NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest UPDATE GRADED A+, Exams of Nursing

Download NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest UPDATE GRADED A+ and more Exams Nursing in PDF only on Docsity!

UPDATE GRADED A+

NR 601 Final exam review Weeks 5-8 content Week Topics 5 Dunphy: Chapter 58: Diabetes Mellitus p. 909- Kennedy : ⮚ Chapter 14: Endocrine, Metabolic, and Nutritional Disorders (p. 69-376) ⮚ Obesity (p. 392-396) Glucose metabolism disorders Types of diabetes (prediabetes, type 1 and type 2) ★ PreDmM = glucose intolerance, Islet cell–specific antibodies, Screening for prediabetes and DM should be considered in all individuals who are overweight or obese, regardless of age, and for all adults aged 45 years and older. ★ Type I - severe insulin deficiency resulting from beta cell destruction, which produces hyperglycemia due to the altered metabolism of lipids, carbohydrates, and proteins ★ Type II - abnormal secretion of insulin, resistance to the action of insulin in the target tissues, and/or an inadequate response at the level of the insulin receptor. Types of diabetes- Two types: Type 1 and Type 2- Improper function of the hormone insulin, secreted by the pancreas. Hyperglycemia is a hallmark sign of diabetes. Prediabetes: Impaired glucose tolerance (IGT) describes a prediabetic state of hyperglycemia where a 2-hour post-glucose load glycemic level is 140 to 199 mg/dL. ★ Type 1 (insulin deficiency)- Presents mostly during childhood. Genetic predisposition plus some sort of environmental trigger. Results in an auto-immune disorder in which the immune system attacks the beta cells of the pancreas to prevent them from producing insulin (decreases production). Inhibits this first step in the insulin pathway. ★ Type 2 - Presents mostly during adulthood. Strongly associated with a genetic predisposition. Accompanied with other predisposing conditions, such as obesity or hypertension. Inability of these cells throughout the body to respond to insulin. The pancreas continues to secrete insulin. The cells throughout the body that are unable to adequately respond to it. ★ Miscellaneous ★ Drug-induced diabetes- caused by medications Most commonly occurs with a group of medications that are known as glucocorticoids (steroids) such as in asthma or chrons. ★ Gestational diabetes Presentation: acute, subacute, and asymptomatic ★ Acute: most severe presenting situation and can be life threatening for both type I and type II diabetes. very sick over a relatively short period of time, usually only a couple of days. S/S: nausea, vomiting, and abdominal pain leads to severe dehydration. Confusion or unconscious as a result. In type I diabetes, this is known as diabetic ketoacidosis. 30% of individuals with type I diabetes will initially present before diagnosis. DKA- acidotic due to the production of ketoacids Type 2 diabetes: 2% of individuals hyperosmolar nonketotic state- ketones are not produced. Can occur with either type I or type II diabetes.

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

★ Subacute: mild to moderate presentation that occurs over a period of weeks to months. S/S: Generally, just not feeling as well. Fatigue, increased thirst, frequent urination, or even weight loss. Most common form of presentation in Type 1 diabetes (70%). ★ Asymptomatic screening tests: Type II diabetes affects nearly 10% of the population. Those with the risk factors of type II diabetes should be routinely screened. Most common means

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

by which type II diabetes is diagnosed. ★ Diagnostic criteria - ADA criteria for diagnosing DM- ★ Random BG >200 (week 5 quiz question) ★ 3 Ps of DM: polyphagia, polydipsia, polyuria (week 5 quiz question) ★ FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hrs ★ 2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75-g anhydrous glucose load dissolved in water. ★ A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay. ★ In a patient with classic s/s of hyperglycemia or hyperglycemic crisis (polyuria, poly dipsia, weight loss), a random plasma glucose ≥200 mg/dL (11.1 mmol/L) Current guidelines for the diagnosis of DM include any one of the following:

