step 3 32 Flashcards
1
Q
DKA workup
A
UPT CBC BMP Calcium amylase lipase EKG UA ABG Serum osms Serum ketones Regular insulin, IV Phenergan IV Discontinue oxygen
2
Q
DKA orders once admitted
A
NPO Bed rest Vitals UOP Replete K HbA1c phos BMP q4 hrs Stop 0.9NS and give 1/2 nS after 4 hours
3
Q
DKA discharge orders
A
subcu insulin
Diabetic diet
Counseling
4
Q
Emergency orders in patient presenting unconscious
A
Airway suction Pulse ox Intubation IV access Cardiac montor Thiamine D50 Naloxone
5
Q
workup of narcotic OD
A
EKG CBC BMP CXR LFT's UA UTox B-hcg Blood alcohol
6
Q
Initial treatment of narcotic OD
A
NG tube
Gastric lavage
Activated charcoal
Naloxone
7
Q
CF workup
A
Nursing orders sputum grain stain sputum culture and sensitivity blood cultures CBC-BMP CXR Sweat chloride 72-hour fecal fat
8
Q
CF treatment
A
O2 Augmentin Nebulized albuterol MVI Chest physiotherapy D5NS Regular diet
9
Q
CF orders at discharge
A
Flu shot + pneumovax
Nutrition consult
Pancreatic enzymes
Genetic counseling
10
Q
renal failure-decreased UOP workup
A
Stat fluids Foley 12 lead ABG CBC BMP mag and phos UA Uculture Urine sodium Urine creatinine
11
Q
renal failure orders once admitted
A
Discontinue nephrotoxic drugs vitals 24 hr urine protein Diabetic diet Renal Ultrasound Strict I-O's Accuchecks HBa1c SSI
12
Q
pediatric gastroenteritis workup
A
IV access CBC BMP UA IVF stool heme check stool for leukocytes stool culture breast-feeding ad lib
13
Q
PCOS workup
A
*need to rule out CAH, hyperprolactenima, Urine beta-HCG Serum testosterone total and free Serum DHEAS Serum prolactin 24-hour urine cortisol 24-hour urine 17-ketosteroids Serum TSH Serum LH Serum FSH Pelvic US Fasting lipid profile Glucose tolerance test
14
Q
PCOS remaining therapy
A
Counseling on weight loss, low fat diet, exercise
OCPs
Pap smear
15
Q
Emergency care for DT
A
pulse ox O2 Cardiac monitor IVF IV thiamine IV folic acid BLood glucose NPO 12-lead ativan seizure and aspiration precautions
16
Q
DT workup
A
CBC BMP LFTs coags Serum mag and phos ABG Utox Blood alcohol CXR (to rule out precipitating infection and aspiration) CT head (to rule out head injury)
17
Q
DT therapy at discharge
A
Rehab
AA
Counseling
18
Q
infant with jaundice workup
A
Blood type, infant and mother Direct coomb's test CRP CBC Total and indirect bili I/Os VS
19
Q
hemolytic disease of newborn workup + therapy
A
H,H q8 hrs total bilirubin q 8 hr Continue breast feeding transfer to NICU phototherpay IVF
20
Q
minimal change disease workup
A
Admit I/O's UA BMP CBC LFTs lipid panel Coags Complement CMP
21
Q
minimal change disease therapy
A
nephrology consult Albumin Lasix no salt, high protein diet prednisone
22
Q
pediatric sepsis workup
A
CBC BMP BCX UCX LP CSF for protein, glucose, cell count, gram stain CXR CRP
23
Q
pediatric sepsis therapy
A
Vitals q4h NS Ampicillin Cefotaxime I-O's Daily CBC, BMP Oxygen Discharge on amoxicillin
24
Q
normal pupil size
A
2-5 mm
25
SAH emergency orders
IV access
IV toradol
ESR
CT head
26
SAH workup + therapy
```
Admit to ICU
Cardiac monitoring
Pulse Ox
NPO
Urine output
Neurochecks q1h (monitor for hydrocephalus)
CBC
BMP
EKG
Coags
CT-angiogram
Stat neurosurgery consult
IVF
Percocet
Stool softener
Nimodipine
Omeprazole (stress ulcer prophylaxis)
Pneumatic compression devices
Keep BP between 120-140 with labetalol
```
27
hyperthyroidism workup
