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NR511 / NR 511 Differential Diagnosis and Primary Care Practicum Final Exam Review | Questions and Answers | Already Rated A | Latest | Chamberlain College

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NR511 / NR 511 Differential Diagnosis and Primary Care Practicum Final Exam Review | Questions and Answers | Already Rated A | Latest | Chamberlain College 1. Explain what a “well rounded” cli... nical experience means - Includes seeing kids from birth through young adult visits for well child and acute visits, as well as adults for wellness or acute/routine visits. Seeing a variety of pt's, including 15% of peds and 15% of women's health of total time in the program. 2. State the maximum number of hours that time can be spent “rounding” in a facility No more than 25% of total practicum hours in the program 3. State 9 things that must be documented when inputting data into clinical encounter Date of service Age Gender and ethnicity Visit E&M code CC Procedures Tests performed and ordered Dx Level of involvement (mostly student, mostly preceptor, together, etc.) 4. What is the first “S” in the SNAPPS presentation? Summarize: present the pt's H&P findings 5. What is the “N” in the SNAPPS presentation? Narrow: based on the H&P findings, narrow down to the top 2-3 differentials 6. What is the “A” in the SNAPPS presentation? Analyze: analyze the differentials. Compare and contrast H&P findings for each of the differentials and narrow it down to the most likely one 7. What is the first “P” in the SNAPPS presentation? Probe: ask the preceptor questions of anything you are unsure of. 8. What is the second “P” in the SNAPPS presentation? Plan: come up with a specific management plan . 9. What is the last “S” in the SNAPPS presentation? Self-directed learning: an opportunity to investigate more about any topics that you are uncertain of. 10. What is the most common type of pathogen responsible for acute gastroenteritis? Viral (can be viral, bacterial, or parasitic), usually norovirus 11. Assessing for prior antibiotic use is a critical part of the history in patients presenting with diarrhea. True 12. Describe the difference between Irritable Bowel Disease (IBS) and Inflammatory Bowel Disorder (IBD) IBS: disorder of bowel function (as opposed to being due to an anatomic abnormality). Changes in bowel habits (diarrhea, constipation, abd pain, bloating, rectal urgency w/diarrhea). Symptoms fall into two categories: abd pain/altered bowel habits, and painless diarrhea. Usually pain is LLQ. PE: normal except for tenderness in colon. Labs: CBC, ESR. Most other labs and radiology/scopes are normal. Dx made on careful H&P. May be associated with non-intestinal (extra-intestinal) symptoms (sexual function difficulty, muscle aches/pains, fatigue, fibromyalgia, HAs, back pain, urinary symptoms). Not associate with serious medical consequences. Not a risk factor for other serious GI dz's. Does not put extra stress on other organs. Overall prognosis is excellent. Major problem: changes quality of life. Treatment: based on symptom pattern. May include diet, education, pharm (for mod-severe pt's)/other supportive interventions. Usually focuses on lifestyle, diet, and stress reduction. NO PROVEN TREATMENT! Antidiarrheals: use temporarily, reserve for severe. Loperamide (Imodium) or diphenoxylate (Lomotil) 2.5-5mg q6h usually works. Constipation: high fiber diet, hydration, exercise, bulking agents. If these don't work, intermittent use of stimulant laxatives (lactulose or mag hydroxide); don't use long-term! Linzess (linaclotide), Trulance (plecanatide), and Amitiza (lubiprostone): newer for constipation, work locally on apical membrane of GI tract to increase intestinal fluid secretion and improve fecal transit. Abd pain: dicloclymine (Bentyl), hyoscyamine (avoid anticholinergics in glaucoma and BPH, especially in elderly). TCAs and SSRIs can relieve symptoms in some pt's. Can be managed by PCP, but if not responsive to tx, refer to GI. IBD: chronic immunological dz that manifests in intestinal inflammation. UC and Crohn's are most common. UC: mucosal surface of colon is inflamed, resulting in friability, erosions, bleeding. Usually occurs in rectosigmoid area, but can involve entire colon. Ulcers form in eroded tissue, abscesses form in crypts, become necrotic and ulcerate, mucosa thickens/swells, narrowing lumen. Pt's are at risk for perforation. Symptoms: bleeding, cramping, urge to defecate. Stools are watery diarrhea with blood/mucus. Fecal leuks almost always present in active UC. Tenderness usually in LLQ or across entire abd. Crohn's: inflammation extends deeper into intestinal wall. Can involve all or any layer of bowel wall and any portion of GI tract from mouth to anus. Characteristic segmental presentation of dz'd bowel separated by areas of normal mucosa ("skipped lesions"). With progression, fibrosis thickens bowel wall, narrowing lumen, leading to obstructions, fistulas, ulcerations. Pt's are at greater risk for colorectal cancer. Most common symptoms: cramping, fever, anorexia, wt loss, spasms, flatulance, RLQ pain/mass, bloody/mucus/pus stools. Symptoms increase with stress, after meals. 50% of pt's have perianal involvement (anal/perianal fissures). Inflammation can lead to bleeding, fever, increased WBC, diarrhea, cramping. Abnormalities can be seen on cross-sectional imaging or colonscopy. No single explanation for IBD. Theory: viral, bacterial, or allergic process initially inflames small or large intestine, results in antibody development which chronically attack intestine, leading to inflammation. Possible genetic predisposition. Dx made by H&P correlated with symptoms, must exclude infectious cause for colitis. Primary dx tools: sigmoidoscopy, colonoscopy, barium enema w/small bowel follow-through, CT. Tx is very complex, managed by GI. Drugs: 5-aminosalicylic acid agents have been used for >50yrs, but have shown to be of little value in CD; still used as first attempt for UC. Antidiarrheals w/caution (constipation). Don't use in acute UC or if toxic megacolon. Corticosteroids used when 5-ASA not working. If corticosteroids don't work, use immunomodulators (azathioprine, methotrexate, 6-mercaptopurine), but can cause bone marrow suppression and infection. Newer class: anti-TNF (biologic response modifiers) for mod-severe dz. Remicade (infliximab), Humira (adalimumab), Entyvio (vedolizumab); can increase risk of infection. 13. What is medical coding? The use of codes to communicate with payers about which procedures were performed and why 14. What is medical billing? Process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider. 15. What are CPT codes? Common procedural terminology Offers the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. 16. What are ICD codes? International classification of disease Used to provide payer info on necessity of visit or procedure performed. [Show More]

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