Download NURS 621 Midterm Exam: Comprehensive Review of Key Concepts and Clinical Applications and more Exams Nursing in PDF only on Docsity!
NURS 621 Midterm Exam with complete
solutions latest version
Dx: .Acute .otitis .media .- .CORRECT .ANSWER-H&P:
- .Ear .pain .(typical) - .Decreased .hearing .(typical) - .Fever .(sometimes) - .Recent .URI .or .exacerbation .of .seasonal .allergic .rhinitis .(can .be) - .Unilateral .(usual) - .Bulging .tympanic .membrane .(needed .to .distinguish .from .otitis .media .with .effusion). .Can .also .be .erythematous .or .opacified. .Tympanic .membrane .can .rupture .(feels .relief .of .ear .pain, .may .then .have .purulent .otorrhea) - .Dysequilibrium .(not .common) - .Conductive .hearing .loss .(usually .transient) - .High .fever, .severe .pain .behind .ear, .facial .paralysis .(unusual .complications) DDx .Otitis .Media .- .CORRECT .ANSWER- • .Otitis .externa o .More .painful, .normal-appearing .ear .drum - .Eustachian .tube .dysfunction o .Check .if .recurrent .unilateral .AOM .(>2 .over. 6 .months). .Do .fiberoptic .nasopharyngoscopy .and/or .contrast .MRI .of .skull .base .to .rule .out .malignant .process - .Herpes .zoster .infection o .Development .of .dermatomal .vesicular .rash .that .evolves .into .crusted .lesions. .Pain .may .precede .rash. .Ramsay .Hunt .syndrome .presents .with .triad .of .ipsilateral .facial .paralysis, .ear .pain, .and .vesicles .involving .auditory .canal .and .auricle. .Can .cause .vertigo Lab/diagnostics .Otitis .Media .- .CORRECT .ANSWER- • .Common .organism: .strep .pneumoniae, .H. .influenza. .Group .A .beta-hemolytic .strep, .staph .aureus, .M. .catarrhalis .less .frequently - .Otoscopic .exam .(standard). o .Redness, .opacification, .bulging .TM o .Otitis .media .with .effusion: .TM .cloudy, .yellowish .or .opaque .when .fluid .in .middle .ear - .Pneumatoscopy .(allows .eval .of .tympanic .membrane .motion) - .Weber .(demonstrates .conductive .hearing .loss)
o .Perceived .louder .in .infected .ear .(common) o .If .sensorineural .loss, .sound .may .lateralize .in .noninfected .ear .(rare) Txt .Plan .Otitis .Media .- .CORRECT .ANSWER- • .Amoxicillin:. 500 .mg .Q12 .hours .or
. 250 .mg .Q. 8 .hours. 10 .days...if .severe:. 875 .mg .Q12 .hours .or. 500 .mg .TID. 5 - 7 .days - .Augmentin .(if .amoxicillin .fails. .Tx .for .another. 10 .days) - .PCN .allergy: o .Cefdinir .(3rd .gen .cephalosporin):. 300 .mg .BID .or. 600 .mg .once .daily o .Cefpodoxime. 200 .mg .BIC o .Cefuroxime .(2nd .gen):. 500 .mg .Q12 .hours o .Ceftriaxone .(3rd .gen):. 2 .g .IM .or .IV .once - .Severe .allergy .to .beta-lactam: o .Macrolide: .erythromycin, .azithromycin, .clarithromycin F/U .Otitis .Media .- .CORRECT .ANSWER- • .Should .start .to .improve .within. 48 .to. 72 .hours .- .if .no .improvement .should .be .re-examined Edu .Otitis .Media .- .CORRECT .ANSWER- • .If .TM .ruptures, .it .will .heal .in .most .cases. .Tx .with .oral .and .topical .abx .(ofloxacin) - .Most .effusions .will .resolve .over. 12 .weeks .- .use .oral .decongestants Viral .Conjunctivitis .- .CORRECT .ANSWER-o .Viral: .Injection, .watery .discharge .during .the .day, .scant, .stringy .that .is .mucus .rather .than .pus. .Burning, .sandy, .or .gritty .feelin .gin .one .eye. .Morning .crusting .with .scant .mucus .throughout .the .day. .Second .eye .usually .becomes .involved .within . 