NR511 Completed Midterm Study Guide for real

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