NR 511 Midterm Study Guide Worksheet

NR 511 Midterm Study Guide Worksheet Recommended tips for success: 1. Studying View/review the material a minimum of three times: a. Read assigned chapters, view module content and take notes by filling in the grid below. b. Create 5x8 flash cards for each disease using your notes and the grid. Test yourself or ask your friends and co-workers to test your knowledge using the flashcards. Success is a team sport. c. Review the flash cards and grid within 24hrs of the exam. 2. Testing a. Do not change your answer unless you are very sure that it is wrong. b. Before answering, carefully read the root of the question. c. Eliminate at least two of the answers and then use your critical thinking to narrow the choices. There may be two correct answers. Your job is to distinguish which of the answers is the MOST correct. d. Make sure that you are rested, nourished and in a good environment for test taking. Directions: For each condition, fill in: 1. risks associated with the condition (e.g. alcoholism and pancreatitis) 2. significant subjective and objective findings especially those unique to the condition (e.g. appendicitis and RLQ abdominal pain) 3. the best diagnostic test used to confirm or diagnose 4. first line treatment with a second line option for the condition 5. most important patient education regarding the treatment (answers should follow EBM guidelines) Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education GI DISORDERS Appendicitis -Most common between 10-30yrs; but can occur at any age; rare in infants -Dx made clinically, based primarily on H&P exam -May have HTNtachy proportional to painsymptoms -Labs are not diagnostic and nonspecific -Surgical; preoperative care, NPO, correction of fluidelectrolyte imbalances -FU with surgeon -Ambulation after and older adults -men more at risk - Diets low in fiber, high in fat, refined sugars, & other carbs at increased risk. - Obstruction of appendix is cause of majority of appendicitis - contributing factors: Intra-abd tumors, positive family hx - Recent roundworm infection or viral GI infection - Classic presentation includes acute onset of mild to severe colicky, epigastric, or periumbilical pain - Pain is vague at first then localizes within 24hrs to RLQ - Pain exacerbated by walkingcoughing - Men may feel radiated pain in testes - Abd muscle rigidity, NV, anorexia - Mildly elevated temp 99-100F common - If RLQ accompanied by shaking chills, perforation should be suspected - Older adults may present with weakness, anorexia, abd distention, mild pain leading to delayed dx and increased morbidity. -When lying flat, may flex R knee to relieve tension in abd muscle -Pain with palpation in abd, diffuse in early stages. Localized to RLQ later -Positive for rebound pain; ask pt to cough to localize pain location -Sudden cessation of pain means perforation and is ER -Women should have urine human chorionic gonadotrophin to ro ectopic pregnancy - +Rovsing’s Sign- deep palpation & release in LLQ causes rebound pain in RLQ - +Psoas Sign- lift R leg against gentle pressure causes pain - +Obturator Sign- flex R hip & knee and slowly rotate internally causes pain - +McBurney’s Sign- pain with pressure applied to point between umbilicus & ilium - x-rayCT helpful when paired with positive H&P findings -Avoid narcotics -Atb with 3rd gen cephalosporin; Ex: ampicillin, gentamycin, flagyl surgery -Adv diet when bowel sounds return -Return to hosp with ss of infection -Avoid heavy lifting for at least 2 wks Celiac disease ** (autoimmune disorder caused by an immunologic response to gluten) Mostly diagnosed in adulthood. A family member with celiac disease Many asymptomatic. May complain of diarrhea, gas, dyspepsia, wt loss. Atypical symptoms: Muscle wasting (anemia), reduces subcutaneous fat, ataxia, & peripheral neuropathy (vitamin Serologic testing for anti-tTG IgA antibody Total IgA (2% of lifelong adherence to a strict gluten-free diet. Referral to a dietician to teaching related to gluten free diet. Some people with celiac disease have vitamin or nutrient or dermatitis herpetiformis Type 1 diabetes Down syndrome or Turner syndrome Autoimmune thyroid disease Microscopic colitis (lymphocytic or collagenous colitis) Addison's disease fatigue, bone or joint pain, arthritis, osteoporosis, or osteopenia (bone loss) liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, depression or anxiety peripheral neuropathy seizures or migraines missed menstrual periods infertility or recurrent miscarriage canker sores inside the mouth dermatitis herpetiformis (itchy skin rash) B12 deficiencies) osteoporosis or osteopenia (bone loss) hypothyroidism Pts with dermatitis herpetiformis found to have signs of celiac disease on intestinal biopsy. pts have IgA deficiency and will falsely test negative) duodenal biopsies Test for nutritional deficiencies associated with malabsorption of C.D. (hemoglobin, iron, folate, vit B12, Calcium, and Vitamin D.) help. Some pts may need treatment with immunomodulating agents. deficiencies that do not cause them to feel ill, such as anemia due to iron deficiency or bone loss due to vitamin D deficiency. However, these deficiencies can cause problems over the long term. Untreated celiac/developing certain types of gastrointestinal cancer. This risk can be reduced by eating a gluten-free diet. Cholelithiasis is the formation of gallstones and is found in 90% of patients with cholecystitis. --Risk factors--2 types of stones Patient complaint of indigestion, nausea, vomiting (after consuming meal high in fat), and pain in RUG or epigastrium that may radiate to the Right side involuntary guarding of abdominal muscles, Positive Murphy's sign, possible palpable gallbladder, Low grade fever Mild elevation of WBC up to 15, 000 Abdominal Xray: Quick, noninvasive, reliable, and cost- a. Initial management-- begins with definitive diagnosis. When asymptomatic (normally an incidental finding while exploring another problem) require no further Nonsurgical intervention: weight loss, avoidance of fatty foods to decrease attacks, alternative birth control for persons