NR511 Final Exam Study Guide, Exams of Nursing

Download NR511 Final Exam Study Guide and more Exams Nursing in PDF only on Docsity! 1 NR511 Final Exam Study Guide Week 5 1. Identify the population most commonly affected by bacterial prostatitis o Acute - Sexually active men 30 to 50 years - Chronic bacterial prostatitis common in men older than 50 years old - Athletes who run long distance are predisposed - Complaints of fever, chills, LBP, malaise, arthralgia, myalgia, frequency, urgency, dysuria, nocturia, and bladder outlet obstruction o Chronic bacterial prostatitis- men over age 50 years of age. Symptoms often absent , perineal pain, lower abdomen pain, scrotal or penile pain, pain with ejaculation, dysuria, irritative voiding 2. Discuss the physical exam characteristics of acute bacterial prostatitis Abdominal exam to detect distended bladder, costovertebral angle tenderness, genital exam, and digital rectal exam Acute bacterial prostatitis- warm, tense, swollen , boggy and very tender prostate. Most common pathogen Strep faecalis and staph aureus 3. Discuss how the Phren sign can differentiate between testicular torsion and epididymitis Epididymis characteristic is relief of discomfort with elevation of testis. Positive Prehn’s sign = pain relief. Testicular torsion elevation of the affected testicle does NOT relieve the pain (Negative Prehn’s sign = pain is NOT relieved) Epididymis Positive Prehn’s sign = pain relief. Neg = no pain relief = testicular torsion). 4. Discuss common symptoms reported from a patient with BPH Affects men age 40 years and older. 2 Obstructive symptoms include •Decreased stream • Hesitancy •Postvoid dribbling • Sensation of incomplete bladder emptying •Overflow incontinence • Inability to voluntarily stop the urine stream •Urinary retention • Straining Irritative symptoms include •Nocturia • Urinary frequency • Urinary urgency • Dysuria Urge incontinence Erectile dysfunction should be assessed on patient taking finasteride. 5. Discuss the hallmark characteristic of a varicocele The hallmark characteristic of varicocele is the sensation that the testes feel like a “bag of worms.” Varicocele can be bilateral, but if it is unilateral it is almost always on the left side due to the anatomy of the vasculature drainage in the testes. Tortuous veins posterior and above testes can be seen with patient sitting upright Venous engorgement may increase with Valsalva maneuver; resolves when patient lies down. Grade 1 varicocele is one that is palpable only when the patient performs the Valsalva maneuver. Grade 2 varicocele is palpable when the patient is standing. Grade 3 varicocele may be assessed with light palpation and visual inspection 6. Identify the population most affected by testicular cancer Males between the ages of 15 and 35 7. Explain spinal stenosis Narrowing of the spinal canal w/ compression of nerve roots - Congenital or acquired (age) - Most commonly from enlarging osteophytes at the facet joints, hypertrophy of the ligamentum flavum and protrusion/buldging of the intervertebral discs - May produce symptoms by directly pushing on nerve or interrupting the blood supply to nerve Common source of chronic low back pain, seen most with aging. All older people have some 5 11. Identify the number of joints involved in a poly-articular disorder Monoarticular: One joint Periarticular: Two to four joints Polyarticular: Four or more joints 12. Describe the four cardinal signs of joint inflammation 1. Erythema 2. Warmth 3. Pain 4. Swelling 13. Differentiate between DeQuervain’s Tenosynovitis and Carpal Tunnel Syndrome Carpal Tunnel Syndrome : - Peripheral nerve compression of the medial nerve - Caused by repetitive flexion and extension of the wrist or direct compression of medial nerve - Pain and/or numbness are usual presenting symptoms o Burning, tingling, or itching numbness of the hand and fingers, especially the thumb, middle, and index fingers - Most often dominant hand – may be bilateral - Pain increases with wrist flexion or extension - Paresthesia and numbness along thumb, index, long and radial half of ring fingers - Nighttime wakening of N/T in affected limb - Positive Phalen’s test, Positive Tinel’s sign - - - Diagnostics o Median nerve conduction velocity study most useful o xray if limited wrist movement only - Treatment o Rest, splinting o NSAIDS, NO CORTICOSTEROIDS o Vitamin B6, and management of concurrent diseases 6 o Often resolves after pregnancy if symptoms related DeQuervain’s Tenosynovitis - Inflammation involving the synovial sheaths and tendons of the abductor pollicis longus and extensor pollicis longus, and brevis tendons (snuff box) - Pain at base of thumb or at the radial styloid process on abduction and extension of the thumb or on radial side of wrist with lifting - Generally seen in patients that perform pinch-grip activities like using hand tools, sewing, assembly - More often middle-aged women - Physical Exam o Allen’s test o Phalen’s test (negative) o Tinel’s sign (negative) o Confirmed by Finkelstein’s test (grasp the thumb in the palm while you deviate the wrist to the ulnar side) o Xray only if history of trauma - - Treatment o Rest, splinting for 3-6 weeks o NSAIDS o Injected corticosteroids 7 o Tendon release surgery. 14. Differentiate between lateral and medial epicondylitis Lateral epicondylitis (AKA tennis elbow) is an overuse syndrome or tenosynovitis (inflammation involving synovial sheaths surrounding the tendon and the tendon) – typically from wrist extension and pronation and supination of the forearm. Presents with pain (worse with motion such as gripping) in elbow and forearm. Diagnosis made with PE. Xray can be used to r/o other causes of pain. MRI will show severe tenosynovitis but not necessary. Treated with rest, ice, NSAIDS, PT, and possible corticosteroid injections and splinting. Medial epicondylitis (AKA golfer’s elbow) is less common. Overuse syndrome of wrist flexion. Pain on medial epicondyle worsens with wrist flexion. Treated same as lateral epicondylitis. Imaging: Usually unnecessary, but it may be useful if needed to rule out alternative diagnoses. 15. Discuss at least 3 vital body functions which thyroid hormones regulate Body Function Hyperthyroidism Hypothyroidism Metabolic Increased appetite (Polyphagia), Weight Loss, hypercalcemia, K wasting, increased alkaline phosphatase Decreased appetite, Weight Gain General Fatigue, Muscle Atrophy, Tremors Fatigue, decreased libido, hypersomnia, periorbital puffiness Integumentary Diaphoresis, Heat Intolerance, thinning hair, pruritus, onycholysis Hair loss, ankle swelling, cold intolerance, dry cool rough skin, alopecia, dry course thick hair GI Diarrhea, Increase in BM Constipation, nausea, hypoactive bowel sounds, ascites, enlarged tongue Eye Blurred vision, tearing, double vision, decreased visual acuity, photophobia, increased orbital pressure, lid lag, exophthalmos, corneal ulcer N/A Neurological Tremors in hands, hyperactive reflexes Memory deficits, personality changes, hyporeflexia, bradykinesia Cardiopulmonary Palpitations, SOBOE, tachycardia, HTN, CHF, A-Fib Exercise intolerance, bradycardia, cardiac enlargement, pleural effusion 10 20. Identify at least 3 causes of obesity Calorie excess —either overeating or high intake of carbohydrates Food insecurity —eating from a fear of potential hunger or past experience with poor availability of food on a regular basis Genetic predisposition with familial history—influences of ghrelin and leptin levels Medication influences —antidepressants, anti-seizure, steroids, insulin, oral contraceptives Psychological factors—self-soothing, large CHO intake = increased serotonin Disease states —hypothyroidism, insulin resistance, PCOS, Cushing’s 21. Discuss one primary prevention for obesity Obesity occurs when one’s intake of calories exceeds metabolic needs. Primary prevention for obesity includes increasing activity level, and managing caloric intake. Triad—Identify, Food, Activity • Identify those at risk—both adults and children—calculate BMI at every preventative visit: adult’s minimum yearly and children at each preventative visit following routine schedule. • Provide targeted nutritional advice—low CHO diets with high protein, small frequent meals throughout the day. • Eliminate sweetened liquid calories including juice. • Recommend 60 minutes of activity on most days of the week for adults and children. • Encourage good nutrition and activity at the family level, not just the individual level. • 24-hour diet recall and use motivational interviewing techniques. • Promote good sleep hygiene. 