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NURS 620 TEST 2 QUESTIONS AND ANSWERS WITH ACCURATE SOLUTIONS RATED A.
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NURS 620 TEST 2 QUESTIONS AND ANSWERS WITH ACCURATE SOLUTIONS RATED A.
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NURS 620 TEST 2 QUESTIONS ANDANSWERS WITH ACCURATE SOLUTIONS
RATED A.
Cholecystitis
Correct Answer -Inflammation of the gallbladder is usually due to stones
within the cystic duct, causing inflammation. If not, with stones very
serious.
SS: generalized GI complaints to intractable pain. C/o indigestion, nausea,
and vomiting, especially after high-fat meals. Acute: colicky-type pain that
localizes to RUP or epigastrium. It may radiate to the middle of the back,
interscapular area, or right shoulder. The pain increased with any
movement, including respiration. If the inflammation extends to the
peritoneal area, the pain worsens, muscles become rigid, and fever is
usually evident. may have mild fever.
PE: Pain over RUQ. Positive Murphy's sign (Press against under ribs and
have pt take a breath. Pt will hold breath when the hand touches liver/gall
bladder). Low-grade fever may have mild jaundice from edema of the
common bile duct. Hyperbilirubinemia should raise suspicion of
choledocholithiasis. Bowel sounds may be diminished.
Rebound tenderness, shaking chills, or increased fever - perforation -
surgery.
Cholecystitis DX
Correct Answer -CBC with mild elevation of WBC. (15K). ALT and AST may
be elevated to 300U/L. Bili can be as high as 4mg/dl.
U/s is good, Xray can show stones, and CT if perforation suspected.
Cholecystitis Tx
Correct Answer -In most cases, resolves spontaneously in 4 days.
,Avoid food high in fat. can try to dissolve stones with Ursodiol
(ursodeoxycholic acid). or direct dissolution by percutaneous instillation of
methyl tertiary-butyl ether. May treat for as long as 2 years but recurrence
occurs in almost 100 % of cases.
Hospital - Iv fluids, antibiotics, pain control and GI rest. NG tube with
vomiting. Ceftriaxone 1 g q 24 hrs started with dx. if septic use
fluoroquinolone (ciprofloxacin 400 mg IV q 12hrs) + metronidazole.
Cholecystectomy.
Refer to general surgeon for surgery.
Pancreatitis
Correct Answer -acute inflammation of the pancreas resulting from the
release of pancreatic enzymes. These enzymes can cause a chemical burn
in the retroperitoneal spaces, which leads to systemic toxicity.
If microcirculation is intact - acute interstitial pancreatitis.
If microcirculation is disrupted - necrotizing pancreatitis.
Severe acute pancreatitis can be life-threatening, and pt ICU.
Pancreatitis SS
Correct Answer -abrupt onset of deep epigastric pain that persists for hrs to
days and may radiate straight through to the back. Intense and usually
does not resolve with large doses of IV narcotics. aggravated by any
vigorous activities such as coughing and by lying supine; it improves
when the pt is seated and leaning forward. Pt appears ill, often with
intractable nausea and vomiting. Pt may experience sweating, weakness
and anxiety due to severe pain.
EXAM: Severe abd pain especially over epigastric area which may come
with guarding but without rigidity or rebound tenderness and there may
be mild pain in lower abd without guarding. May have abd distention. BS
can be hypoactive or absent. No stools on blood. DRE normal.
,Pt is tachy (100-140bpm) with rapid shallow resp. Low inspiratory effort
(pain with inspiration). BP high due to pain. or low if shock is imminent.
Temp initially normal but them up to 102. Skin may be cool, pale and
clammy is shock. Screra may be icterus with mild jaundice.
Pancreatitis DX
Correct Answer -Elevated amylase and /or lipase levels. U/S
Gold standard is elevated amylase level up to 3 times normal. Amylase
may be normal in alcohol use disorder. Serum amylase and lipase may
return to normal after day 7 of acute sx. with damage to acinar cells
pancreas may not be able to continue to elevate amylase levels so they
drop. Level of amylase/lipase not indicative of severity of disease.
WBC 12k-20K. H&H high - fluid sequestration in third space. Blood
concentrated. Decrease in calcium levels is indicative of dz severity. Less
than 7mg/dL can cause tetany - poor prognosis.
Elevated C reactive protein - necrosis.
If biliary pancreatitis - LFT"s elevated. ALT elevated 3 x - cause if gall
stones. if ALT, alkaline phosphatase and bilirubin - gallbladder disease.
CT scan to dx. May also have u/s. Endoscopic retrograde
cholangiopancreatography (ERCP) with sphincterotomy and stone
extraction can be done - decrease morbidity and mortality.
Ranson's criteria - assess severity of pancreatitis.
Pancreatitis TX
Correct Answer -NPO, NG suction, bed rest, narcotics (meperidine),
anticholinergics, GI protectants
Carefully advance clears when pt pain free, amylase and lipase are wnl
and BS returned. Low fat diet as tolerated.
If severe - fluid resuscitation (6=8 L day- severe third spacing) in ICU.
Some may need plasma, albumin and blood. Daily monitoring of
electrolytes, amylase, lipase total protein, albumin and CBC. May need CT
, guided needle aspiration of necrotic tissue. ABX to prevent morbidity and
mortality.
Correct BS >250. Pt may be in fasting state for 2-4 weeks.
Gastroenteritis
Correct Answer -inflammation of stomach and intestine that manifests as
anorexia, nausea and vomiting and diarrhea. Can be acute or chronic. Can
be caused by bacteria, virus, parasites, injury to the bowel mucosa,
inorganic poisons (sodium nitrate), organic poisons (mushrooms or
shellfish), and drugs. Also could be food allergies and intolerance, stress,
and lactase deficiency. If cause by bacteria in food - food poisoning.
Self limiting for most adults but serious for old, young or
immunocompromised.
Severity indicated by level of dehydration, fever (>101) vomiting or
dysentery (frequent small stools with blood and mucus).
Trasmission fecal oral route. Person to person in hospitals, long term
facilities, day care centers. Anyone traveling to dev country, anal
intercourse, eating raw shellfish and seafood.
Acute is usually infectious/ Chronic, usually noninfectious.
Gastroenteritis DX
Correct Answer -Good history (antibiotics, otc, sexual preference,
laxatives, antacids, alcohol, and sugar substitutes).
LAb tests depends on hx - occult blood stool sample,(high leukocytes in
stool - cdiff, salmonela, shigella, e.coli - with acute, with chronic -
Inflammatory bowel disease IBD). CMP b/d diarrhea and dehydration.
Analyze for ova and parasite.
Do culture on anyone with severe diarrhea, fever blood instools. Blood
cultures if typhoid or enteric fever, hospitalized pts. Do culture before
starting antibiotics.
If diarrhea after atbx - test for ecoli
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