• Glycosylated hemoglobin (A1C) of 6.5% or higher
• Symptoms of diabetes (e.g., polyuria, polydipsia, weight loss) plus a random plasma glucose level of 200 mg/dL or higher
• Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloric intake)
• Two-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test (OGTT) with a 75-g glucose load Diagnostic testing: laboratory tests. The hyperglycemia and the hemoglobin A1C are tested for in the blood to aid in the diagnosis of diabetes mellitus. Hemoglobin A1C: greater than or equal to 6.5% Blood glucose levels: greater than or equal to 200 mg/dL. ★ Random- cannot be used to diagnose pre-diabetes. ★ Fasting- slightly lower, then the level is 126 mg/dL. ★ Two-hour glucose tolerance test ★ Initial treatment recommendations ★ If FPG is above 126, next action: order A1C (week 5 quiz question) ★ Treatment goals for older adults (Kennedy table 14-2)

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

provided this can be achieved without hypoglycemia or other adverse effect. ★ Weight loss recommendations (Kennedy) ★ modest weight loss of 5% can improve glycemic control Risk factors (Dunphy p.922) ★ Family history (first-degree relative) ★ Body mass index >25 kg/m2 (lower for Asian Americans) ★ Age >45 years ★ Impaired fasting glucose or A1C >5.7% ★ History of gestational diabetes ★ Hypertension (> 140/90 mm Hg or on antihypertensive therapy) ★ Hyperlipidemia (high-density lipoprotein <35 mg/dL, triglycerides >250 mg/dL) ★ Women with polycystic ovarian syndrome ★ Race/Ethnicity

• African American
• Latino
• Native American
• Asian American
• Pacific Islander Complications (Dunphy p.919) ★ Type 1 DM, the risk of development or progression of retinopathy, nephropathy, hyperlipidemia, and neuropathy ★ Most common s/e of DM: Yeast infections (week 5 quiz question) : page 932 Dunphy
• Retinopathy - Optimizing blood pressure and lipid levels can reduce the risk or slow the progression of retinopathy.
• Hyperlipidemia - an annual fasting lipid profile, including serum cholesterol, triglyceride, HDL, and calculated LDL cholesterol measurements. Lifestyle management (i.e., modifications to diet and physical activity), pharmacologic therapy. The purpose of treatment is to reduce cardiovascular events.
• Diabetic Kidney disease - A routine spot UACR (normal < 30 mcg albumin/mg creatinine) and eGFR should be performed annually on all diabetic patients. Maintaining normal serum glucose levels, controlling BP is the most effective method to slow or reduce the risk of diabetic kidney disease. ACEIs or ARBs are the recommended treatment for patients with DM and hypertension, abnormally high UACR, or a lower than normal eGFR.
• Hypertension - Systolic blood pressure should be less than 140 mm Hg and diastolic blood pressure below 90 mm Hg. A lower blood pressure goal of 130/80 mm Hg may be appropriate for patients at high risk for cardiovascular events. Treatment can be with ACEIs, ARBs, thiazide-like diuretics, or dihydropyridine calcium channel blockers.
• Macrovascular disease - Evidence of uncontrolled angina, carotid bruits, or ECG abnormalities may require advanced intervention and calls for referral to a cardiologist.

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

diagnosis and then at least annually. Patients with significant urinary symptoms or impotence should be referred to a urologist.

• Pregnancy- every pregnancy in a woman with type 2 DM should be planned. Insulin is the first-line medication for the treatment of diabetes in pregnancy.
• Hypoglycemia
• DKA – Dunphy pg 914 table 58.
• HHS – Dunphy pg 920 table 58. Treatments for complications ★ Metformin – contraindicated in renal disease, abnormal creatinine clearance, acute MI, or septicemia (week 5 quiz question) Hypoglycemia is a medical emergency because of the seriousness of potential sequelae (e.g., seizures, coma, cardiovascular dysfunction, death). Initial testing for suspected hypoglycemia includes measurement of the blood glucose level. Hypoglycemia is typically diagnosed if the patient experiences a decrease in blood glucose concentration of greater than 100 mg/dL per hour or a blood glucose level of less than 50 mg/dL at any point during the test. The treatment of acute hypoglycemia for alert patients who can ingest by mouth is 6 to 12 ounces of orange juice or other fruit juice without additional sugar. The long-term management of hypoglycemia includes treatment of its underlying causes and dietary modifications as needed. SMBG is the cornerstone of long-term self-management of hypoglycemia. Treatment of choice for insulinoma is surgical resection Obesity o Comorbidities related to obesity ★ type 2 diabetes, hypertension, sleep apnea, nonalcoholic fatty liver disease, hyperlipidemia, osteoarthritis, or heart disease Coronary heart disease/congestive heart failure
• Hypertension
• Dyslipidemia/hyperlipidemia
• Type 2 diabetes mellitus/insulin resistance
• Metabolic syndrome
• Sleep apnea
• Restrictive lung disease
• Asthma
• Varicose veins and venous insufficiency
• Gout/hyperuricemia
• Osteoarthritis
• Reflux esophagitis
• Gallbladder disease
• Thromboembolic disease
• Cancers: Endometrial, breast, prostate, colon o BMI classifications (Kennedy)

