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NR 511 Midterm study guide
Differential Diagnosis & Primary Care Practicum (Chamberlain University)
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, lOMoARcPSD|10144563
GRADED A+
NR511 Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common between -Dx made clinically, -May have HTN\tachy -Labs are not -Surgical; preoperative -F\U with surgeon
10-30yrs; but can occur based primarily on H&P proportional to diagnostic and care, NPO, correction of -Ambulation after
at any age; rare in exam pain\symptoms nonspecific fluid\electrolyte imbalances surgery
infants and older adults - Classic presentation -When lying flat, may -Women should have -Avoid narcotics -Adv diet when
-men more at risk includes acute onset of flex R knee to relieve urine human chorionic -Atb with 3rd gen bowel sounds return
- Diets low in fiber, high mild to severe colicky, tension in abd muscle gonadotrophin to r\o cephalosporin; Ex: -Return to hosp with
in fat, refined sugars, & epigastric, or -Pain with palpation in ectopic pregnancy ampicillin, gentamycin, s\s of infection
other carbs at increased periumbilical pain abd, diffuse in early - +Rovsing’s Sign- flagyl -Avoid heavy lifting
risk. - Pain is vague at first stages. Localized to deep palpation & for at least 2 wks
- Obstruction of appendix then localizes within RLQ later release in LLQ causes
is cause of majority of 24hrs to RLQ -Positive for rebound rebound pain in RLQ
appendicitis - Pain exacerbated by pain; ask pt to cough - +Psoas Sign- lift R
- contributing factors: walking\coughing to localize pain leg against gentle
Intra-abdominal - Men may feel radiated location pressure causes pain
tumors, positive family pain in testes -Sudden cessation of - +Obturator Sign-
hx - Abd muscle rigidity, pain means perforation flex R hip & knee and
- Recent roundworm N\V, anorexia and is ER slowly rotate internally
infection or viral GI - Mildly elevated temp causes pain
infection 99-100F common - +McBurney’s Sign-
- If RLQ accompanied pain with pressure
by shaking chills, applied to point
perforation should be between umbilicus &
suspected ilium
- Older adults may - x-ray\CT helpful
present with weakness, when paired with
anorexia, abd positive H&P findings
distention, mild pain
leading to delayed dx
and increased
morbidity.
Celiac disease ** Mostly diagnosed in Many asymptomatic. Muscle wasting Serologic testing for lifelong adherence to a teaching related to
(autoimmune disorder adulthood. May complain of (anemia), reduces anti-tTG IgA antibody strict gluten-free diet. gluten free diet.
caused by an diarrhea, gas, subcutaneous fat, Some people with
immunologic response A family member with dyspepsia, wt. loss. ataxia, & peripheral Total IgA (2% of pts Referral to a dietician to celiac disease have
to gluten) celiac disease or Atypical symptoms: neuropathy (vitamin have IgA deficiency help. vitamin or nutrient
dermatitis herpetiformis fatigue, B12 deficiencies) and will falsely test deficiencies that do
bone or joint pain, osteoporosis or negative) Some pts may need not cause them to
Type 1 diabetes arthritis, osteopenia (bone loss) treatment with feel ill, such as
osteoporosis, or hypothyroidism duodenal biopsies immunomodulating agents. anemia due to iron
Down syndrome or osteopenia (bone loss) deficiency or bone
Turner syndrome liver and biliary tract Pts with dermatitis Test for nutritional loss due to vitamin D
disorders (transaminitis, herpetiformis found to deficiencies deficiency. However,
Autoimmune thyroid fatty liver, primary have signs of celiac associated with these deficiencies
disease sclerosing cholangitis, disease on intestinal malabsorption of C.D. can cause problems
depression or anxiety biopsy. (hemoglobin, iron, over the long term.
