ACNP 807 Exam 2: Questions And Accurate Solutions
Appendicitis Overview Right Ans - Considered an inflammatory GI
disorder;
Is extremely common....there are 250,000 appendectomy a year
MUST be treated because if left untreated for longer than 36
hours....perforation or gangrene can occur
Appendicitis S&S Right Ans - PAIN; pain that is located in the right lower
quadrant....sometimes it starts as periumbilical pain and then starts really
hurting in that lower right side
Guarding can occur as can rebound tenderness
When left abdomen is palpated can be felt in the right also
Can check hips...active extension of the hip or internal rotation will worsen
abd pain
Nausea with or without vomiting; constipation or diarrhea
low grade fever....high fever .... suspect perf
Things to ask a pt with appendicitis Right Ans - When did the pain
start......and then assess rebound tenderness, guarding, vitals....especially
temperature and bp.....ask if the pt is having difficulty voiding
differential: kidney stone, peritonitis, appendicitis
How to manage appendicitis Right Ans - SURGERY! Don't wait for the
perf.....get a ABD CT scan to confirm, Urinalysis, lactate, CBC, CMP.....and then
focus on pain control and fluid/electrolyte replacement as needed.....will need
antibiotics before and 7 days after surgery.....will decide what antibiotics post
surgery after a culture is taken........if pt has a high fever and is high risk then
treat with merem or zosyn before.
Appendicitis antibiotics Right Ans - Before surgery:
cefoxitin 2g IV q6;
Ertapenem 1g IVQ24 and
, Moxifloxacin 400mg IV Q24
High risk:
3.375g zosyn q6
1g merem 1g IV q6
Primaxin 500mg IV or Doripenem 500mg IV
Appendicitis pain Right Ans - 1 mg dilaudid IV; morphine sulfate 1-2mg IV
Appendicitis diagnostics: what you most likely will see Right Ans - Positive
Ct, leukocytosis 10-20 and urinalysis will show elevated specific gravity,
minimal pyuria , hematuria and albuminuria
Cholecystitis overview Right Ans - It's a form of biliary dysfunction.....can
be caused by many things, however, it's mainly caused by
gallstones.....gallstones or cholethisiasis occurs in 90 percent of
cases.....cholecystitis can be acute or chronic....often times you just have to take
the gallbladder out or remove the stones....gall stones get lodged in the cystic
duct
Causes of cholecystitis Right Ans - Most of the time cholethisiasis,
otherwise.....acalculous cholecystitis....dangerous....suspect this if a pt has had
recent trauma or surgery.....or ICU admission where they had poor GI
intake.....it's dangerous and mortality rates are high....could be caused by
bacteria or virus's in immunocompromised pt's (cytomegalovirus can cause
it), neoplasms, strictures, ischemia, torsion is twisting of the cystic duct,
How does cholecystitis present? Right Ans - Abdominal tenderness with
guarding and rebound tenderness almost always present, positive murphys
sign (pain on inspiration when palpating under right rib cage), often the
patients will have an elevated t-bili and jaundice in 25% of cases, elevated
temperatures, leukocytosis mild under 20 and then referred right shoulder
pain.......if abdominal tenderness with guarding and rebound tenderness plus
fever have been progressing for 2-3 days that's accompanied by severe
leukocytosis then expect gangrene, perf or empyema
also nausea and vomiting occurs in 70% of pt's...abdominal fullness, anorexia
etc
Appendicitis Overview Right Ans - Considered an inflammatory GI
disorder;
Is extremely common....there are 250,000 appendectomy a year
MUST be treated because if left untreated for longer than 36
hours....perforation or gangrene can occur
Appendicitis S&S Right Ans - PAIN; pain that is located in the right lower
quadrant....sometimes it starts as periumbilical pain and then starts really
hurting in that lower right side
Guarding can occur as can rebound tenderness
When left abdomen is palpated can be felt in the right also
Can check hips...active extension of the hip or internal rotation will worsen
abd pain
Nausea with or without vomiting; constipation or diarrhea
low grade fever....high fever .... suspect perf
Things to ask a pt with appendicitis Right Ans - When did the pain
start......and then assess rebound tenderness, guarding, vitals....especially
temperature and bp.....ask if the pt is having difficulty voiding
differential: kidney stone, peritonitis, appendicitis
How to manage appendicitis Right Ans - SURGERY! Don't wait for the
perf.....get a ABD CT scan to confirm, Urinalysis, lactate, CBC, CMP.....and then
focus on pain control and fluid/electrolyte replacement as needed.....will need
antibiotics before and 7 days after surgery.....will decide what antibiotics post
surgery after a culture is taken........if pt has a high fever and is high risk then
treat with merem or zosyn before.
Appendicitis antibiotics Right Ans - Before surgery:
cefoxitin 2g IV q6;
Ertapenem 1g IVQ24 and
, Moxifloxacin 400mg IV Q24
High risk:
3.375g zosyn q6
1g merem 1g IV q6
Primaxin 500mg IV or Doripenem 500mg IV
Appendicitis pain Right Ans - 1 mg dilaudid IV; morphine sulfate 1-2mg IV
Appendicitis diagnostics: what you most likely will see Right Ans - Positive
Ct, leukocytosis 10-20 and urinalysis will show elevated specific gravity,
minimal pyuria , hematuria and albuminuria
Cholecystitis overview Right Ans - It's a form of biliary dysfunction.....can
be caused by many things, however, it's mainly caused by
gallstones.....gallstones or cholethisiasis occurs in 90 percent of
cases.....cholecystitis can be acute or chronic....often times you just have to take
the gallbladder out or remove the stones....gall stones get lodged in the cystic
duct
Causes of cholecystitis Right Ans - Most of the time cholethisiasis,
otherwise.....acalculous cholecystitis....dangerous....suspect this if a pt has had
recent trauma or surgery.....or ICU admission where they had poor GI
intake.....it's dangerous and mortality rates are high....could be caused by
bacteria or virus's in immunocompromised pt's (cytomegalovirus can cause
it), neoplasms, strictures, ischemia, torsion is twisting of the cystic duct,
How does cholecystitis present? Right Ans - Abdominal tenderness with
guarding and rebound tenderness almost always present, positive murphys
sign (pain on inspiration when palpating under right rib cage), often the
patients will have an elevated t-bili and jaundice in 25% of cases, elevated
temperatures, leukocytosis mild under 20 and then referred right shoulder
pain.......if abdominal tenderness with guarding and rebound tenderness plus
fever have been progressing for 2-3 days that's accompanied by severe
leukocytosis then expect gangrene, perf or empyema
also nausea and vomiting occurs in 70% of pt's...abdominal fullness, anorexia
etc
