NSG6420 / NSG 6420: Practicum I Family Health - Adult and Gerontology Final Review | 2021/2022

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Final Review This is not an exhaustive list of what you may see on the final exam. You are responsible for all readings and content covered in the course. This is the only blueprint that will be pro... vided for the final exam. 60 Questions Otitis externa – administration of topical agents Topical antibiotics are indicated for uncomplicated conditions x 7 days. Choose medications that are effective against both P. aeruginosa and S. aureus, such as Fluoroquinolone antibiotics. OTITIS EXTERNA WITH SWOLLEN OR OCCLUDED EAR CANAL. WHAT IS INTERVENTION? I CHOSE THE ONE WITH EAR WICKING IN THE ANSWER EENT – differentials, assessment SEVERAL QUESTIONS ON BRONCHITIS… Acute bronchitis tx- symptom management, no abx There was one about what was the diff dx for hypothyroidism, devated nasal septum, chronic sinusitis and one more thing…I answered mumps. I don’t know if it’s right but for some reason my gut told me to answer that so I didn’t 2nd guess myself lol Bacterial conjunctivitis – education, counseling Counsel and educate patients that symptoms are self-limited and abx not always necessary. Controversial re: initially starting abx or not. Initial choices for a topical antibiotic include trimethoprim–polymyxin B or fluoroquinolone drops QID x 1 week. Patient should avoid touching eyes, throw away eye makeup and purchase new after infection resolves, if not could re-infect eyes. 3 types of bacterial conjunctivitis require systemic tx: H. influenzae- tx with augmentin, Gonococcal- tx with ceftriaxone 1g IM or cipro 500mg PO x1, if PCN allergy, and azithromycin 1gm PO x1; requires same day ophthalmologist referral Chlamydial- azithromycin 1gm po x1 or doxycycline 100mg BID x 7days. INTERVENTION THAT IS NOT APPROPRIATE- CLEAN ALL LINENS Group A Strep Group A β-hemolytic Streptococcus (GAS) - most important to identify b/c responsible for acute rheumatic fever (ARF) and poststreptococcal glomerulonephritis. Peak incidence late winter- early spring but seen all yr long. Spread by respiratory secretions or lg droplets, incubation 2-5 days. THERE IS A QUESTION ABOUT THIS… I ANSWERED 24-72 HOURS S/S: erythema of the throat and tonsils; patchy, discrete, white or yellowish exudate; pharyngeal petechiae; and tender anterior cervical adenopathy. Fever above 38.3 or 101 previous exposure- may exhibit the typical diffuse exanthem of scarlet fever, a sandpaper-type rash, and erythematous (strawberry) tongue. Pressure on the tonsillar pillars may produce purulent drainage. The uvula may also be edematous. Diagnostic studies: throat culture, a rapid antigen detection test (RADT), and sometimes an antistreptolysin O (ASO) titer (not used initially as takes longer and may not be positive with initial infx). Treatment: PCN V, 500 mg BID -TID x10 days, or Amoxicillin 250mg TID-QID or 500mg BID x10 days. If PNC allergy, clarithromycin 250mg BID x 10 days. Influenza/Bronchitis – risk factors- environmental risk-living in substandard housing esp. greater risk for kids, exposure to sick individuals, diabetes pt have increased risk, those in nursing homes higher risk of getting viruses treatment- symptomatic management-antipyretics, bedrest, increased fluids, cough meds, etc Macrolides are first line treatment. Azithromycin 500mg day 1, then 250mg d 2-5, erythromycin 500mg QID x 14 days, clarithromycin 500mg BID x 7d. Second line therapy: Bactrim 160-800mg (DS) BID x 14 days. THIS QUESTION WAS ABOUT WHICH PATIENT WAS NOT AT GREATER RISK FOR COMPLICATIONS…choices were young kids, pregnant, ppl with chronic dx and one other. I answered kids because it seemed the least wrong. National Asthma Education and Prevention Program – Stepwise Treatment WHAT is step 1 tx for persistent asthma? I answered low dose ICS + LABA COPD – assessment, education, treatment Question about what is dx? Increased AP diameter, exp wheezes, and chronic bronchitis or something? Answer was clearly COPD There was 1 more question about COPD, I can’t remember it though Most common complaint- dyspnea on exertion How is COPD diagnosed: spirometry COPD stages & GOLD tx: Stage I-Mild, FEV1/FVC<70%, FEV<80%, chronic cough and sputum production/ tx: SABA Stage II- Moderate: FEV1/FVC<70, FEV1 50-80%, SOB with exertion, cough/sputum production / tx: SABA + LABA Stage III- severe, FEV1/FVC <70, FEV1 30-50%, Greater SOB, reduced exercise capacity, fatigue, exacerbations more frequent with decrease QOL. / tx: SABA + LABA + INHALED GLUCORTICOIDS Stage IV: VERY severe, FEV1/FVC<70, FEV1>30, respiratory failure, cor pulmonale (increase jvp, edema), QOL