Microscopic colitis peripheral neuropathy folate, vit B12, Untreated
(lymphocytic or seizures or migraines Calcium, and Vitamin celiac/developing
collagenous colitis) missed menstrual D.) certain types of
periods gastrointestinal
Addison's disease infertility or recurrent cancer. This risk can
miscarriage be reduced by eating
canker sores inside the a gluten-free diet.
mouth
, lOMoARcPSD|10144563
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NR511 Midterm Study Guide Worksheet
dermatitis herpetiformis
(itchy skin rash)
Cholelithiasis is the formation of Patient complaint of Right side involuntary Mild elevation of WBC a. Initial management-- Nonsurgical
gallstones and is found indigestion, nausea, guarding of abdominal up to 15, 000 begins with definitive intervention: weight
in 90% of patients with vomiting (after muscles, Positive Abdominal Xray: diagnosis. When loss, avoidance of
cholecystitis. consuming meal high in Murphy's sign, Quick, noninvasive, asymptomatic (normally an fatty foods to
--Risk factors--2 types of fat), and pain in RUG or possible palpable reliable, and cost- incidental finding while decrease attacks,
stones (cholesterol and epigastrium that may gallbladder, Low grade effective means of exploring another problem) alternative birth
pigmented) radiate to the middle of fever between 99-101 identifying the require no further treatment control for persons
a. Cholesterol (most the back, infrascapular degrees. Possible presence of except teaching s/sx of taking oral
common form): female, area or right shoulder. jaundice from common cholelithiasis. "gallbladder attack". contraceptives,
obesity, pregnancy, bile duct edema and Nonsurgical candidate can menopausal women
increased age, drug- diminished bowel be treated with dissolution taking estrogen
induced (oral sounds. therapy or lithotripsy. Acute informed about
contraceptives and includes hydration (IV alternative sources
clofibrates: cholesterol fluids), antibiotics, of phytoestrogens
lowering agent), cystic analgesics, GI rest. (soy products).
fibrosis, rapid weight b. Treatment of choice for
loss, spinal cord injury, Acute cholecystitis is early
Ileal disease with surgical intervention after
extensive resection, stabilization. Poor surgical
Diabetes mellitus, sickle risk may benefit from
cell anemia. cholecystectomy
b. Pigmented: hemolytic operatively or
diseases, increasing percutaneously.
age, hyperalimentation
(artificial supply of
nutrients, typically IV),
cirrhosis, biliary stasis,
chronic biliary infections.
Crohn’s ** Ages 15-25 of onset and Mild-Four or fewer Tenderness in LLQ or Stool analysis to r/o Glucocorticoids, there is no Pt educated on
then again at 50-80. loose bowel across entire abd with bacterial, fungal, or cure for CD and treatment disease process, diet
Familial tendency, movements per day, guarding and abd parasitic infection for is aimed at suppressing and lifestyle
smoker can have small distension. DRE cause of diarrhea. inflammation and changes. Stress
Carcinoma less common amounts of blood and performed to look for CBC to check for symptomatic relief of reduction, adequate
in patients with CD due mucus in the stool, and anal and perianal anemia, eval for complications. Initially oral rest to decrease
to treatment sometimes cramping in the rectum. inflammation, rectal hypocalcemia, vit D prednisone 40-60 mg/d, bowel motility and
colectomy Moderate-4-6 loose tenderness, and blood deficiency., tapered over 2-4 months, promote healing.
bowel movements per in stool. S/Sx of hypoalbuminemia, and then can have daily Low residue diet
day containing more peritonitis and ileus steatorrhea. LFT to maintenance dose of 5- when obstructive sx
blood and mucus and may be found screen for primary 10mg/d. Sulfasalazine for present such as
other sx such as depending on severity sclerosis cholangitis, mild to moderate CD 500 canned fruits,
tachycardia, weight of crohns. Tender and other liver mg BID, increased to 3-4 vegetables and white
loss, fever, mild edema. mass in RLQ, anal problems assoc with g/d. Clinical improvement bread
Severe-frequent bloody fissure, perianal IBD. Check fluid and in 3-4 wks, and then
bowel movements (6- fissure, edematous electrolytes. May tapered to 2-3 g/d for 3-6
10), abd pain and pale skin tags. Extra have elevated WBC months, this medication
tenderness, sx of intestinal finding may count and sed rate interferes with folid acid
anemia, hypovolemia, be episcleritis, and prolonged absorption and patient must
impaired nutrition. erythema nodosum, prothrombin time. take supplements.
