NR 511 CONSOLIDATED FINAL EXAM QUESTIONS AND ANSWERS 100%CORRECTLY/VERIFIED GUARANTEED SUCCESS BEST GRADED A+

N R 5 1 1 F i n a l E x a m Week 1 • Discuss how specificity, sensitivity & predictive value contribute to the usefulness of the diagnostic data -Specificity of a test, we are referring to the ability of the test to correctly detect a specific condition. -Predictive value is the likelihood that the patient actually has the condition and is, in part, dependent upon the prevalence of the condition in the population. -When a test is very sensitive, we mean it has few false negatives. • Discuss the diagnosis of diverticulitis, risk factors, and treatments Symptoms: LLQ pain/ tenderness, fever, N/V/D Need imaging especially if perforation or peritonitis is suspected; free air = perforation; patient may have ileus, small or large bowel obstruction Can use plain x-ray CT or barium enema are preferred CT with contrast is more sensitive and accurate Diverticular disease is the term used to describe the inflammatory changes that occur within the diverticular mucosa of the intestine (diverticulitis), as well as the asymptomatic, uninflamed outpouchings called diverticulosis. Although there is noknown cause for diverticular disease, a low-fiber diet has been implicated because it causes increased intraluminal pressures within the colon, which lead to mucosal herniation through the weaker areas in the bowel wall. Other factors believed to contribute to the formation of diverticula include hypertrophy of the segments of the circular muscle of the colon, chronic constipation and straining, irregular and uncoordinated bowel contractions, obesity, and weakness of the bowel muscle brought on by aging. Risk factors are directly related to the suspected causes of the disease: older than age40, low-fiber diet, previous diverticulitis, and the number of diverticula present within the colon. Diverticula occur most often in the left lower quadrant (LLQ); a right lower quadrant presentation is a rare condition, with a higher incidence in Asian populations. Patients with diverticulosis characteristically present with pain in the LLQ of the abdomen. When the diverticula have become inflamed, there are the usual signs and symptoms of infection—fever, chills, and tachycardia. A physical exam reveals tenderness in the LLQ of the abdomen, and—if the patient can tolerate more vigorous examination —a firm, fixed mass may be identified in the area of the diverticuli. Initial laboratory testing can show mild to moderate leukocytosis, depending on whether the patient presents with diverticulitis or with a more advanced inflammatory process such as peritoneal abscess. The white blood cell (WBC) count is usually normal in patients with diverticulosis. Hemoglobin and hematocrit may be low if there is associated rectal bleeding. Patients with signs suggestive of peritonitis should have a blood culture to assess for bacteremia. An incidental finding of uncomplicated diverticulosis requires no further intervention and can be managed with a high-fiber diet or daily fiber supplementation with psyllium. Treatment ofa patient presenting with mild symptoms can often be managed on an outpatient basis with rest, oral antibiotics, and a clear liquid diet. Initial antibiotic therapy varies with the extent of the inflammatory process and can include metronidazole (Flagyl) 500 mg by mouth three times daily with ciprofloxacin (Cipro) 500 mg by mouth twice daily, or trimethoprim/sulfamethoxazole (Bactrim DS) 160/800 mg by mouth twice daily for 7 to 10 days. The symptoms usually subside quickly; then the diet can be advanced to soft, low roughage and next to high fiber as tolerated. Pain due to spasms can be managed with antispasmodics such as hyoscyamine (Levsin) 0.125 mg every 4 hours, dicyclomine (Bentyl)20 to 40 mg four times daily, buspirone (BuSpar) 15 to 30 mg/day, and/or meperidine (Demerol) 100 to 150 mg/day in divided doses. To evaluate or diagnose diverticular disease, all patients will require colonoscopy at some point during their disease process; therefore, referral to a gastroenterologist is indicated for symptoms that do not respond to treatmentafter 6 months. Patients diagnosed with diverticular disease will need to make modifications in their diets with an emphasis on increasing the amount of dietary fiber. The goal of diet therapy is to avoid constipation and straining during bowel movements, which can further increase intraluminal pressures and cause complications. Patients should also be instructed to drink at least ten 8-ounce glasses of water a day to have regular, soft bowel movements. Pages 584-586 • Identify the significance of Barrett’s esophagus After repeated exposure to gastric contents, inflammation of the esophageal mucosa becomes chronic. • Blood flow increases, erosion occurs • As erosion heals, normal squamous epithelium replaced with metaplastic columnar epithelium containing goblet and columnar cells • More resistant to acid and supports esophageal healing • Premalignant tissue • 40-fold risk for development of esophageal adenocarcinoma • Fibrosis and scarring during healing of erosions; leads to strictures