NR 511 Midterm Exam Study Guide, Exams of Nursing

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NR511 Midterm Study Guide Worksheet Disease Appendicitis Risk: age 10-30; men twice as likely as women; diet low in fiber, high in fat and highin refined sugars and other carbs Subjective: acute onset of mild to severe colicky, epigastric, or periumbilical pain; nausea/vomiting; fever Objective: looks ill; diffuse tenderness with palpation of abdomen — tenderness over RLQ Tests: CBC - mild to moderate leukocytosis; urinalysis — microscopic hematuria or pyuria; x- ray — fecalith, gas-filled appendix, small bowel ileus, deviation in bowel gas pattern, or loss of right iliopsoas shadow; US — to visualize inflamed appendix Treatment 1S line: IV antibiotics, correcting fluid and electrolyte imbalances, bedrest, NPO, NG tube if indicated 2"4 line: surgery Celiac disease Risk: family history, Down’s syndrome, HLA-DQ2 or HLA-DQ8, Turner’s syndrome, or other genetic based autoimmune disease such as Type 1 DM and thyroiditis Subjective: most are asymptomatic; may complain of diarrhea, weight loss, dyspepsia, and flatulence Objective: exam may be normal; signs of malabsorption such as muscle wasting, pallor (anemia), reduced subcutaneous fat, ataxia, and peripheral neuropathy (Vitamin B12 deficiency) Tests: serological testing for anti-tTG IgA antibodies; total IgA; nutritional deficiencies — hemoglobin, iron, folate, vitamin B12, calcium, and vitamin D 1 line: strict gluten-free diet 2"4line: immunomodulating agents Cholelithiasis - gallstones Risk: > 25 y/o; most prevalentin American Indian women; Cholesterol stones: female, obesity, pregnancy, increased Subjective: symptoms vary, generalized GI complaints to intractable pain; indigestion, nausea, and vomiting — especially after a Objective: if pain is severe patient may have involuntary guarding over the RUQ; positive Murphy’s sign w/ palpation over the RUQ; low grade fever; may have Tests: gold standardis abdominal ultrasound During acute phase — mild WBC elevation to 15,000/mL; serum transaminases elevated 1S line for asymptomatic patients: avoid foods high in fat 2"4line: Treatment of choice for acute cholecystitis: