Exam Study Guide for Medical Diagnostics and Management, Exams of Nursing

Download Exam Study Guide for Medical Diagnostics and Management and more Exams Nursing in PDF only on Docsity! VISE NR 661 Exam Study Guide (Latest Update 2024 / 2025)GRADED[ A+] Hypertension-Presentation - Correct answerMost are not symptomatic, Occipital Headaches, headache on awakening in am, blurry vision, Diagnostic studies for Hypertension - Correct answerEKG, fasting lipid profile, fasting blood glucose, CBC, CMP, and urinalysis. Diagnosis: > 140/90 mm Hg start on B/P medication. Non-pharmacologic Management for Hypertension - Correct answero Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week. o Limit alcohol o stop smoking o stress management Pharmacologic Management for Hypertension - Correct answero hydrochlorothiazide (HCTZ) 25 mg/day o ALTERNATIVE Amlodipine besylate 5 mg /day. I o lisinopril 10mg/day complicated HTN Follow up for Hypertension - Correct answerReferral: o 2-4weeks o Cardiology if EKG is normal Hyperlipidemia Presentation - Correct answerXanthomata (lipid deposits around the eyes) o Corneal Arcus prior to age 50 years Diagnostics for Hyperlipidemia - Correct answero lipid profile o Glucose, o UA and creatinine (for detection of nephrotic syndrome which can induce dyslipidemia), o TSH (for detection of hypothyroidism) o CMP Diagnosis: Pt with LDL >= 190mg/dL Non-pharmacologic Management for Hyperlipidemia - Correct answero Lifestyle Modification; diet and exercise. ----------------------------------------- Pharmacologic Management for Hyperlipidemia - Correct answer• Atorvastatin 10mg once a day • Alternative Welchol 625 mg tab daily once a day. for LDL .>190 Diabetes type 2 Presentation: - Correct answer•Polydipsia, Polyuria, Polyphagia, • agitation, • nervousness, • obesity, • fatigue • blurry vision Diagnostics for Diabetes type 2: - Correct answerEKG, CBC, CMP, LIPIDS< Microalbuminuria, TSH, Diagnostic criteria for Diabetes type 2 - Correct answerA1C Diagnosis: Hgb A1C >or equal to 6.5% or Fasting glucose>126mg/dl and confirmed on a different day Non-pharmacologic Management for Diabetes Type 2 - Correct answer• Monitor Blood glucose at home and diary •Lifestyle modification: diet and Exercise • avoid alcohol • avoid smoking --------------------------------- Pharmacologic Management for Diabetes Type 2 - Correct answer• Metformin 500mg twice a day. (first line) • Actos 15 mg daily • Levemir 10 units once a day Referral for Diabetes Type 2 - Correct answer• Ophthalmologist • Diabetic educator • Podiatry Back pain Presentation: - Correct answerback pain complaint. Maybe localized, referred, or radiating. Follow up for Depressive disorder Referral for Depressive Disorder - Correct answer2-4 weeks ---------------------- Psychologist for counseling Diagnostics for Obesity - Correct answerTSH, Lipid panel, glucose/A1c, CBC, CMP, Lipase, EKG insulin level Diagnosis: BMI >30 Non-Pharmacological management for Obesity - Correct answer• Lifestyle modification: exercise and diet ---------------------------- Pharmacological management for Obesity - Correct answer• Adipex-P 37.5mg daily x12weeks ****can only prescribe for 3 months in Ohio then requires a 3 month "holiday"**** Follow up for Obesity Referral for Obesity - Correct answer2-4 weeks . Monthly while on Adipex for BP and weight check ---------------- Nutritionist GERD Presentation: - Correct answerHeartburn, burning beneath the sternum, postprandial and nocturnal, regurgitation, chest pain, neck pain, chronic cough. Diagnostica for GERD - Correct answerEKG, CBC, CMP, Diagnosis: Save as presentation (decreased lower esophageal sphincter tone (LES)). Non-pharmacological management for GERD - Correct answer• 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 management for GERD - Correct answerAntacids first then H2 Receptor Blockers-zantac/tagament then PPI-Omeprazole 20mg daily before breakfast if no improvement after initiation of PPI in 4-6 weeks-refer to GI Follow up for GERD - Correct answer2-4 weeks-->if no improvement in 4-6 weeks REFER Non-pharmacological management of Allergic Rhinitis - Correct answer• Avoidance/elimination of offending allergen • frequent vacuuming, dusting, remove feather pillows from the bedroom, • change air conditioner filter frequently, • removal house plants remove carpet ------------------------------------- Pharmacological management of Allergic Rhinitis - Correct answer• Flonase 2 sprays in each nostril daily; • Claritin 10mg once a day. Allergic Rhinitis Presentation: - Correct answerS&S: intermittent allergies, Seasonal allergies. Pale boggy turbinates'. Red conjunctivitis. Clear nasal discharge sneezing nasal stuffiness mucosal edema Follow up for Allergic Rhinitis Referral for Allergic Rhinitis - Correct answerin 1-2 weeks if symptoms persist ------------------------- none Diagnostics for Allergic Rhinitis - Correct answernone Diagnosis: Conjunctival injection, pale, boggy turbinates' with clear nasal secretions, sore throat, palpable lymph nodes URI (common cold) Presentation: - Correct answerNasal stuffiness, sneezing, scratchy, irritated throat/hoarseness, red or irritated nasal mucosa with clear or yellow mucus discharge, malaise, headache, cough, occasional low- grade fever (cause is usually Rhinoviruses and adenoviruses) Diagnostic: for URI - Correct answer• nasal washing culture/ flu wash Diagnosis: Same as presentation Follow up for URI Referral for URI - Correct answerusually not needed unless symptoms persist over 10 days. ------------------------ NONE Pharmacological management for URI - Correct answerTylenol/ibuprofen for fever and aching body pain OTC • saline nasal spray, • throat lozenges • antibiotics not necessary unless illness lasts greater than 10 days. Nonpharmacological management for URI - Correct answer• Increase fluid and rest. • Humidifier HAND washing Lozenges for scratchy throat • Saline nose drops. --------------------- Acute laryngopharyngitis Presentation: - Correct answerSore throat, tonsillar exudate, malaise, cervical adenopathy, fever, nausea, absence of cough, petechiae on soft palate, beefy red tonsils, sandpaper rash (strep), conjunctivitis, nasal congestion, hoarseness, cough, diarrhea, viral rash (virus) Diagnostics for acute larnygopharyngitis - Correct answerRapid strep test with a throat culture Nonpharmacological management for laryngopharyngitis - Correct answer• Gargling with warm saltwater, • increase fluids, • Mild Persistent: symptoms >2 times per week • Albuterol inhaler 2 inhalations Q4-6 hours as needed • Flovent HFA 88mcg inhaled twice a day • Singular 10mg once a day. Hypothyroidism Presentation: - Correct answerLethargic, mild weight gain, swelling of hands and feet, Intolerance to cold, constipation, menstrual irregularities, decreased libido, infertility, memory loss, depression, muscle cramps, coarse hair, dry skin, hair loss, brittle nails, bradycardia. Diagnostic testing for hypothyroidism - Correct answerTSH, T4, T3, CBC, CMP, Lipid panel, EKG Diagnosis: TSH (increased), T4(decreased), T3(maybe decreased) Pharmacological management - Correct answer• Levothyroxine Synthroid 50mcg daily (empty stomach) Nonpharmacological management for hypothyroidism - Correct answerHigh 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. ---------------------------- Osteoarthritis Presentation: - Correct answerGeneralized disease with no known cause. Most common joint disease. Progressive destruction of the articular cartilage. Joint pain, usually asymmetrical, develops insidiously and accompanies or follows physical activity. Assess for Morning stiffness lasting <1 hour. Stiffness resumes towards the day end and after periods of activity. Assess for crepitus and limited range of motion. Assess for bunions (MTP joints) Assess for site warm and redness. Diagnostics for Osteoarthritis - Correct answerx-ray findings (joint space narrowing), CBC, CMP, ESR, Rheumatoid factors Nonpharmacological management for Osteoarthritis - Correct answer• Weight loss • braces to stabilize joints while exercising, • apply heat/cold to affected joints ------------------------------------ Pharmacological management for Osteoarthritis - Correct answerAcetaminophen 650mg up to 4 times a day as needed for pain Voltaren cream on the affected area as needed for pain. Follow up for Osteoarthritis Referral for Osteoarthritis - Correct answer• 2-4 weeks. Physical therapy and nutritionist for weight loss Ortho Knee pain Presentation: - Correct answercomplaint of knee pain. Assess the history of OA and RA. Assess in trauma is blunt hit to the knees or twisting motion. Asses using Posterior drawer test (bend 90 degrees-if