NR 511 FINAL EXAM STUDY GUIDE 4 – QUESTION AND ANSWERS

NR 511 FINAL EXAM STUDY GUIDE 4 – QUESTION AND ANSWERS ● Identify the most common type of pathogen responsible for acute gastroenteritis. -Viral: Norovirus (Leading cause for adults) -Rotovirus (Leading cause for peds up to 2 years old) ● Recognize that assessing for prior antibiotic use is a critical part of the history in patients presenting with diarrhea. -Order stool studies ● Describe the difference between Irritable Bowel Disease (IBS) and Inflammatory Bowel Disorder (IBD). -IBS (Irritable bowel syndrome): disorder of bowel function not from anatomic abnormality +S/S: result from disordered sensation or abnormal function of the small and large bowel -IBD (Inflammatory bowel disease): chronic immunologic disease that manifests in intestinal inflammation ● Discuss two common Inflammatory Bowel Diseases. -Ulcerative colitis (UC): the mucosal surface of the colon is inflamed and ultimately results in friability, erosions, and bleeding. -Crohns (CD): the inflammation extends deeper into the intestinal wall and can involve all or any layer of the bowel wall and any portion of the GI tract from the mouth to the anus. ● Discuss the difference between sensorineural and conductive hearing loss. - Sensorineural: Results from deterioration of cochlea -Loss of hair cells form the organ of Corti -Gradual and progressive -Not correctable but preventable - Conductive: Obstruction between middle and outer ear -Most types are reversible ● Identify the triad of symptoms associated with Meniere's disease. -Meniere’s Disease: Sensory disorder of labyrinth (semi-circular canal system) and cochlea -S/S: -Vertigo -Hearing loss -Tinnitus ● Identify the symptoms associated with peritonsilar abcess. -increasing unilateral ear and throat pain ipsilateral to the affected tonsil -dysphagia -drooling -trismus -erythema -edema of the soft palate with fluctuance on palpation ● Identify the most common cause of viral pharyngitis. -adenovirus: MOST common -RSV -Influenza A&B -Epstein-Barr -coxsackie -enteroviruses -herpes simplex ● Identify the most common cause of acute nausea & vomiting. -Gastroenteritis: AGE ● Describe the differences between medical billing and medical coding. -Medical coding: is the use of codes to communicate with payers about which procedures were performed and why. -Medical billing: is the process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider. ● Compare and contrast the two coding classification systems that are currently used in the U.S. healthcare system. -The CPT system offers the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. -CPT codes are recognized universally and also provide a logical means to be able to track healthcare data, trends, and outcomes. -ICD-10 codes are shorthand for the patient’s diagnoses, which are used to provide the payer information on the necessity of the visit or procedure performed. ● Accurately describe why every procedure code must have a corresponding diagnosis code. -Every procedure code needs a diagnosis to explain the necessity whether the code represents an actual procedure performed or a nonprocedural encounter like an office visit. ● Identify the three components required in determining an outpatient, office visit E&M code. -Place of service -Inpatient -Outpatient -Type of service -Consolations -Office visit -Hospital admission -Patient status -New patient: one who has not received professional service from a provider from the same group practice within the past 3 years. -Established patient of your practice: has received professional service from a provider of your office within the last 3 years. - There are three key components that determine risk-based E&M codes. -History -Physical -Medical Decision Making (MDM) ● Discuss the importance of obtaining an abdominal xray to rule out perforation or obstruction even though the diagnosis of diverticulitis can be made clinically. -Abdominal X-ray films should be obtained on all patients with suspected diverticulitis to look for free air (indicating perforation), ileus, or obstruction. ● Discuss colon cancer screening recommendations relative to certain populations. -Anyone over age 50 should have a routine c-scope -African American’s should start screenings at age 40 -Individuals with a single first-degree relative with CRC or advanced adenomas diagnosed at age ≥60 years can be screened like average-risk persons. ● Identify at least two disorders that are considered to be disorders related to conductive hearing loss. -Chronic Otitis Media (OM) -middle ear effusion -mass -vascular anomaly -cholesteatoma ● Identify the most common bacterial cause of pharyngitis. -Group A Beta Hemolytic Streptococcus (GABHS) ● Identify the clinical findings associated with mononucleosis. -Fever -Malaise -Severe sore throat -Exudative tonsillitis (50% of cases) -Palatal petchiae -Rash -Anterior and posterior cervical lymphadenopathy -Splenic enlargement -POC Monospot test: (+) ● Discuss that the diagnosis of streptococcal pharyngitis can be made clinically based on the Centor criteria. -Absence of cough -Tonsillar exudates -History of fever -Tender anterior cervical adenopathy ● Describe an intervention for a patient with gastroenteritis. -Supportive care: fluid and nutrients -Low residue diet (BRAT) -Viral cause = NO antibiotics -Education surrounding not prescribing antibiotics/not spreading germs/eating safe foods -Imodium/Zofran/Phenergan ● Discuss an appropriate treatment for prophylaxis or treatment of traveler's diarrhea. -empirical antimicrobial therapy: Trimethoprim-sulfamethoxazole (Bactrim) 1 PO BID ×3d -Mild: -ciprofloxacin (Cipro) 500 mg -norfloxacin (Noroxin) 400 mg -ofloxacin (Floxin) 300 mg ● Identify at least one effective treatment for Irritable Bowel Syndrome (IBS). -Linzess (linaclotide), Trulance (plecanatide), and Amitiza (lubiprostone): drugs work by acting locally on the apical membrane of the GI tract to increase intestinal fluid secretion and improve fecal transit. ● Identify at least one prescription medication for the treatment of chronic constipation. -Miralax is a gentle but effective laxative that is safe for long-term use ● Discuss at least one treatment for Meniere's disease. -Acute attacks best treated with BEDREST -Attacks rarely last 4 hours -Diuretics to reduce lymphatic pressure and volume: Diurel 500mg/day -Vestibular suppressants