NR 576 Final Exam Review| Brand New Expert Exam Questions with Clear correct Verified Answers| All Graded A+| Latest Premium Update()| 100% Guaranteed Success.

NR 576 Final Exam Review| Brand New Expert Exam Questions with Clear correct Verified Answers| All Graded A+| Latest Premium Update()| 100% Guaranteed Success. Assessing for prior antibiotic use is a critical part of the history in patients with presenting with _______________ due to_________________ - AnswerDiarrhea/CDiff Irritable bowel syndrome - Answerdisorder of the bowel function not from anatomic abnormality--constipation, diarrhea, bloating, urgency w/diarrhea +s/s--result from disordered sensations or abnormal function of the small and large bowel NOT associated with serious medical conditions, IBD, CA Inflammatory bowel disorder - Answerchronic immunologic disease that manifests in intestinal inflammation Ulcerative colitis crohn's disease Two common inflammatory bowel diseases - AnswerUlcerative colitis-mucosal surface of the colon is inflamed and ultimately results in frability, erosions, and bleeding--most common in recto-sigmoid colon. Can involve entire colon, pain in RLQ Crohns disease-inflammation extends deeper into the intestional wall and can involve all or any layer of the bowel wall and any portion of the GI tract from the mouth to the anus--skipped lesions, pain in LLQ Diverticulitis - AnswerSymptoms: LLQ pain/tenderness, fever, N/V/D Need imagining especially if perforation or peritonitis is suspected--free air=perforation; patient may have ileus, small or large bowel obstruction Can use plain x-ray CT or Barium enema are preferred CT with contrast is more sensitive and accurate Identify the significance of Barrett's esophagus - AnswerAfter repeated exposure to gastric contents, inflammation of the esophageal mucosa becomes chronic Blood flow increases, erosion occurs As erosion heals, normal squamous epithelium replaced with metaplastic columnar epithelium containing goblet and columnar cells. More resistant to acid and supports esophageal healing Premalignant tissue 40-fold frisk for developing esophageal adenocarcinma Fibrosis and scarring during healing of erosions; leads to strictures Diagnosis of GERD - Answermade on history alone: sensitivity of 80% if symptoms are unclear/patient does not respond to 4 weeks of empiric tx made by ambulatory esophageal pH monitoring pH 4 above the lower esophageal sphincter correlates with symptoms = GERD EDG with biopsy-Barrett's esohagus Normal results in 50% of symptomatic patients Risks of GERD - AnswerObesity Increase after age 50 Equal across gender, ethnic, and cultural groups Treatments of GERD - AnswerSmall frequent meals-main meal in midday Avoid trigger foods No bedtime snacks: no eating 4 hours prior to bed Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the bed elevated. Medications for GERD - Answerantacids or OTC H2 (Tagamet, zantac, axid) Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole 40mg daily, omeprazole 20mg daily) PPI (Omeprazole 40mg daily) Surgery (fundoplication) Differential diagnosis of acute abd pain - AnswerAcute appendicitis Acute pancreatitis Acute cholecystitis Acute appendicitis - AnswerInflammation of the vermiform appendix; due to obstruction or infection Most common surgical emergency of the abdomen Hollow tube - most common cause is obstruction of appendix Fecaltih - hard lump of fecal matter Undigested seeds Pinworm infections Lymphoid follicle growth/lymphoid hyperplasia Symptoms 4. Symptoms Nausea/vomiting RLQ pain Guarding Acute pancreatitis - AnswerSudden inflammation and hemorrhaging of the pancreas due to destruction by its own digestive enzymes 1. Autodigestion Most of the time mild, but can be severe Pancreas Long skinny gland, length of dollar bill Located in upper abdomen Behind the stomach Endocrine Alpha/beta cells produce insulin & glucagon that are secreted into the blood stream Exocrine Leading causes: ETOH abuse Gallstones Other Causes of acute pancreatitis 1. I Get Smashed I - idoipathic G- gallstones E- ETOH abuse T - trauma S - steroids M - mumps virus A - autoimmune diseases S - scorpion stings H - hypertriglyceridemia & hypercalcemia E - ERCP D - drugs Symptoms Nausea Vomiting Hypocalcemia Cullen's sign - bruising around umbilicus Grey-Turner's Sign - Bruising along flank Necrosis induced hemorrhaging spreads Acute cholecystitis - AnswerInflammation of gallbladder (GB) Usually due to gallstone in cystic duct 1. Cystic duct - leaves gall bladder & connects to common bile duct Symptoms Patient will have mid-epigastric pain Because GB is still squeezing, increasing pressure w/ nowhere for bile to go Can lead to nausea/vomting Stone can get more stuck w/ more squeezing Bile starts to irritate mucosa Mucosa starts to produce mucous and inflamm enzymes Leads to inflammation, distention, pressure build up Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim) As GB "balloons", pain shifts to RUQ, R scapula/shoulder Bacteria invades in & through GB wall, into peritoneum, causing peritonitis Rebound tenderness Murphy's Sign = Put pressure on right side under ribs. This will hold GB in place. Have patient take a deep breath. The diaphragm will push on the GB & a painful response = Cholecystitis Immune response Neutrophilic leukocytosis Fever Acute appendicitis diagnostics - AnswerDiagnosis is made clinically and based on history and physical Elevated WBC Mild Fever, 99-100 RLQ pain/McBurneys point CT abd may help rule out other diagnostic possibilities ABD ultrasound helps to visualize the inflamed appendix Acute pancreatitis diagnostics - AnswerPain in epigastrium which radiates to back Labs Increase in amylase; gold standard in diagnoses (up to 3x the normal level) Increase in lipase CT scan US to look for gallstones Acute cholecystitis diagnostics - AnswerUS confirmed