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

• 25.0-29.9 Overweight
• 30.0-34-9 Class I obesity
• 35.0-39.9 Class II obesity

• 40.0 Class III extreme obesity Facts: If an individual has symptoms of diabetes, then only one positive test, either the blood glucose or the hemoglobin A1C is necessary for the diagnosis of diabetes mellitus. If the individual is asymptomatic, then a diagnosis of diabetes mellitus requires two positive tests that are separated by at least one week of time. Often individuals will have a test result that is above the normal level however not severe enough to be considered diabetes and this is known as pre-diabetes. As the blood glucose levels in the body rise, this is sensed by the beta cells in the pancreas (secrete the hormone insulin). Insulin then acts on cells throughout the body to take the glucose from the blood up and thus lower the blood glucose levels. In diabetes mellitus, this insulin pathway is not working properly, therefore the body is not able to lower blood glucose levels. This results in increased blood glucose (hyperglycemia), characteristic finding of diabetes mellitus. A side effect of hyperglycemia is a process known as glycosylation, which is the non-enzymatic attachment of glucose to proteins. And one protein that this occurs with that is of importance in diabetes mellitus is the protein hemoglobin (located within red blood cells). In the presence of hyperglycemia, glucose will attach itself to an abnormally high percentage of hemoglobin within the red blood cells (known as glycosylated hemoglobin, or hemoglobin). The complications of inadequately treated DM include cardiovascular and peripheral vascular disease (PVD), decreased immune system functioning, renal failure, retinopathy, and nephropathy

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

6 Dunphy: ⮚ Incontinence p. 628- ⮚ Lower Urinary Tract Disorders p. 636- ⮚ Menopause p. 716- ⮚ Erectile dysfunction p.761- ⮚ Advanced Assessment 43.1 Urinalysis p. 624 Kennedy : ⮚ Chapter 5: Symptoms and Urology and aging (Kennedy) Complicated UTI ★ acute or chronic infection with factors that predispose a patient to the infection or make treatment more difficult, such as instrumentation (e.g., indwelling, suprapubic, or intermittent catheterization), underlying chronic disease, systemic symptoms, or pregnancy. Uncomplicated UTI ★ Resolves without addressing other factors and is localized to the lower urinary tract UTI risk factors, differences based on gender ★ Women = gram-negative rod bacterium Escherichia coli. ★ Second most common is gram-positive coccus Staphylococcus saprophyticus ★ Men - abnormal urethral anatomy or inadequate treatment of prostatitis ★ asymptomatic bacteriuria, patients experience no obvious clinical symptoms or signs of UTI ★ dysuria–pyuria syndrome (also called “acute urethral syndrome”) is characterized by painful urination with WBCs on microscopic urinalysis in the absence of a positive

