WGU D118 ADULT PRIMARY CARE OBJECTIVE ASSESSMENT Comprehensive Resource To Help You Ace Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!!

WGU D118 ADULT PRIMARY CARE OBJECTIVE ASSESSMENT Comprehensive Resource To Help You Ace Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!! 1. Describe the clinical presentation, physical examination, and treatment of patients with anaphylaxis. - ANSWER Uni phasic and biphasic reactions can occur anywhere from minutes to up to 10 to 12 hours after exposure.1-3 Protracted reactions can be severe, lasting from 24 to rarely 72 hours Initial Diagnostics Laboratory • Pulse oximetry • Arterial blood gases • Electrocardiogram (ECG)a • Serum glucose to assess for hypoglycemia • Additional diagnostics • 24-h urine specimen for histamine metabolites9, a • Plasma histamine level9: to confirm anaphylaxisa • Serum tryptase level—elevation is indicative of mast cell activation9, a Imaging • Chest radiograph Epinephrine dose for pregnant or non-pregnant adults: • Aqueous epinephrine: 1:1000 dilution (1 mg/mL), 0.2 to 0.5 mg intramuscularly in the anterolateral aspect of the mid-thigh as the preferred site. Repeat every 5 to 15 minutes as needed to a maximum dose of 1 m 2. Describe the he clinical presentation, physical examination, and treatment of patients with various types of bites and stings: - ANSWER tick bites, -Ticks are effectively removed with blunt, angled, medium-tipped forceps or a specific tickremoval instrument. The tick should be removed as soon as possible by grasping it close to the mouth, flipping the tick so the backside is closest to the skin, and pulling the tick straight up.5 After removal of the tick, the health care provider should inspect the bite area for retained mouth parts, remove if possible, then carefully clean the area with an antiseptic.5 Antibiotic prophylaxis may be indicated where Lyme disease is endemic or if the length of time the tick has been imbedded is not known. A tick needs to be embedded and feeding for more than 36 hours to infect with Lyme disease (see Chapter 213). All insect bites and stings require local wound care, removal of the stinger, cleaning the area with soap and water, ice packs, antihistamines (H1 and H2 blockers) for itching, topical steroids for inflammation, topical or systemic antibiotics for secondary infection, and nonsteroidal anti-inflammatory drugs to relieve discomfort.1,3 Flea bites may resemble varicella. Reactions to blister beetles may resemble bullous impetigo, burns, contact dermatitis, and viral exanthems. Because of such similarities, a history of exposure may be the only diagnostic clue.3 3. Describe the clinical presentation, physical examination, and management of patients with cardiac arrhythmias, including tachyarrhythmias and brady arrhythmias-ATROPINE OR PACINING - ANSWER tachyarrhythmias -NARROW I. Sinus tachycardia-Treat the cause- Requires appropriate diagnostic workup after analysis of the history and possible causes WIDE-V TACH -Amiodarone IV Dose: First dose: 150 mg over 10 minutes. electrical cardioversion bradyarrhythmias-ATROPINE OR PACING 4. Describe the various diagnostic tests used to diagnose/monitor cardiac arrhythmias. - ANSWER Common Tests for Arrhythmia · Holter monitor · Event recorder · Treadmill testing · Tilt-table test · Electrophysiologic testing (EP study).EKG 5. Describe the clinical presentation, physical examination, and treatment of patients with acute bronchospasm. - ANSWER A patient who speaks in words instead of phrases, sits in a hunched position, and uses accessory muscles is in severe respiratory compromise While waiting for transport, the patient should be given inhaled short-acting β2agonists (SABAs), ipratropium bromide, systemic corticosteroids and, if available, supplemental oxygen.5 For patients unable to coordinate a metered-dose inhaler (MDI) or who show no improvement, epinephrine and terbutaline, if available, are indicated. Pulsus paradoxus (a change in blood pressure during inspiration) of greater than 20 mm Hg is a uniform indicator of severe respiratory compromise. The presence of a urticarial rash with decreasing blood pressure is a sign of anaphylaxis, necessitating immediate treatment with supplemental oxygen through nasal cannula or mask and diphenhydramine (Benadryl), 25 or 50 mg intravenously (no faster than 25 mg per minute) or intramuscularly; or epinephrine, 0.3 to 0.5 mg of a 1 : 1000 (1 mg/mL) solution intramuscularly in the vastus lateralis muscle (middle-outer aspect of the thigh), anterolateral aspect for the adult patient MDI or nebulizer. Short-acting β2 agonists include medications such as albuterol, levalbuterol (Xopenex), metaproterenol (Alupent), and pirbuterol (Maxair). Other medications include anticholinergics, such as ipratropium bromide (Atrovent), and systemic corticosteroids, such as methylprednisolone, prednisolone, and prednison Treatment to reverse bronchospasm by an MDI (90 mcg/puff) consists of 4 to 10 puffs of albuterol every 20 minutes for the first hour. "After the first hour, the dose of SABA required varies from 4-10 puffs every 3-4 hours up to 6-10 puffs every 1-2 hours, or more often As an alternative, nebulizer treatments with 2.5 to 5 mg of albuterol can be administered every 20 minutes for up to three treatments. 6. Describe the management of hypotension, syncope, and hypovolemic shock. - ANSWER hypotension, S/S Lightheadedness and dizziness are common symptoms of hypotension. In addition, some individuals may experience blurred or tunnel vision and a dull pain in the back of the neck and shoulders failure of the pulse to increase with a decrease in blood pressure is indicative of neurogenic hypotension or central or peripheral nervous system diseases resulting in autonomic failure.7 Tachycardic heart rates that are exaggerated suggest underlying volume depletion such as dehydration Relatively simple bedside tests with a high diagnostic yield include electrocardiography (ECG), Laboratory • Hemoglobin • Serum electrolytes, BUN and creatinine, glucose • Stool testing for occult blood • Urine or serum pregnancy test (all women of childbearing age) • D-dimer test (when pulmonary embolus is suspected) • Urinalysis and blood cultures (when sepsis is suspected) Imaging • Electrocardiogram • Echocardiography, cardiac monitoring (when cardiac dysfunction is suspected) • CT imaging of the chest (when pulmonary embolus is suspected) • CT imaging of the abdomen (when intraabdominal bleeding is suspected)