Transcript General Medical Conditions and Surgeries

Med Surg II
WOUNDS,
INFECTIONS,
DEBRIDEMENT,
GRAFTS
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Meds
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Antibiotics
Labs/Diagnostics
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WBC
Pathology Cultures
 Blood, urine, site
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Medical Equipment
IV
 Foley
 Wound Vac
 PICC
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Precautions/Contraindications
ROM limitations with graft sites
 Mobility/ROM with dehiscence
 Wt bearing if on sole of foot
 First time dressing changes or check orders for
dressing or ace wrap changes
 Universal Precautions
 Isolation
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 Private Room
 Equipment washed each session or left in room
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PT Eval
How active is the pathogen (fever or stable?)
 Pain
 Assess functional limitation with dressing
 If on foot, wt bear status
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PT POC – 3 Days
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Mobility
Ther Ex for deficits
Tolerance related to vital signs, RPE, pain
AMPUTATION
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Meds
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Labs/Diagnostics
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Antibiotics if infection (pre and post)
IV for fluids
Blood for pathology
Urine specimen
Medical Equipment
IV, heplock
 PICC
 Post OP Dressings/Stump Shrinker
 O2
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Precautions/Contraindications
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Universal Precautions
Isolation pending pathology
Weight bearing on the heel of the foot for metatarsal
or toe amputations
Non weight bearing at tarsal level
Maintain the condition of the non-surgical extremity
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PT Eval
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Pain level
Joint assessment
Tissue assessment
Mobility
PT POC – 3-7 Days
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Pain management
Ther ex pending deficits
Mobility
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Sit balance
Standing balance
Transfers (pivot, walker and positional, slideboard
W/C mobility and safety
Gait with walker
Position of limb (sit in chair and use slideboard under
residual limb
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Meds
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Hepatitis
 Interferon monotherapy
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Liver Failure
 Cephuluc, Flagyl
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Labs/Diagnostic
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Hepatitis
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Liver Failure
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CBC with WBC normal or low, ALT and AST levels increased
Increased PT with decreased glucose = severe liver damage
Urine analysis for proteinuria
Diagnostic blood values immunoglobin IgM, IgG
Cardiac
Renal
Fluid and Electrolytes
GI – bilirubin elevated, albumin decreased, AST, ALT elevated
Anemia, coagulation, DIC – PT prolonged
Immune
Neuro with encephalopathy, cerebral edema
Renal
Medical Equipment
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TIPS (transjugular intrahepatic portosystemic shunt) for severe ascites
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Precautions/Contraindications
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Jaundice: no heavy lifting, straining or elevated
activity (normal mobility is fine)
I & O with fluid restrictions
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Meds
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Antibiotics per pathogen
TPN for nutrition
Zantac, Tagamet, Pepcid for immediate; Prilosec, prevacid, nexium longer term pre
meals
Labs/Diagnostics
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Lab
 H. pylori in serum or stool
 Blood for pathology – anemia. Leukocytosis, elevated serum amylase for pancreas,
hypokalemia
 ABG for metabolic alkalosis,
 BUN may rise absorption of blood nitrogen from small intestine
 Urine specimen
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Diagnostics
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Endoscopy/biopsy
Urea breath test
Abdominal Xray for free air in peritoneal cavity
Upper GI with radiograph
Medical Equipment
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IV, heplock – meds, blood transfusions
PICC
NG tube for bleeding
Wound Vac
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Precautions/Contraindications
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Universal Precautions
Isolation
Pain
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Pain at night (supine position)
Pain associated with eating patterns
 1-3 hours post meal
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Meds post surgical
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Choly:
 Analgesics:
 Antibiotics: Cephalosporin, Flagyl
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Pancreatitis:
 Morphine, fresh frozen plasma, albumin infusions
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Labs/Diagnostics
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Choly:
 CBC for WBC, Hb, Hct
 Pre surgical Xray, Ultrasound or ERCP (Endoscopic Retrograde
Cholangiopancreatography) for stones
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Pancreatitis:
 Serum amylase and lipase levels elevated
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Medical Equipment
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IV
Foley
O2
NG tube for pancreatitis
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Precautions/Contraindications
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Log roll for comfort
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Meds
Antibiotic: Ciprofloxin, Flagyl
Analgesic: Pentazocine
Sulfasalazine, Azulfidine
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Labs/Diagnostics
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Lab – WBC, elevated erythrocycte sedimentation rate, Creactive protein; anemia for ulcerative colitis; electrolytes; CBC
for bleed
Stool samples
Diagnostics – CT scan, flexible sigmoidoscopy or colonoscopy
Medical Equipment
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IV, heplock – meds, hydration
PICC
NG tube for bleeding or suction
Wound Vac
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Precautions/Contraindications
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NPO – Nothing per os (Nothing by mouth)
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Meds
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Labs/Diagnostics
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Antibiotics
Fluid imbalances
Analgesics
CBC with WBC for infections
Specific cultures
Medical Equipment
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IV
Foley
NG for feeding
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Precautions/Contraindications
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Universal Precautions
Psychosocial Issues
Weight limitations on equipment
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Meds
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UTI – TMP-SZM, Ciprofloxicin
Labs/Diagnostics
Urine analysis
 Blood cultures
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Medical Equipment
IV for meds
 Foley for specimen
 Clean catch
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Meds
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Labs/Diagnostics
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Lasix for volume overload
Replenish electrolytes via IV
Antibiotics if infection
BUN, creatinine, ADH (antidiuretic hormone)
CBC for electrolytes primarily Na, K
ABGs for metabolic alkalosis/acidosis
U/P levels (urine to plasma)
Urine analysis for bacteria, cellular debris
CT or MI for obstructions
Medical Equipment
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IV for meds
Foley
Catheter drain, urethral stents, percutaneous nephrostomy (drains out the
back)
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Precautions/Contraindications
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Urine output in 24 hour period
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Anuria: less than 100 ml
Oliguria: 100-400 ml
Nonoliguria >400 ml
Polyuria: > 600 ml
Kidney Failure using Glomerulus Filtration Rate (80-120
ml/min)
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Stage I – >90ml/min
Stage II – 60-89 ml/min
Stage III – 30-59 ml/min
Stage IV – 15-29 ml/min
Stage V – failure or ESRD End stage renal disease at <15
ml/min
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Precautions/Contraindications
 Multisystem
 Integument
 Edema
 Bruising
 Pulmonary
 SOB
 Pleural Effusion
 Cardiovascular
 DOE
 Pericarditis
 HTN
 Cardiomegaly
 GI
 Nausea/Vomiting
 GU
 Neuro
 Inability to concentrate
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Meds
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Labs/Diagnostics
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Volume control
System conditions
Electrolytes
Medical Equipment
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PAS stockings or foot pumps
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Precautions/Contraindications
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Cardiac System vital signs
BP post dialysis
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Meds
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Labs/Diagnostics
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Fluid volumes
HTN (preclampsia, eclampsia)
CBC
Ultrasound
Medical Equipment
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PAS stockings or foot pumps
IV
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Precautions/Contraindications
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Activity level for pregnancy which is usually ABR in
the hospital
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Post Partum
 Move like pt with THA, rolling many times applies
pressures into the pelvis
 Use of RW recommended so pt does not have to pick
up the walker
 May slide or scoot the extremity at first due to pain
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PT Eval
Assess joints
 Assess general strength
 If ABR - Assess bed mobility and follow order for ability
for sitting
 Post Partum are usually pelvic mal-alignment assessment
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PT POC – Usually in 7 or 8 month
ABR: DVT prophylaxis, Limit intra abdominal pressure
with mobility much as possible
 Post Partum: Gentle muscle setting, SI belt or abdominopelvic binder for hypermobility, walker for stability and
unload painful side, engage the core
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Activity orders: ABR, limited sitting, Bathroom
Privileges
Limit the activity of the abdominals
DVT prophylaxis
Breathing exercises
Coughing with guarding