NR 574 final Exam with precise detailed solutions ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
How often should a CK level be drawn and why? - correct answer✔✔least every 6-12 hours
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
to establish a peak level and then subsequently a downward trend.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Sylvie is a 26-year-old who presents to the emergency department (ED) after just finishing a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
full marathon. She complains of feeling lightheaded, nauseous, and has vomited twice since
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
completing the race. Her legs feel tired, weak, and sore which she attributes to running 26.2 ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
miles. She reports that she didn't stop to rehydrate as much as she would have liked because
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she was intent on finishing with her personal best time. She became very concerned when
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she went to use the restroom and noticed that her urine was dark - almost like tea. The
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
AGACNP suspects rhabdomyolysis. Which test is needed to confirm the diagnosis? - correct ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔serum creatine kinase ||\\//|| ||\\//||
Sylvie's EKG shows markedly elevated T waves and prolongation of the PR and QRS intervals.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The AGACNP should anticipate which of the following results? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔hyperkalemia
Risk factors for acute intestinal obstruction? - correct answer✔✔Adhesions from previous
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abdominal surgery Internal or external hernias Foreign bodies Feces ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and mal- rotation) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Trauma (hematoma formation)Inflammation (inflammatory bowel disease, diverticulitis,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
radiation, and tuberculosis) Neoplasms including carcinomatosis, colon cancer, primary small ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
bowel cancer, and extraintestinal malignancies such as ovarian cancer
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Endometriosis Volvulus Ischemic injury Intussusception Intraperitoneal abscess ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Subjective findings of acute intestinal obstruction - correct answer✔✔colicky abdominal pain ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(cramping periumbilical pain initially; later becomes constant and diffuse)abdominal pain ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
often more severe with distal obstruction vomiting (more significant with proximal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction) abdominal bloatingobstipation ||\\//|| ||\\//||
,What key information should be discussed during H/P, if you are concerned for bowel
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction? - correct answer✔✔History should include essential elements such as previous ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abdominal or pelvic surgeries, comorbid conditions such as inflammatory bowel disease or
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
malignancy.
Objective findings in a patient with intestinal obstruction? - correct answer✔✔Key physical
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
exam findings may include:
||\\//|| ||\\//|| ||\\//||
Fever (systemic inflammation or strangulation)
||\\//|| ||\\//|| ||\\//|| ||\\//||
High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction) Abdominal distention (more significant with distal obstruction due to the greater ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
volume of intraluminal fluid accumulation)Mild abdominal tenderness but no peritoneal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
findingsTender abdominal or groin masses (can represent incarcerated hernia) Signs of shock ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(tachycardia, hypotension, oliguria) ||\\//|| ||\\//||
Significant abdominal tenderness with palpation should increase the NP's suspicion for? -
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
correct answer✔✔ischemia, peritonitis, or necrosis.
||\\//|| ||\\//|| ||\\//|| ||\\//||
why is a serum lactate useful in dx a bowel obstruction? - correct answer✔✔Serum lactate
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(increased serum lactate should raise concern for strangulated obstruction) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what diagnostic imaging should be used for bowel obstruction? - correct answer✔✔plain film
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
xray
||\\//||
what will a plain film xray show if a patient has a bowel obstruction? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔Obstruction will reveal dilated loops of bowel and visible air-fluid levels which ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
should prompt further studies.A horizontal pattern of dilated small bowel loops can be seen
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
with small bowel obstruction (SBO)
||\\//|| ||\\//|| ||\\//|| ||\\//||
Should barium contrast be given to a patient with a bowel obstruction? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔NO! Imaging studies requiring administration of barium are contraindicated in ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
cases of high- grade or complete obstruction.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,What does barium contrast do within the body with a bowel obstruction? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔Barium should NEVER be given orally to a client until the diagnosis of obstruction ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
has been excluded completely as retained barium can cause concretions which create an
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
additional source of blockage which can require surgical intervention in clients who may have||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
otherwise recovered. Retained barium also severely limits the ability to interpret subsequent
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
angiography or cross-sectional imaging.
||\\//|| ||\\//|| ||\\//|| ||\\//||
Treatment of bowel obstruction - correct answer✔✔Gen surg consult, NG tube (intermittent ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
suction) for decompression, fluid rescusitation, electrolyte management as indicated,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
complete obstruction= immediate surgical intervention ||\\//|| ||\\//|| ||\\//|| ||\\//||
Superior Vena Cava Syndrome (SVCS) - correct answer✔✔SVCS is the clinical manifestation of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
SVC obstruction with severe reduction in venous return from the head, neck, and upper
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
extremities.