Most common sx are nondeforming Barium upper GI Metronidazole effective in
abd peripheral arthritis, and series, colonoscopy, tx perianal disease and in
cramping/tenderness, axial arthropathy and CT to determine controlling crohns colitis,
fever, anorexia, wt loss, bowel wall thickening other ABT’s such as Cipro,
spasm, flatulence, RLQ or abscess formation Ampicillin, and Tetracycline
pain or mass effective in controlling CD
ileitis, and ileocolitis.
, lOMoARcPSD|10144563
GRADED A+
NR511 Midterm Study Guide Worksheet
Immunosuppressive meds
when unresponsive to other
treatments.
Diverticulitis ** -Uncommon under -25% develop -LLQ abd tenderness -Abd x-ray can reveal -Asymptomatic cases -Increase fiber in diet
40yrs; risk rises after symptoms with possible Firm, free air, ileus, managed with high fiber to avoid constipation
-Rare in pediatric; equal -LLQ abd pain, worsens fixed mass may be obstruction diet or fiber supplement and straining
in men\women after eating identified in area of -Barium studies show with psyllium -H2O intake of at
-More common in -Pain sometimes diverticula sinus tracts, fistulas, -Mild symptoms managed least 8\8oz glasses
developed countries relieved with BM or -May have rebound obstruction outpatient with clear liquid to promote bowel
-High in low fiber, high flatus tenderness with -Colonoscopy to r\o diet and rest regularity
fat\red meat diets -BM may alternate guarding\rigidity Ca, but less sensitive -Atb should not be routinely -Bulk-forming
-Obesity, chronic between diarrhea\ -Tender rectal exam; than barium for used but can be with laxative may be
constipation, h\o constipation stool usually + for diverticula diverticula abscess culture needed Ex: psyllium,
diverticulitis, & number of -May present with occult blood -CT with contrast -Amoxicillin\clavulanate K FiberCon, Metamucil
diverticula which occur in bleeding w\o pain or (or) flagyl with bactrim
sigmoid colon. discomfort -Symptoms usually subside
-Fever, chills, tachy; quickly and diet can be
LLQ with anorexia, N\V advanced slowly
-Fistula may form -Pain managed with
causing dysuria, antispasmotics Ex; Levsin,
pneumaturia, fecaluria Bentyl, BuSpar
-Avoid morphine
-NG for ileus or intractable
N\V
-Pt can be D\C’d from hosp
once able to maintain
adequate nutrition\
hydration if acute phase
resolved
-Colon resection may be
necessary if no
improvement or
deterioration after 72hrs of
treatment
GERD ** -Can occur at any age -Heartburn; mild to -H&P usually normal -Usually Hx alone -8wk trial of PPI; weight -Weight loss, med
-Risk increases with age, severe -May be + for occult diagnoses loss, avoiding triggers compliance and
then decreases after -Regurgitation, water blood in stool -May manifest with -If unresponsive to once avoidance of triggers
69yrs brash, dysphagia, sour atypical symptoms daily dosing; can increase -Small frequent
-Prevalence equal taste in AM, belching, such as adult-onset to twice daily; if no relief meals; main meal
across gender, ethnic, coughing, odynophagia asthma, chronic EGD needed mid-day, avoid
cultural (painful swallow), cough, chronic -PPI and H2-RA should not eating 4hrs before
-Obesity, alcohol, hoarseness or laryngitis, sore throat, be taken together bed, avoid straining,
caffeinated beverages, wheezing at night noncardiac chest pain -Pt’s on long term therapy sleep with HOB
chocolate, fruit, decaf -Substernal\ -If pt fails to respond to should be re-eval’d q6mos elevated, smoking
coffee, fatty foods, retrosternal pain 4-8wks PPI, EGD is cessation, stress
onions, peppermint\ -Worsens if reclined ordered mgmt
spearmint, tomato after eating, eating -EGD warranted over
products large meals, empiric treatment
Anticholinergics, beta- constrictive clothing when heartburn &
adrenergics, CaChannel -May present with dysphagia, bleeding,
blockers, diazepam, dysphagia; dysphagia anemia, weight loss,