displacement of the tibia suggests ACL injury) Diagnostics for Knee Pain - Correct answerx-rays to rule out fractures, MRI to diagnose soft tissue injury. Diagnosis: knee pain complaint Nonpharmacological management for Knee Pain - Correct answer• RICE (Rest Ice, compression, Elevate). • Physical therapy, ---------------------------------- Pharmacological management for Knee Pain - Correct answer• 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 Shoulder pain Presentation: - Correct answerRotator cuff syndrome: Rotator cuff tears, advanced age, repetitive use, occupation-related, a higher risk with obesity and diabetes Pain often at night, deltoid pain, weakness with abduction/ forward flexion, positive impingement signs Diagnostics for knee pain - Correct answerx-rays to rule out fractures, MRI to diagnose soft tissue injury Diagnostics for Shoulder Pain - Correct answerX-ray results typically normal, MRI to diagnose Nonpharmacological management for Shoulder Pain - Correct answer• Rest • physical therapy cold/heat pack ---------------------------------- Pharmacological management for Shoulder Pain - Correct answer• 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 Hip pain (info retrieved from UpToDate) Presentation: - Correct answerYoung adults: Hip joint labral injuries or synovitis Middle age & older adults: trochanteric pain syndrome, osteoarthritis Dangerous Exclude: referred pain from lumbosacral radiculopathy, ****aortoiliac arterial insufficiency, septic arthritis, osteonecrosis, and tumor**** Assessment of Hip Pain - Correct answerAssess: 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) ●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) frequency/urgency, incontinence, retention, hematuria, firm/smooth symmetrical prostate Diagnostics of BPH - Correct answerUA-pyuria if residual urine presents, Creatine, PSA, Post-void measurement, US also can be ordered. Digital rectal exam. AUA score >8 on the questionnaire start pharmacological management nonpharmacological management for BPH - Correct answer• limit fluids before bed, • frequent voiding, • avoid caffeine • sit to urinate instead of standing to have better emptying, Pharmacological management for BPH - Correct answer• AUA score >8 start pharmacological management, • Flomax 0.4mg daily Follow up for BPH Referral for BPH - Correct answer• 2-4 weeks • Urology Eczema Presentation: - Correct answeratopic dermatitis is an inflammatory skin condition and chronic pruritic skin eruption. Dry skin, erythema Nonpharmacological management of Eczema - Correct answerPrevent dry skin by using ointment • manage stress • avoid wool clothing, • fragrance-free detergents, • keep the environment free of dust as possible • oatmeal bath • products without scents/for sensitive skin. • Avoid sun trauma. • Moisturize. Pharmacological management of Eczema - Correct answer• Topical Corticosteroids (NOT ON FACE) low potency steroids • Hydrocortisone butyrate 0.1% 15g apply thin film 2-4 times daily. No more than 3 weeks. • Antihistamines • Eucerin Fibromyalgia/ Myositis Presentation - Correct answerPresentation: patients present with chronic widespread body pain and almost always have accompanying comorbid symptoms such as fatigue, memory difficulties, and sleep and mood difficulties. Physical examination is typically normal but may have tenderness Diagnostics for Fibromyalgia/Myositis - Correct answerESR/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). UTI (Cystitis) Presentation: - Correct answerMostly E-coli, mostly impacts females, "infection of your urinary system from bacteria (kidneys, ureters, bladder, urethra)). Urgency and frequent to void. burning, frequency, and or urgency during urination fever, chills, Sensation of incomplete bladder emptying, Hematuria, lower abdominal pain, Dribbling of urine in men, foul-smelling urine, small volume and/of frequent voiding Nonpharmacological management of fibromyalgia/myositis - Correct answer• Patient education about the disease (chronic pain disorder that affects connective tissues, muscles ligaments cause is unknown. • exercise • cognitive behavior therapy • sleep hygiene. Pharmacological management of fibromyalgia/myositis - Correct answer• Tricyclic antidepressant- • Amitriptyline (Elavil) 10 mg once daily at bedtime • Flexeril 5-30mg once daily at bedtime.