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Syndromes (Urinary Incontinence section only) bacterial culture (possibly Chlamydia) ★ contamination from the patient’s own gastrointestinal tract. ★ Bacteria from fecal contamination secondary to poor perineal hygiene, unprotected p. 83- ⮚ Chapter 11: Urological and Gynecological Disorders: sexual (particularly anal) intercourse, and/or an anatomically shortened urethra in women UTI risk factors : Indwelling Catheters, urethral or condom catheters, incontinence (urinary and fecal), cognitive impairment, neurological conditions that impair bladder emptying, and diabetes. Sexual o Atrophic intercourse, functionality disability, sickle cell, prior antibiotic use, genetic predisposition, functional vaginitis p. 282- or structural genitourinary tract abnormalities. o Cystitis p.289- 291 o Erectile Differences based on gender: Women have a higher percentage of UTI. This is due to the Urethra being shorter in women than men. dysfunction p.297- UTI pathophysiology- common bacterial causes ★ Escherichia coli ★ Staphylococcus saprophyticus ★ Proteus mirabilis, Klebsiella, Enterobacter, Serratia, and Pseudomonas. ★ Enterococcus ★ Staphylococcus aureus ★ Fungi, particularly Candida ★ Urease gene, expressed by certain gram-negative bacteria such as Proteus, Klebsiella, Ureaplasma, Providencia, and Pseudomonas species. UTI Pathophysiology: Cystitis is a pathogenic invasion of the wall of the bladder, usually resulting from an ascending infection via the urethra, of bowel flora organisms from the perineum. Common Bacterial Causes- E.- coli. (Most common), Klebsie l a,Proteus,andEnterococcus. UTI diagnostic criteria and when to treat (review discussion) ★ presence of bacteria, especially if more than 100,000 organisms/mL ★ Urine culture is gold standard ★ UA with pyuria (greater then 10 neutrophils & RBCs ★ Interstitial cystitis – dx by potassium sensitivity test (put 40mL of sterile water in bladder by foley, wait 5 min determine level of pain 0-5, then put 0.4M of KCL, wait 5min & see if pain). UTI diagnostic criteria and when to treat- Urinalysis with culture, Treatment is based on the need of patient. Incontinence - Urinary incontinence ★ Involuntary loss of urine from the bladder ★ So common in women many consider it normal ★ Common in older men w/ enlarged prostate ★ Can affect quality of life ★ Significance-One of the most common complains w/ older adults, Distress & embarrassment, Cost burden to pt & society as a whole, Not life-threatening, may

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

effect QOL, PCP essential to educating individuals ★ Epidemiology- Increased prevalence w/ age in men & women, Nursing home population – 40-70%, Often a factor in placement ★ URGENCY UI is greater in men ★ STRESS UI is greater in women ★ Overflow incontinence is usually associated with: Bladder outlet obstruction ★ Meds

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

★ Oxybutynin (anticholinergic/antispasmodic) – urge, stress & OAB ★ Flomax (Alpha1 blocker)– BPH ★ Amitriptyline (tricyclic antidepressant) – OAB, Urge ★ Botox - OAB ★ Terminology ★ UI- Unintentional voiding, loss or leakage of urine ★ Continuous incontinence-Continuous loss or leak of urine ★ Increased daytime frequency-More frequent during day than considered normal ★ Nocturia-Interruption of sleep one or more times due to the need to urinate – increases in frequency after age 50 ★ Urgency-Sudden, compelling desire to pass urine that’s difficult to prevent ★ Overactive bladder syndrome- Urgency, frequency, nocturia w/ or w/o incontinence Incontinence: Urinaryincontinence(UI)isaninvoluntarylo s o furine. Stress incontinence- Urineleakagea s ociatedwithincreasedabdomin alpre s urefromlaughing, sneezing,coughing,climbingstairs,orotherp hysicalstre s orsincreasingabdominalpre s ure Urge incontinence- Urineleakagea s ociatedbyorimmediatelyprece dedbythefeelingofanurgent n e dtovoid Overflow- Urineleakagewhenthebladderisover- distendedandmayresultinincompletebladder emptyingSymptomscanpresentasconstantdribb ling,frequency,hesitationwheninitiatinguri nation, andnocturiaOftena s ociatedwithbladderoutlet obstruction,suchasbenignprostatichypertrop hyin menandpelvicorganprolapseinwomen Functional- Theinabilitytoholdurineduetoreasonsothert hanneurologicalandlowerurinarytract dysfunctionincludingdelirium,psychiatricdi sorders,UTI,impairedmobility Mixed- Acombinationofstre s andurgeincontinence,mar kedbyinvoluntaryleakagea s ociatedwith urgencyandalsowithexertion,effort,sneezing, orcoughing

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Dysuria ★ Pain & burning with urination ★ r/t inflammatory lesion or bladder/urethral infection ★ most common lower UTI ★ Meds that cause Dysuria: SSRI, Opiates, Scopalamine ★ Less common causes: tumor, renal failure, nephrolithiasis, STDs Causes of hematuria and proteinuria ★ Hematuria – blood in urine (3 RBCs or more) ★ Gross (can be seen in urine) or Occult (visible by microscope) ★ Transient – on occasion or Persistent – two or more consecutive occasions ★ Athletes (long distance runners) common to get hematuria ★ Foods that mimic hematuria – beets. ★ Causes – caffeine, spices, tomatoes, chocolate, alcohol, citrus, soy sauce, some herbal meds ★ Meds that cause – beta-lactam abx, sulfonamides, NSAIDs, cipro, Allopurinol, Tagamet, Dilantin ★ Anticoags to consider – warfarin, heparin, Asa, NSAIDs ★ Hematuria in men over 50 – work up for risk of urinary tract malignancy ★ Hematuria with Cast = indicate a renal origin Causes of Hematuri a: Dietary substances such as beets mimic hematuria only , medications,