24 - 48 .hours .Usually .gets .worse .for .the .1st. 3 - 5 .days, .with .gradual .resolution .over .the .following. 1 .or. 2 .weeks .for .total .course .of. 2 - 3 .weeks. Chlamydial .Conjunctivitis .- .CORRECT .ANSWER-o .Chlamydial .Unilateral, .sometimes .bilateral, .follicular .conjunctivitis. .Weeks .to .months, .does .not .respond .to .topical .abx .therapy. .Can .be .associated .keratitis .Dx .confirmed .with .Giemsa .or .direct .fluorescent .antibody .staining .or .conjuctival .smears, .culture, .or .PCR .of .swabbed .specimens Bacterial .Conjunctivitis .- .CORRECT .ANSWER-o .Bacterial: .Organisms: .Staph .aureus, .strep .pneumoniae, .H .influenza, .M .catarrhalis .Redness .and .discharge .in. 1 .eye, .but .can .be .bilateral. ."stuck .shut" .in .morning. .Purulent .discharge, .thick .and .globular, .yellow, .white, .or .green Noninfectious .Conjunctivitis .- .CORRECT .ANSWER- • .Noninfectious o .Allergic: .Bilateral .redness, .watery .discharge, .and .itching o .Nonallergic: Conjunctivitis .Lab/diagnostics: .- .CORRECT .ANSWER-Lab/diagnostics: - .Not .normally .necessary. .They .now .have .rapid .test .for .adenoviral .conjunctivitis
- .Stop .smoking .- .counseling, .pharmacotherapy, .social .support.. o .Bupropion .SR. .Nicotine .gum, .inhaler, .nasal .spray, .patch. .Wellbutrin, .transdermal .patch, .chantix. - .Dyspnea .management - .Regular .exercise - .Adequate .diet .and .fluid .intake - .Infection .prevention Dx: .Peripheral .Vascular/artery .disease .H&P .- .CORRECT .ANSWER-H&P: - .Atherosclerosis .(most .common .cause) - .Risks: .>50y, .smoking, .DM, .overweight, .male, .sedentary .life, .HTN, .high .cholesterol, .fam .hx .heart .or .vascular .disease, .CAD, .AA - .Virchow's .triad: .hypercoagulable .state, .vascular .wall .injury, .circulatory .stasis -. 5 .P's: .pain, .pallor, .pulselessness, .paralysis, .paresthesia .(3,4,5 .surgial .emergency) - .Pulses o. 0 .= .no .pulse. o .1+ .= .thread .pulse o .2+ .= .normal o .3+ .= .bounding. o .4+ .= .aneurysm PVD/PAD .DDX .- .CORRECT .ANSWER-DDx: - .Intermittent .claudication o .Cramping, .gradual .onset, .consistent, .relieved .by .standing .still. .Affects .buttock, .thigh, .calf, .usually .one .leg - .Venous .Claudication o ."bursting" .pain. .Gradual .onset .or .immediate. .Relieved .by .elevation .of .leg. .Affects .whole .leg, .usually .one - .Neurogenic .Claudication o .Electric .shock-like .pain. .Can .be .immediate .and .inconsistent. .Relieved .by .sitting .down .and .bending .forward. .Poorly .localized, .can .affect .whole .leg, .often .bilateral PAD/PVD .- .CORRECT .ANSWER-Lab/diagnostics: - .Ankle-Brachial .Index o .BP .in .arms .and .ankles .checked .using .regular .BP .cuff .and .Doppler. .Pressure .in .ankle .is .compared .to .pressure .in .arm .to .determine .how .well .blood .is .flowing. .Index .determined .by .dividing .ankle .systolic .BP .by .arm .systolic .BP o .>1.3 .= .noncompressible .arteries o. 1 - 1.29 .= .normal o .0.91-0.99 .= .borderline o .0.41-0.90 .= .mild-to-mod .PAD o. 0 - 0.4 .= .severe .PAD - .CBC, .chem .profile - .EKG .- .r/o .cardiac .abnormalities - .Inflammatory .blood .markers .- .D .dimer, .homocysteine, .CRP, .interleukin. 6 - .Doppler .studies .- .not .100% - .MRI
• .CT
