (bone Pts with dermatitis Test for nutritional bone loss due to
loss) liver and biliary herpetiformis deficiencies vitamin D
Autoimmune tract disorders found to have associated with deficiency.
thyroid disease (transaminitis, fatty signs of celiac malabsorption of However, these
liver, primary disease on C.D. (hemoglobin, deficiencies can
Microscopic sclerosing intestinal biopsy. iron, folate, vit cause problems
colitis cholangitis, B12, Calcium, and over the long
(lymphocytic or depression or Vitamin D.) term. Untreated
collagenous anxiety peripheral celiac/developing
colitis) neuropathy certain types of
seizures or gastrointestinal
Addison's disease migraines missed cancer. This risk
menstrual periods can be reduced by
infertility or eating a gluten-
recurrent free diet.
miscarriage
canker sores inside
the mouth
, NR511 Midterm Study Guide
dermatitis Worksheet
herpetiformis
(itchy skin rash)
Cholelithiasis is the formation of Patient complaint of Right side Mild elevation of a. Initial management-- Nonsurgical
gallstones and is indigestion, nausea, involuntary WBC up to 15, 000 begins with definitive intervention:
found in 90% of vomiting (after guarding of Abdominal Xray: diagnosis. When weight loss,
patients with consuming meal abdominal muscles, Quick, noninvasive, asymptomatic (normally an avoidance of
cholecystitis. high in fat), and pain Positive Murphy's reliable, and cost- incidental finding while fatty foods to
--Risk factors--2 types in RUG or sign, possible effective means of exploring another problem) decrease attacks,
of stones (cholesterol epigastrium that palpable identifying the require no further treatment alternative birth
and pigmented) may radiate to the gallbladder, Low presence of except teaching s/sx of control for
a. Cholesterol (most middle of the back, grade fever cholelithiasis. "gallbladder attack". persons taking
common form): infrascapular area or between 99-101 Nonsurgical candidate can oral
female, obesity, right shoulder. degrees. Possible be treated with dissolution contraceptives,
pregnancy, jaundice from therapy or lithotripsy. Acute menopausal
increased age, drug- common bile duct includes hydration (IV women taking
induced (oral edema and fluids), antibiotics, estrogen
contraceptives and diminished bowel analgesics, GI rest. informed about
clofibrates: sounds. b. Treatment of choice for alternative
cholesterol lowering Acute cholecystitis is early sources of
agent), cystic surgical intervention after phytoestrogens
fibrosis, rapid weight stabilization. Poor surgical (soy products).
loss, spinal cord risk may benefit from
injury, Ileal disease cholecystectomy
with extensive operatively or
resection, Diabetes percutaneously.
mellitus, sickle cell
anemia.
b. Pigmented:
hemolytic diseases,
increasing age,
hyperalimentation
(artificial supply of
nutrients, typically
IV), cirrhosis, biliary
stasis, chronic biliary
infections.
Crohn’s ** Ages 15-25 of onset Mild-Four or fewer Tenderness in LLQ Stool analysis to Glucocorticoids, there Pt educated on
and then again at 50- loose bowel or across entire abd r/o bacterial, is no cure for CD and disease process,
80. movements per day, with guarding and fungal, or treatment is aimed at diet and lifestyle
Familial can have small abd distension. DRE parasitic infection suppressing changes. Stress
tendency, amounts of blood performed to look for cause of inflammation and reduction,
smoker and mucus in the for anal and diarrhea. symptomatic relief of adequate rest to
Carcinoma less stool, and cramping perianal CBC to check for complications. Initially decrease bowel
common in patients in the rectum. inflammation, rectal anemia, eval for oral prednisone 40-60 motility and
with CD due to Moderate-4-6 loose tenderness, and hypocalcemia, vit D mg/d, tapered over 2-4 promote healing.
treatment sometimes bowel movements blood in stool. S/Sx deficiency., months, then can have Low residue diet
colectomy per day containing of peritonitis and hypoalbuminemia, daily maintenance dose when obstructive
more blood and ileus may be found and steatorrhea. of 5- 10mg/d. sx present such
mucus and other sx depending on LFT to screen for Sulfasalazine for mild as canned fruits,
such as tachycardia, severity of crohns. primary sclerosis to moderate CD 500 vegetables and
weight loss, fever, Tender mass in cholangitis, and mg BID, increased to 3- white bread
mild edema. Severe- RLQ, anal fissure, other liver 4 g/d. Clinical
frequent bloody perianal fissure, problems assoc improvement in 3-4
bowel movements edematous pale with IBD. Check wks, and then tapered
(6- 10), abd pain skin tags. Extra fluid and to 2-3 g/d for 3-6
and tenderness, sx intestinal finding electrolytes. May months, this
of anemia, may be episcleritis, have elevated WBC medication interferes
, NR511 Midterm Study Guide
Worksheet
impaired nutrition. nondeforming and prolonged absorption and patient
Most common sx are peripheral arthritis, prothrombin time. must take
abd and axial Barium upper GI supplements.
cramping/tendernes arthropathy series, Metronidazole effective
s, fever, anorexia, colonoscopy, and in tx perianal disease
wt loss, spasm, CT to determine and in controlling
flatulence, RLQ pain bowel wall crohns colitis, other
or mass thickening or ABT’s such as Cipro,
abscess formation Ampicillin, and
Tetracycline effective in
controlling CD ileitis,
and ileocolitis.
