Common conditions in hosp pts Flashcards
what can constipation in a hospitalized pt represent
define constipation
- <3 BM per wk
- passing hard/lumpy stool
- straining w defecation
- sense of incomplete evacuation
any of em
what are some potential causes of constipation (8)
what drug classes can cause constipation
literally so many
what would suggest you should get imaging in a pt with constipation? what imaging would you use?
- pain, distention, hypo/hyperactive bowel sounds
- Xray of abdomen
what is the tx of moerate to severe constipation w no suspicion of obstruction
stimulant laxative such as senna or bisacodyl
what is the tx of mild constipation w no s/s of obstruction
osmotic laxative such as:
* lactulose
* polyethylene glycol
* magnesium salt
do you use stool softeners to tx constipation
NO!
used to prevent constipation and are not typically helpful in hospitalized pts
If stool is mostly left sided what may be helpful to relieve constipation
enema
tx for severe pain, NV, fever, blood or mucous in stool
consult GI or gen surg
for those at risk for constipation what should you do to prevent it once theyre in the hospital
- osmotic laxative daily
- stimulant laxative if multiple risk fx
define diarrhea
abnormal increase in excretion of fecal matter to >200g/day
what is considered nosocomial diarrhea
diarrhea not present on admission and occuring after 3 days of hospitalization
what is considered community acquired diarrhea
diarrhea present on admission or within the first 3 days of admission
with infectious diarrhea, is viral or bacterial more common?
viral
except C diff which accounts for the majority of all infectious diarrhea cases
what accounts for the majority of all infectious diarrhea
C diff
what are causes of noninfectious diarrhea
- meds/supplements
- nutritional therapy
- contrast agents
- new GI pathologys (colitis, IBD, ect)
what abx increase the risk for c diff
- clinda
- cephalosporins
- PCN
- FQ’s
what is the presentation of C diff
- water (possibly foul smelling)
- 3+/day for >1day
- mild abdominal pain/cramping
what is the clinical criteria for mild C diff and how do you treat it?
- WBC <15,000 AND serum Cr <1.5x premorbid
- Tx - oral metro
what is the clinical criteria and tx for severe C diff
- WBC>15,000 OR Serum Cr >1.5x of premorbid
- tx: oral vanc
didnt know vanc came orally, learn somthin new every day
what is the clinical criteria and tx of severe complicated C diff
- hypotension, shock ileus or megacolon
- oral vanc AND IV metro
- If ileus, megacolon or distension add rectal vanc and surg consult
recurrence of C diff occurs in ()% of pateints and presents (how long) after treatment
20%
presents 5 days after abx are stopped but can take up to 1 month
how do you treat a first recurrence of C diff? what about the second? what about third?
1st = same as first occurence
2nd = pulsed vac regimen
3rd = microbiota transplant considered
huge list of drugs that can cause diarrhea
What are the infectious red flags for diarrhea?
- fever
- abdominal pain
- immunocomp
- recent abx
- elevated WBC
if you have infectious red flags in a patient w diarrhea what do you order
- Fecal WBC or lactoferrin
- Cdiff test
- bacterial testing (if bloody)
- protozoa testing (if watery)
what are the antidiarrheal agents and who should they NOT be used in
- loperamide
- bismuth subsalicylate
- diphenoxylate
- not in pts w inflammatory diarrhea or infectious causes
If you suspect a bacterial cause for diarrhea what should you consider
starting ciprofloxacin
if diarrhea is d/t new IBD what is the management
immunosuppressive agents and bowel rest
what is delerium
abrupt alteration in the level of consiousness which waxes/wanes over the cours of a day w associatd changes in cognition or perception
delerium is a nonspecific warning sign and therefore is considerd a ()
red flag
causes for delerium
drugs that induce delerium
what drug should ou be wary of when using it in patients w delerium
BZDs
does not say why, just says be wary lol
what are nonpharm ways to manage delerium
- 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
what pharm agents are used to treat delerium
antipsychotics!
what labs do you need to run prior to starting antipsychotics
- Serum K+, Ca+, and Mg
- calculate QTc on EKG
If a patient has QTc longer than 450 (men) or 470 (women) what do you do to treat their delerium?
- reduce dose of other QTc prolonging drugs
- keep serum K+ >4
- Keep Mg+ > 2
- normalize serum calcium
How often should you reassess a patient while they take antipsychotics for delerium
daily!
what is considered indsomnia
- difficulty initiating or maintaining sleep
- waking up too early
- sleep that feels poor in quality (daytime physical/mental sequelae)
Although pharm treatments are not really recomended for pts in the hospital, what three pharms COULD you use for insomnia?
- 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)
what are the 4 main modalities of pain management
- medications
- interventions
- behavioral therapies
- PT/complementary tx
best for static nocioceptive pain like surgcial pain, not great for neuropathic pain or moevement related pain
opioids
SE = NV, constipation, sedation, resp depression
opioids
not sure what this is
when do you use NSAIDs
what is their main SE
acetaminophin is the same but w/o the SE
- mild/mod pain
- mod/severe pain to supp w opioids
- ortho injuries, muscle infflammation, uterine contraction
increases risk of bleeding and CV events
What medications are affected by liver disease?
what medication is not
- NSAIDs (coag dysfunction)
- opioid metabolism (decreased)
- anything hepatically metabolized
- use fentanyl (not affected by liver Dz)
Renal disease affects the use of what pain medications
NSAIDs, they have an increased SE severity in pts w renal function impairement
not CI but avoid if you can