- .Angiography PAD ./ .PVD .TX .PLAN .- .CORRECT .ANSWER-Tx .plan: - .Stop .smoking - .Lifestyle .mod - .Diet-low .in .cholesterol .and .fat - .Meds o .Decrease .cholesterol .and .BP o .Decrease .blood .viscosity .- .pentoxifylline, .dipyridamole, .or .warfarin o .Antiplts .- .ASA. 81 .to .425, .ticlopidine, .clopidogrel - .Exercise .training - .Vascular .surgery .- .revascularization o .Angioplasty, .stents, .grafts, .thrombolytics - .Interventional .radiology - .Gene-based .therapy o .Direct .gene .transfer .by .IM .injection .of .DNA .encoded .with .vascular .growth .factors Follow-up: Education: .- .CORRECT .ANSWER-RESOURCES DVT .H&P .- .CORRECT .ANSWER-H&P: - .Risks: .genetic .clotting .disorders, .immobility, .prolonged .bedrest, .inactivity, .paralysis, .injury/trauma, .surgery, .dehydration, .oral .contraceptives, .hormonal .replacement, .overweight, .tobacco .use, .cancer/malignancy, .prolonged .sitting, .fam .hx .or .DVT .or .PE, .60+, .HF/CV .conditions, .inflammatory .bowel .diseases, .pregnancy/postpartum, .varicose .veins - .Symptoms: .swelling .usually .unilateral, .calf .pain, .leg .cramps/tenderness/sore, .erythema, .pallor, .cyanosis - .Vascular .assessment .- .palpate .peripheral .pulses - .Capillary .refill - .Neurological .exam .- .motor, .sensory, .reflex .deficits - .Homan's .sign .- .pain .in .posterior .calf .or .knee .with .forced .dorsiflexion .of .foot - .PE .symptoms - .Virchow's .triad DVT .DDX .- .CORRECT .ANSWER- • .Phelbitis .- .occurs .in .superficial .veins DVT .LABS/DIANGNOSTICS .- .CORRECT .ANSWER-Lab/diagnostics: - .*venography - .Wells .score .- .risk .factors, .symptoms, .clnical .signs, .clinical .probability. o. 0 - 2 .= .low .risk o. 3 - 6 .= .moderate o .>6 .= .high - .Compression .USG - .MRI - .D-Dimer .- .negative .= .unlikely .DVT
- .Bronchiectasis - .Vocal .cord .dysfunction - .Angiotensin-converting .enzyme .inhibitors - .GERD - .Different .forms .of .asthma: o .Occupational, .cough .variant, .nocturnal, .exercise .induced ASTHMA .DDX .- .CORRECT .ANSWER-Lab/diagnostics: - .Spirometry .- .at .initial .dx .and .at .least .every. 1 - 2 .years - .PEFR .- .used .for .follow-up, .not .dx - .Normal .FEV1/FVC: o. 8 - 19y .= .85% o. 20 - 39y .= .80% o. 40 - 59% .= .75% o. 60 - 80y .= .70% ASTHAM .TXT .PLAN .- .CORRECT .ANSWER-Tx .plan: - .Stepwise .- .pt .is .reassessed .in. 2 - 6 .weeks .for .effectiveness .of .therapy. .When .pt .controlled .for. 3 .months, .therapy .is .step .down o .Step .1: .intermittent .- .SABA .PRN o .Step .2: .mild .persistent .- .low .inhaled .corticosteroid .(ICS) o .Step .3: .mod .persistent .- .low .ICS .+ .LABA .or .medium .ICS o .Step .4: .severe .persistent .- .consult .asthma .specialist - .Relievers o .SABA o .Adrenergic .agonists .- .albuterol, .advair, .serevent .diskus o .Anticholinergics .- .atrovent .for .acute .exacerbations o .Theophylline o .Oral .corticosteroids .- .prednisone .or .prednisolone - .Controllers o .Cromolyn .(intal) o .Leukotrienes .(singulair, .accolade) o .Inhaled .corticosteroids .- .asmanex, .aerobid, .aerospan, .flovent, .QVAR, .pulmicort .(neb) o .LABA o .Inhaled .NSAIDs o .Methylxanthines o .Anti-IgE .therapy .(Xolair) - .Combo .drugs .- .ICS/LABA .Fluticasone/salmeterol .(Advair) .Budsonide/formoterol .(symbicort) .Mometasone/formoterol .(Dulera ASTHMA .FU .- .CORRECT .ANSWER-RESOURCES ASTHMA .EDUCATION .- .CORRECT .ANSWER-Education: - .ICS o .Delayed .onset .of .action, .take .EVERY .DAY, .demonstrate .proper .technique .and .teach .back, .use .spacer, .rinse .and .spit .after .use, .change .canister
