NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Sati, Exams of Nursing

Download NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Sati and more Exams Nursing in PDF only on Docsity! NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, blurry vision, Assessment: • Asymptomatic • Occipital headache • Blurry vision • Headache upon wakening • Look for AV nicking • LVH Exam: • Carotid bruits • Abdominal bruits • Kidney bruits Diagnostic studies: to look for secondary causes of HTN like target organ damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP (electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria). Diagnosis: Measure BP 5 minutes apart. Average of 2 or more BP readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN. If Stage 1 (ASCVD <10%) then non-pharmacologic management only: • First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week. • Limit alcohol • stop smoking • stress management. • DASH • Medication compliance • Reduce sodium intake • Measure BP daily If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic Management: • Alone: hydrochlorothiazide (HCTZ) 25 mg/day (chlorthalidone is preferred over HCTZ) • Alone: lisinopril 10mg/day complicated HTN first line • Combo: thiazide + ACE or ARB • Alternative CB (especially in isolated HTN seen mainly in older adults) • Black population: thiazide + CCB is recommended first line Follow up: • 2-4weeks Referral: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Cardiology if EKG is abnormal Differential: • Secondary hypertension • Pregnant • Pregnancy induced hypertension Hollier: page 62 NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ 3. Diabetes type 2 - Etiology: genetics, high BMI with central obesity, inactivity, drug or chemical induced like glucocorticoids or antiretroviral therapy Risk factors: • BMI >/= 25 • Hx of gestational diabetes • First or second degree relative with DM • PCOS, acanthosis nigricans • HDL-C <35 / TG >250 • HTN or HTN treatment meds • CVD Presentation (assessment): insulin resistance in target tissues • Polydipsia, Polyuria, Polyphagia, (showing symptoms) • agitation, • nervousness, • obesity, • fatigue • blurry vision • Exam feet, pulses, nail thickness, odor, swelling, mobility Diagnostics: EKG, CBC and urinalysis (glucosuria, proteinuria, hyperglycemia), CMP, LIPIDS< Microalbuminuria, TSH, A1C Diagnosis: • Diabetes Hgb A1C >or equal to 6.5% Fasting glucose>126mg/dl and confirmed on a different day Fasting between 100-126 = impaired glucose Nonfasting less than 126 = normal values Recurrent yeast infections Non-pharmacologic Management/prevention: • Weight loss (5-10 pound goal) • Monitor Blood glucose at home and diary (daily) • Exercise 150 minutes or more per week (no more than 2 consecutive days without activity); resistance training 2-3 days per week on nonconsecutive days • avoid alcohol • avoid smoking Pharmacologic Management: • First: Initiate metformin 500mg BID if not contraindicated, then, when needed add- • Actos 15 mg daily, then, when needed add- • Levemir 10 units once a day • *Initiate insulin early in course of oral therapy: 0.1-0.2 units/kg/day or 10 units daily of peakless insulin • With older adults, start low and go slow Follow up: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction • • • • • NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • recheck A1C in 90 days • Screening in adults >45 years be done every 3 years and ore often if fasting glucose close to 126 NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Screen patients with hx of gestational diabetes at 6-12 weeks gestation with OGTT and Q3years after that for life Referral: • Ophthalmologist at time of diagnosis • Fundoscopic exam • Diabetic educator/ specialist • Podiatry Education: • Carbs 50% • Protein 30% • Fat 20% • Good glycemic control – no low sugars • 10-15 years develop complications Complications (usually present within 10-15 years after onset of DM but may earlier): • Neuropathy • Nephropathy • Glaucoma = blindness • Cataracts • Charcot foot Differentials: • Gestational diabetes • Cushing’s syndrome • Corticosteroid use Hollier: page 216 4. Back pain – Etiology: often unable to pinpoint; may be due to stretching or tearing of nerves (radiculopathy), muscles, tendons, ligaments, or fascia of the back secondary to trauma or just chronic mechanical stress; compression or irritation of the nerve roots are common Presentation: • back pain complaint, buttock or one or more thighs that is aggravated by