What is responsible for the majority of SVCS cases? - correct answer✔✔malignant tumors,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
such as lung cancer, lymphoma, and metastatic tumors.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Subjective findings with SVCS patients - correct answer✔✔Commonly: neck and facial ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
swelling (especially around the eyes) dyspnea, and cough other symptoms:hoarseness,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
dizziness, syncope, and lethargy. ||\\//|| ||\\//|| ||\\//||
what can cause symptoms of SVCS to become worse? - correct answer✔✔bending down,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
laying supine, position changes. ||\\//|| ||\\//|| ||\\//||
Physical exam findings of SVCS - correct answer✔✔dilated neck veins increase number of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
collateral veins covering the anterior chest wall cyanosis edema of the face, arms and chest.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
typically will be worse when the patient is laying supine ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, treatment of SVCS - correct answer✔✔symptomatic relief:diuretics w/ low sodium diet head
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
elevation supplemental 02Radiation therapy is the primary treatment for SVCS. obstruction
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
needs to be taken care of to relief symptoms.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Abdomen Pain in the RLQ Pain differentials - correct answer✔✔appendicitis, ectopic
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
pregnancy, nephrolithiasis, ||\\//||
ABD PAIN: "RUQ pain" is a red flag for.. - correct answer✔✔cholecystitis, pancreatitis
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(referred pain) PNA/empyema hepatitis ||\\//|| ||\\//|| ||\\//||
ABD PAIN:: "LUQ pain" is a red flag for.. - correct answer✔✔pancreatitis
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
ABD PAIN : "LLQ pain" is red flag for.. - correct answer✔✔Diverticulitis ectopic
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
nephrolithiasis, IBS ||\\//||
Periumbilical abdominal pain - correct answer✔✔gastroenteritis early appy bowel obstruction ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Ruptured aortic aneurysm
||\\//|| ||\\//|| ||\\//||
epigastric pain - correct answer✔✔PUD, gastritis GERD pancreatitis MI pericarditis Ruptured
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
AAA
Abdomen pain differential - correct answer✔✔Appy gallstones, pancreatitis, diverticulitis,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
ulcer disease, esophagitis, GI obstruction, IBD, renal stone
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Acute mesenteric ischemia (AMI) - correct answer✔✔occurrence of abrupt cessation of
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
blood flow to bowel, usually embolic or thrombotic in nature.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
How often should a CK level be drawn and why? - correct answer✔✔least every 6-12 hours
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
to establish a peak level and then subsequently a downward trend.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Sylvie is a 26-year-old who presents to the emergency department (ED) after just finishing a
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
full marathon. She complains of feeling lightheaded, nauseous, and has vomited twice since
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
completing the race. Her legs feel tired, weak, and sore which she attributes to running 26.2 ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
miles. She reports that she didn't stop to rehydrate as much as she would have liked because
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she was intent on finishing with her personal best time. She became very concerned when
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
she went to use the restroom and noticed that her urine was dark - almost like tea. The
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
AGACNP suspects rhabdomyolysis. Which test is needed to confirm the diagnosis? - correct ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔serum creatine kinase ||\\//|| ||\\//||
Sylvie's EKG shows markedly elevated T waves and prolongation of the PR and QRS intervals.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
The AGACNP should anticipate which of the following results? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔hyperkalemia
Risk factors for acute intestinal obstruction? - correct answer✔✔Adhesions from previous
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abdominal surgery Internal or external hernias Foreign bodies Feces ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and mal- rotation) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Trauma (hematoma formation)Inflammation (inflammatory bowel disease, diverticulitis,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
radiation, and tuberculosis) Neoplasms including carcinomatosis, colon cancer, primary small ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
bowel cancer, and extraintestinal malignancies such as ovarian cancer
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Endometriosis Volvulus Ischemic injury Intussusception Intraperitoneal abscess ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Subjective findings of acute intestinal obstruction - correct answer✔✔colicky abdominal pain ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(cramping periumbilical pain initially; later becomes constant and diffuse)abdominal pain ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
often more severe with distal obstruction vomiting (more significant with proximal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction) abdominal bloatingobstipation ||\\//|| ||\\//||
,What key information should be discussed during H/P, if you are concerned for bowel
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction? - correct answer✔✔History should include essential elements such as previous ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abdominal or pelvic surgeries, comorbid conditions such as inflammatory bowel disease or
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
malignancy.