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Urolithiasis, and menses. ★ Proteinuria ★ Typically renal pathology (Glomerular) ★ Functional r/t illness, stress or exercise ★ Mild transient – r/t fever, CHF, acute pulm edema, head injury or stroke (will improve at pt improves) ★ Can result from overproduction of filterable plasma protein, assoc w/ multiple myeloma ★ Bence Jones proteins r/t multiple myeloma, lymphosarcoma, leukemia and Hodgkin’s disease. ★ Urine dip is most sensitive to larger proteins like albumin not Bence Jones proteins ★ BEST Test is 24-hr urine (↑160mg of protein in 24hrs is abnormal) ★ More than 3.5G is indicative of nephrotic disease ★ Nonfunctional proteinuria do 24hr urine (protein & creatine), if excretion is above 3.0-3.5G per day, pt has nephrotic syndrome (refer to nephrology) ★ Diff Dx = orthostatic proteinuria, exercise, environmental conditions, fever, acute illness, albumin transfusion, heart failure, acute pulmonary edema, cerebral vascular accident or head injury. Causes of proteinuria: Proteinuria can be functional- related to illness, stress or exercise. Mild transient proteinuria can result from fever, congestive heart failure, acute pulmonary edema, head injury or stroke. Proteinuria can develop from an overproduction of filterable plasma protein, which may be associated with multiple myeloma. UA dip interpretation

Advanced Assessment 43.1: Urinalysis

Urinalysis Result Finding/Abnormal Value Common Differential Diagnosis Appearance (^) Colorless Dark Cloudy Pink/red Orange/yellow Brown/black Green Foamy Diabetes insipidus, diuretic agents, fluid overload Hematuria, malignancy, stones, acidic urine Urinary tract infection, hematuria, bilirubin, mucus Hematuria, hemoglobin, myoglobin, beets, food coloring Phenazopyridine (Pyridium), rifampin (rifampicin), bile pigments Myoglobin, bile pigments, melanin, cascara (laxative), iron preparation Bile pigments, methylene blue, indigo carmine (food dye) Proteinuria, bile salts

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Specific gravity Increased Decreased (^) Dehydration, congestive heart failure, adrenal insufficiency, diabetes mellitus, nephrosis, antidiuretic hormone Diabetes insipidus, pyelonephritis, glomerulonephritis, excess fluid intake pH Acidic Alkaline (^) Diet, medications, acidosis, ketoacidosis, chronic obstructive pulmonary disease

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Diet, sodium bicarbonate, vomiting, metabolic alkalosis, urinary tract infection Bilirubin Positive Jaundice, hepatitis Blood Positive Kidney stones, tumors, kidney disease, trauma, infection, injury from instrumentation, coagulation problems, menses Glucose Positive Diabetes mellitus, pancreatitis, Cushing’s disease, shock, burns, corticosteroids, renal disease, hyperthyroidism, cancer Ketones Positive Starvation, diet, ketoacidosis, vomiting, diarrhea, pregnancy Nitrate Positive Infection Protein Positive Kidney disease, pregnancy, congestive heart failure, diabetes mellitus, cancer, benign cause Leukocyte esterase Positive Infection Reducing substance Positive (^) Signifies the presence of glucose, fructose, or galactose, lactose, pentose May also signify certain medications (e.g., salicylates, levodopa, ascorbic acid, nalidixic acid, tetracyclines) Liver disease, hyperthyroidism Sexuality and aging (Dunphy ch51) STIs ★ Common STIs include herpes simplex virus (HSV), human immunodeficiency virus (HIV), human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Treponema pallidum (the causative agent of syphilis). ★ Less common STIs include chancroid (Haemophilus ducreyi), donovanosis or granuloma inguinale (Klebsiella granulomatis), mycoplasma genitalium, and lymphogranuloma venereum. In addition, hepatitis B virus (HBV), hepatitis C virus (HCV), molluscum contagiosum, pediculosis pubis, scabies, and methicillin-resistant Staphylococcus aureus ★ Common vaginal infections, such as Candida infections and bacterial vaginosis (BV) TABLE 51.1 Sexually Transmitted Infections CDC Treatment Diagnostic Recommendations Pathogen Clinical Presentation Reasoning (2015)