22. Identify the categories of obesity based on the BMI Overweight BMI is 25-29.9; relative weight is 100%-120% Obesity BMI is 30-40 140%-200% Severe (morbid) obesity BMI is greater than 40 greater than 200% 23. Discuss how acute low back pain without neurological dysfunction does not warrant radiological imaging Acute back pain may have several differential diagnoses. If pain isn’t found to be related to any neurological complaints, radiological imaging is not warranted. 24. Identify the roles of TSH, FT4, TT3, and TPO Abs in determining thyroid function 11 Thyroid Stimulating Hormone (TSH)—Pituitary “messenger” to thyroid to increase or decrease thyroid hormone production. used to diagnose hypothyroidism. TSH and FT4 should be used to 12 follow treatment. If the TSH is low or insufficiently elevated in the presence of low T4, central hypothyroidism caused by hypothalamic or pituitary disease should be excluded before starting replacement therapy. Free T4 (FT4)—Circulating unbound thyroid hormone produced by the thyroid, replaced by levothyroxine medication, useful for the diagnosis of hypothyroidism both overt and subclinical *Primary hypothyroidism is associated with a low FT4 and elevated TSH *Subclinical hypothyroidism is a mildly increased TSH with a normal FT4 Total T3 (TT3)— Circulating unbound thyroid hormone that has been converted from T4. T3 is not routinely used as a diagnostic tool because it isn’t sensitive or specific to the hypothyroidism. T3 levels may be normal in early disease, and may not fall until late in the disease. Thyroperoxidase antibodies (TPO Abs )—Useful in detecting autoimmune thyroiditis (Graves’ or Hashimoto’s) Diagnostic for Hashimoto’s thyroiditis when found in high titers (1:400). Higher levels TPO = more thyroid destruction = more severe hypothyroidism - No universal screening recommendations for thyroid disease. - ATA recommends screening for o Baseline at 35 o Pregnant women o Women older than 60 o Individuals with autoimmune disease. 25. Identify at least one “at-risk” population who should be considered for thyroid screening -Pregnant women -Women older than 60 years -Persons with other autoimmune diseases -Persons with pernicious anemia -Persons with a family history (1st degree relative) of thyroid disease -Persons with a history of prior thyroid surgery or dysfunction or neck radiation -Persons with Abnormal thyroid exam -Persons with psychiatric disorders (Dunphy, p. 847 & 859 and “Thyroid Disorders” Lecture) 26. Discuss one physical characteristic seen in a hyperthyroid patient -Smooth, velvety skin 15 2.Diagnosing meniscal tears: McMurray and Appley 3.Diagnosing PCL injury: posterior drawer test and Thumb sign 16 4.Diagnosing collateral (MCL and LCL) injury: Valgus and Varus stress test Week 6 1. Differentiate between resting, postural and intention tremors and describe each Resting tremor-Occurs at rest, against gravity, or sitting still with arms resting in lap. The most common condition that causes resting tremors is Parkinson’s Disease and medication tremors. Postural tremor -Seen when the patient is asked to extend the arm in front of them. The most common type is an essential tremor. It's bilateral and generally symmetric. There’s often a family Hx. Drinking alcohol can reduce the tremor. Intention (Kinetic) tremor -Characterized by an increase in amplitude when the patient attempts movement. Can be checked by having the patient perform finger to nose coordination. 2. Describe one disease with resting tremor as a clinical finding Parkinson’s Disease. It is a progressive neurological disease - 4 hallmark signs: o resting tremor o cogwheel rigidity o bradykinesia, o postural instability - Other characteristics are facial masking, difficulty staining from sitting in a chair, “freezing”, reduced arm swing, festinating (quick, short stride, with head down) and shuffling gait. Wilson's disease is another condition that is associated with resting tremor. This is a very rare genetic disorder associated with copper toxicity. Patients who are affected may have extrapyramidal symptoms [similar to 17 Parkinson's] with a slow and progressive course. There may be symptoms of incoordination in the hands, dysarthria, and gait 20 Parkinson’s disease - Dopamine agonist o Carbidopa/levodopa (Sinemet) o Pramipexole (Mirapex) o Ropinirole (Requip) - Anticholenergics o Benztropine (Cogentin) o Trihexyphenidyl (Artane) - If pharmacological therapy has been ineffective, localized botox injections may be considered - Deep brain stimulation in severe cases. - If tremor is due to alcohol withdrawal: diazepam, lorazepam (mild symptoms) 7. Describe an appropriate empiric antibiotic treatment plan for cellulitis Cellulitis = bacterial infection most commonly group A beta-hemolytic streptococcus or staphylococcus aureus (gram positive) tx = dicloxacillin or cephalexin for 10-14 days if PCN allergy, erythromycin If caused by animal or human bite: amoxicillin-clavulanic acid (augmentin) for 2 weeks 8. Discuss an intervention to prevent HIV and HIV-associated behaviors *safe sex practices - latex condoms *needle exchange programs *universal testing of donated blood products *education to HIV positive women of childbearing age about c-sections, arv drugs for mother and baby *voluntary HIV testing a routine part of medical care *new models for HIV diagnosing outside medical setting *prevent new infection by working with HIV infected and their partners to minimize risk 9. Identify physical exam findings in the patient with HIV fever, sore throat, myalgia, headaches, cervical lymphadenopathy, night sweats, majority are asymptomatic flu-like sumptoms 6 days to 6 weeks after viral transmission dark purple colored spots (karposi's sarcoma) Cephalexin 500 mg four times daily (alternative for mild penicillin allergy) Clindamycin 300 mg to 450 mg four times daily (alternative for severe penicillin allergy) Patients with cellulitis should be managed with empiric therapy for infection due to beta-hemolytic streptococci and methicillin-susceptible Staphylococcus aureus (MSSA) with: 21 non-productive cough, SOB, and fever for several weeks pulmonary symptoms: pcp pneumonia, tb, bacterial pneumonia localized candida infections other STD's weight loss anemia, leukopenia, and/or thrombocytopenia 10. Describe symptoms, DDx, pathogens, testing, and treatment for the following conditions: Cellulitis, impetigo, MRSA, Bites (dogs, cats, humans), Erysipelas - Cellulitis o Pathogens ▪ Strep (A,B,C,G,F) ▪ Staph o Symptoms ▪ Skin erythema, edema, warmth, pain, possible fever ▪ Lymphangitis, lymphadenopathy, peau d’orange (orange peel texture) ▪ No fever/chills, localized symptoms only ▪ Underlying infection, lymphedema, venous insufficiency o Treatment ▪ I&D if abscess is involved - Erysipelas o Pathogens ▪ Group A Strep o Symptoms ▪ Skin erythema, edema, warmth, pain, possible fever ▪ Lymphangitis, lymphadenopathy, peau d’orange (orange peel texture) ▪ Acute onset with systemic symptoms (fever, chills) ▪ Clear demarcation ▪ Butterfly involvement on face or ear o Milian’s Ear Sign Patients with erysipelas should be managed with empiric therapy for infection due to beta-hemolytic streptococci with: ▪ Penicillin V potassium 500 mg orally every 6 hours ▪ Amoxicillin 875 mg twice daily ▪ Cephalexin 500 mg four times daily (alternative for mild penicillin allergy) ▪ Clindamycin 300 mg to 450 mg four times daily (alternative for severe penicillin allergy) 22 ▪ Involvement of ear, classic for erysipelas o Treatment ▪ I&D if abscess is involved - MRSA o Risk factors ▪ ATB use • Cephalosporins • Fluoroquinolones ▪ HIV infection ▪ Hemodialysis ▪ ECFs o Signs and Symptoms ▪ Skin abscess • Painful, fluctuant, erythematous nodule, with or without surrounding cellulitis • Spontaneous drainage may occur • Regional lymphadenopathy may be observed • Fever, chills, and systemic toxicity are unusual • Also manifested as furuncles (abscess of hair follicles) or carbuncles (coalesced masses of furuncles) ▪ Experts recommend oral ATB for patients undergoing I&D of an abscess if • Single abscess is equal or greater than 2cm or multiple lesions • Extensive surrounding cellulitis • Immunosuppression or systemic signs of toxicity (fever>100.5/38) • Presence of an indwelling medical device • High risk of transmission of S aureus to others o Athletes or military personnel ▪ ATB with coverage for CA-MRSA include • Bactrim DS 2x day • Doxycycline 100mg 2x day • Minocycline 200mg PO once, then 100mg Q12 hours • Clindamycin 300-450 mg 4xday ▪ Treatment should be offered for at least 5 days • Beta-lactam drug should be added if the abscess is peri-rectal or peri-oral