movement, rising from seated positions, standing, and flexion (may be relieved by rest) • muscle spasm may be present over lumbosacral area • Maybe localized, referred, or radiating (down leg and below knee) • Assess rectal tone in those describing cauda equina • Motor, sensory, and reflex exams should be done o DTRs: patellar tests nerve roots at L2-L4 & Achilles tests nerve roots at S1-S2 o Diminished or absent imply myopathies, decreased muscle mass, and nerve root impairment • New onset of radicular pain on older adults is often sign of spinal stenosis • Straight leg raise test: elevation of affected leg in supine will elicit pain at 20- 30 degrees for severe disease, 30-60 degrees for moderate. • Determine OLDCARTS, any pre-existing conditions, past surgeries or trauma NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Glucose, EKG (rule out cardia issues, arrhythmias), Hamilton Anxiety scale Diagnosis: Assess tools like Hamilton Anxiety scale- Positive Greater than 18 ; PROMIS assessment NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Non-pharmacological: • Psychotherapy/Counseling, • Exercise, • healthy diet • Avoid stressors as much as possible. • Relaxation • Regular exercise Pharmacological: • Benzodiazepines should be of limited duration (up to 1-3 months with planned taper) • Drugs should play an adjunct role to CBT, except in panic disorder • Drugs reduce, not eradicate, symptoms • Log term use of SSRI may be required • First line is SSRI o Fluoxetine, escitalopram, paroxetine o Older adults start low and go slow • Anxiolytics like S1A partial agonist o Buspirone 7.5mg PO BID-TID (range of 20-30mg daily) • Benzo o clonazepam initially 0.25-0.5mg PO BID-TID with max 4mg PO in divided doses o Older adults start low and go slow Follow up: • 2-4 weeks • 4-6 weeks for effect • Max effect of SSRI in 8-12 weeks before trying a new SSRI or alternate Referral: • Psychologist/Psychiatrist Differentials: • Substance abuse withdraw • Substance abuse reaction • Anemia • Asthma • COPD • Arrhythmias Hollier: page 611 6. Depressive Disorder Etiology: still not well understood; impaired synthesis of norepinephrine, serotonin, dopamine, and/or other neurotransmitters Presentation: loss of interest or pleasure, suicide Ideology, early morning wakening Hopelessness, depressed mood, fatigue, loss of energy, feelings of worthlessness NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Risk factors: • Female • Physical or chronic illness, like migraines, back pain • Prior episodes of depression or suicide attempts NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ 7. Obesity Presentation: • Chronic disease due to abnormal/excessive fats accumulate which impairs health • Increased morbidity and morality • Defined as 20% more than ideal body mass index • Parental obesity, hypothyroidism, Cushing syndrome, diabetes, Diagnostics: TSH, Lipid panel, glucose/A1c, CBC, CMP, Lipase/amylase, EKG, associated with PCOS, screening for depression, anxiety or binge eating Sleep apnea Diagnosis: • Stage 0 BMI 25-29.9 (overweight) and BMI 30 or greater (obesity) with no complications • Stage 1 BMI 25 or greater with mild to moderate complications • Stage 2 BMI 25 or greater with mild to moderate complications or requiring aggressive weight loss treatment • Stage 3 BMI 25 or greater with at least one severe complication • BMI 23 or greater for some ethnicities • Waist circumference >35 inches in women • Waist circumference > 40 inches in men Non-Pharmacological: • Lifestyle modification: exercise and diet o Goal 150 minutes/week, including resistance training • Dietary intake and eating habits • Modify times of eating • Less calories consistently • A deficit, calories in < calories out Pharmacological: • Phentermine • Orlistat • Lorcaserin • Phentermine-topiramate • Naltrexone-bupropion • liraglutide Follow up: 2-4 weeks, long term management and support Referral: Nutritionist/dietitian; may require referral to bariatric surgery for management, support programs like weight watchers Hollier: page 281 8. GERD Etiology: movement of GI contents into the esophagus or higher usually facilitated by decrease in LES. Assessment/Presentation: • Heartburn, burning beneath the sternum, neck, mid-back • Postprandial and nocturnal, regurgitation NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Chest pain (requires a cardiac workup) • Chronic cough. • Dysphagia, sour taste in mouth NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Post-nasal drip, throat clearing • Chronic sore throat or hoarseness • Erosion of teeth by acid • Sensation of lump in throat Diagnostic: EKG, CBC, CMP, Diagnosis: Can be made on symptoms; Same as presentation (decreased lower esophageal sphincter tone (LES). Non-pharmacological: • Removing or modifying risk factors like coffee, spicy food, chocolate • small more frequent meals • sit up for 2 hours after meals • don’t eat before going to bed. Pharmacological: • Antacids for immediate relief • PPI therapy, 20mg omeprazole daily for 4 weeks should be initiated o If esophagitis is also present, 20mg daily for 4-8 weeks Complication: • Barretts esophagitis is always a bad finding. Outcomes are not good • Esophageal adenocarcinoma • Aspiration pneumonia • Erosion and ulceration Follow up: • 2-4 weeks • CBC, screen for B21 deficiency and increased risk of osteopenia with long term use of PPI Referral: None Differentials: • Cardiac disease • Esophageal spasm • Peptic ulcer disease • Asthma • Pulmonary edema • CHF Hollier: page 260 9. Allergic Rhinitis Etiology: • From any substance that causes and IgE mediated response characterized by rupture of mast cells and release of histamines, leukotrienes, prostaglandins and other substances • most common seasonal allergies are pollen from trees, grass, and weeds • Most common perennial allergens are mold, animal dander, dust mites, and smoke Presentation: • Allergic shiners – under eyes NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • nasal congestion, rhinorrhea, of clear mucus (coryza) and runny eyes • May complain of headache Assessment: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Swollen nasal turbinates with clear mucus • Reddened anterior pharynx • Cervical nodes are smooth, mobile, and small or “shotty”, submandibular and anterior cervical chain • Lungs are clear Diagnostic: • nasal washing culture/ flu wash Diagnosis: mostly objective Nonpharmaceutical: • Increase fluid and rest. • Humidifier. • Lozenges for scratchy throat • Saline nose drops. Education: • Frequent HAND washing • Wash bedding • Change toothbrush Pharmaceutical: Symptoms relieve that can be taken are • Tylenol/ibuprofen for fever and aching body pain OTC • Oral decongestants like Sudafed • saline nasal spray, topical nasal decongestants like Afrin BID (do not use for more that 3 days, rebound) • antitussives (Robitussin) • Antihistamines (Benadryl) • throat lozenges • antibiotics not necessary unless illness lasts greater than 10 days. (secondary sinusitis) Follow up: usually not needed unless symptoms persist over 10 days. Referrals: NONE Liek: page 231 11. Acute laryngopharyngitis - Etiology: acute inflammation of the pharynx/tonsils most commonly causes by viruses like rhinovirus, adenovirus, parainfluenza, Epstein-Barr (mononucleosis), and respiratory syncytial virus. Other times may be causes by Group A beta-hemolytic strep where accurate dx and tx is important to prevent rheumatic fever, poststreptococcal glomerulonephritis, reduce the spread, and limit complications Presentation: • Sore throat, pharyngeal edema, tonsillar exudate and/or enlarged tonsils, malaise Clinical findings alone are not specific to viral or bacterial infection because so many s/s of strep pharyngitis overlap with other conditions • Suggestive of strep etiology - o cervical adenopathy, fever >102, absence of other respiratory findings (cough, runny nose, nasal congestion), abdominal pain and headache, petechiae on soft NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ palate, beefy red tonsils, sandpaper rash (bridge of nose, neck, and/or torso), strep tonsilitis has a distinct odor • Suggestive of viral etiology - NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • headache, sore throat, • Pain and pressure over cheeks and upper teeth suggest maxillary • Pain and pressure over eyebrows suggest frontal • Pain and pressure/tenderness behind and between eyes suggests ethmoid • cough, anosmia, halitosis, postnasal discharge, periorbital edema Symptoms > 10 days that worsen after initial improvement, persistent purulent nasal discharge, fever, unilateral face or tooth pain is more likely a bacterial infection Diagnostics: • CBC (elevated WBC), • sinus x-rays for recurrent disease • transillumination: opacification with air-fluid levels if sinus cavity is infected • CT scan for recurrent disease • Consider c and s for treatment resistant infections Nonpharmacological: • Avoid environmental irritants, • Humidified air • treat otitis media, • sleep with HOB elevated to