Exam (elaborations)
NR 509 Final Exam/162 Questions and Answers/A+ Graded
NR 509 Final Exam/162 Questions and Answers/A+ Graded
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NR 509 Final Exam/162 Questions andAnswers/A+ Graded
Appendicitis - -1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing
sign, and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then
migrates to the RLQ. Older adults are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests
appendicitis.
-McBurney Point - -1. McBurney point lies 2 inches from the anterior
superior spinous process of ilium on a line drawn from that process to the
umbilicus
2. Appendicitis is three times more likely if there is McBurney point
tenderness.
-Rovsing sign - -Press deeply and evenly in the LLQ. Then quickly withdraw
your fingers.
Pain in the RLQ during left-sided pressure is a positive Rovsing sign.
-Psoas Sign - ---Place your hand just above the patient's right knee and ask
the patient to raise that thigh against your hand. Alternatively, ask the
patient to turn onto the left side. Then extend the patient's right leg at the
hip. Flexion of the leg at the hip makes the psoas muscle contract; extension
stretches it.
--Increased abdominal pain on either maneuver is a positive psoas sign, sug-
gesting irritation of the psoas muscle by an inflamed appendix.
-Obturator Sign - ---Less helpful
--Flex the patient's right thigh at the hip, with the knee bent, and rotate the
leg internally at the hip. This maneuver stretches the internal obturator
muscle.
--Right hypogastric pain is a positive obturator sign, from irritation of the
obturator muscle by an inflamed appendix. This sign has very low sensitivity.
-Acute Cholecystits - -RUQ pain
Murphy Sign
-Murphy Sign - -Hook your left thumb or the fingers of your right hand under
the costal margin at the point where the lateral border of the rectus muscle
,intersects with the costal margin. Alternatively, palpate the RUQ with the
fingers of your right hand near the costal margin. If the liver is enlarged,
hook your thumb or fingers under the liver edge at a comparable point. Ask
the patient to take a deep breath, which forces the liver and gallbladder
down toward the examining fingers. Watch the patient's breathing and note
the degree of tenderness.
--A sharp increase in tenderness with inspiratory effort is a positive Murphy
sign. When positive, Murphy sign triples the likelihood of acute cholecystitis.
-Acute Pancreatitis Process - -Intrapancreatic trypsinogen activation to
trypsin and other enzymes, result-ing in autodigestion and inflammation of
the pancreas
-Acute Pancreatitis Location - -Epigastric, may radiate straight to the back
or other areas of the abdomen; 20% with severe sequelae of organ failure
-Acute Pancreatitis Quality - -Usually steady
-Acute PancreatitisTiming - -Acute onset, persistent pain
-Acute Pancreatitis Aggrevating Factors - -Lying supine; dyspnea if pleural
effusions from capillary leak syn-drome; selected medications, high
triglycerides may exacerbate
-Acute Pancreatitis Relieving factors - -Leaning forward with trunk flexed
-Acute Pancreatitis Associated Symptoms and Setting - -Nausea, vomiting,
abdominal dis-tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
-Peptic Ulcer Disease Process - -Mucosal ulcer in stomach or duode-num >5
mm, covered with fibrin, ex-tending through the muscularis mu-cosa; H.
pylori infection present in 90% of peptic ulcers
-Peptic Ulcer Disease Location - -Epigastric, may radiate straight to the back
-Peptic Ulcer Disease Quality - -Variable: epigastric gnawing or burning
(dyspepsia); may also be boring, aching, or hungerlike
No symptoms in up to 20%
-Peptic Ulcer Disease Timing - -Intermittent; duodenal ulcer is more likely
than gastric ulcer or dyspepsia to cause pain that (1) wakes the patient at
night, and (2) occurs intermittently over a few wks, disappears for months,
then recurs
-Peptic Ulcer Disease aggravating factors - -Variable
, -Peptic Ulcer Disease relieving factors - -Food and antacids may bring re-lief
(less likely in gastric ulcers)
-Peptic Ulcer Disease associated symptoms and setting - -Nausea, vomiting,
belching, bloating; heartburn (more common in duodenal ulcer); weight loss
(more common in gastric ulcer); dyspepsia is more com-mon in the young
(20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in those
30-60 yrs
-GERD Process - -Prolonged exposure of esophagus to gastric acid due to
impaired esopha-geal motility or excess relaxations of the lower esophageal
sphincter; Helico-bacter pylori may be present
-GERD Location - -Chest or epigastric
-GERD Quality - -Heartburn, regurgitation
-GERD timing - -After meals, especially spicy foods
-GERD aggravating factors - -Lying down, bending over; physical activity;
diseases such as scleroderma, gastroparesis; drugs like nicotine that relax
the lower esophageal sphincter
-GERD : relieving factors - -Antacids, proton pump inhibi-tors; avoiding
alcohol, smoking, fatty meals, chocolate, selected drugs such as
theophylline, cal-cium channel blockers
-GERD associated symptoms and setting - -Wheezing, chronic cough, short-
ness of breath, hoarseness, choking sensation, dysphagia, regurgitation,
halitosis, sore throat; increases risk of Barrett esophagus and esopha-geal
cancer
-Diverticulitis process - -Acute inflammation of colonic diver-ticula,
outpouchings 5-10 mm in di-ameter, usually in sigmoid or descend-ing colon
-Diverticulitis location - -Left lower quadrant
-Diverticulitis quality - -May be cramping at first, then steady
-Diverticulitis timing - -Often gradual onset
-Diverticulitis aggravating factors - ---
-Diverticulitis relieving factors - -Analgesia, bowel rest, antibiotics
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