Estrogen\ progesterone, should only occur with or recurrent vomiting
Nicotine, Theophylline first bite -EGD with Barrett’s
esophagus q3-5yrs
GRADED A+
NR 511 Midterm study guide
Differential Diagnosis & Primary Care Practicum (Chamberlain University)
StuDocu is not sponsored or endorsed by any college or university
Downloaded by ritz patil ()
, lOMoARcPSD|10144563
GRADED A+
NR511 Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common between -Dx made clinically, -May have HTN\tachy -Labs are not -Surgical; preoperative -F\U with surgeon
10-30yrs; but can occur based primarily on H&P proportional to diagnostic and care, NPO, correction of -Ambulation after
at any age; rare in exam pain\symptoms nonspecific fluid\electrolyte imbalances surgery
infants and older adults - Classic presentation -When lying flat, may -Women should have -Avoid narcotics -Adv diet when
-men more at risk includes acute onset of flex R knee to relieve urine human chorionic -Atb with 3rd gen bowel sounds return
- Diets low in fiber, high mild to severe colicky, tension in abd muscle gonadotrophin to r\o cephalosporin; Ex: -Return to hosp with
in fat, refined sugars, & epigastric, or -Pain with palpation in ectopic pregnancy ampicillin, gentamycin, s\s of infection
other carbs at increased periumbilical pain abd, diffuse in early - +Rovsing’s Sign- flagyl -Avoid heavy lifting
risk. - Pain is vague at first stages. Localized to deep palpation & for at least 2 wks
- Obstruction of appendix then localizes within RLQ later release in LLQ causes
is cause of majority of 24hrs to RLQ -Positive for rebound rebound pain in RLQ
appendicitis - Pain exacerbated by pain; ask pt to cough - +Psoas Sign- lift R
- contributing factors: walking\coughing to localize pain leg against gentle
Intra-abdominal - Men may feel radiated location pressure causes pain
tumors, positive family pain in testes -Sudden cessation of - +Obturator Sign-
hx - Abd muscle rigidity, pain means perforation flex R hip & knee and
- Recent roundworm N\V, anorexia and is ER slowly rotate internally
infection or viral GI - Mildly elevated temp causes pain
infection 99-100F common - +McBurney’s Sign-
- If RLQ accompanied pain with pressure
by shaking chills, applied to point
perforation should be between umbilicus &
suspected ilium
- Older adults may - x-ray\CT helpful
present with weakness, when paired with
anorexia, abd positive H&P findings
distention, mild pain
leading to delayed dx
and increased
morbidity.
Celiac disease ** Mostly diagnosed in Many asymptomatic. Muscle wasting Serologic testing for lifelong adherence to a teaching related to
(autoimmune disorder adulthood. May complain of (anemia), reduces anti-tTG IgA antibody strict gluten-free diet. gluten free diet.
caused by an diarrhea, gas, subcutaneous fat, Some people with
immunologic response A family member with dyspepsia, wt. loss. ataxia, & peripheral Total IgA (2% of pts Referral to a dietician to celiac disease have
to gluten) celiac disease or Atypical symptoms: neuropathy (vitamin have IgA deficiency help. vitamin or nutrient
dermatitis herpetiformis fatigue, B12 deficiencies) and will falsely test deficiencies that do
bone or joint pain, osteoporosis or negative) Some pts may need not cause them to
Type 1 diabetes arthritis, osteopenia (bone loss) treatment with feel ill, such as
osteoporosis, or hypothyroidism duodenal biopsies immunomodulating agents. anemia due to iron
Down syndrome or osteopenia (bone loss) deficiency or bone
Turner syndrome liver and biliary tract Pts with dermatitis Test for nutritional loss due to vitamin D
disorders (transaminitis, herpetiformis found to deficiencies deficiency. However,
Autoimmune thyroid fatty liver, primary have signs of celiac associated with these deficiencies
disease sclerosing cholangitis, disease on intestinal malabsorption of C.D. can cause problems
depression or anxiety biopsy. (hemoglobin, iron, over the long term.