aid with drainage, • Good hand hygiene • blowing nose, not sniffing. Pharmacological • First line- Augmentin 875 mg/125 mg PO BID for 5 days, • Allergic to Penicillin then o Doxycycline 100mg BID for 5-7 days OR 200mg PO daily for 5-7 days o Levofloxacin 500mg PO daily for 10-14 days o Monifloxacin 400mg PO daily for 5-7 days • Macrolides no longer recommended due to high resistance • Analgesics for headache and fever • Saline irrigation Follow up: • 1 week or until clinically free of infection Referral: • May refer to ENT for recurrent infections or resistance to tx • Consider immediate referral if periorbital cellulitis • ER if meningitis suspected Hollier: page 200 13. Acute bronchitis Etiology: acute cough due to inflammation of the bronchioles, bronchi, and trachea which usually follows an URI or exposure to chemical irritant • Adenovirus, rhinovirus, flu A/N, parainfluenza, RSV, coxsackie virus, other viral agents • Secondary bacterial infection from strep pneumoniae, haemophilus influenzae, Moraxella catarrhalis, chlamydia pneumoniae, Bordetella pertussis, and other bacteria NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Inhaled chemical irritant • Fungal infection Presentation: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Cough: dry and non-productive, then productive; may be purulent • URI symptoms • Fatigue • Fever due to bacterial infection, more common in smokers and patients with COPD • Fever due to viral is usually after the first few days of other symptoms • Burning sensation in chest • Crackles, wheezes, chest wall pain The cause is usually by adenovirus/rhinovirus – viral in etiology Diagnostics: • Decision criteria for Chest x-ray: hypoxia, tachypnea, fever, abnormal lung exam, or at high risk for pneumonia or superimposed heart failure • Consider PPD but expect neg results • Flu swab • Consider CBC, viral panel, influenza titer • Test for pertussis if local outbreak or known exposure Nonpharmacological: • increase fluid intake, • use humidifier, • rest, • Smoking cessation Pharmacological: • Antibiotics not recommended • Cough suppressants - nighttime • Antivirals if flu is diagnosed • IF bacterial, Z-Pack 500mg day one and 250 mg for 4 days (positive Pneumonia) • Tessalon pearls 200mg TID PRN • Albuterol inhaler 2 inhalations every 4-6 hours as needed, if wheezing or prior history of asthma • Decongestants and antihistamines are not effective Follow up • 1 week if condition worsens or not improved • High risk groups (those with co-existing conditions) require quicker follow up Referral • None now • pulmonologist if not improved in 4 weeks. Complications: • chronic cough • secondary infection Differentials: • Pneumonia • TB • Asthma • Pertussis NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • 1 week • As needed, 3-6 months for stable disease Referral: • pulmonary if not tolerating treatment or those with severe persistent asthma NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • allergist Differentials: • respiratory infection (URI) • CHF • GERD • Habitual cough • TB • Foreign body Hollier: page 662 15. Hypothyroidism (everything slows down) Etiology: results from a reduction in circulating free thyroid hormone or from the resistance to the action of thyroid hormone. Majority due to primary thyroid gland failure resulting from autoimmune destruction (Hashimoto’s thyroiditis). Other causes are congenital, secondary or tertiary, and due to pituitary or hypothalamic disease Presentation: • Lethargy and delayed tendon reflexes • mild weight gain, swelling of hands and feet, • Intolerance to cold, constipation, • menstrual irregularities, decreased libido, infertility, • memory loss, flat affect, depression, • muscle cramps, coarse hair, dry skin, hair loss, brittle nails, bradycardia, enlarged heart • anemia, hyponatremia, enlarged thyroid, decreased sweating • Age greater than 40 Expect lipid levels to be elevated in hypothyroidism: treat lipids if still elevated after TSH <10 Diagnostic: TSH, T4, T3, CBC (rule out anemia), CMP (electrolyte), Lipid panel, EKG Diagnosis: • Hypothyroidism: TSH (increased), T4 (decreased), T3 (maybe decreased) • Subclinical hypothyroid: slightly elevated TSH and nonspecific symptoms- monitor Q3 months (treatment increases risk of osteopenia/osteoporosis) Nonpharmacological: • High fiber diet to prevent constipation • diet for weight loss • Educate regarding the need for lifelong compliance with thyroid replacement medication • need to report signs of toxicity, infection