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 This was a study guide someone else made, I also used questions from the book which abour 75% were from. There was a questions about diagnosing carpel tunnel syndrome, eiher phalens or tinnels sign. 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. 2 2 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. 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) 6 6 10. Define chronic pain • 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 11 11 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 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 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 12 12 - 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 19. Identify at least 3 risks associated with obesity Diabetes, CVD, Afib, HTN, NSTEMI, varicosities, cancer, skin infections, arthritis Gallbladder disease, GERD, acute pancreatitis, NAFLD Stress incontinence, infertility, OSA 15 15 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 16 16 -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 17 17 -Soft, thin hair -Skin with increased pigmentation, spider angiomas, and vitiligo -Onycholysis (splitting and spooning of the nails) -Exophthalmos (buldging eyes) (Dunphy, p. 851 & Hollier, p. 231) Muscle atrophy, tremors, hyperpigmentation, warm flushed moist skin, fine silky hair, thin hair, increased LFT, Exopthalamos, lid lag and edema, corneal ulceration, sinus tach, elevated BP, A.Fib, symptoms of CHF, gynecomastia, osteoporosis, hypercalcemia, potassium wasting 27. Identify the CDC recommended antibiotic class for treatment of acute bacterial prostatitis -Flouroquinolones (Ciprofloxacin, levofloxacin, ofloxacin, or norfloxacin) (Dunphy, p. 657 & “Male GU Problems” Lecture) Alternatives to a fluoroquinolone include Doxycycline 100 mg Q 12 hours; and TMP-SMX [160 mg/800 mg] (Bactrim DS) one tab Q 12 hours 28. Identify at least one treatment for BPH -Medication (conservative): -Alpha Blockers (Terazosin, Tamsulosin) -5-alpha Reductase Inhibitors (finasteride, dutasteride) -Surgical -TURP (transurethral resection of the prostate) 20 20 32. Identify at least 3 physical exam maneuvers to assess the knee 1. Diagnosing ACL injury: Lachman’s, anterior drawer test, 21 21 2. Diagnosing meniscal tears: McMurray and Appley 3. Diagnosing PCL injury: posterior drawer test and Thumb sign Posterior Drawer Test - EXAMINATION POSTERIOR NS (PCL) Injury 22 25 25 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 26 26 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 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. 27 27 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 30 30 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 31 31 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 32 32 • Beta-lactam drug should be added if the abscess is peri-rectal or peri-oral