Hospitalist Medicine-GL Van Bockern Flashcards

1
Q

ADC Vandalism

A
Admit to
	Diagnosis
	Condition
	Vitals
	Allergies
	Nursing Orders
	Diet
	Activity
	Labs
	IV Fluids
	Special Studies
	Medications
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2
Q

Nursing: Pt ratio

Floor?

A

1:4+

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3
Q

Nursing: Pt ratio

IMC?

A

1:3+

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4
Q

Nursing: Pt ratio

ICU?

A

1:1 or 1:2

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5
Q

Dispo: Floor vs ICU

Floor–> hyperglycemic Pt?

A

Hyperglycemia (>400) without anion gap

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6
Q

Dispo: Floor vs ICU

IMC–>

A

DKA but pH > 7.2 and resolving anion gap

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7
Q

Dispo floor vs ICU:

A

DKA with multi-organ dysfunction, pH < 7.2

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8
Q

Lab draws: (how often)

floor?

A

daily, BID

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9
Q

Lab draws:
IMC? (step down unit)
ICU?

A

q2h

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10
Q

Ex’s of ICU Pts:

A

ventilator, BiPAP
Central lines/pressors/drips
Nursing needs (ie insulin)
Pt at risk of decompensation

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11
Q

Renal failures Pts:

floor vs ICU criteria

A

floor= Chronic hemodialysis/ non-emergent

ICU: Emergent dialysis, CRRT, K > 6.0with EKG changes, any K > 7.0

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12
Q

Hemodynamics: floor vs ICU criteria

A

floor: Stable hemodynamics (HR 50-130, SBP 85-200, RR 10-30)

ICU: Hemodynamically unstable; hypertensive emergency; IV antihypertensives

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13
Q

Respiratory status: floor vs ICU

A

Floor: Chronic stable NPPV overnight (CPAP for OSA)

ICU: NIPPV (BiPAP, CPAP); intubated;impending respiratory failure; threatened airway

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14
Q

Inpatient vs. Observation

list rules

A
  • **Two-midnight rule= in patient
  • “Complex medical judgment”
  • “Generally, a patient is considered an inpatient … with the expectation that he or she will require hospital care that is expected to span at least two midnights”

-“However, the decision to admit a patient is a complex medical judgment which can be made only after the physician has considered a number of factors …”

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15
Q

Ex case:
66 year old female with past medical history of HTN, DM, and tobacco use disorder who presented with chest pain that was associated with shortness of breath. She has tried taking ASA with some relief. She denies any sick contacts. Negative ROS except chest pain and shortness of breath. Takes Lisinopril and Metformin at home. FH significant for Dad having MI. Social history significant for Tobacco use

Vitals: BP 130/80, pulse 110, RR 19, afebrile
Exam: No acute distress, CV: mild tachycardia with normal rhythm, Mild tachypneic with clear lungs, mild peripheral edema
Labs: Elevated cr (1.8), nml LFTs, trop elevated, BNP elevated,
D-dimer elevated, ECG with sinus tach and right axis deviation, CXR clear no PNA

DONT FORGET TO ASK CODE STATUS.
DDx?

A

Differential Diagnosis: MI, cardiac arrhythmia, pulmonary emboli
Outcome: Chest pain with elevated trop -> provider order stress test

Assessment and Plan from ED: Diagnosis NSTEMI, ordered stress and admitted to medicine

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16
Q

Ex 66yo Pt with CP:
2 hours later, pt developed worsening chest pain and went into PEA arrest resulting in death
WHY???