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Chancroid Haemophilus ducreyi Painful, irregularly shaped, deep red ulcer with red halo and undermined edges. Found on the penis, labia, fourchette, and Risk factors: coinfection with HIV, HSV, or syphilis. Test patients for HIV at time of Azithromycin 1 g orally single dose OR Ceftriaxone 250-mg intramuscular injection single dose

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

vaginal walls. Painful inguinal adenopathy with buboes. Females may have multiple lesions and may be asymptomatic. diagnosis. Definitive diagnosis is obtained with culture (no FDA- approved PCR test available in United States).

OR

Ciprofloxacin 500 mg orally twice a day for 3 days OR Erythromycin base 500 mg orally four times a day for 7 days LGV Chlamydia trachomatis Primary lesion: small painless erosion that heals quickly Inguinal stage: inguinal lymphadenopathy; may have headache, fever, and polymyalgia Late stage: anorectal swelling, perirectal abscesses, fistulae, swelling and ulcerations on labia Risk factors: history of travel and sexual contact in endemically infected area. Diagnosis is confirmed with serological LGV complement fixation test; suspect if titer above 1:16 and diagnostic if titer above 1:64. Doxycycline 100 mg orally twice a day for 21 days OR Erythromycin base 500 mg orally four times a day for 21 days. Granuloma inguinale (donovanosis) Klebsiella granulomatis Initial papule progresses into a painless, broad, superficial ulcer with clean, sharp rolled edges; may spread to inguinal folds. Lesion may be friable. Genital edema may occur. Late development of perianal fistulae and abscesses. Risk factors: history of travel and sexual contact in endemically infected area. Diagnosis: Cannot be cultured; most reliable diagnostic method is direct visualization of Donovan bodies (i.e., rod-shaped, oval bacteria in the cytoplasm of mononuclear phagocytes or histiocytes) on stained tissue samples. Azithromycin 1 g orally weekly for 3 weeks or 500 mg daily for 3 weeks OR Doxycycline 100 mg orally twice a day for 3 weeks OR Ciprofloxacin 750 mg orally twice a day for 3 weeks OR Trimethoprim- sulfamethoxazole 160 mg/800 mg one tablet orally twice a day for 3 weeks OR Erythromycin base 500 mg orally twice a day for 4 weeks

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Genital HSV (^) Multiple painful vesicular or ulcerated lesions that may last 12 days in the initial outbreak or 4–5 days in recurrent outbreaks. NAAT (PCR assays for HSV DNA) Type-specific serology testing is available and useful when developing First episode: Acyclovir 400 mg orally three times a day for 7– 10 days OR

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Flu-like symptoms (common with first outbreak), adenopathy, and tingling at the site before outbreak. plan of care. Acyclovir 200 mg orally five times per day for 7– 10 days OR Valacyclovir 1 g orally twice a day for 7–10 days OR Famciclovir 250 mg orally three times a day for 7–10 days Recurrent episodes: Acyclovir regimens 400 mg orally three time a day for 5 days 800 mg orally twice a day for 5 days 800 mg orally three time a day for 2 days OR Valacyclovir regimens 500 mg orally twice a day for 3 days 1 g orally once a day for 5 days OR Famciclovir regimens 125 mg orally twice a day for 5 days 1 g orally twice a day for 1 day 500 mg orally once and then 250 mg orally twice a day for × 2 days Suppression therapy: Acyclovir 400 mg orally twice a day OR Valacyclovir 500 mg orally once a day OR Valacyclovir 1 g orally once a day OR s

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Molluscum contagiosum Pox virus Usually asymptomatic Pearly, raised, painless, flesh-colored lesions (mollusca) with umbilicated (dimpled) centers; may be diffuse or singular; may be self-limited Diagnosis is based on visual inspection of characteristic lesions. No treatment; lesions may last months to years and often heal spontaneously. Once healed, the patient has lifetime immunity to the virus. Physical treatments to remove lesions, such as cryotherapy or curettage may be considered in extreme cases or for lesions in unsightly areas, but these methods may lead to scarring.

