NR 667 CEA prep with 100% accurate solutions + rationales -Chamberlain

Treatment of Multiple Sclerosis

Acute Flare: steroids

Chronic: monoclonal antibodies

Lupus Treatment

Meds: hydroxychloroquine, NSAIDs, DMARDs, Corticosteroids, immunosuppressants

Non Pharm: sunlight, diet, exercise, NO smoking, avoid stress

Lupus Presentation

Butterfly (malar) rash

Joint pain

Fatigue

Rheumatoid Arthritis Treatment

Acute: steroids

Chronic: DMARDs

Rheumatoid Lab

RF rheumatoid factor

Rheumatoid Arthritis Presentation

Bilateral, symmetrical joint swelling, Pain, Stiffness, Deformity

Osteoarthritis (OA) Presentation

Unilateral joint swelling and stiffness

When treating lymphoma, what is often caused?

Pleural effusion

Tumor lysis syndrome

Lymphoma S/S

Night sweats (drenching)

Weight loss

Nickname for lymphnodes

"trash cans" of the body

Epiglotitis treatment

Ceftriaxone

Oxygen therapy

Intubation: with skilled physician and tracheostomy available

4 Ds of epiglotitis

Dysphagia (painful swallowing);

Drooling

Dysphonia (muffled voice)

Distress

Retropharyngeal Abscess Treatment

IV ceftriaxone

IV clindamycin

Retropharyngeal Abscess is

life-threatening infection in the lateral pharyngeal space *potential to occlude the airway

*ENT Emergency, refer to ED

First line treatment periodontal abscess

augmentin

What can be caused by untreated periodontal abscess

bacterial endocarditis

Common reaction when mono is treated with a penicillin

rash

Mono adenopathy most commonly occurs where

posterior cervical chain

Pharyngitis/strep adenopathy most commonly occurs

Anterior cervical chain

Risk of untreated strep infection

Endocarditis

Meniere's disease Treatment

Sodium Restriction

Increase fluids (flush)

Diuretics

Meclizine

Meniere's disease s/s

Unilateral tinnitus

Vertigo

Hearing loss

Sensation of fullness

Otitis Media with effusion

NO infection

Fluid in the middle ear

Otitis Externa Treatment

Mild: acetic acid drops

Mod- Severe (intact TM): Topical antibiotics, glucocorticoids 7 days

(non intact TM): topical fluoroquinolone (ciprodex) or ORAL antibiotics

Acute Otitis Media Treatment

augmentin

Hyphema s/s

Collection of blood in the anterior chamber of the eye

Makes visual fields appear reddish, blurred, or diminished

light sensitivity

Hordeolum Treatment

"stye" hot compress 2-3x daily

Empiric Antibiotic -for preseptal cellulitis

May need referral to ophthalmologist for I and D

Chalazion Treatment

Warm Compress

No antibiotics

What is an abscessed hair follicle or sebaceous gland with an acute onset, edematous, erythematous, and warm on the upper or lower eyelid?

Hordeolum (stye)

Chronic inflammation of the meibomian gland that is painless and described as a "bead" in the eye

Chalazion

Detached Retina s/s

Flashing lights

Floaters

Gray curtain over part of view

Shadowy peripheral vision

Open angle glaucoma presentation?

Fundoscopic finding?

Peripheral visual field loss- PROGRESSING to central vision loss

Fundoscopic findings: cupping

Acute angle closure glaucoma s/s

Painful, injected eye

halos around lights

Increased eye pressure

Sometimes nausea/vomiting

Acute angle closure glaucoma vs Open angle Which requires emergent treatment

ACUTE **refer to ED

Macular Degeneration s/s

Gradual OR sudden loss of central vision

*painless

When should an H2 blocker be taken?

Before meals (spiciest meal)

Adverse effect of ondansetron

prolonged QT interval

Chronic management of irritable bowel disease

5-ASA, sulfasalazine, "-alazine" meds

Acute flare management of irritable bowel disease

steroids

Separating Chron's disease from Ulcerative colitis

Chron's: mouth to anus

UC: colon only

Diverticulitis S/S

Acute onset of LLQ pain

Nausea and vomiting

Fever, chills

Rebound tenderness

Positive Rovsings sign?

board like abdomen

AST: ALT ratio 2:1 may indicate

alcoholic liver damage

alcohol abuse

Hep C testing

HCV + (doesn't differentiate chronic vs acute)

Viral copies present = acute

Hep B surface antigen- positive

ACTIVE infection

Hep B core antibody

old/chronic infection

Hep B surface Antibody

Protected

*vaccine

Most common tests for appendicitis

Rovsings, mcburneys

Rovsings

deep palpation to LLQ = referred pain to RLQ

McBurney's point

Tenderness 1.5- 2 inches from the anterior superior iliac spine (RLQ)

Acute pancreatitis treatment

**refer to ED

hydration

antibiotics

gut rest

Acute pancreatitis s/s

Acute onset epigastric pain that radiates to the LUQ

Positive cullens and grey turners signs

guarding, rebound tenderness over epigastric region

Fever, N/V

What labs to check if suspecting acute pancreatitis? -2

amylase

lipase

What should be ruled out if patient has painless jaundice

pancreatic cancer

Cholangitis s/s

fever

jaundice

abdominal pain

What is cholangitis

infection of the bile ducts often caused by infection, blockages, or tumors

Four F's of cholecystitis

Forty

Fat (foods)

Female

Fertile

Medication treatments for C-diff (2)

metronidazole (flagyl)

IV vancomycin

MCV

size of blood cells

MCH

color/redness

RDW

Red cell distribution

**if elevated = presence of immature RBCs

**elevates with almost all anemias EXCEPT thalassemia

Aplastic anemia can present as which two types of anemia?

