Chamberlain NR 511 Midterm exam with complete solutions

What are common causes of N/V associated with gastritis? Alcohol, NSAIDs, ASA, ABX, and illicit substances What is the most common cause of nausea and vomiting? Acute Gastroenteritis (AGE) What are some manifestations of AGE? Nausea, vomiting, and diarrhea, fever, abdominal pain. May also include fatigue, malaise, anorexia, tenesmus and borborygmus. How is the severity of AGE gauged? Dehydration secondary to profuse watery diarrhea, fever greater than 101ºF (38.3ºC), vomiting, or dysentery. What are important parts of a patient's history when AGE is suspected? Travel, dining locations, ABX history.. What happens to the pH of the stomach when antacids are taken and how does this affect bacteria? High pH can make it easier for bacteria to survive and cause and infection. How does motility of the GI tract affect bacteria colonization? Small bowel stasis as a result of obstruction, diverticulitis, or blind loop syndrome frequently develop an overgrowth of bacteria within the stagnant segment. Which immunoglobulin may protect the GI tract against invading organisms? IgA...may also help protect against a future attack by the same pathogen. Onset of N/V begin within 6 hours after exposure. Is this bacterial or viral? Bacterial: time frame suggests food poisoning resulting from the ingestion of a preformed toxin such as that of Bacillus cereus. What two indications are highly suggestive of viral AGE? Incubation periods greater than 14 hours and the initial symptom of vomiting. If a patient presents with AGE and reports bloody stools, what can be understood about the reason for blood in the stool/ Mucosal damage and inflammatory process secondary to invasive pathogens. What do frothy stools and flatus suggest? Malabsorption problem. Patients with prolonged AGE illness who are malnourished may present with edema. What is the reason? Hypoalbuminemia T or F: Chronic diarrhea usually has a noninfectious etiology. True T or F: Acute diarrhea usually is caused by infectious agents or toxins True What is the most common viral pathogen causing AGE in adults? Norovirus What is the most common viral pathogen causing AGE in pediatrics? Rotavirus. This has been greatly reduced since the introduction of the rotavirus vaccine. T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic disease False T or F: A CBC will help distinguish between viral and bacterial AGE False When are stool studies warranted? Severe or prolonged diarrhea, a fever > 38.5ºC, bloody stools or stools that test positive for leukocytes or occult blood. What are common pathogens involved in Traveler's Diarrhea? Shigella, Campylobacter, and E. coli. What should the clinician do if the patient develops diarrhea after initiation of completion of antibiotic therapy? Test for C. diff. What are some DDx of AGE, particularly in patients with persistent or chronic diarrhea and severe abdominal pain? IBS, IBD, ischemic bowel disease, partial bowel obstruction, small bowel diverticulosis. What are some red flag symptoms that may indicate the need for hospitalization? Hypovolemia, dehydration, abnormal electrolytes, decreased renal function, bloody stool/rectal bleeding, weight loss, severe abdominal pain, prolonged symptoms greater than 1 week, pregnancy, advanced age, history of hospitalization or antibiotic use in the last 3-6 months. What is the usual course of treatment for AGE? Only supportive treatment is initiated since AGE is usually self-limiting and resolves within 1 week after onset of symptoms. How such patients with evidence of dehydration be treated initially? Fluid repletion and nutrition. Sports drinks aren't as effective as specific electrolyte replenishing drinks. At what point should a patient be referred to the hospital for dehydration? Signs of hypovolemia such as hypotension, tachycardia, pallor, and poor skin turgor. T of F: Empiric antimicrobial therapy is recommended for patients with severe diarrhea suspected form traveling. True. Bactrim, Ciprofloxacin, Norfloxacin, Floxacin. T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is appropriate. True How effective is antibiotic prophylaxis for patients traveling to high-risk areas? 90% effective What does antibiotic prophylaxis treatment consist of? Bactrim, Ciprofloxacin, Norfloxacin, or Floxacin given once daily until 2 days after returning home. What is an appropriate symptomatic treatment for patients < 65 years or age with moderate to severe diarrhea? Two-day course of Loperamide (Imodium) What is an appropriate symptomatic treatment for patients < 65 years or age with significant vomiting? Two-day course of Zofran or Phenergan. What is the best way to prevent AGE? Hand washing. T or F: Kids can attend daycare with infectious diarrhea as long as they're separated from other children. False! Not until the diarrhea has stopped. If pain is present in the right lower quadrant, what might be the etiology related to bowel disorders? IBD, IBS, Infectious Colitis, and Constipation