Pain/Fever/Nutrition In Adults Flashcards
Acute vs chronic pain
Chronic is greater than 6 months
What medications can be given for post operative patients
Start with non optiates with adjuvant therapy can add opiate after that as a prn
What should be given for breakthrough pain in cancer patients
Fentanyl patch
What can be given for bone pain in cancer patients
Oral bisphosphonates
What is a major complication of pressure ulcers
Osteo and sepsis
Causes of fevers
Infections, serotonin syndrome, precedex, PE, MI, succinylcholine, procanimide, ABX
What indicates a non-infectious fever in post op
Insidious onset, refractory to Tylenol, typically correlated to atelectasis, give IVF first
What is the absolute contraindication to succinylcholine
Hyperkalemia
Malignant hyperthermia treatment
Dantrolene, O2
Normal albumin
3.5-5
What albumin level does edema typically occur
<2.7
When to consider a peg
Nutritional support >6 weeks
What are the signs of refeeding syndrome
Hypophosphatemia, hypokalemia, hypocalcemia, hypomagnesemia
Complications of TPN
Pneumothorax, air embolus, sepsis, hyperglycemia, hypertriglyceridemia, HHNK
Describe the WHO 3 step ladder approach to pain management
Step one (Mild): ASA, acetominophen, NSAIDs, or Adjuvant. Step Two(Mod): Codeine, Hydrocoodone, oxycodone, tramadol, adjuvants. Step 3 (severe): Morphine, Hydromorphone, methadone, fentanyl, adjuvants
What is a reliable factor in determining the development of pressure ulcers
Hypoalbuminemia
What is neuroleptic malignant syndrome caused by
Increase in antipsychotics.
How can you determine if a fever is drug induced
Minimally effected by Tylenol
Normal WBC count
5-10k
A patient with a WBC >30K is indicative of what
Non-infectious causes
What is the initial treatment in a post op fever
Hydration and lung expansion
Calorie calculation for the normal adult
25-30 kcal/kg/day
How to position a patient if you suspect and air embolus?
Left lateral decubitus
S/s of compartment syndrome, diagnostics, and treatment
S/s: Severe ischemic pain, tense swelling, parasthesias,
Diagnostics: Stryker tonometer intracompartmental pressure >30. Delta pressure <30.
Tx: fasciotomy
Normal compartment pressure
0-8 mmhg
What is the compartment delta pressure
Difference between the diastolic blood pressure and compartment pressure. DBP-ICP
<30 indicates need for fasciotomy
What kind of pain is a used by a mastectomy incision
Neuropathic
Outpatient cellulitis is most often caused by
Strep pyogenese