What do you need?

normocytic

macrocytic

*get a bone marrow biopsy

Macrocytic Anemia examples

B12, folate deficiency

Pernicious Anemia

Normocytic Anemia examples

acute blood loss

Anemia of chronic disease

What do labs look like with iron deficiency anemia?

low ferritin

Increased TIBC

Microcytic anemia examples

iron deficiency

thalassemia

*lead poisoning

Gram positive bacteria

staph

strep

enterococcus

H pylori is gram positive or gram negative?

gram negative

H. pylori management

Triple/quad therapy

TWO Antibiotics:

-clarithromycin

-amoxicillin

-metronidazole

-tetracyclines

PPI

sometimes bismuth

Upper GI bleed causes

Upper GI S/S

Causes: peptic ulcers, esophageal varices, mallory- weiss tears

S/S: dark, coffee ground emesis or stool

What is Barrett's esophagus?

Metaplastic columnar epithelium replaces the normal stratified squamous epithelium

Develops from chronic GERD

Increased risk of cancer

Adverse effects of longterm PPI use -2

osteoporosis

B12 deficiency

Battery

intentional act that causes PHYSICAL harm

Assault

Intentional act of making someone FEEL/FEAR that you will cause them harm

4 requirements to prove negligence

-existence of a legal duty that the defendant owed to the plaintiff

-Defendants breach of that duty

-Plaintiff's sufferance of an injury

-Proof that the defendants breach caused the injury

Negligence

Doing or not doing something that a prudent, careful, and reasonable nurse would do/not do in the same situation

Nonmaleficence

do no harm

Beneficence

Kindness and charity action to benefit others

Emergency consent

2 providers must sign off that care is required.

Impending loss of life is involved

No reasonable surrogate can be identified

Implied consent

Patient lacks ability to state their wishes

Care under best medical practices consistent with a reasonable person's presumed wishes

Hospice Care

Manage the last 6 months of less of anticipated lifespan

Palliative Care

Duration may vary considerably

Goal: increased comfort

Social determinants of health 5

1. Economic status

2.Education access and quality

3.Health care access and quality

4.Neighborhood and Built environment

5.Social and community context

SIADH symptoms

Impaired water excretion (retaining water), - in return water will exceed urine output and cause low sodium (hyponatremia)

What is SIADH

overproduction of ADH aka vasopressin

Diagnostic workup for diabetes insipidus

24-hour testing of:

-urine osmolality (concentrated urine)

-creatinine

-fluid intake (>70mL/kg)

-urine specific gravity (<1.005 / low)

-urine glucose (negative)

Water deprivation test

-to differentiate between cental and nephogenic

Consider MRI of brain

Diabetes Insipidus s/s

Excessive thirst and urination

What is diabetes insipidus?

a disorder caused by inadequate amounts of ADH which causes excessive water loss

Inadequate arginine vasopressin secretion or inadequate renal response

Primary test to diagnose cushing's syndrome?

24 hours urine: free cortisol

Cushing syndrome s/s

thin skin

moon face

abdominal obesity

striae

muscle atrophy and weakness

Adrenal Insufficiency aka Addison's Disease s/s

Cold

hypotensive

stop making urine

hypoglycemia

N/V

tanning of skin

Salt craving

Muscle weakness

Abd pain

Treatment for Adrenal Insufficiency aka Addisons

Primary: glucocorticoids and mineralocorticoids

Secondary: glucocorticoids only

Secondary adrenal insufficiency causes

-Lack of ACTH production in the pituitary gland

-abrupt withdrawal of corticoids

Primary Adrenal Insufficiency causes

-Impairment of the adrenal glands

-Autoimmune

-Infectious cause

-Adenoma

Thyroid storm s/s

-High fever

-CNS dysfunction

Longstanding untreated hyperthyroid can lead to....

thyroid storm

What medication can be used to manage symptoms/tachycardia in hyperthyroid patients?

propranolol

Hyperthyroid Treatment

methimazole

propylthiouracil (PTU)

radioactive iodine

Ablation

Thyroidectomy (rare)

What should you do if both TSH and T4 labs are elevated?

Scan the brain (brain tumor, etc.)

What do labs look like to diagnose hyperthyroid

-low TSH

-elevated T4

Hyperthyroid s/s

-fatigue

-insomnia

-anxiety/nervousness

-weight loss

-palpitations/tachycardia

-diarrhea

-exopthalmos

-heat intolerance

-goiter

-new onset afib