Med Surg II. WOUNDS, INFECTIONS, DEBRIDEMENT, GRAFTS 2.
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Transcript of Med Surg II. WOUNDS, INFECTIONS, DEBRIDEMENT, GRAFTS 2.
Integument ConditionsWounds, Incisions, Grafts, Debridement
Meds Antibiotics
Labs/Diagnostics WBC Pathology Cultures
Blood, urine, site Medical Equipment
IV Foley Wound Vac PICC
Integument ConditionsWounds, Burns, Incisions, Infections
Precautions/Contraindications ROM limitations with graft sites Mobility/ROM with dehiscence Wt bearing if on sole of foot First time dressing changes or check orders for
dressing or ace wrap changes Universal Precautions Isolation
Private Room Equipment washed each session or left in room
Integument ConditionsWounds, Burns, Incisions, Infections
PT Eval How active is the pathogen (fever or stable?) Pain Assess functional limitation with dressing If on foot, wt bear status
PT POC – 3 Days Mobility Ther Ex for deficits Tolerance related to vital signs, RPE, pain
Amputation
Meds Antibiotics if infection (pre and post) IV for fluids
Labs/Diagnostics Blood for pathology Urine specimen
Medical Equipment IV, heplock PICC Post OP Dressings/Stump Shrinker O2
Amputation
Precautions/Contraindications Universal Precautions Isolation pending pathology Weight bearing on the heel of the foot for
metatarsal or toe amputations Non weight bearing at tarsal level Maintain the condition of the non-surgical
extremity
Amputation PT Eval
Pain level Joint assessment Tissue assessment Mobility
PT POC – 3-7 Days Pain management Ther ex pending deficits Mobility
Sit balance Standing balance Transfers (pivot, walker and positional, slideboard W/C mobility and safety Gait with walker Position of limb (sit in chair and use slideboard under
residual limb
Hepatitis, Liver Failure Meds
Hepatitis Interferon monotherapy
Liver Failure Cephuluc, Flagyl
Labs/Diagnostic Hepatitis
CBC with WBC normal or low, ALT and AST levels increased Increased PT with decreased glucose = severe liver damage Urine analysis for proteinuria Diagnostic blood values immunoglobin IgM, IgG
Liver Failure Cardiac Renal Fluid and Electrolytes GI – bilirubin elevated, albumin decreased, AST, ALT elevated Anemia, coagulation, DIC – PT prolonged Immune Neuro with encephalopathy, cerebral edema Renal
Medical Equipment TIPS (transjugular intrahepatic portosystemic shunt) for severe ascites
Hepatitis, Liver Failure
Precautions/Contraindications Jaundice: no heavy lifting, straining or
elevated activity (normal mobility is fine) I & O with fluid restrictions
Peptic Ulcer Disease Meds
Antibiotics per pathogen TPN for nutrition Zantac, Tagamet, Pepcid for immediate; Prilosec, prevacid, nexium longer term
pre meals Labs/Diagnostics
Lab H. pylori in serum or stool Blood for pathology – anemia. Leukocytosis, elevated serum amylase for pancreas,
hypokalemia ABG for metabolic alkalosis, BUN may rise absorption of blood nitrogen from small intestine Urine specimen
Diagnostics Endoscopy/biopsy Urea breath test Abdominal Xray for free air in peritoneal cavity Upper GI with radiograph
Medical Equipment IV, heplock – meds, blood transfusions PICC NG tube for bleeding Wound Vac
Peptic Ulcer Disease
Precautions/Contraindications Universal Precautions Isolation
Pain Pain at night (supine position) Pain associated with eating patterns
1-3 hours post meal
CholeycystecomyAcute Pancreatitis
Meds post surgical Choly:
Analgesics: Antibiotics: Cephalosporin, Flagyl
Pancreatitis: Morphine, fresh frozen plasma, albumin infusions
Labs/Diagnostics Choly:
CBC for WBC, Hb, Hct Pre surgical Xray, Ultrasound or ERCP (Endoscopic Retrograde
Cholangiopancreatography) for stones
Pancreatitis: Serum amylase and lipase levels elevated
Medical Equipment IV Foley O2 NG tube for pancreatitis
Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed
MedsAntibiotic: Ciprofloxin, FlagylAnalgesic: PentazocineSulfasalazine, Azulfidine
Labs/Diagnostics Lab – WBC, elevated erythrocycte sedimentation rate, C-
reactive protein; anemia for ulcerative colitis; electrolytes; CBC for bleed
Stool samples Diagnostics – CT scan, flexible sigmoidoscopy or colonoscopy
Medical Equipment IV, heplock – meds, hydration PICC NG tube for bleeding or suction Wound Vac
Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed
Precautions/Contraindications NPO – Nothing per os (Nothing by mouth)
Bariatric Surgery
Meds Antibiotics Fluid imbalances Analgesics
Labs/Diagnostics CBC with WBC for infections Specific cultures
Medical Equipment IV Foley NG for feeding
Bariatric Surgery
Precautions/Contraindications Universal Precautions Psychosocial Issues Weight limitations on equipment
UTI
Meds UTI – TMP-SZM, Ciprofloxicin
Labs/Diagnostics Urine analysis Blood cultures
Medical Equipment IV for meds Foley for specimen Clean catch
Renal Insufficiency/Failure
Meds Lasix for volume overload Replenish electrolytes via IV Antibiotics if infection
Labs/Diagnostics BUN, creatinine, ADH (antidiuretic hormone) CBC for electrolytes primarily Na, K ABGs for metabolic alkalosis/acidosis U/P levels (urine to plasma) Urine analysis for bacteria, cellular debris CT or MI for obstructions
Medical Equipment IV for meds Foley Catheter drain, urethral stents, percutaneous nephrostomy (drains
out the back)
Renal Insufficiency/Failure
Precautions/Contraindications Urine output in 24 hour period
Anuria: less than 100 ml Oliguria: 100-400 ml Nonoliguria >400 ml Polyuria: > 600 ml
Kidney Failure using Glomerulus Filtration Rate (80-120 ml/min) Stage I – >90ml/min Stage II – 60-89 ml/min Stage III – 30-59 ml/min Stage IV – 15-29 ml/min Stage V – failure or ESRD End stage renal disease at <15
ml/min
Renal Insufficiency/Failure
Precautions/Contraindications Multisystem
Integument Edema Bruising
Pulmonary SOB Pleural Effusion
Cardiovascular DOE Pericarditis HTN Cardiomegaly
GI Nausea/Vomiting
GU Neuro
Inability to concentrate
Renal Insufficiency/Failure
Meds Volume control System conditions
Labs/Diagnostics Electrolytes
Medical Equipment PAS stockings or foot pumps
Renal Insufficiency/Failure
Precautions/Contraindications Cardiac System vital signs BP post dialysis
Pregnancy, Post Partum
Meds Fluid volumes HTN (preclampsia, eclampsia)
Labs/Diagnostics CBC Ultrasound
Medical Equipment PAS stockings or foot pumps IV
Pregnancy, Post Partum
Precautions/Contraindications Activity level for pregnancy which is usually
ABR in the hospital
Post Partum Move like pt with THA, rolling many times applies
pressures into the pelvis Use of RW recommended so pt does not have to
pick up the walker May slide or scoot the extremity at first due to
pain
Pregnancy, Post Partum
PT Eval Assess joints Assess general strength If ABR - Assess bed mobility and follow order for
ability for sitting Post Partum are usually pelvic mal-alignment
assessment PT POC – Usually in 7 or 8 month
ABR: DVT prophylaxis, Limit intra abdominal pressure with mobility much as possible
Post Partum: Gentle muscle setting, SI belt or abdomino-pelvic binder for hypermobility, walker for stability and unload painful side, engage the core