- .Written .asthma .plan - .Monitoring .asthma - .Environmental .control Dx: .Cough .- .CORRECT .ANSWER-H&P: - .Cough, .dyspnea .(on .exertion, .rest, .constant, .or .intermittent). .Associated .symptoms. .Chest .pain/pleurisy. .F/V, .night .sweats. .Sputum .production .(color, .quality, .consistency). .PND, .orthopnea. .Chest .pain/discomfort. .Wheezing. .Hemoptysis - .Tobacco .(packs, .years). .Exposure .to .allergens, .travel. .Medications .(OTC .and .herbal .too). .Alternative .therapies - .Duration o .Acute .= .less .than. 3 .weeks o .Sub .acute .= .more .than. 3 .wks .but .less .than. 8 o .Chronic .= .>8 .wks COUGH .DDX .- .CORRECT .ANSWER-DDx: - .Postnasal .drainage/sinusitis - .Acute .bronchitis - .Med .SE - .Environmental .irritants - .GERD - .Asthma - .COPD - .Pneumonia - .TB COUGH .Lab/diagnostics: .- .CORRECT .ANSWER-Lab/diagnostics: - .CXR - .Spirometry COUGH .TX .PLAN .- .CORRECT .ANSWER-Tx .plan: - .Narcotic .cough .suppressants .- .codeine - .Nonnarcotic .cough .suppressants .- .Benzonatate, .Dextromethorphan - .Expectorants Dx: .Dyspnea .H/P .- .CORRECT .ANSWER-H/P DYSPNEA .DDX .- .CORRECT .ANSWER-DDx: - .Acute o .LV .failure o .Bronchospasm o .PNA o .PE - .Chronic o .COPD o .Restrictive .lung .disease DYSPNEA .LABS/DIAGNOSTICS .- .CORRECT .ANSWER-Lab/diagnostics:
Education:• .Stop .smoking, .meds .(bronchodilators), .bronchial .hygiene Pleuritic .chest .pain .DX .- .CORRECT .ANSWER-H&P:
- .Sudden .intense .chest .pain .that .is .most .severe .during .deep .breathing .and .coughing .but .relatively .unaffected .by .movement .or .palpitation o .caused .by .inflammation .or .distention .of .pleura Pleuritic .chest .pain .DDX .- .CORRECT .ANSWER- • .PNA - .PE - .Malignancy - .Spontaneous .pneumothroax PLEURITIC .CHEST .PAIN Lab/diagnostics: Tx .plan: Follow-up: Education: .- .CORRECT .ANSWER- Influenza .DX .HP .- .CORRECT .ANSWER-H&P: - .Usually .between .December-march .in .northern .hemisphere - .Symptoms: .nonproductive .cough, .nasal .drainage, .HA, .sore .throat, .myalgia, .significant .f/c INFLUENZA .DDX .- .CORRECT .ANSWER-Lab/diagnostics: - .Caused .by .orthoxmyxovirus .(usually .type .A, .sometimes .B) - .Rapid .influenza .testing INFLUENZA .TX .PLAN .- .CORRECT .ANSWER-Tx .plan: - .OTC .meds .for .symtoms - .Tamiflu .if .immunocompromised .or .co-morbidities INFLUENZA .- .CORRECT .ANSWER-Follow-up: Education: Acute .bronchitis .DX .HP .- .CORRECT .ANSWER-H&P: - .Acute .infection .of .lower .respiratory .tract .manifested .by .cough .with .or .without .sputum .that .lasts .up .to. 3 .weeks - .Risks o .Smoking, .malignancy, .hx .splenectomy, .HIV .positive Acute .bronchitiIS .DDX .- .CORRECT .ANSWER-DDx: - .Common .cold/viral .URI - .Asthma .exacerbation - .Acute .exacerbation .of .chronic .bronchitis - .PNA
Acute .bronchitis .labs/dx .- .CORRECT .ANSWER-Lab/diagnostics:
