NR 511 Completed Midterm study guide
NR 511 Completed Midterm study guide for real
NR511 Midterm Study Guide Worksheet
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Disease ... [Show More] 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 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-abdominal
tumors, positive family
hx
- Recent roundworm
infection or viral GI
infection
-Dx made clinically,
based primarily on
H&P exam
- 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
walking\coughing
- Men may feel
radiated pain in testes
- Abd muscle rigidity,
N\V, 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.
-May have HTN\tachy
proportional to
pain\symptoms
-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
-Labs are not
diagnostic and
nonspecific
-Women should have
urine human
chorionic
gonadotrophin to r\o
ectopic pregnancy
- +Rovsing’s Signdeep palpation &
release in LLQ causes
rebound pain in RLQ
- +Psoas Sign- lift R
leg against gentle
pressure causes pain
- +Obturator Signflex R hip & knee and
slowly rotate
internally causes pain
- +McBurney’s Signpain with pressure
applied to point
between umbilicus &
ilium
- x-ray\CT helpful
when paired with
positive H&P findings
-Surgical; preoperative
care, NPO, correction of
fluid\electrolyte
imbalances
-Avoid narcotics
-Atb with 3rd gen
cephalosporin; Ex:
ampicillin, gentamycin,
flagyl
-F\U with surgeon
-Ambulation after
surgery
-Adv diet when
bowel sounds
return
-Return to hosp
with s\s 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 or
dermatitis herpetiformis
Type 1 diabetes
Many asymptomatic.
May complain of
diarrhea, gas,
dyspepsia, wt loss.
Atypical symptoms:
fatigue,
bone or joint pain,
arthritis,
osteoporosis, or
Muscle wasting
(anemia), reduces
subcutaneous fat,
ataxia, & peripheral
neuropathy (vitamin
B12 deficiencies)
osteoporosis or
osteopenia (bone
loss)
Serologic testing for
anti-tTG IgA antibody
Total IgA (2% of pts
have IgA deficiency
and will falsely test
negative)
duodenal biopsies
lifelong adherence to a
strict gluten-free diet.
Referral to a dietician to
help.
Some pts may need
treatment with
immunomodulating
teaching related to
gluten free diet.
Some people with
celiac disease have
vitamin or nutrient
deficienciesthat do
not cause them to
feel ill, such as
anemia due to iron
Down syndrome or
Turner syndrome
Autoimmune thyroid
disease
Microscopic colitis
(lymphocytic or
collagenous colitis)
Addison's disease
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
cankersores inside the
mouth
dermatitis
herpetiformis (itchy
skin rash)
hypothyroidism
Pts with dermatitis
herpetiformis found
to have signs of celiac
disease on intestinal
biopsy.
Test for nutritional
deficiencies
associated with
malabsorption of C.D.
(hemoglobin, iron,
folate, vit B12,
Calcium, and Vitamin
D.)
agents. 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. Thisrisk can
be reduced by
eating a gluten-free
diet.
Cholelithiasis is the formation of
gallstones and isfound
in 90% of patients with
cholecystitis.
--Risk factors--2 types of
stones (cholesterol and
pigmented)
a. Cholesterol (most
common form): female,
obesity, pregnancy,
increased age, druginduced (oral
contraceptives and
clofibrates: cholesterol
lowering agent), cystic
fibrosis, rapid weight
loss, spinal cord injury,
Ileal disease with
extensive resection,
Diabetes mellitus,sickle
cell anemia.
b. Pigmented: hemolytic
diseases, increasing age,
hyperalimentation
Patient complaint of
indigestion, nausea,
vomiting (after
consuming meal high
in fat), and pain in RUG
or epigastrium that
may radiate to the
middle of the back,
infrascapular area or
right shoulder.
Right side involuntary
guarding of
abdominal muscles,
Positive Murphy's
sign, possible palpable
gallbladder, Low grade
fever between 99-101
degrees. Possible
jaundice from
common bile duct
edema and
diminished bowel
sounds.
Mild elevation of
WBC up to 15, 000
Abdominal Xray:
Quick, noninvasive,
reliable, and costeffective means of
identifying the
presence of
cholelithiasis.
a. Initial management--
begins with definitive
diagnosis. When
asymptomatic (normally
an incidental finding while
exploring another
problem) require no
further treatment except
teaching s/sx of
"gallbladder attack".
Nonsurgical candidate can
be treated with dissolution
therapy or lithotripsy.
Acute includes hydration
(IV fluids), antibiotics,
analgesics, GI rest.
b. Treatment of choice for
Acute cholecystitis is early
surgical intervention after
stabilization. Poorsurgical
risk may benefit from
cholecystectomy
operatively or
percutaneously.
Nonsurgical
intervention: weight
loss, avoidance of
fatty foods to
decrease attacks,
alternative birth
control for persons
taking oral
contraceptives,
menopausal women
taking estrogen
informed about
alternative sources
of phytoestrogens
(soy products) [Show Less]
