Monday, December 18, 2006

more review


  • More Review
  • Endocarditis--strep, staph. Vegetative lesions. Flu like symptoms. Fever high as 103F Roth spots. Petechiae. Splinter hemorrhages. Numbness tingling. Oslers nodes are small and painful on fingers toes. Janeway lesions not tender. Heart murmur, enlargement, failure. Hemiparesis or change in LOC. PE. Splenic Embolization pain in LUQ radiates to left shoulder. Rigid Abdomen. Blood cultures + for causative organsism. Elevated WBC and ESR. Anemia. IV antibiot for 4-6 weeks--penicillin, amphotericin B. Arthralgia. Amox before dental work, childbirth.
  • AAA 1 ½ times the stretch. 6:1 risk w/ first degree relative. Check yearly. Silent but may have prominent pulse in the abdomen when supine. Dx usually made when looking for something else. Rupture is Coming if---low back pain, abdominal pain, flank pain. Ruptured--intense low back pain. Lower abd pain, collapse, shock, mottling of lower extremities, decreased Hgb. Sx= resection of aneurysm. Low mortality stats if repaired before rupture, 5%. 50-80% mortality stat if repaired after rupture. Pre Op--compare peripheral pulses. Skin for color and temp, Mark pulses. During Sx- emboli risks from clamped aorta. Risks= MI, CHF, CVA, Kidney damage. Post Op= OUTPUT measured hourly. Assess for bleeding b/c heparin used during Sx. Check for Distal Arterial Perfusion= check for color pain level, motion sensation, temp. Check for distal arterial occlusion==darkened patches in soles/toes of feet. S/s of hemorrhage…drop in CV pressure. Drop in arterial pressure. Decreased urine output. Assess for spinal cord ischemia--assess motor and sensory function. Assess for pain from long incision. Assess for ischemic colitis--bloody diarrhea before bowel function is expected to return--normal return is 4-5 days post op. Assess mobility--OOB 1-2 days post op. discharge plan in 5-7 days. Lifting only to 5lbs. No driving. Showers ok. Assess family members after age 50.
  • Hepatitis--pt hospitalized for dehydration or a prolonged PT. Rest, hydration. NO ETOH. Low fat high CHO diet. Corticosteroids. Need Vitamins B--liver can not absorb. K--for coags--C for healing. Education---Gamma globulin indirect contact for Hep A. Hep A vaccine for travelers. Hep B vaccine for health care workers, newborns, and adolescents. Prevention for Hep C. No vaccine for E.
  • Cirrhosis--Early signs=vague, flu like. General weakness. Fatigue. Anorexia. Indigestion. Consitpation/diarrhea. Late signs= Jaundice, dry skin, pruitus. Edema. Ascites. Anemia. Bleeding. Infections (lost Kupfer cells). Menstrual irregular. Impotence. Gynecomastia. Renal failure. Dark amber urine. Clay colored stools.
    The Fs of distention= fluid, flatulence, fat, feces, fibroid tumors.
  • Rupture of Esophageal varicies. Med emergency. IV fluids, lytes, volume expanders. Sengstaken-Blakemore tube to stop the hemorrhage. Meds= Vasopressin.--constricts the arterial bed. Somatistatin--decreases bleeding w/out vasocontriction. Propranolol--beta blocker to decrease portal pressure.
  • Increased intracranial pressure--Bp up. Pulse down. Resps down.= cushings triad.
  • Shock--BP down. Pulse up. Resps up.
  • Tx for Hyperkalemia in ARF--Insulin +glucose IV. Sodium bicarb. Calcium gluconate IV. Dialysis. Kayexalate.
  • Diet for ARF= decrease protein. Increase calories. Low K+ and low phosphorus (bananas, citrus, coffee). Low Na+. Increase iron.
  • Colon Cancer locations of lesions= R. sided lesions--dull abd pain. Black tarry stools. L. sided lesions---bright red blood in the stool. Rectal lesions--tenesmus. Rectal pain. Constipation/diarrhea. Bloody stool.
  • Hyperflexion of the neck--chin to chest
  • Hyperextension of the neck--think falling down stairs chin first. Head back

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