NURS660 Exam 2 - Correct Answers Rated A+ You start your patient...

NURS660 Exam 2 Exam Latest Update Questions and Correct Answers Rated A+

You start your patient with suspected PUD on PPIs and they follow up in 2 weeks with no improvement. What is your next step? -ANSWER- Referral to GI or endoscopy

Describe who with a peptic ulcer needs to be seen in the ED. - ANSWER-anemia, GI bleed s/s, rigid abdomen, weight loss, new onset dyspepsia, older than 50 years

Which type of ulcer requires an endoscopy? Gastric or duodenal? - ANSWER-Gastric increased incidence of gastric cancer

RFs for colorectal cancer -ANSWER-FH diet of red meats, fat, low in fiber, refined carbs

Summarize colorectal screening guidelines in regards to age. - ANSWER-Start between ages 45-50 (patient preference) until 75, then stop 10 years prior to expected death

Describe the options patients have for colorectal cancer screening. - ANSWER-High sensitivity guaiac fecal occult blood test or fecal immunochemical test (FIT) every year (only $20) Stool DNA-FIT every 1-3 years (cologuard-$600)

Note: DNA-FIT and FIT are not synonyms

Colonography every 5 Flex sig every 5 or every 10 if annual FIT is completed

Colonoscopy every 10 (gold standard, performed whenever another screening test is abnormal) Capsule colonscopies are not recommended

Who is a high risk patient that should only screen for colon cancer via colonoscopy? -ANSWER-a patient with a history of familial polyposis

What are some causes of hemorrhoids (suspected)? -ANSWER-fiber deficiency, straining, constipation, prolonged sitting, pregnancy, anal infection, heredity, history of diarrhea, IBD

A thrombosed hemorrhoid will present as -ANSWER-a VERY painful perianal lump

What is required for definitive diagnosis of internal hemorrhoids? - ANSWER-Scope may as well just do a colonoscopy and r/o cancer if you already have to scope them

Treatment of hemorrhoids -ANSWER-Hydration, oral analgesia w/ tylenol/ibuprofen, sistz baths, bulk-forming laxative, increased fiber + water, topical hydrocortisone for itching, surgical excision prn etc

Define constipation. -ANSWER-2 of the following for >3 months:

<3 BMs/week Straining 25% Hard lumpy stool Incomplete evacuation Manual manuevers to remove stool Pain with defecation

Why would you recommend Miralax over Ex lax? -ANSWER-ex lax is habit forming, as are the stimulant laxatives

miralax is osmotic, not known to be habit forming

Is diagnostic imaging required for constipation? -ANSWER-no unless concerned for something serious like a bowel obstruction (patient has constipation + n/v + rectal bleeding, for example)

How much fiber is recommended to prevent/treat constipation? - ANSWER-25-30g/day

Which patients would you avoid recommending Miralax to? - ANSWER-CHF or CKD patients

Briefly describe the major types of IBD -ANSWER-Ulcerative colitis:

involves mucosal surface of the colon leading to friability, erosions, and bleeding (starts at rectum, continuous)

Crohn's: can involve all or any layer of the bowel wall as well as any

portio of the GI tract from mouth to anus (skip lesions)

Clinical presentation of UC -ANSWER-Bloody diarrhea 4-10x/day, tenesmus, abdominal pain/tenderness, impaired nutrition, anemia, hypovolemia (severe disease)

Clinical presentation of Crohn's -ANSWER-Diarrhea (bloody stool intermittently, steatorrhea), insidious gradual onset, abdominal cramping, pain, tenderness, fever, anorexia, weight loss

What needs to be ruled out when you suspect IBD? -ANSWER-colon cancer colonoscopy should be performed

Why are IBD patients at risk for anemia? -ANSWER-malabsorption of folate, vitamin d, calcium

What surgical options are available for ulcerative colitis? -ANSWER-

colectomy OR newer surgery: ileoanal pouch (should be able to avoid

ostomy)

What nutrition counseling is required for UC and Crohn's patients? - ANSWER-no caffeine, raw fruits, vegetables, bland diet high in calories and protein

What drugs might you see prescribed for UC patients? -ANSWER-

steroids, immunosuppressive agents (goal: avoid long term steroids)

like imuran, cyclosporine, etc., 5-ASA preparations like sulfasalazine, immune modulators

Is surgery indicated for Crohn's? -ANSWER-not typically, usually will just return or spread into another area

What drugs might you see prescribed for Crohn's patients? - ANSWER-steroids, mesalamine, immunosuppressive agents (cyclosporine, methotrexate), immunomodulators, antibiotics (if fistula or abscess)

Name the subsets of IBS. -ANSWER-IBS-Constipation IBS-Diarrhea IBS-Mixed

Diagnostic criteria for IBS -ANSWER-Abdominal pain once per week

WITH two or more of the following:

defecation related pain pain related to frequency pain associated with change in appearance of stool