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hospital medicine > Common conditions in hosp pts > Flashcards

Common conditions in hosp pts Flashcards

1
Q

what can constipation in a hospitalized pt represent

A
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1
Q

define constipation

A
  • <3 BM per wk
  • passing hard/lumpy stool
  • straining w defecation
  • sense of incomplete evacuation

any of em

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2
Q

what are some potential causes of constipation (8)

A
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3
Q

what drug classes can cause constipation

literally so many

A
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4
Q

what would suggest you should get imaging in a pt with constipation? what imaging would you use?

A
  • pain, distention, hypo/hyperactive bowel sounds
  • Xray of abdomen
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5
Q

what is the tx of moerate to severe constipation w no suspicion of obstruction

A

stimulant laxative such as senna or bisacodyl

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6
Q

what is the tx of mild constipation w no s/s of obstruction

A

osmotic laxative such as:
* lactulose
* polyethylene glycol
* magnesium salt

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7
Q

do you use stool softeners to tx constipation

A

NO!

used to prevent constipation and are not typically helpful in hospitalized pts

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8
Q

If stool is mostly left sided what may be helpful to relieve constipation

A

enema

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9
Q

tx for severe pain, NV, fever, blood or mucous in stool

A

consult GI or gen surg

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10
Q

for those at risk for constipation what should you do to prevent it once theyre in the hospital

A
  • osmotic laxative daily
  • stimulant laxative if multiple risk fx
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11
Q

define diarrhea

A

abnormal increase in excretion of fecal matter to >200g/day

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12
Q

what is considered nosocomial diarrhea

A

diarrhea not present on admission and occuring after 3 days of hospitalization

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13
Q

what is considered community acquired diarrhea

A

diarrhea present on admission or within the first 3 days of admission

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14
Q

with infectious diarrhea, is viral or bacterial more common?

A

viral

except C diff which accounts for the majority of all infectious diarrhea cases

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15
Q

what accounts for the majority of all infectious diarrhea

A

C diff

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16
Q

what are causes of noninfectious diarrhea

A
  • meds/supplements
  • nutritional therapy
  • contrast agents
  • new GI pathologys (colitis, IBD, ect)
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17
Q

what abx increase the risk for c diff

A
  • clinda
  • cephalosporins
  • PCN
  • FQ’s
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18
Q

what is the presentation of C diff

A
  • water (possibly foul smelling)
  • 3+/day for >1day
  • mild abdominal pain/cramping
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19
Q

what is the clinical criteria for mild C diff and how do you treat it?

A
  • WBC <15,000 AND serum Cr <1.5x premorbid
  • Tx - oral metro
20
Q

what is the clinical criteria and tx for severe C diff

A
  • WBC>15,000 OR Serum Cr >1.5x of premorbid
  • tx: oral vanc

didnt know vanc came orally, learn somthin new every day

21
Q

what is the clinical criteria and tx of severe complicated C diff

A
  • hypotension, shock ileus or megacolon
  • oral vanc AND IV metro
  • If ileus, megacolon or distension add rectal vanc and surg consult
22
Q

recurrence of C diff occurs in ()% of pateints and presents (how long) after treatment

A

20%

presents 5 days after abx are stopped but can take up to 1 month

23
Q

how do you treat a first recurrence of C diff? what about the second? what about third?

A

1st = same as first occurence
2nd = pulsed vac regimen
3rd = microbiota transplant considered

24
Q

huge list of drugs that can cause diarrhea

A
25
Q

What are the infectious red flags for diarrhea?

A
  • fever
  • abdominal pain
  • immunocomp
  • recent abx
  • elevated WBC
26
Q

if you have infectious red flags in a patient w diarrhea what do you order

A
  • Fecal WBC or lactoferrin
  • Cdiff test
  • bacterial testing (if bloody)
  • protozoa testing (if watery)
27
Q

what are the antidiarrheal agents and who should they NOT be used in

A
  • loperamide
  • bismuth subsalicylate
  • diphenoxylate
  • not in pts w inflammatory diarrhea or infectious causes
28
Q

If you suspect a bacterial cause for diarrhea what should you consider

A

starting ciprofloxacin

29
Q

if diarrhea is d/t new IBD what is the management

A

immunosuppressive agents and bowel rest

30
Q

what is delerium

A

abrupt alteration in the level of consiousness which waxes/wanes over the cours of a day w associatd changes in cognition or perception

31
Q

delerium is a nonspecific warning sign and therefore is considerd a ()

A

red flag

32
Q

causes for delerium

A
33
Q

drugs that induce delerium

A
34
Q

what drug should ou be wary of when using it in patients w delerium

A

BZDs

does not say why, just says be wary lol

35
Q

what are nonpharm ways to manage delerium

A
  • orient pts by providing environmental cues
  • reduce overstimulation
  • reduce restraint use (1:1 sitter preferred)
  • improve sleep/wake cycle
  • mobilize early
  • maintain nutrition, hydration and oxygenation
36
Q

what pharm agents are used to treat delerium

A

antipsychotics!

37
Q

what labs do you need to run prior to starting antipsychotics

A
  • Serum K+, Ca+, and Mg
  • calculate QTc on EKG
38
Q

If a patient has QTc longer than 450 (men) or 470 (women) what do you do to treat their delerium?

A
  • reduce dose of other QTc prolonging drugs
  • keep serum K+ >4
  • Keep Mg+ > 2
  • normalize serum calcium
39
Q

How often should you reassess a patient while they take antipsychotics for delerium

A

daily!

40
Q

what is considered indsomnia

A
  • difficulty initiating or maintaining sleep
  • waking up too early
  • sleep that feels poor in quality (daytime physical/mental sequelae)
41
Q

Although pharm treatments are not really recomended for pts in the hospital, what three pharms COULD you use for insomnia?

A
  • benzos (causes resp depression/delerium/over sedation possibily)
  • Lunesta, Ambien (assocaited w delerium, v rapid onset)
  • Rozerum (melatonin agonist w no resp depression. short half life)
  • Antihistamines (avoid in urinary retention, BPH, >60 y/o, ortho hypotension)
  • trazadone (depression + insomnia is when this is used)
  • melatonin (effective in circadian mismatch)
42
Q

what are the 4 main modalities of pain management

A
  • medications
  • interventions
  • behavioral therapies
  • PT/complementary tx
43
Q

best for static nocioceptive pain like surgcial pain, not great for neuropathic pain or moevement related pain

A

opioids

44
Q

SE = NV, constipation, sedation, resp depression

A

opioids

45
Q

not sure what this is

A
46
Q

when do you use NSAIDs

what is their main SE

acetaminophin is the same but w/o the SE

A
  • mild/mod pain
  • mod/severe pain to supp w opioids
  • ortho injuries, muscle infflammation, uterine contraction

increases risk of bleeding and CV events

47
Q

What medications are affected by liver disease?

what medication is not

A
  • NSAIDs (coag dysfunction)
  • opioid metabolism (decreased)
  • anything hepatically metabolized
  • use fentanyl (not affected by liver Dz)
48
Q

Renal disease affects the use of what pain medications

A

NSAIDs, they have an increased SE severity in pts w renal function impairement

not CI but avoid if you can

hospital medicine (6 decks)

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