Microscopic colitis peripheral neuropathy folate, vit B12, Untreated
(lymphocytic or seizures or migraines Calcium, and Vitamin celiac/developing
collagenous colitis) missed menstrual D.) certain types of
periods gastrointestinal
Addison's disease infertility or recurrent cancer. This risk can
miscarriage be reduced by eating
canker sores inside the a gluten-free diet.
mouth
, lOMoARcPSD|10144563
GRADED A+
NR511 Midterm Study Guide Worksheet
dermatitis herpetiformis
(itchy skin rash)
Cholelithiasis is the formation of Patient complaint of Right side involuntary Mild elevation of WBC a. Initial management-- Nonsurgical
gallstones and is found indigestion, nausea, guarding of abdominal up to 15, 000 begins with definitive intervention: weight
in 90% of patients with vomiting (after muscles, Positive Abdominal Xray: diagnosis. When loss, avoidance of
cholecystitis. consuming meal high in Murphy's sign, Quick, noninvasive, asymptomatic (normally an fatty foods to
--Risk factors--2 types of fat), and pain in RUG or possible palpable reliable, and cost- incidental finding while decrease attacks,
stones (cholesterol and epigastrium that may gallbladder, Low grade effective means of exploring another problem) alternative birth
pigmented) radiate to the middle of fever between 99-101 identifying the require no further treatment control for persons
a. Cholesterol (most the back, infrascapular degrees. Possible presence of except teaching s/sx of taking oral
common form): female, area or right shoulder. jaundice from common cholelithiasis. "gallbladder attack". contraceptives,
obesity, pregnancy, bile duct edema and Nonsurgical candidate can menopausal women
increased age, drug- diminished bowel be treated with dissolution taking estrogen
induced (oral sounds. therapy or lithotripsy. Acute informed about
contraceptives and includes hydration (IV alternative sources
clofibrates: cholesterol fluids), antibiotics, of phytoestrogens
lowering agent), cystic analgesics, GI rest. (soy products).
fibrosis, rapid weight b. Treatment of choice for
loss, spinal cord injury, Acute cholecystitis is early
Ileal disease with surgical intervention after
extensive resection, stabilization. Poor surgical
Diabetes mellitus, sickle risk may benefit from
cell anemia. cholecystectomy
b. Pigmented: hemolytic operatively or
diseases, increasing percutaneously.
age, hyperalimentation
(artificial supply of
nutrients, typically IV),
cirrhosis, biliary stasis,
chronic biliary infections.
Crohn’s ** Ages 15-25 of onset and Mild-Four or fewer Tenderness in LLQ or Stool analysis to r/o Glucocorticoids, there is no Pt educated on
then again at 50-80. loose bowel across entire abd with bacterial, fungal, or cure for CD and treatment disease process, diet
Familial tendency, movements per day, guarding and abd parasitic infection for is aimed at suppressing and lifestyle
smoker can have small distension. DRE cause of diarrhea. inflammation and changes. Stress
Carcinoma less common amounts of blood and performed to look for CBC to check for symptomatic relief of reduction, adequate
in patients with CD due mucus in the stool, and anal and perianal anemia, eval for complications. Initially oral rest to decrease
to treatment sometimes cramping in the rectum. inflammation, rectal hypocalcemia, vit D prednisone 40-60 mg/d, bowel motility and
colectomy Moderate-4-6 loose tenderness, and blood deficiency., tapered over 2-4 months, promote healing.
bowel movements per in stool. S/Sx of hypoalbuminemia, and then can have daily Low residue diet
day containing more peritonitis and ileus steatorrhea. LFT to maintenance dose of 5- when obstructive sx
blood and mucus and may be found screen for primary 10mg/d. Sulfasalazine for present such as
other sx such as depending on severity sclerosis cholangitis, mild to moderate CD 500 canned fruits,
tachycardia, weight of crohns. Tender and other liver mg BID, increased to 3-4 vegetables and white
loss, fever, mild edema. mass in RLQ, anal problems assoc with g/d. Clinical improvement bread
Severe-frequent bloody fissure, perianal IBD. Check fluid and in 3-4 wks, and then
bowel movements (6- fissure, edematous electrolytes. May tapered to 2-3 g/d for 3-6
10), abd pain and pale skin tags. Extra have elevated WBC months, this medication
tenderness, sx of intestinal finding may count and sed rate interferes with folid acid
anemia, hypovolemia, be episcleritis, and prolonged absorption and patient must
impaired nutrition. erythema nodosum, prothrombin time. take supplements.