```
CBC
BMP
EKG
TSH
T3-T4
24-hour radioiodine uptake
```
28
hyperthyroid therapy + timeline
```
propranolol
methimazole
follow up in 1 month
CBC with diff at followup
Stop methimazole
Radioiodine
follow up in 1 month
```
29
pediatric constipation workup
```
Blood lead level, then venous blood level if high
CBC
BMP
Calcium
UA
```
30
pediatric lead poisoning therapy
```
Lead paint assay at home
Increase calcium in diet
Serum iron, ferritin, TIBC
Succimer (DMSA) chelation therapy
LFTs
Lead abatement agency
```
31
Other possible presentation of lead poisoning
- Fatigue, lethargy, not doing well in school, pallor on exam
- CBC with microcytic anemia and basophilic stippling
32
hypertrophic osteoarthropathy presentation
clubbing + arthritis due to periostitis of small hand joints + cancer
33
community acquired pneumonia workup + therapy
```
O2
IVF
UOP
vitals q4hr
CXR
Blood cultures
Sputum sample for gram stain, culture, and cytology
CBC
BMP
Levaquin
```
34
lung cancer workup
```
CT thorax
Sputum cytology
lymph node biopsy
Fiberoptic bronchoscopy
Pleural biopsy if effusion present
Transthoracic FNA biopsy if peripheral
Pulm consult
```
35
lung cancer therapy-staging + therapy
```
PFTs
LFTs
Serum calcium
CT abdomen and pelvis
MRI brain
bone scan
Consult oncology
Consult rad onc
Quit tobacco
```
36
meningitis workup
```
IVF
NPO
Hold betablockers
Pneumatic compression stockings
Vitals q2h
UOP
Head elevation
BCX
UA
UCX
CBC
BMP
Coags
```
37
meningitis therapy
```
Phenergan
acetaminophen
CTX
Vanc
LP
Send CSF for cell count, protein, glucose, gram stai, fungal stain, culture, sensitivity
Tailor abx
```
38
Infective endocarditis workup
```
emergency orders
CBC
BMP
coags
BCX
UA
CXR
Ecg
Utox
TEE
HbsAG, hep C, HIV
IF staph aureus, dc vanc and start nafcillin
Central line (for continued antibiotics)
Repeat BCX
```
39
Infective endocarditis therapy
vancomycin
gentamicin
acetaminophen
NS
40
Afib with RVR workup
```
Cardizem IV
CBC
BMP
CXR
Troponin
UA
LFTs
TSH
T4
Coags
```
41
Afib with RVR timeframe + therapy
```
Cardizem bolus
heparin
Monitor telemetry strip
Discontinue drip once HR is less than 80
Start PO cardizem
Start coumadin
Daily PT-INR
NEXT DAY:
Once INR above 2.0, dc heparin
```
42
other possible tamponade presentation
steering wheel trauma with elevated JVD on exam + hypotensive
43
initial tamponade orders
IV at 150 cc per hour
Elevate legs
cardiac monitoring
stat pericardiocentesis
44
second tamponade order set
```
EKG stat
CXR
TTE
Pericardial fluid for cell count
ABG
Cardiovascular thoracic surgeon consult
```
45
tamponade orders once in ICU
```
Swan-ganz catheter
Foley
UOP
Pneumatic compression devices
PPI
type and screen
```
46
pancreatitis therapy
NPO
hydromorphone
phenergan
47
pancreatitis workup
```
amylase-lipase
LFTs
AXR
CBC
BMP
calcium
US (look for gallstones, if present get GI consult + ERCP)
```
48
hepatitis workup
```
LFTs
CBC
BMP
retic count
coags
hep panel
```
49
acute hep a therapy
Phenergan
Counseling (no alcohol, smoking)
No antivirals, other meds available
Outpatient management
50
GI bleed workup
```
CBC
BMP
LFTs
Coags
12-lead
UOP
serial H H
```
51
GI bleed therapy
```
GI consult
type and cross
discontinue meds
endoscopy
RBC transfusion
FFP
Counseling
Avoid NSAIDs
ferrous sulfate
protonix for 4-8 weeks
```
52
pediatric constipation therapy
Milk of magnesia
| Docusate