,

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Syphilis Treponema pallidum Primary: painless ulcer at initial site of contact (chancre), adenopathy Secondary: maculopapular rash on the palms and soles, flu-like symptoms, mucocutaneous lesions, lymphadenopathy Tertiary/late: cardiac, neurologic, ophthalmic, auditory, and gummatous lesions Risk factors: test all patients for HIV and other common STIs. Definitive diagnosis: dark- field microscopy positive for spirochetes. Presumptive diagnosis:

1. Nontreponemal test (VDRL or RPR)
2. Confirmation with treponemal test (e.g., FTA- ABS, TP-PA) Treatment is driven by staging. Primary and secondary or early latent (<1 year since infection) Benzathine PCN G 2.4 million units intramuscularly one time If PCN allergy: Doxycycline 100 mg orally twice a day for 14 days OR Tetracycline 500 mg orally four times a day for 14 days OR Ceftriaxone 1 g intramuscularly or intravenously daily for 8–10 days Late latent, latent of unknown duration, or tertiary with normal cerebrovascular fluid examination: Benzathine penicillin B 2.4 units intramuscularly once a week for 3 doses If PCN allergy: Tetracycline 400 mg orally four times a day for 4 weeks OR Doxycycline 100 mg orally twice a day for 4 weeks

:

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Neurosyphilis and ocula syphilis: Aqueous crystalline penicillin G 3–4 million units intravenously every 4 hours for 10–14 days (or continuous infusion). Alternate therapy if compliance is assured: Procaine penicillin 2.4 million units intramuscularly daily PLUS Probenecid 500 mg orally four times a day for 10-14 days If PCN allergy: Desensitize and treat with penicillin as above OR Ceftriaxone 2 g intramuscularly/intraven ously once a day for 10– 14 days r Trichomoniasis Trichomonas vaginalis Most infected persons have minimal or no symptoms. Some infected women may have diffuse, frothy, malodorous, or yellow-green discharge and vulvar irritation. Infected men may have symptoms of urethritis, epididymitis, or prostatitis. Vaginal pH >5; cervical smear wet mount shows motile protozoa and WBCs. Strawberry cervix may rarely be noted on examination. NAAT is highly sensitive: APTIMA T. vaginalis assay, amplified DNA Assay. In men, obtain penile-meatal swab. Rapid testing is available. Metronidazole 2 g orally for one dose OR Tinidazole 2 g orally for one dose OR Metronidazole 500 mg orally twice a day for 7 days Avoid alcohol consumption during treatment with metronidazole.

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

Urethritis Neisseria gonorrhoeae (most common) Nongonococcal Urethritis (NGU) Chlamydia May be asymptomatic Dysuria, urethral pruritus, mucoid or purulent discharge Microscopic examination of urethral secretions will show WBCs and GNID or MB/GV purple intracellular Treat with drug regimens recommended for N. gonorrhoeae and C. trachomatis. M. genitalium responds better to azithromycin than doxycycline.

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest

UPDATE GRADED A+

trachomatis, Mycoplasma genitalium diplococci. Test all patients for C. trachomatis; test men with NGU for HIV and syphilis. In men, complications of NGU include epididymitis, prostatitis, and reactive arthritis. No FDA-approved test for M. genitalium. Gonorrhea Neiss eria gonorrhoeae Usually asymptomatic. Partner may have an infection, requiring treatment. Women may report purulent, yellow, or green vaginal discharge; bleeding or pain with intercourse; and pelvic pain; may have inflammation of Skene’s and Bartholin’s glands. Men may report inflammation of the urethra, discharge, and dysuria. Gonococcal culture and NAAT Women: endocervical swab Men: urethral swab Primary therapy: Ceftriaxone 250 mg intramuscularly for one dose PLUS Azithromycin 1 g orally for one dose Alternative therapy (less effective): Cefixime 400 mg orally for one dose PLUS Azithromycin 1 g orally for one dose If azithromycin allergy: Doxycycline 100 mg orally twice a day for 7 days AND test of cure in 1 week. Follow CDC guidelines for complicated or refractory gonorrhea; consider EPT.

NR 601 Final Exam Study Guide / NR601 Final Exam Study Guide. Latest