NR511 Complete midterm study guide worksheet, NR 511 Differential Diagnosis and Primary Care Practicum, Chamberlain.
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NR 511
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NR511 Complete midterm study guide worksheet, NR 511 Differential Diagnosis and Primary Care Practicum, Chamberlain.
Appendicitis -Most common between 10-30yrs; but can occur at any age; rare in infants and older adults -men more at risk - Diets low in fiber, high in fat, refined su...
Appendicitis -Most common -Dx made clinically, -May have HTN\tachy -Labs are not -Surgical; preoperative -F\U with surgeon
between 10-30yrs; but based primarily on proportional to pain\ diagnostic and care, NPO, correction of
can occur at any age; H&P exam symptoms nonspecific fluid\electrolyte -Ambulation after
rare in infants and older imbalances surgery
adults - Classic presentation -When lying flat, may -Women should have
includes acute onset of flex R knee to relieve urine human -Avoid narcotics -Adv diet when
-men more at risk mild to severe colicky, tension in abd muscle chorionic bowel sounds
epigastric, or gonadotrophin to r\o -Atb with 3rd gen return
- Diets low in fiber, high periumbilical pain -Pain with palpation in ectopic pregnancy cephalosporin; Ex:
in fat, refined sugars, & abd, diffuse in early ampicillin, gentamycin, -Return to hosp
other carbs at increased - Pain is vague at first stages. Localized to - +Rovsing’s Sign- flagyl with s\s of infection
risk. then localizes within RLQ later deep palpation & -Avoid heavy lifting
24hrs to RLQ release in LLQ causes for at least 2 wks
- Obstruction of -Positive for rebound rebound pain in RLQ
appendix is cause of - Pain exacerbated by pain; ask pt to cough
majority of appendicitis walking\coughing to localize pain - +Psoas Sign- lift R
location leg against gentle
- contributing factors: - Men may feel pressure causes pain
Intra-abdominal radiated pain in testes -Sudden cessation of
pain means - +Obturator Sign-
tumors, positive family - Abd muscle rigidity, perforation and is ER flex R hip & knee and
hx N\V, anorexia slowly rotate
- Recent roundworm - Mildly elevated temp internally causes pain
infection or viral GI 99-100F common - +McBurney’s Sign-
infection pain with pressure
- If RLQ accompanied
by shaking chills, applied to point
perforation should be between umbilicus &
ilium
, NR511 Midterm Study Guide Worksheet
suspected - x-ray\CT helpful
when paired with
- Older adults may positive H&P findings
present with
weakness, anorexia,
abd 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
adulthood. May complain of (anemia), reduces anti-tTG IgA antibody strict gluten-free diet. gluten free diet.
(autoimmune diarrhea, gas, subcutaneous fat,
disorder caused by an dyspepsia, wt loss. ataxia, & peripheral Some people with
immunologic neuropathy (vitamin celiac disease have
response to gluten) A family member with Atypical symptoms: Total IgA (2% of pts Referral to a dietician to vitamin or nutrient
celiac disease or B12 deficiencies) have IgA deficiency help.
fatigue, deficiencies that do
dermatitis herpetiformis osteoporosis or and will falsely test not cause them to
bone or joint pain, osteopenia (bone negative) feel ill, such as
arthritis, loss) Some pts may need anemia due to iron
Type 1 diabetes treatment with deficiency or bone
osteoporosis, or hypothyroidism duodenal biopsies immunomodulating loss due to vitamin
osteopenia (bone loss) agents. D deficiency.
However, these
Down syndrome or liver and biliary tract
Turner syndrome Pts with dermatitis Test for nutritional deficiencies can
disorders herpetiformis found cause problems
(transaminitis, fatty deficiencies
to have signs of celiac associated with over the long term.
liver, primary disease on intestinal
Autoimmune thyroid sclerosing cholangitis, malabsorption of C.D. Untreated
biopsy. (hemoglobin, iron,
disease celiac/developing
depression or anxiety folate, vit B12, certain types of
Calcium, and Vitamin gastrointestinal
peripheral neuropathy D.) cancer. This risk can
Microscopic colitis seizures or migraines
be reduced by
(lymphocytic or
missed menstrual eating a gluten-free
collagenous colitis)
periods diet.
infertility or recurrent
Addison's disease miscarriage
canker sores inside the
, NR511 Midterm Study Guide Worksheet
mouth
dermatitis
herpetiformis (itchy
skin rash)
Cholelithiasis is the formation of Patient complaint of Right side involuntary Mild elevation of a. Initial management-- Nonsurgical
gallstones and is found indigestion, nausea, guarding of WBC up to 15, 000 begins with definitive intervention: weight
in 90% of patients with vomiting (after abdominal muscles, diagnosis. When loss, avoidance of
cholecystitis. consuming meal high Positive Murphy's Abdominal Xray: asymptomatic (normally fatty foods to
in fat), and pain in RUG sign, possible palpable Quick, noninvasive, an incidental finding while decrease attacks,
--Risk factors--2 types of or epigastrium that gallbladder, Low reliable, and cost- exploring another alternative birth
stones (cholesterol and may radiate to the grade fever between effective means of problem) require no control for persons
pigmented) middle of the back, 99-101 degrees. identifying the further treatment except taking oral
infrascapular area or Possible jaundice presence of teaching s/sx of contraceptives,
a. Cholesterol (most cholelithiasis.
common form): female, right shoulder. from common bile "gallbladder attack". menopausal women
obesity, pregnancy, duct edema and Nonsurgical candidate can taking estrogen
increased age, drug- diminished bowel be treated with dissolution informed about
induced (oral sounds. therapy or lithotripsy. alternative sources
contraceptives and Acute includes hydration of phytoestrogens
clofibrates: cholesterol (IV fluids), antibiotics, (soy products).
lowering agent), cystic analgesics, GI rest.
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 age, percutaneously.
hyperalimentation
(artificial supply of
nutrients, typically IV),
cirrhosis, biliary stasis,
chronic biliary
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