or cardiac symptoms. Pharmacological: • Levothyroxine Synthroid 12.5-25mcg (if older), 50mcg daily (empty stomach) • In young, healthy: 1.6mcg/kg/day • Levo helps prevent mental retardation in babies of expectant mothers with hypothyroid • Reassess every 6-8 weeks, once stable reassess every 6-12 months • Pregnant monitor monthly and adjust accordingly, medication needs ay increase • See improvement within 2 weeks; symptoms resolve in 3-6 months NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Follow up: • 6 Weeks, recheck in 3-4 months Referral: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Voltaren cream on the affected area as needed for pain. • Consider HF or vascular risks increase with use of NSAIDs Follow up: • 2-4 weeks. • If on NSAIDS, monitor periodic CBC, renal function, and stool for occult blood Referral: Physical therapy and nutritionist for weight loss. Orthopedic if complete joint destruction/ bone on bone. Education: • Exercise 3 days week • Lose weight • Strengthen quadriceps Differentials: • Gout • Infective arthritis • RA • Joint injury • Soft tissue injury • Peripheral vascular disease • Giant cell arteritis • Bursitis • Tendonitis • Osteopenia • Neuropathy Hollier: page 516 17. Knee pain - Presentation: complaint of knee pain. Exercise and injury: within first 48 hours, protect joint, and acutely inflamed joints should not • Be exercised in any form • Engage in active ROM • Undergo exacerbating activities Within the first 48 hours, follow RICE: • Rest: avoid using injured joint or limb • Ice: apply cold packs on injured area (20 min on, 10 off) • Compression: use elastic bandage wrap (ACE) over joints to decrease swelling and stabilize (joints and ankles) • Elevation: prevents or decreases swelling, avoid weight bearing Assess the history of OA and RA. Assess in trauma is blunt hit to the knees or twisting motion. Drawer sign- tests for knee stability (get referral to othro) • Anterior drawer sign: lies supine, hip flexed to 45 degrees, and patient knee bent to 90; grasps at joint line and pulls anteriorly like opening a drawer NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ o Positive sign is indicative of damaged or torn anterior cruciate ligament (ACL) NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Posterior drawer sign: supine, hip flexed to 45 degrees, and knee bent to 90 degrees; examiner sits on forefoot of patient to stabilize leg grasps lower leg by joint line and pushes it posteriorly like closing a drawer o Positive sign is indicative of damage or torn posterior cruciate ligament (PCL) • McMurray’s test: knee pain and a click sound are positive upon manipulation of the knee, suggests injury to the medial meniscus • Lachman’s sign: positive suggests ACL damage • Collateral ligaments: positive is an increase laxity in the knee o Valgus stress test: tests the MCL o Varus stress test: tests the LCL Diagnostic: x-rays to rule out fractures, Gold standard test for joint damage is the MRI Diagnosis: knee pain complaint Nonpharmacological: • RICE (Rest Ice, compression, Elevate). • Physical therapy, Pharmacological: LOWEST EFFECTIVE DOSE FOR SHORTEST PEROD OF TIME • Steroid injection may be needed • Tylenol 650 Po as needed for pain every 6 hours, • Naproxen 250 mg twice a day. • Pain over 5/10 Tramadol 50 mg once a day Follow up • 2-4 weeks after initiating medication or treatment Referral: • physical therapy Differentials: • Osteoarthritis • Rheumatoid arthritis • Patellofemoral pain syndrome • Meniscus tear • Tendonitis Liek: page 335 Hollier: page 522 18. Shoulder pain Presentation: Rotator cuff syndrome: Rotator cuff tears, advanced age, repetitive use, occupation-related, a higher risk with obesity and diabetes • Pain often at night, may refer down deltoid and increase with overhead movement • weakness with abduction/ forward flexion, positive impingement signs, • limited active range of motion • positive drop arm test may indicate full thickness cuff tear • cross arm test to identify acromioclavicular joint disease NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Assess: pain history including PMH FMH of RA or OA & gait (heels and toes): ●Onset (eg, sudden, gradual, traumatic or nontraumatic) ●Provocative and palliating factors (eg, increased pain with weight-bearing) NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ ●Quality ●Radiation (eg, to or from the low back) ●Site (lateral, anterior, posterior hip or other joints; focal weakness- r/o radiculopathy) ●Symptoms (paresthesia, mechanical catching, systemic-fever, etc; Trendelenburg; rash/ psoriasis hx= r/o psoriatic arthritis; GI- r/o IBD; Iritis/uveitis r/o inflame i.e. spondylarthritis; leg length?) ●Time course (overall duration, length of episodes) Diagnostic: Labs not typically needed; imaging only needed in acute hip pain to exclude fracture/SCFE, moderate to severe chronic hip pain, or initial hip OA assessment; CT or MRI if inconclusive or inconsistent; Ultrasonography for hip effusion or joint aspiration (interventional radiology or ortho not FP) External, internal rotation, abduction, adduction Nonpharmacological: • Rest • physical therapy • cold/heat pack • Pain nerve blocks (not 1st line) Pharmacological: • Tylenol 650 Po as needed for pain every 6 hours Follow up: • 2-4weeks Referral: • physical therapy • Ortho 20. Nail Fungus (tinea ungium, onychomycosis) Presentation: nail becomes opaque, yellow, and thickened with scaling under the nail; can become infected with yeasts and mold • Oncholysis – separation of nail from bed • Hyperkeratosis – thickening and scaling under skin • Most common location – great toe Diagnostic: • nail specimen will be sent to the lab, KOH slide for microscopy check • hepatic function before starting medication and after medication! Liver function 2-3 months. Non-pharmacological: • spray shoes with Lysol daily • change socks twice a day, moisture wicking shoes (like dress socks) • keep feet clean and dry, • do not share shoes/socks, • avoid walking barefoot in gyms/shared spaces Pharmacological: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Severe cases: Terbinafine (Lamisil) oral 250mg daily for 6 weeks for fingernail and 12- 16 weeks for toenail up to one year. NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Dribbling in men • Small volume voiding • Foul-smelling urine Diagnostics: • UA dipstick: leukocyte positive (WBC 10 or greater/mcL • Nitrites: negative or positive (indicative of enterobacteriacease seen in e coli infection) • Sometimes: hematuria (>5 RBCs) • Urine C&S: o UTI infection- 100,000 CFU/mL of a single organism or 100,000 CFU/mL of one organism and growth of a second organism 50,000 CFU/mL or greater • Urinalysis: WBC present, positive leukocyte esterase, positive nitrites, urine culture with sensitivity • STI panel. Uncomplicated UTI • Dysuria, frequency, nocturia- no testing is needed beyond the UA • But if fever >100, chills, significant fatigue, flank pain, or CVA tenderness, must rule out pyelonephritis o Nitrofuranitoin (Macrobid) 100mg BID for 5 days o Bactrim x 3 days o Fosfomycin 3G x 1 dose o Pyridium PO BID x 2 days o Increase fluids to 2-3L per day and restrict dietary oxalate (beans, spinach, beets, potato chips, nuts, tea, French fries) Complicated UTI • Men, poorly controlled diabetes, Pregnant women, Children, Older adults, Immune compromised, Recurrent UTIs or reinfections, Anatomic abnormalities o Ciprofloxacin (fluroquinolone that works below the belt) 500mg BID or 1,000mg ER once daily o If high risk of MDROs, Macrobid 100mg PO BID o UA and CND before and after treatment to confirm resolution Nonpharmacological: • Increase water intake • Emptying bladder immediately after sexual intercourse • Practice good hygiene, • wipe from front to back • cotton underwear. • Good hydration Differentials: • Vaginitis • STD • Pregnancy • Pelvic inflammatory disease • Prostatitis, epididymitis NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • enuresis Liek: page 288 Hollier: page 730 NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ 23. BPH – Presentation: benign enlargement of the prostate gland creating a narrowing of the urethral lumen and leading to increased prostatic smooth muscle tone. • Weak urinary stream, • hesitancy, post-void dribbling, incomplete emptying of the bladder, • frequency/urgency, • incontinence, retention, • hematuria, • firm/smooth symmetrical prostate Diagnostics: • UA-pyuria if residual urine presents, • Creatine to assess renal function • PSA may be elevated but <10mg/mL • Post-void measurement (>100ml) • US also can be ordered but not necessary for routine exam • Digital rectal exam in the absence of infection • AUA score >8 on the questionnaire start pharmacological management • PSA (normal 0-4 ng/mL) Nonpharmacological: • limit fluids before bed, • frequent voiding, • avoid caffeine • sit to urinate instead of standing to have better emptying, Pharmacological: • AUA score >8 start pharmacological management, • Flomax 0.4mg daily o Alpha 1 