NR511 Final Exam Study Guide download for an A, Exams of Nursing

Download NR511 Final Exam Study Guide download for an A and more Exams Nursing in PDF only on Docsity! 1 1 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). 2 2 4. Discuss common symptoms reported from a patient with BPH Affects men age 40 years and older. 5 5 8. Discuss common characteristics (subjective and objective findings) of patients with lumbar spinal stenosis Subjective - Radicular complaints in calves, buttocks, upper thighs - Pain w/ walking or prolonged standing o Vascular claudication – pain stops w/ rest o Psuedoclaudication – pain doesn’t stop immediately at rest - Short term relief by leaning forward/stooping - Sometimes relief w/ sitting - Pain in back/leg when sleeping on back at night - Pain w/ walking/standing Objective - Muscle weakness - Impaired proprioception - Diminished reflexes - Sensory changes (numbness/tingling) - Bowel or bladder symptoms o Sphincter tone decreased o Don’t confuse w/ prostate problems in older men 9. Identify the red flags associated with back and neck complaints which warrant further investigation “TUNA FISH” T- Trauma F- Fever U- Unexplained weight loss I – IV Drug User N- Neurologic symptoms S – Steroid Use A- Age>50 H – History of cancer (prostate, renal, breast, lung) 10. Define chronic pain 6 6 • Pain that extends beyond the expected period of healing • Pain > 3 months in duration • More generalized, less localized to the site of injury/initial complaint • Referral patterns can shift in location, intensity, frequency & quality • Pain does not change with movement, rest or time • Usually reported as constant/continuous (less likely intermittent) • Mood or current psychological status tends to affect/worsen c/o pain 7 7 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 10 10 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 11 11 Cardiopulmonary Palpitations, SOBOE, tachycardia, HTN, CHF, A-Fib Exercise intolerance, bradycardia, cardiac enlargement, pleural effusion GU Decreased menstrual flow, gynecomastia Irregular menses, decreased fertility Head & Neck Increased neck size, enlarged thyroid gland Enlarged neck, enlarged tongue (late), hoarseness Psychosocial Anxiety, nervousness, insomnia, irritability, restlessness, Depression, slowing of mental processes 12 12 emotional lability, Increase in HR, RR, and BP Musculoskeletal Weakness, loss of muscle tone, Osteoporosis in women Muscle weakness and cramping Hematological Fatigue, normochromic normocytic anemia 16. Describe a goiter and the type of thyroid dysfunction that can be associated with it A goiter is the hypertrophy and hyperplasia of the thyroid gland in response to TSH levels. Most commonly seen with Hashimoto’s thyroiditis (hypothyroidism) in the United States. Toxic multinodular goiter (hyperthyroidism) in iodine deficiency. Grave’s Disease (hyperthyroidism) has a firm goiter. 17. Differentiate between overt hypothyroidism and subclinical hypothyroidism - Overt hypothyroidism o TSH above 10 and FT4 is decreased o Too little hormone is being produced o Pituitary is attempting to get the thyroid to produce more ▪ Low FT4 and high TSH - Subclinical hypothyroidism o TSH levels are increased, but the FT4 is within range o Some have symptoms, others do not 18. Differentiate between Hashimoto’s thyroiditis and Grave’s disease Both are autoimmune, attacking thyroid cells. Graves – overproduction of thyroid leading to hyperthyroidism - 90% of hyperthyroidism cases Hashimoto’s – underproduction of thyroid leading to hypothyroidism -Identified via TPO and TBG Abs in blood 15 15 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 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 16 16 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 17 17 -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 20 20 1200–1500 calories per day for women and 1500–1800 calories per day for men; 500– 750 calorie deficit per day; low CHO diet, increased fiber, and decreased saturated fats; and less than 800 calories per day in certain circumstances under medical supervision. 30. Describe the Spurling test and what condition it is used to diagnose Spurling’s maneuver assesses nerve root compression (i.e. radiculopathy) in the neck resulting in pain. - Spurling’s maneuver: o With patient’s neck in extension, rotate the neck to the affected side o Apply downward pressure on the head o Assess for patient complaint of or accentuation of limb pain or paresthesia (THIS IS A POSITIVE SIGN). Also, observe for neck atrophy. 31. Describe how to perform a Phalen and Tinnel test A. Phalen test: Purpose: Assess for median nerve compression Procedure: Have the patient maintain forced flexion of the wrist for 1 minute or more, with the dorsal surface of each hand pressed together. If the patient complains of numbness and paresthesia in the fingers =TEST IS POSTIVE B. Tinel test: Purpose: Assess for compression neuropathy Procedure: Percuss the median nerve at the wrist. If the patient complains of tingling in the digits (POSITIVE TINEL SIGN), compression at the site of percussion is likely. 32. Identify at least 3 physical exam maneuvers to assess the knee 21 21 1. Diagnosing ACL injury: Lachman’s, anterior drawer test, 22 22 2. Diagnosing meniscal tears: McMurray and Appley 3. Diagnosing PCL injury: posterior drawer test and Thumb sign 25 25 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 Parkinson's] with a slow and progressive course. There may be symptoms of incoordination in the hands, dysarthria, and gait 26 26 disorder, bradykinesia, rigidity, and ophthalmologic changes. The work up for Wilson’s includes serum ceruloplasmin and copper. Diagnosis is confirmed with liver biopsy, which identifies the copper toxicity. Treatment is aimed at lowering copper levels. 3. Describe a medication commonly associated with tremors Extrapyramidal side effects similar to Parkinson's disease. Antipsychotics are the most common offending agent. Metoclopramide (Reglan) Phenothiazine -Compazine Steroids Caffeine Anti-epileptics Antidepressants Asthma medications Intention tremor may be associated with medications, alcohol or drug abuse, multiple sclerosis, stroke, or a mass affecting the cerebellum. 4. Identify at least 3 laboratory tests to rule out systemic causes of tremor □ Electrolyte/ABGs (metabolic imbalances, drugs, caffeine, physiological fatigue) □ Serum glucose (hypoglycemia) □ Toxicology screen/drug levels (toxic conditions, antipsychotic drugs, caffeine) 5. Describe at least one at-risk population that is recommended to have HIV screening Anyone who had unprotected sex should be screened for HIV Men who have sex with men Those who exchange sex for drugs/money Those who have other STIs IV drug users Healthcare workers 27 27 6. Describe at least one pharmacologic treatment option for tremor Primidone (Mysoline) - beta blocker benzodiazepine (lorazepam) If monotherapy is ineffective, REFER TO NEURO If the tremor is medication induced, that agent may be reduced or eliminated. 30 30 • 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: 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 31 31 ▪ 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 32 32 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) ▪ 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 35 35 • PLUS o Metronidazole 500mg 3xday 36 36 o Clindamycin 450mg 3xday - ALL bites treatment considerations o Treatment ▪ Copiously irrigate with sterile saline ▪ Remove grossly visible debris ▪ Prophylactic ATB are given if • Deep puncture wounds • Wounds requiring surgical repair • Moderate to severe wounds w/ associated crush injury • Wounds in areas of underlying venous and/or lymphatic compromise • Wounds on the hands or in close proximity to a bone or joint • Wounds on the face or in the genital area • Immunocompromised hosts