Common conditions in hosp pts

Question 1

what can constipation in a hospitalized pt represent

Answer 1

Question 1

define constipation

Answer 1

• <3 BM per wk
• passing hard/lumpy stool
• straining w defecation
• sense of incomplete evacuation

any of em

Question 2

what are some potential causes of constipation (8)

Answer 2

Question 3

what drug classes can cause constipation

literally so many

Answer 3

Question 4

what would suggest you should get imaging in a pt with constipation? what imaging would you use?

Answer 4

• pain, distention, hypo/hyperactive bowel sounds
• Xray of abdomen

Question 5

what is the tx of moerate to severe constipation w no suspicion of obstruction

Answer 5

stimulant laxative such as senna or bisacodyl

Question 6

what is the tx of mild constipation w no s/s of obstruction

Answer 6

osmotic laxative such as:
* lactulose
* polyethylene glycol
* magnesium salt

Question 7

do you use stool softeners to tx constipation

Answer 7

NO!

used to prevent constipation and are not typically helpful in hospitalized pts

Question 8

If stool is mostly left sided what may be helpful to relieve constipation

Answer 8

enema

Question 9

tx for severe pain, NV, fever, blood or mucous in stool

Answer 9

consult GI or gen surg

Question 10

for those at risk for constipation what should you do to prevent it once theyre in the hospital

Answer 10

• osmotic laxative daily
• stimulant laxative if multiple risk fx

Question 11

define diarrhea

Answer 11

abnormal increase in excretion of fecal matter to >200g/day

Question 12

what is considered nosocomial diarrhea

Answer 12

diarrhea not present on admission and occuring after 3 days of hospitalization

Question 13

what is considered community acquired diarrhea

Answer 13

diarrhea present on admission or within the first 3 days of admission

Question 14

with infectious diarrhea, is viral or bacterial more common?

Answer 14

viral

except C diff which accounts for the majority of all infectious diarrhea cases

Question 15

what accounts for the majority of all infectious diarrhea

Answer 15

C diff

Question 16

what are causes of noninfectious diarrhea

Answer 16

• meds/supplements
• nutritional therapy
• contrast agents
• new GI pathologys (colitis, IBD, ect)

Question 17

what abx increase the risk for c diff

Answer 17

• clinda
• cephalosporins
• PCN
• FQ’s

Question 18

what is the presentation of C diff

Answer 18

• water (possibly foul smelling)
• 3+/day for >1day
• mild abdominal pain/cramping

Question 19

what is the clinical criteria for mild C diff and how do you treat it?

Answer 19

• WBC <15,000 AND serum Cr <1.5x premorbid
• Tx - oral metro

Question 20

what is the clinical criteria and tx for severe C diff

Answer 20

• WBC>15,000 OR Serum Cr >1.5x of premorbid
• tx: oral vanc

didnt know vanc came orally, learn somthin new every day

Question 21

what is the clinical criteria and tx of severe complicated C diff

Answer 21

• hypotension, shock ileus or megacolon
• oral vanc AND IV metro
• If ileus, megacolon or distension add rectal vanc and surg consult

Question 22

recurrence of C diff occurs in ()% of pateints and presents (how long) after treatment

Answer 22

20%

presents 5 days after abx are stopped but can take up to 1 month

Question 23

how do you treat a first recurrence of C diff? what about the second? what about third?

Answer 23

1st = same as first occurence
2nd = pulsed vac regimen
3rd = microbiota transplant considered

Question 24

huge list of drugs that can cause diarrhea

Answer 24

Question 25

What are the infectious red flags for diarrhea?

Answer 25

* fever * abdominal pain * immunocomp * recent abx * elevated WBC

Question 26

if you have infectious red flags in a patient w diarrhea what do you order

Answer 26

* Fecal WBC or lactoferrin * Cdiff test * bacterial testing (if bloody) * protozoa testing (if watery)

Question 27

what are the antidiarrheal agents and who should they NOT be used in

Answer 27

* loperamide * bismuth subsalicylate * diphenoxylate * not in pts w inflammatory diarrhea or infectious causes

Question 28

If you suspect a bacterial cause for diarrhea what should you consider

Answer 28

starting ciprofloxacin

Question 29

if diarrhea is d/t new IBD what is the management

Answer 29

immunosuppressive agents and bowel rest

Question 30

what is delerium

Answer 30

abrupt alteration in the level of consiousness which waxes/wanes over the cours of a day w associatd changes in cognition or perception

Question 31

delerium is a nonspecific warning sign and therefore is considerd a ()

Answer 31

red flag

Question 32

causes for delerium

Answer 32

Question 33

drugs that induce delerium

Answer 33

Question 34

what drug should ou be wary of when using it in patients w delerium

Answer 34

BZDs does not say why, just says be wary lol

Question 35

what are nonpharm ways to manage delerium

Answer 35

* orient pts by providing environmental cues * reduce overstimulation * reduce restraint use (1:1 sitter preferred) * improve sleep/wake cycle * mobilize early * maintain nutrition, hydration and oxygenation

Question 36

what pharm agents are used to treat delerium

Answer 36

antipsychotics!

Question 37

what labs do you need to run prior to starting antipsychotics

Answer 37

* Serum K+, Ca+, and Mg * calculate QTc on EKG

Question 38

If a patient has QTc longer than 450 (men) or 470 (women) what do you do to treat their delerium?

Answer 38

* reduce dose of other QTc prolonging drugs * keep serum K+ >4 * Keep Mg+ > 2 * normalize serum calcium

Question 39

How often should you reassess a patient while they take antipsychotics for delerium

Answer 39

daily!

Question 40

what is considered indsomnia

Answer 40

* difficulty initiating or maintaining sleep * waking up too early * sleep that feels poor in quality (daytime physical/mental sequelae)

Question 41

Although pharm treatments are not really recomended for pts in the hospital, what three pharms COULD you use for insomnia?

Answer 41

* benzos (causes resp depression/delerium/over sedation possibily) * Lunesta, Ambien (assocaited w delerium, v rapid onset) * Rozerum (melatonin agonist w no resp depression. short half life) * Antihistamines (avoid in urinary retention, BPH, >60 y/o, ortho hypotension) * trazadone (depression + insomnia is when this is used) * melatonin (effective in circadian mismatch)

Question 42

what are the 4 main modalities of pain management

Answer 42

* medications * interventions * behavioral therapies * PT/complementary tx

Question 43

best for static nocioceptive pain like surgcial pain, not great for neuropathic pain or moevement related pain

Answer 43

opioids

Question 44

SE = NV, constipation, sedation, resp depression

Answer 44

opioids

Question 45

not sure what this is

Answer 45

Question 46

when do you use NSAIDs what is their main SE | acetaminophin is the same but w/o the SE

Answer 46

* mild/mod pain * mod/severe pain to supp w opioids * ortho injuries, muscle infflammation, uterine contraction increases risk of bleeding and CV events

Question 47

What medications are affected by liver disease? what medication is not

Answer 47

* NSAIDs (coag dysfunction) * opioid metabolism (decreased) * anything hepatically metabolized * use fentanyl (not affected by liver Dz)

Question 48

Renal disease affects the use of what pain medications

Answer 48

NSAIDs, they have an increased SE severity in pts w renal function impairement | not CI but avoid if you can