common problems in acute care Flashcards
acute vs chronic pain
plus or minus 6 months
cutaneous pain
skin
visceral
poorly localized in the organs
somatic
in muscle or soft tissue
neuropathic
nerve pain
step one pain control
asa, tylenol, nsaids, + adjuvants
step two pain control
insitial nsaid plus codeine, oxy or hydro, tramadol (not with asa or tylenol)
step three pain control,
nsaid plus morphene, dilaudid, methadone, fent
break through cancer pain
fent patches
causes of fever non bacterial
autoimmune disease, cns, neoplasm, blood disease, mi, gi disease, endocrine, nms
38.3 =
101.5
nms
antipsychotics, high fever, treat with fluids
treatment of fever
abx when microbe is present, tylenol, treat underlying cause
sux
not used with hyperkalemia
post op fever (non infecitous) leading cause
post op atelectesis, increased metabolic rate, dehydration, drug reactions,
infectious causes of post op fever
- leftshift, band formation lots of immature bands
2. wbc over 30K usually not infection
treatment of post op fever
in abcence of infection, expand lungs and hydrate
headache
chronology is most important history item
tension
most comon, vice like, tx withtylenol, no focal neuro symptoms
migrane
classic with aura- common without aura, related to diation and pulsation of external carotid, female > male, family history often present,
migrane symptoms
unilateral pain, dull or throbbing, lasts for hours, + focal neuro disturbances,
migrane tx
asa + sumatryptan iv or po- 6mg sq and up to three per day vs 25 po
albumin <3.5
malnutrition
albumin <2.7
edema
hgb repletion levels
8/24
need nutritional support for > 6 weeks <6weeks
peg tube ND nasoduedeanl tube if at risk of aspiration
need nutrition but cant use gi tract,
2 weeks or more or dex >10% central line, 2 weeks or less picc
Hyponatremia most common e abnormality determine and treat the cause eval includes
Urine NA- normal is 10-20
serum osmo 2xNA
Clinical status
hyponatremia urine
> 20 renal salt wasting ie a kidney problem
< 10 outside kidney
isotonic or psuedo hyponatremia
284-295 hiigh lipids, no symptoms, cut fat
fluid volume ranges
<280 is dry, 280-294 normal >290 is overloaded
hypernatremia cause and management
low volume
euvolemic
wet
145+ excess water loss,
dry- nss and 1/2 nss
nromal - free water
wet - free water and loop diuretics, may need HD
low K
cause
> 3.5 chronic use of diuretics, alkalosis , gi or renal loss
Low K sx
muscle weakness, constipation or illeus,
flacid paralysis if <2.5 tetany hyperrelfexia and rhabdo
Low K on diagnostics
broad T, low amplitude EKG, prominent U waves, PVC, vtach or fib
Low K treatment
oral if >2.5
IV at 10meq/hr if cant do po
if <2.5 or with sx give 40 IV, check q3, fix the mag. (1.7-2.2)
High K >5 causes
renal failure, nsaids, excess intake, low aldosterone, cell death, acidosis
High K acidosis
ph drops .1 K increase 0.7
High K S and S
weak, facid paralysis
ab distention
diarrhea
labs K>5
peaked T but not all
K>5 management
kayexalate
insulin 10uiv and and 1amp dex if >6.5
normal total ca
2.2-2.6mmol/L or 8.5-10.5mg/dl
normal ionized CA
1.1-1.4mmol/L or 4.5-5.5 mg/dl
if albumin is jacked up
use i calc cause it does not vary with serum albumin 3.4-5.4
50% of ca is bound to albumin so normal ca (2.2-2.6mmol/L or 8.5-10.5mg/dl) with low albumin <3.4
means that ca is high
ca <2.2 or 8.5 causes
hypoparathyroidism low mag >1.7, kidney failure, severe trauma, blood transfusion