Impaired How does FEV1 decrease: inflammation, narrowing of peripheral airway, airway collapse in severe emphysema Education for COPD: Smoking cessation is the MOST important intervention to stop the rapid decline in lung function. Education on medication, oxygen therapy, smoking cessation, nutrition, exercise, breathing techniques to minimize dyspnea, and health promotion should be stressed. JNC 8 – Treatment recommendations (Buttaro p. 575) - HTN o Goal- bp <140/90 for everyone o Over 60 without CKD 150/90 - Medications HTN o Black- thiazide and CCBs avoid ace/arbs o Non-black- thiazide- ace/arbs, CCBs o CKD- ace/arb - NOTE- AVOID THIAZIDES IF ALLERGIC TO SULA (contains sulfa) What would prescribe if patient failed to reach 6 week BP goal with just HCTZ? I answered ACE-I/ARB Aortic stenosis – assessment, treatment - Mid-systolic murmur - Radiates to the neck - Harsh and noisy murmur Classic symptoms: Chest pain, syncope, exercise intolerance, and dyspnea are assoc w/ severe AS Management: Asymptomatic AS- periodic monitoring for symptom development and dx prog. Symptomatic management is surgical: 2 options: surgical replacement and transcatheter aortic valve replacement (TARV) Question about testing and which one would NOT be recommended or something like that…I answered cardiac stress test, others were about consult with cardiologists, and lifestyle modifications A fib – assessment, treatment Treatment: initial tx should be to convert back to SR either by cardioversion or antiarrhythmic drugs (amiodarone). Long term goals: rate control and prevention of thromboembolism. Amiodarone is the most effective antiarrhythmic drug, has long half-life, can build up in liver and cornea. Beta-blockers or nondihydropyridine CCBs (verapamil or diltiazem) are best for rate control alone. Diverticular disease – assessment, treatment -Diverticulosis-sac like herniations in the colon; increasing dietary fiber will reduce incidence of diverticular dx. Treatment is increased fiber intake WHO recommends 27-40g/day; can find dietary fiber in whole grains and cereals, fruits, vegetables and legumes -Most patients are asymptomatic; if c/o symptoms- irregular defecation, intermittent abdominal pain, bloating, or excessive flatulence, associated complaints include urinary dysfunction, anorexia, nausea, vomiting, and heartburn, and older individuals often relate recurrent bouts of steady or crampy pain Diverticulitis: -Most common complication is acute diverticulitis; Most patients with infection or localized inflammation have mild to moderate, colicky to steady, aching abdominal pain usually present in the LLQ, accompanied by fever, and leukocytosis, N/V, constipation or diarrhea. CT of A/P is standard to eval diverticulitis. -Treatment: treatment consists of taking clear liquids for 2 or 3 days, limiting physical activity, and taking oral antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS, 160 mg/800 mg twice daily) plus metronidazole (500 mg three times daily), amoxicillin–clavulanate potassium (Augmentin, 875 mg/125 mg), or ciprofloxacin (500 mg twice daily) plus metronidazole (500 mg three times daily) for 7-14 days What is non-pharmacological tx for diverticular dx? Increase dietary fiber IBS – -assessment- abd pain must be present for dx, may have constipation or diarrhea or alternating pattern of constipation/diarrhea. -treatment- focus of IBS treatment is symptomatic and includes dietary modifications, medications, supportive and behavioral therapy, education, and reassurance. -successful management of IBS appears to be the establishment of a therapeutic patient/provider relationship; physiologic and psychosocial factors play a role in the severity of symptoms, expression of illness and should be in development of a management plan -Meds used: antispasmodics, antidiarrheals, anti-constipation, psychotropic (antidepressants) and alternative therapies such as probiotics or peppermint oil Question about why are psychosocial interventions important in tx of IBS? There are 2 answers that could be right, I picked the one that said something along the lines of psychosocial plays a role in the dx but not the one with diagnosis in the answer. I can’t remember how the question and answer are worded specifically C-dif – Risk FactorsIncreasing age (excluding infancy) Severe underlying disease Non-surgical gastrointestinal procedures Presence of a nasogastric tube Receiving anti-ulcer medications Stay on intensive care unit Long duration of hospital stays Long duration of antibiotic course Receiving multiple antibiotics Which is not a risk factor for c diff? I picked [Show More]

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