- .No .dx .test .to .differentiate .b/t .this .and .common .cold - .Usually .caused .by .virus .(90%) .- .influenza .A,B; .parainfluenza, .respiratory .syncytial .viruses o .Bacteria .- .mycoplasma .pneumoniae, .chlamydophila .pneumonia, .bordatella .pertussis bronchitis .txt .plan .- .CORRECT .ANSWER-Tx .plan: - .Symptom .control .with .OTC .meds Dx: .CAP .- .CORRECT .ANSWER-Dx: .CAP H&P: - .Symptoms: .cough .- .productive .or .nonproductive, .f/c, .chest .discomfort, .fatigue, .dyspnea, .pleuritic .pain Follow-up: Education: CAP .DDX .- .CORRECT .ANSWER-DDx: - .Acute .bronchitis - .Acute .exacerbation .of .chronic .bronchitis - .Hypersensitivity .pneumonitis - .Atelectasis - .Pulmonary .edema CAP .LABS/DX .- .CORRECT .ANSWER-Lab/diagnostics: - .Organisms o .Strep .pneum, .H .influenza, .Mycoplasma .pneum, .Chlamydophia .pneum, .viral .infections - .*CXR .- .infiltrate .required .for .dx - .CBC, .BMP, .sputum .culture CAP .TX .PLAN .- .CORRECT .ANSWER-Tx .plan: - .Empirical .abx .tx o .Previously .health .AND .no .risk .factors .for .drug .resistant .strep .pneumo o .Comorbids .OR .abx .use .within .last. 3 .months .OR .risk .factors .for .drug .resistant .strep .pneumo .Risk .factors: .<2 .or .>65y, .beta .lactam .therapy .within .previous. 3 .months, .alcoholism, .comorbids, .immunosuppressive .illness .or .therapy, .exposure .to .child .in .daycare - .Hospitalize .indications o .CURB- 65 .- .confusion, .BUN .> .19, .RR .> .30, .BP .<90/<60, .age .> . 0 - 1 .= .low .risk; .consider .home .tx . 2 .= .short .inpt .hospitalization .or .closely .supervised .outpt .tx . 3 - 4 .= .severe .pna; .hospitalize .and .consider .intensive .care
TB .DDX .- .CORRECT .ANSWER-DDx:
- .PNA - .Malignancy - .Lung .abscess - .Fungal .infection .of .lung TB .LAB/DX .- .CORRECT .ANSWER-Lab/diagnostics: - .Cause .= .Mycobacterium .TB - .Usually .in .lungs, .some .in .GU, .bone, .lymph .nodes - .PPD o .May .be .negative .in .20% .of .pts .with .malnutrition .and .debility.. o .HIV .+ .pts .with .low .CD- 4 .cell .counts .have .50% .false .negative .PPD - .Sputum .for .AFB .x - .Bronchoscopy .- .bronchial .lavage, .brushing TB .TXT .PLAN .- .CORRECT .ANSWER-x .plan: - .Prophylaxis o .BCG-bacille .Calmette-Guerin .vaccine .- .given .to .kids .where .TB .rates .are .high .PPD .will .be .+ - .Latent o .INH. 5 .mg/kg .daily .(max .dose .300mg) .x. 9 .months o .Pyridoxine .- .vitamin .B6. 50 .mg .daily o .Importance .of .taking .med .to .prevent .reactivation .TB .must .be .stressed o .Pretreatment .LFTs .with .periodic .monitoring. - .Active .TB .- .tx .depends .on .HIV .status .and .if .infected .with .multi-drug .resistant .TB - .Core .of .tx. o .INH o .Ethambutol o .Rifampin o .Pyrazinamide TB .FU/EDU .- .CORRECT .ANSWER-Follow-up: Education: Dx: .OSA .HP .- .CORRECT .ANSWER-Dx: .OSA H&P:. - .Risk .factors .- .obesity .(nuchal), .deviated .septum, .nasal .polyps, .enlarged .uvula .and .soft .palate, .small .chin .with .deep .overbite, .enlarged .tonsils, .large .tongue Dx: .OSA .DDX .- .CORRECT .ANSWER-DDx: - .Chronic .fatigue - .Hypothyroidism - .Depression Dx: .OSA .LAB/DX .- .CORRECT .ANSWER-Lab/diagnostics: - .Polysomnogram
Dx: .OSA .S/S .- .CORRECT .ANSWER-Symptoms .- .loud .intermittent .snoring, .disturbed .restless .sleep, .periods .of .irregular .breathing .or .apnea, .choking .or .gasping .that .awaken .the .pt, .excessive .daytime .somnolence, .morning .headache Dx: .OSA .TXT .- .CORRECT .ANSWER-Tx .plan:
- .Avoid .alcohol .and .sedatives - .Weight .loss - .Position .therapy - .CPAP/bi-level - .Surgical .managment Follow-up: Education: eye .hp .- .CORRECT .ANSWER-Sudden .vision .loss, .eye .pain, .traumatic, .photophobia, .irriation, .griitness,
