C admission

Question 1

Chemotherapy (langerhan histiocytosis)

Answer 1

Hx
Nil active complains
No fever
TOCC -ve
+- No bleeding (epistaxis, gumbleeding, easy bruising)
+- No frequent infection, LN, abdominal pain
+- No SOB, palpitation, dizziness

PE
BP, P, T, SpO2
Chest, CVS, Abdomen, LL edema

Mx

• DAT
• Obs BD
• Blood x CBC LRFT clotting bone LDH urate CMVpp65
• Consult hemat
• Resume usual meds

Question 2

FOB

Answer 2

Mx 
 - low residual diet
 - Obs QID
 - FOB protocol
 - Fast after light breakfast mane
 >>>> IVF after fast
 >>>> Consent
 - Transfuse 1U PC q4H
 - Blood x CBC, LRFT, CaPO4 +- TxS
 - CXR
 - ECG

Question 3

Renal bx

Answer 3

Mx

• DAT
• Obs QID
• +- Hstix
• Bld x CBC LRFT bone clotting RG TxS
• Follow renal bx protocol
• Resume usual meds (w/h aspirin, anticoagulant)
• PPP x Renal bx
• FMN
• IVF: 2D1S or 1/2 1/2 q8H when fast
• Consent
• Premed: PO valium 4mg on call
• Post-renal bx order
• Bed rest x 24H
• BP/P q15min x4, q30min x4, q1H x4, q4H if stable
• CBP mane
• Save every urine x inspection
• analgesics

Question 4

Tenckhoff insertion/ removal

Answer 4

Mx

• DAT (renal diet)
• Obs QID
• +- Hstix
• Bld x CBC LRFT bone clotting RG TxS
• Resume usual med (w/h aspirin and anticoagulant)
• PPP x renal bx
• FMN
• IVF: 2D1S or 1/2 1/2 q8H when fast
• Consent
• Premed: PO valium 4mg on call, IM pethidine 50mg on call, IV cefazolin 1g on call

Question 5

OGD

Answer 5

Mx

• DAT
• Obs QID
• Bld x CBC LRFT clotting +- TxS
• CXR
• ECG
• Resume usual meds
• FMN
• IVF after fasting
• Consent

Question 6

Colonoscopy

Answer 6

Mx

• Low residual diet
• Obs QID
• Bld x CBC LRFT clotting +- TxS
• CXR
• ECG
• Resume usual meds
• FMN
• IVF after fasting
• Consent
• Klean prep 2L 6pm and 6am mane

Question 7

Manual/ machine IPD

Answer 7

Mx

• DAT (renal diet)
• Obs QID
• Hstix
• Bld x CBC LRFT bone RG
• Resume usual meds
• RFT, Hstix postPD

IPD regimen
- 1.5% 2L q2H x ___cycles
(usu total treatment vol 40-50L i.e. 20-25 cycles)
- 2.5% if fluid overload
- 2H cycle = inflow 10min + dwell 90min + drain 20min
- if TK inserted within 2W, use 1L cycles