NURS 623 Exam 3 - Questions and Answers Describe the clinical presentation of appendicitis? (Subjective and objective findings) Vague symptoms first 24
... [Show More] hours, worse when walking or jumping, N/V, low grade temp, +Rovsings, Psoas, obturator, mcburneys Describe the various maneuvers for diagnosing appendicitis? ROVSING'S: Deep Papation LLQ do sudden unexpected release; Positive if causes Tenderness to RLQ. PSOAS: Pt on back and raise RT leg against pressure or on left side extend RT leg at hip; Positive if increased pain OBTURATOR: Pt on back with the right hip and knee flexed the examiner slowly rotates the right leg internally; Positive if pain over RLQ McBURNEY'S: pressure applied to McBurney's point (halfway between the umbilicus and the anterior spine of the ilium); Positive if pain with pressure applied Describe the clinical presentation for Gastroesophageal Reflux Disease (GERD)? heartburn, regurgitation, water brash (reflex salivation), sour taste in morning, belching, coughing, and hoarseness. Objective: only sign may be occult blood in stool. How is GERD diagnosed (when to refer to GI)? With symptoms, sometimes with upper endo; refer if failed treatment of step 2- after 6 weeks of treatment Discuss the patient education regarding lifestyle changes for management of GERD. lifestyle changes including diet weight loss, raising the head of their bed 6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes, wearing loose comfortable clothing, and starting a routine exercise and weight loss program Describe medical management of GERD? step-up: LIFESTYLE changes, PRN OTC H2ra and antacid; PPI; referral Step-down: starts with PPI then step down until Sx under control 46 year old male complains of dysphasia hoarseness and cough he states he wakes up with a sour taste in his mouth. What is the most likely cause of the patient symptoms? GERD Management of peptic/gastric ulcer *relieve pain, heal the ulcer, and prevent complications/reoccurrence *PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI, antacids, antibx w/H-pylori) Describe the diagnosis criteria IBS 3 Criteria: 1. pain relieved by defacation or change in BMs for 3 months 2. BM with patterns of constipation/diarrhea 25% of the time 3. 2 features of either: altered frequency, form, sensory act of defecation or varied bloating and pain What are the risk factors are associated with Cholelithiasis? [Show Less]