Objective findings in a patient with intestinal obstruction? - correct answer✔✔Key physical
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
exam findings may include:
||\\//|| ||\\//|| ||\\//||
Fever (systemic inflammation or strangulation)
||\\//|| ||\\//|| ||\\//|| ||\\//||
High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
obstruction) Abdominal distention (more significant with distal obstruction due to the greater ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
volume of intraluminal fluid accumulation)Mild abdominal tenderness but no peritoneal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
findingsTender abdominal or groin masses (can represent incarcerated hernia) Signs of shock ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(tachycardia, hypotension, oliguria) ||\\//|| ||\\//||
Significant abdominal tenderness with palpation should increase the NP's suspicion for? -
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
correct answer✔✔ischemia, peritonitis, or necrosis.
||\\//|| ||\\//|| ||\\//|| ||\\//||
why is a serum lactate useful in dx a bowel obstruction? - correct answer✔✔Serum lactate
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(increased serum lactate should raise concern for strangulated obstruction) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
what diagnostic imaging should be used for bowel obstruction? - correct answer✔✔plain film
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
xray
||\\//||
what will a plain film xray show if a patient has a bowel obstruction? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔Obstruction will reveal dilated loops of bowel and visible air-fluid levels which ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
should prompt further studies.A horizontal pattern of dilated small bowel loops can be seen
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
with small bowel obstruction (SBO)
||\\//|| ||\\//|| ||\\//|| ||\\//||
Should barium contrast be given to a patient with a bowel obstruction? - correct
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
answer✔✔NO! Imaging studies requiring administration of barium are contraindicated in ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
cases of high- grade or complete obstruction.
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,What does barium contrast do within the body with a bowel obstruction? - correct
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answer✔✔Barium should NEVER be given orally to a client until the diagnosis of obstruction ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
has been excluded completely as retained barium can cause concretions which create an
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additional source of blockage which can require surgical intervention in clients who may have||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
otherwise recovered. Retained barium also severely limits the ability to interpret subsequent
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angiography or cross-sectional imaging.
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Treatment of bowel obstruction - correct answer✔✔Gen surg consult, NG tube (intermittent ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
suction) for decompression, fluid rescusitation, electrolyte management as indicated,
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complete obstruction= immediate surgical intervention ||\\//|| ||\\//|| ||\\//|| ||\\//||
Superior Vena Cava Syndrome (SVCS) - correct answer✔✔SVCS is the clinical manifestation of
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SVC obstruction with severe reduction in venous return from the head, neck, and upper
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extremities.
What is responsible for the majority of SVCS cases? - correct answer✔✔malignant tumors,
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such as lung cancer, lymphoma, and metastatic tumors.
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Subjective findings with SVCS patients - correct answer✔✔Commonly: neck and facial ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
swelling (especially around the eyes) dyspnea, and cough other symptoms:hoarseness,
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tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain,
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dizziness, syncope, and lethargy. ||\\//|| ||\\//|| ||\\//||
what can cause symptoms of SVCS to become worse? - correct answer✔✔bending down,
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
laying supine, position changes. ||\\//|| ||\\//|| ||\\//||
Physical exam findings of SVCS - correct answer✔✔dilated neck veins increase number of
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collateral veins covering the anterior chest wall cyanosis edema of the face, arms and chest.
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typically will be worse when the patient is laying supine ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, treatment of SVCS - correct answer✔✔symptomatic relief:diuretics w/ low sodium diet head
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elevation supplemental 02Radiation therapy is the primary treatment for SVCS. obstruction
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needs to be taken care of to relief symptoms.
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Abdomen Pain in the RLQ Pain differentials - correct answer✔✔appendicitis, ectopic
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pregnancy, nephrolithiasis, ||\\//||
ABD PAIN: "RUQ pain" is a red flag for.. - correct answer✔✔cholecystitis, pancreatitis
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(referred pain) PNA/empyema hepatitis ||\\//|| ||\\//|| ||\\//||
ABD PAIN:: "LUQ pain" is a red flag for.. - correct answer✔✔pancreatitis
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ABD PAIN : "LLQ pain" is red flag for.. - correct answer✔✔Diverticulitis ectopic
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nephrolithiasis, IBS ||\\//||
Periumbilical abdominal pain - correct answer✔✔gastroenteritis early appy bowel obstruction ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Ruptured aortic aneurysm
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epigastric pain - correct answer✔✔PUD, gastritis GERD pancreatitis MI pericarditis Ruptured
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AAA
Abdomen pain differential - correct answer✔✔Appy gallstones, pancreatitis, diverticulitis,
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ulcer disease, esophagitis, GI obstruction, IBD, renal stone
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Acute mesenteric ischemia (AMI) - correct answer✔✔occurrence of abrupt cessation of
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blood flow to bowel, usually embolic or thrombotic in nature.
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