blocker (alpha-adrenergic antagonist) improve 50% of symptoms within 4 weeks o Can cause orthostatic hypotension • Proscar 5mg PO daily o 5-alpha-reductase inhibitors takes 12 months to take effect to shrink tissue Follow up: • 2-4 weeks Referral: • May refer to urology • Indications for surgery: severe symptoms, refractory urinary retention, recurrent UTI, recurrent hematuria, bladder stones, renal insufficiency due to BPH Education: • Avoid antihistamines, caffeine, • Take medication at bedtime Differentials: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • 2-4 weeks • Important to ensure compliance and that steroid isn’t being overused or used inappropriately Refer: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • Dermatology Differential: • Contact dermatitis • Seborrheic dermatitis • Scabies • Psoriasis Hollier: page 100 25. Fibromyalgia / myositis – disease of exclusions Presentation: • patients present with chronic widespread body pain accompanied by fatigue, sleep, memory, and mood issues o Pain and stiffness, fatigue and tiredness, depression and anxiety o Sleep problems, thinking and memory, o Headaches and migraines o Tingling and numbness in hands and feet, pain in jaw or TMJ o Digestive problems with abdominal pain, bloating, constipation, IBS • Physical examination is typically normal but may have tenderness Diagnostics: ACR uses several criteria to diagnose • Widespread pain index o Neck, jaw, shoulder girdle, upper and lower arm, upper and lower leg, and hip • Symptoms present at similar levels for at least 3 months • Presence of pain or tenderness at certain body sites • ESR/C-reactive protein (to exclude inflammatory cause), Thyroid function test (exclude hypothyroidism), CBC (exclude anemia), Rheumatoid factor (r/o RA), ANA (R/o Lupus), vitamin D (Vit D deficiency). Diagnosis: Based on symptoms Nonpharmacological: • Patient education about the disease (chronic pain disorder that affects connective tissues, muscles ligaments cause is unknown. • exercise • cognitive behavior therapy • sleep hygiene Pharmacological: Exact cause is unknown, so treatment is symptomatic: • Tricyclic antidepressant- Amitriptyline (Elavil) 10 mg once daily at bedtime • Flexeril 5-30mg once daily at bedtime. • Doxlenatine (Cymbalta) anxiety/depression and pain indication Follow up: 2-4 weeks Referral: NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ • psychologist for therapy • Pain clinic if interested/ applicable Liek: page 667 and 730 NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Otitis Media; Pediatric Retropharyngeal Abscess; Reflux Laryngitis; Tuberculosis (TB) Sinusitis DD: Migraine headache; URI; Allergic Rhinitis; Rhinovirus (RV) Infection (Common Cold); Chemical rhinitis; Nasal foreign body Tracheomalacia DD Adults: laryngomalacia, subglottic stenosis, cysts, vocal cord paralysis, and hypocalcemic tetany Tracheomalacia DD Infants: Asthma; Bronchiolitis; GERD; Bronchogenic Cyst; Double Aortic Arc; Bronchopulmonary Dysplasia; Pulmonary Artery Sling; Right Aortic Arch in Vascular Ring Defects; Sinonasal Manifestations of Cystic Fibrosis Otalgia Differential Diagnosis: AOM AEM AME; temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis Nonotogenic otalgia: referred or reflex pain, neuralgia, or to a psychogenic problem, referred also from primary carcinoma of the head and neck Cardiovascular DD: CHF DD: Pneumonia (CAP, bacterial, viral); COPD; Noncardiac pulmonary edema; Emphysema; Acute Kidney Injury; Idiopathic/ interstitial Pulmonary Fibrosis; MI; Respiratory failure Gastrointestinal DD: Acute Abdomen DD: BAD GUT PAINS= Bowel obstruction; Appendicitis, Adenitis (mesenteric); Diverticulitis; DKA; Dysentery/Diarrhea Drug withdrawal; Gastroenteritis; Gall bladder disease/stones/obstruction/infection; Urinary obstruction (stone) infection (pyelonephritis/cystitis); Testicular Torsion; Toxin - Lead, black widow spider bite; Pneumonia/Pleurisy; Pancreatitis; Perforated bowel/ulcer; Porphyria; Abdominal aneurysm; IN - Infarcted bowel; Infarcted myocardium (AMI); Incarcerated hernia; Inflammatory bowel disease; Splenic rupture/infarction; Sickle cell pain crisis; sequestration crisis Gastritis DD: GERD; GE/Viral GE; PUD; Cholelithiasis/Cholecystitis; Crohn Disease; Gastric Cancer Gastroenteritis DD: High fever, bloody diarrhea, or severe diarrhea suggests bacterial GE. Protozoal infections (endemic protozoal areas - Mexico, India, South America, parts of the US), C dif, IBS, food poisoning. NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ GERD: Acute/chronic gastritis; H Pylori; Hiatal hernia; PUD: IBS; Esophagitis; CAD; Esophageal Spasm; Cholelithiasis; Achalasia; Esophageal Cancer. IBS DD: IBS criteria: Bloating, Minimum 1 Manning criteria (pain onset correlates with BM frequency increase, onset of pain associated with looser bowel movements, Pain relieved by BM, NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Visible abdominal bloating, Subjective incomplete evacuation sense >25% time, Mucorrhea > 25% of time); IBS-C= types 1-3 Bristol Stool Scale; IBS-D types 5-7 stools BSS. DD: Bacterial/ Viral GE; Food allergies/ lactose intolerance; Anxiety Disorders; C Diff; Biliary Colic/ disease; Pancreatitis; Celiac Disease (Sprue); Ulcerative Colitis; Colon Cancer; Hypo/Hyperthyroidism and Thyrotoxicosis; Giardiasis; Acute Intermittent Porphyria. Protozoal infections DD: Travel to endemic protozoal areas - Mexico, India, South America, parts of the US. Amebic dysentery- bloody diarrhea with excessive mucus and abdominal pain. Giardiasis- bloating and prolonged diarrhea. R/O Parasitic infections in immunocompromised patients. DD- IBS, CDif, GE, food intolerance, anxiety. Genitourinary DD: UTI DD: Overactive bladder; Noninfectious urethritis; Asymptomatic bacteriuria; Interstitial cystitis; Vaginitis/ vaginosis; Urethral diverticulum; Infected Skene gland cyst; Radiation cystitis. Pelvic Pain (female) DD: See above acute abdomen plus “ECTOPIC” Ectopic; Endometriosis; Cyst rupture (corpus lutetium cyst rupture); Torsion of ovary or cyst; Ovulation: Mittelschmerz; PID; salpingitis, tubo - ovarian abscess; Incomplete abortion; Cystitis/pyelonephritis Musculoskeletal/ Ortho DD: Back Pain/ lumbago DD: Spinal stenosis (Numbness, BLE weakness, radiculopathy to buttock/ leg); Radiculopathy/sciatica (Numbness, weakness in lower extremities, pain radiating to buttock and leg, often unilateral); Cauda equina syndrome (GI/GU incontinence or retention, saddle anesthesia, and sudden unexplained BLE weakness); Spinal compression fracture; AAA; Nephrolithiasis; Pyelonephritis; back Abscess/ osteomyelitis/ or septic diskitis; Spinal neoplasia ( nocturnal pain, weight loss); Ankylosing or psoriatic spondylitis, or reactive arthritis; Sprain/ Strain DD: sprain = stretch/tearing ligaments (bone-bone), may have bruises; strain = stretch/tearing muscles or tendons (muscle-bone) may have muscle spasm; Fracture (difficult to differentiate from grade 3 injuries); Cartilage injury (Difficult to differentiate from sprain); Nerve Impingement; Achilles tendinopathy; Tibialis posterior tendinitis (posteromedial ankle pain and swelling; flatter than the other foot; tip-toe = difficult); fifth metatarsal fractures, navicular fractures, talar dome lesions, and peroneal tendon injuries Ottawa ankle X-ray rules : Required only if the patient has pain near the malleolus and one or more of the following: Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Integumentary DD: Contact Dermatitis Differential Diagnoses: Allergy versus Irritant Contact Dermatitis; Eczema; Contact Urticaria Syndrome; Drug-Induced Bullous Disorders; Drug-Induced Photosensitivity; Seborrheic Dermatitis; Tinea Corporis NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction KJ Drug Eruption/ Allergic Reaction to Med DD: viral exanthems {Measles (rubeola), Rubella, Erythema infectiosum/5th disease (human parvovirus B19), Roseola infantum or exanthem subitum (human herpesvirus 6 or 7), mono (EBV or CMV), HIV infection}; bacterial exanthems {Scarlet fever, Mycoplasma infection}, rashes associated with systemic diseases {Juvenile idiopathic arthritis and adult-onset Still disease}, and cutaneous diseases { Acute cutaneous lupus erythematosus} Ingrown Nails (toenail= unguis incarnatus or onychocryptosis) DD: Paronychia (tender bacterial or fungal nail infection); Foreign body; Nailbed Injuries; Bunion; Cellulitis; Group A Streptococcal (GAS) or staph aureus Infections; Subungual exostoses; Periungual fibroma; Onychomycosis; Amelanotic melanoma; Osteomyelitis; Herpetic Whitlow; Paronychia; Pyogenic granuloma Note: paronychia is NOT the same as onychocryptosis. Paronychia is a fingernail or toenail area skin infection, which usually affects the cuticle/sides of the nail. Acute paronychia – sudden onset, fingers, short lasting. Chronic paronychia – lasts longer; fingers or toes; doesn’t get better or keeps coming back. NURS 661 Vice Study Guide Chamberlain College of Nursing UPDATED 2022-2023 GUARANTEED Satisfaction