Most common sx are nondeforming Barium upper GI Metronidazole effective in
abd peripheral arthritis, and series, colonoscopy, tx perianal disease and in
cramping/tenderness, axial arthropathy and CT to determine controlling crohns colitis,
fever, anorexia, wt loss, bowel wall thickening other ABT’s such as Cipro,
spasm, flatulence, RLQ or abscess formation Ampicillin, and Tetracycline
pain or mass effective in controlling CD
ileitis, and ileocolitis.
, lOMoARcPSD|10144563
GRADED A+
NR511 Midterm Study Guide Worksheet
Immunosuppressive meds
when unresponsive to other
treatments.
Diverticulitis ** -Uncommon under -25% develop -LLQ abd tenderness -Abd x-ray can reveal -Asymptomatic cases -Increase fiber in diet
40yrs; risk rises after symptoms with possible Firm, free air, ileus, managed with high fiber to avoid constipation
-Rare in pediatric; equal -LLQ abd pain, worsens fixed mass may be obstruction diet or fiber supplement and straining
in men\women after eating identified in area of -Barium studies show with psyllium -H2O intake of at
-More common in -Pain sometimes diverticula sinus tracts, fistulas, -Mild symptoms managed least 8\8oz glasses
developed countries relieved with BM or -May have rebound obstruction outpatient with clear liquid to promote bowel
-High in low fiber, high flatus tenderness with -Colonoscopy to r\o diet and rest regularity
fat\red meat diets -BM may alternate guarding\rigidity Ca, but less sensitive -Atb should not be routinely -Bulk-forming
-Obesity, chronic between diarrhea\ -Tender rectal exam; than barium for used but can be with laxative may be
constipation, h\o constipation stool usually + for diverticula diverticula abscess culture needed Ex: psyllium,
diverticulitis, & number of -May present with occult blood -CT with contrast -Amoxicillin\clavulanate K FiberCon, Metamucil
diverticula which occur in bleeding w\o pain or (or) flagyl with bactrim
sigmoid colon. discomfort -Symptoms usually subside
-Fever, chills, tachy; quickly and diet can be
LLQ with anorexia, N\V advanced slowly
-Fistula may form -Pain managed with
causing dysuria, antispasmotics Ex; Levsin,
pneumaturia, fecaluria Bentyl, BuSpar
-Avoid morphine
-NG for ileus or intractable
N\V
-Pt can be D\C’d from hosp
once able to maintain
adequate nutrition\
hydration if acute phase
resolved
-Colon resection may be
necessary if no
improvement or
deterioration after 72hrs of
treatment
GERD ** -Can occur at any age -Heartburn; mild to -H&P usually normal -Usually Hx alone -8wk trial of PPI; weight -Weight loss, med
-Risk increases with age, severe -May be + for occult diagnoses loss, avoiding triggers compliance and
then decreases after -Regurgitation, water blood in stool -May manifest with -If unresponsive to once avoidance of triggers
69yrs brash, dysphagia, sour atypical symptoms daily dosing; can increase -Small frequent
-Prevalence equal taste in AM, belching, such as adult-onset to twice daily; if no relief meals; main meal
across gender, ethnic, coughing, odynophagia asthma, chronic EGD needed mid-day, avoid
cultural (painful swallow), cough, chronic -PPI and H2-RA should not eating 4hrs before
-Obesity, alcohol, hoarseness or laryngitis, sore throat, be taken together bed, avoid straining,
caffeinated beverages, wheezing at night noncardiac chest pain -Pt’s on long term therapy sleep with HOB
chocolate, fruit, decaf -Substernal\ -If pt fails to respond to should be re-eval’d q6mos elevated, smoking
coffee, fatty foods, retrosternal pain 4-8wks PPI, EGD is cessation, stress
onions, peppermint\ -Worsens if reclined ordered mgmt
spearmint, tomato after eating, eating -EGD warranted over
products large meals, empiric treatment
Anticholinergics, beta- constrictive clothing when heartburn &
adrenergics, CaChannel -May present with dysphagia, bleeding,
blockers, diazepam, dysphagia; dysphagia anemia, weight loss,
Estrogen\ progesterone, should only occur with or recurrent vomiting
Nicotine, Theophylline first bite -EGD with Barrett’s
esophagus q3-5yrs
