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General Medical Conditions and Surgeries

General Medical Conditions and Surgeries. Med Surg II. WOUNDS, INFECTIONS, DEBRIDEMENT, GRAFTS. Integument Conditions Wounds, Incisions, Grafts, Debridement. Meds Antibiotics Labs/Diagnostics WBC Pathology Cultures Blood, urine, site Medical Equipment IV Foley Wound Vac PICC.

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General Medical Conditions and Surgeries

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  1. General Medical Conditions and Surgeries Med Surg II

  2. WOUNDS, INFECTIONS, DEBRIDEMENT, GRAFTS

  3. Integument ConditionsWounds, Incisions, Grafts, Debridement • Meds • Antibiotics • Labs/Diagnostics • WBC • Pathology Cultures • Blood, urine, site • Medical Equipment • IV • Foley • Wound Vac • PICC

  4. 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

  5. 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

  6. AMPUTATION

  7. 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

  8. 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

  9. 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

  10. GASTROINTESTINAL CONDITIONS

  11. 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

  12. Hepatitis, Liver Failure • Precautions/Contraindications • Jaundice: no heavy lifting, straining or elevated activity (normal mobility is fine) • I & O with fluid restrictions

  13. 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

  14. Peptic Ulcer Disease • Precautions/Contraindications • Universal Precautions • Isolation • Pain • Pain at night (supine position) • Pain associated with eating patterns • 1-3 hours post meal

  15. 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

  16. Cholecystectomy • Precautions/Contraindications • Log roll for comfort

  17. Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed • Meds Antibiotic: Ciprofloxin, Flagyl Analgesic: Pentazocine Sulfasalazine, 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

  18. Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed • Precautions/Contraindications • NPO – Nothing per os (Nothing by mouth)

  19. BARIATRIC SURGERY

  20. Bariatric Surgery • Meds • Antibiotics • Fluid imbalances • Analgesics • Labs/Diagnostics • CBC with WBC for infections • Specific cultures • Medical Equipment • IV • Foley • NG for feeding

  21. Bariatric Surgery • Precautions/Contraindications • Universal Precautions • Psychosocial Issues • Weight limitations on equipment

  22. GENITOURINARY

  23. UTI • Meds • UTI – TMP-SZM, Ciprofloxicin • Labs/Diagnostics • Urine analysis • Blood cultures • Medical Equipment • IV for meds • Foley for specimen • Clean catch

  24. 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)

  25. 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

  26. 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

  27. Renal Insufficiency/Failure • Meds • Volume control • System conditions • Labs/Diagnostics • Electrolytes • Medical Equipment • PAS stockings or foot pumps

  28. Renal Insufficiency/Failure • Precautions/Contraindications • Cardiac System vital signs • BP post dialysis

  29. PREGNANCYPOST PARTUM

  30. Pregnancy, Post Partum • Meds • Fluid volumes • HTN (preclampsia, eclampsia) • Labs/Diagnostics • CBC • Ultrasound • Medical Equipment • PAS stockings or foot pumps • IV

  31. 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

  32. 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

  33. Pregnancy – Pre-Birth • Activity orders: ABR, limited sitting, Bathroom Privileges • Limit the activity of the abdominals • DVT prophylaxis • Breathing exercises • Coughing with guarding

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