A

Don’t ignore the other differentials! Pt with elevated dimer, right axis deviation, and tachycardic.
**Ultimately, pt had a pulmonary emboli

Code status NOT discussed prior to PEA arrest

17
Q

Code Status Discussion prior to Admit

A

Normalizing statements

Education/explanation

Further steps if patient interested

MOST form

18
Q

During the hospital Stay: (steps)

A
  • Daily (at least) re-evaluation of patients
  • Adjustment of treatment plan
  • Communication with consultants
  • Discharge planning / longer-term plan
19
Q

Case Manager (describe their role)

A
Arranging logistics/finances of:
Home health
Outpatient IV antibiotics
Wound vacs, durable medical equipment
Transfer to outside hospital
SNF or LTAC referrals/placement
20
Q

Social worker (describe their role)

A
Homelessness
Uninsured
Undocumented
Substance abuse
Adjustment to illness counseling
Complex social issues Legal issues/guardianship
21
Q

Role Of OT

A

Assess/improve ADLs, mobility
Cognitive screens, MOCA

-“Just because you’re walking around doesn’t mean you’re safe to go home”

22
Q

Respiratory therapist: role

A

Ventilator and NIPPV management

Home oxygen evaluations

Nebulizers, chest PT

OSA screens

Sometimes intubate (hospital-dependent)

23
Q

Pharmacy: role

A
  • Confirmation of all inpatient med orders
  • clarification of orders w providers
  • prep meds
  • RRT/MET/code involvement
24
Q

Team base care: consultants

A
  • How do you call a consult?
  • “This is a consult for [main concern]. Ms. Jones is a 35 year old woman with h/o SIADH, who came in with….

-What will the consultant contribute?:
Procedures
Advice on workup
Advice on treatment

25
Q

78 year old female with h/o of HTN, DM, admitted for altered mental status found to have new ICH
Vitals: BP 155/70, RR 16, HR 85, Pulse Ox 92%

Exam: No change in Neuro
Exam from the day

Recent Imaging: Stable Head CT from the day

Follow up: CT-H for serial imaging

Concerns?
questions to ask?

A

What is her code status?
What do I do if there’s something on the CT Scan that is abnormal?
What does her neuro exam consist of?

26
Q

78-yo female–> CT-H shows small increased ICH no change from prior

What should you do next?

A

d.) See the patient, do a neuro exam, and call your consultant (NSGY)

27
Q

38 year old male with no PMH admitted for UE cellulitis in the setting of IV drug use
Vitals: BP: 90/60 Resp: 18 HR: 113 Pulse Ox: 97%
Exam: NAD. CV: tachy with regular rhythm msk: LUE wrapped with surround erythema
No u/s completed today

Follow up: u/s results

Any Concerns????
Next steps?

A

Why is he hypotensive and tachy?
What abx is he on?
What should I do with the u/s results?

Order blood cultures, switch pt from cefazolin to vancomycin, IVF, call gen surg, and go see patient

(vanco!!! need to have an abx that will cover for MRSA**

28
Q

Pt is 68 year old male with history of obesity and HTN who presented with shortness of breath found to have COVID PNA.
Vital Signs: BP: 130/70, RR: 24 HR: 105 Pulse Ox: 92% on 6L
Exam: Tachypneic with bilateral rales
Follow up: Just an FYI he isn’t looking great

Questions to ask?

A

What’s his Code status? Does he want to be moved to ICU?
What was his O2 requirement all day?
Is he getting RDV/Dex?

A rapid response is called after the day team leaves that he’s becoming more tachypneic and not able to maintain his saturations above 90% on 6L

CXR shows diffuse ground glass opacities

29
Q

Pt is 68 year old male with history of obesity and HTN who presented with shortness of breath found to have COVID PNA.
Vital Signs: BP: 130/70, RR: 24 HR: 105 Pulse Ox: 92% on 6L
Exam: Tachypneic with bilateral rales
Follow up: Just an FYI he isn’t looking great

A rapid response is called after the day team leaves that he’s becoming more tachypneic and not able to maintain his saturations above 90% on 6L
CXR shows diffuse ground glass opacities

Next steps?

A

b.) Get patient to prone, increase O2 to heated high flow, call ICU

Prone position for ventilated pts!!!

30
Q

Discharge Details

A

Discharge summary
Follow up scheduled
Discharge Order
Coordinating DC meds