NR 576 Week 4 Midterm Study Guide

Negative Predictive Value is the percentage of non-diseased people out of those who tested negative • Negative predictive value is inversely correlated with prevalence • Negative predictive value decreases with prevalence, and sensitivity/specificity do not vary. Predictive values depend on the prevalence of disease in the population. Pretest probability is the chance the patient has the disease, estimated before the results of the test are known. • It is based on the probability of the suspected disease given the patient's symptoms or clinical context • If the pretest probability is high, diagnostic testing may be warranted to clarify or confirm a diagnosis Specificity: proportion of ‘test negative’ of total without the disease; the number of true negatives over all negatives. Sensitivity is the proportion of patients with the disease that have a positive result; it is the number of true positives divided by the total number of patients who have the disease. Complete Blood Count (CBC) • Used to obtain data in evaluating a variety of disorders such as anemia, infection, or leukemia • Measures red blood cells, white blood cells, hemoglobin, hematocrit, and platelets • Check platelet count for unexplained bruising • Check CBC with differential for neutrophil shift in suspected infection for fever • Check RBC, Hgb and Hct for anemia if patient c/o fatigue • Check WBC for inflammation or possible cancer if patient has unexplained wright loss Chief complaint Test Rationale Fever CBC Check CBC with differential for neutrophil shift in suspected infection Unexplained bruising CBC Check platelet count Fatigue both Check RBC, Hgb and Hct for anemia, CMP for potential liver or kidney abnormalities Cardiac dysrhythmias CMP Monitor electrolytes for abnormalities Unexplained weight loss Both Check WBC for inflammation or possible cancer, CMP for glucose, liver or kidney abno Edema CMP Check for kidney function Week 2 It is important to use specific terminology to describe skin lesions and rashes. Good descriptions include each of the following elements: number, size, color, shape, texture, primary lesion, location, and configuration • Number—solitary or multiple; estimate of total number • Size—measured in millimeters or centimeters • Color—including erythematous if blanching; if non-blanching, vascular-like cherry angiomas and vascular malformations, petechiae, or purpura • Shape—circular, oval, annular, nummular, or polygonal • Texture—smooth, fleshy, verrucous, or warty, keratotic; greasy if scaling • Primary lesion—flat, a macule or patch; raised, a papule or plaque; or fluid filled, a vesicle or bulla (may also be erosions, ulcers, nodules, ecchymoses, petechiae, and palpable purpura) • Location—including measured distance from other landmarks • Configuration—grouped, annular, linear Key Questions Key questions to ask in the history of all rashes: • Onset? • Where is the rash located? Where did it start? • Does it hurt or itch? What other symptoms? • Has it spread (if so, what is the pattern)? What is the evolution and timeframe of the rash? • Have individual lesions changed? • Exposures and etiologies search: Have you traveled recently? Are you or could you be pregnant? Is there a relationship to exercise,