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NR 511 Completed Midterm study guide

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Disease

Risk

Subjective Finding

Objective Findings

Diagnostics

Treatment

Education

 

GI DISORDERS

Appendicitis

 

-Most common between 10-30yrs; but can occur at any age; rare in infants and older adults

-men more at risk

- Diets low in fiber, high in fat, refined sugars, & other carbs at increased risk.

- Obstruction of appendix is cause of majority of appendicitis

- contributing factors: Intra-abdominal

tumors, positive family hx

- Recent roundworm infection or viral GI infection

 

 

 

 

 

-Dx made clinically, based primarily on H&P exam

- Classic presentation includes acute onset of mild to severe colicky, epigastric, or periumbilical pain

- Pain is vague at first then localizes within 24hrs to RLQ

- Pain exacerbated by walking\coughing

- Men may feel radiated pain in testes

- Abd muscle rigidity, N\V, anorexia

- Mildly elevated temp 99-100F common

- If RLQ accompanied by shaking chills, perforation should be suspected

- Older adults may present with weakness, anorexia, abd distention, mild pain leading to delayed dx and increased morbidity.

-May have HTN\tachy proportional to pain\symptoms

-When lying flat, may flex R knee to relieve tension in abd muscle

-Pain with palpation in abd, diffuse in early stages. Localized to RLQ later

-Positive for rebound pain; ask pt to cough to localize pain location

-Sudden cessation of pain means perforation and is ER

-Labs are not diagnostic and nonspecific

-Women should have urine human chorionic gonadotrophin to r\o ectopic pregnancy

- +Rovsing’s Sign- deep palpation & release in LLQ causes rebound pain in RLQ

- +Psoas Sign- lift R leg against gentle pressure causes pain

- +Obturator Sign- flex R hip & knee and slowly rotate internally causes pain

- +McBurney’s Sign- pain with pressure applied to point between umbilicus & ilium

- x-ray\CT helpful when paired with positive H&P findings

-Surgical; preoperative care, NPO, correction of fluid\electrolyte imbalances

-Avoid narcotics

-Atb with 3rd gen cephalosporin; Ex: ampicillin, gentamycin, flagyl

-F\U with surgeon

-Ambulation after surgery

-Adv diet when bowel sounds return

-Return to hosp with s\s of infection

-Avoid heavy lifting for at least 2 wks

 

Celiac disease **

(autoimmune disorder caused by an immunologic response to gluten)

 

Mostly diagnosed in adulthood.

 

A family member with celiac disease or dermatitis herpetiformis

 

Type 1 diabetes

 

Down syndrome or Turner syndrome

 

Autoimmune thyroid disease

 

Microscopic colitis (lymphocytic or collagenous colitis)

 

Addison's disease

 

 

 

 

 

Many asymptomatic. May complain of diarrhea, gas, dyspepsia, wt loss.

Atypical symptoms: fatigue,

bone or joint pain,

arthritis,

osteoporosis, or osteopenia (bone loss)

liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis,

depression or anxiety

peripheral neuropathy seizures or migraines

missed menstrual periods

infertility or recurrent miscarriage

canker sores inside the mouth

dermatitis herpetiformis (itchy skin rash)

Muscle wasting (anemia), reduces subcutaneous fat, ataxia, & peripheral neuropathy (vitamin B12 deficiencies)

osteoporosis or osteopenia (bone loss)

hypothyroidism

 

Pts with dermatitis herpetiformis found to have signs of celiac disease on intestinal biopsy.

Serologic testing for anti-tTG IgA antibody

 

Total IgA (2% of pts have IgA deficiency and will falsely test negative)

 

duodenal biopsies

 

Test for nutritional deficiencies associated with malabsorption of C.D. (hemoglobin, iron, folate, vit B12, Calcium, and Vitamin D.)

lifelong adherence to a strict gluten-free diet.

 

Referral to a dietician to help.

 

Some pts may need treatment with immunomodulating agents.

teaching related to gluten free diet.

Some people with celiac disease have vitamin or nutrient deficiencies that do not cause them to feel ill, such as anemia due to iron deficiency or bone loss due to vitamin D deficiency. However, these deficiencies can cause problems over the long term.

Untreated celiac/developing certain types of gastrointestinal cancer. This risk can be reduced by eating a gluten-free diet.

 

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[Solved] NR 511 Completed Midterm study guide

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Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education GI DISORDERS Appendicitis -Most common between 10-30yrs; but can occur at any age; rare in infants and older adults -men more at risk - Diets low in fiber, high in fat, refined sugars, & other carbs at increased risk. - Obstruction of appendix is cause of majority of appendicitis - contributing factors: Intra-abdominal tumors, positive family hx - Recent roundworm infection or viral GI infection -Dx made clinically, based primarily on H&P exam - Classic presentation includes acute onset of mild to severe colicky, epigastric, or periumbilical pain - Pain is vague at first then localizes within 24hrs to RLQ - Pain exacerbated by walking\coughing - Men may feel radiated pain in testes - Abd muscle rigidity, N\V, anorexia - Mildly elevated temp 99-100F common - If RLQ accompanied by shaking chills, perforation should be suspected - Older adults may present with weakness, anorexia, abd distention, mild pain leading to d...
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Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education GI DISORDERS Appendicitis -Most common between 10-30yrs; but can occur at any age; rare in infants and older adults -men more at risk -...
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NR 511 Completed Midterm study guide

Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education GI DISORDERS Appendicitis -Most common between 10-30yrs; but can occur at any age; rare in infants and older adults -men more at risk -...

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