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H and P > GU/other > Flashcards

GU/other Flashcards

1
Q

• The main reason for elective admission to the hospital is ….

A

elective surgery/procedures

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2
Q

these are examples of elective or non-elective hospitalizations?
− Substance abuse treatment.
− Psychiatric.
− Simple surgery like carpal tunnel, biopsies or AV fistulas for dialysis.
− Pregnancy/childbirth

A

elective

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3
Q

• Most hospital admissions are initiated as a treatment for an ____

A

acute problem

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4
Q

2 requirements for admission to hospital

A
  1. A complete history and physical exam (admit note) is required within 24 hours of admission.
  2. Admitting orders are your instructions to the hospital staff on how you want your patient cared for.
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5
Q

AD CAVA DIMPLS for admission

A 
Admit
Diagnosis
Condition
Activity
Vital signs
Allergies
Diet
Interventions
Medications
Procedures
Labs
Special instructions/Nursing Notes
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6
Q

what kinds of hospital orders should be limited d/t errors?

A

verbal orders

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7
Q

classes of anesthetic risk. which has highest risk?

A

I Normal healthy person 24 hours, regardless of surgery

V has highest risk

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8
Q

if you add E to anesthetic risk class, how much does that double their mortality risk?

A

E=emergency surgery doubles risk of death

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9
Q

major risk factors for surgery

A
  • Decompensated CHF
  • Unstable coronary syndromes
  • Significant arrhythmias
  • Severe valvular diseases
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10
Q

intermediate risk factors for surgery

A
  • Mild angina pectoris (Class I/II)
  • Compensated or prior CHF
  • Prior MI by history and Q waves
  • Diabetes mellitus
  • Renal insufficiency
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11
Q

minor risk factors for surgery

A
  • Advanced age
  • Abnormal EKG (RBBB, LVH, ST-T)
  • Rhythm other than sinus
  • Low functional capacity
  • History of CVA
  • Uncontrolled blood pressure
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12
Q

when would you preoperatively do Hematocrit

?

A

Hematocrit All women, men > 60 yrs, anticipated blood loss

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13
Q

when do you preoperatively do electrolytes?

A

Electrolytes Patients > 60 yrs, diabetics, renal and liver disease, patients on diuretics

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14
Q

when do you preoperatively do eUA?

A

Recommended only for prosthetic joint placement surgeries (r/o occult infection

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15
Q

when do you preoperatively do pt/PTT?

A

Patient with liver disease, anticoagulated patients, malignancy, neurosurgery patients.

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16
Q

when do you preoperatively do CXR?

A

Patients >60 yrs, patients with cardiac and pulmonary disorders

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17
Q

when do you preoperatively do EKG?

A

All men older than 40 yrs and women over 50 years, all diabetics and patient’s with history of heart disease

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18
Q 
when should this be done?
•	Signed consent.
•	Pre-op H&P.
•	Anesthesia visit
•	Surgical site marking.
A

before patient goes to OR

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19
Q

when should this be done?
• Proper positioning/securing on OR table.
• Verify patient, surgical site, & allergies.
• Instrument counts

A

in or

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20
Q

when does the surgical time out occur?

A

• Surgical “time-out”- last verification before first incision

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21
Q

when should instrument counts happen/

A

before and after surgery

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22
Q

what should be included in procedure note?

A
  • Name of procedure
  • Indication for procedure
  • Consent (if required, including risks and benefits, potential complications)
  • Anesthesia (if applicable)- GETA- general endotracheal anesthesia
  • Details of the procedure
  • Findings (if relevant)- pus, foreign material
  • Complications
  • Estimated blood loss
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23
Q

what details should be included in the operative note?

A 
•	Date of procedure
•	Name of procedure
•	Indication: reason for the procedure
•	Surgeon
•	Surgical assistant(s)	•	Anesthesia
•	Pre-op presumptive diagnosis
•	Post-op diagnosis
•	Complications
•	Disposition- where pt is after surgery	•	Descriptions:
1.	Specimens
2.	Estimated blood loss (EBL)
3.	Drains
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24
Q

what should be included in a delivery note?

A
  1. Type of delivery- vaginal, C-section, any assistance
  2. Estimated gestational age of fetus- in weeks
  3. Viability of the fetus
  4. Sex of the fetus
  5. Apgar scores at 1 and 5 minutes: Activity, Pulse, Grimace, Appearance, Respiration.
  6. Weight of the fetus- in grams
  7. Delivery of the placenta- delivery weight
  8. Number of vessels in the placenta and whether the placenta was intact
  9. Extent of any lacerations or episiotomies and how repaired.
  10. EBL & Condition of mother immediately after delivery- estimated blood loss
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25
Q

hospitalized patients should be seen at least _____

A

once/day

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26
Q

the purpose of rounding is to…

A

determine: effectiveness of tx, complications, modify tx, update patient’s discharge disposition

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27
Q

review the chart before ___

A

you see the patient

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28
Q

• Where the admission H&P is comprehensive, the progress note is ______

A

problem based

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29
Q

where do you note post op day?

A

in progress note

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30
Q

what should you include in discharge notes?

A 
−	Activity level/restrictions*
−	Diet*
−	Medications*
−	Follow-up instructions
−	Disposition
*from AD CAVA DIMPLS
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31
Q

• The patient’s hospital course is then documented in the ______

A

discharge summary.

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32
Q

the discharge summary is req’d for any stay over ____

A

24 hours

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33
Q

a ____ is req’d by insurers before they will pay and is required within ___ days

A

discharge summary; 30 days

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34
Q

what should be included in discharge summary

A
  • Date of admission
  • Date of discharge
  • Admitting diagnosis
  • Discharge diagnosis
  • Attending provider
  • Referring and consulting provider, if applicable
  • Procedures, if any. • Brief, pertinent H&P and lab values.
  • Hospital course. (what happened during course in narrative)
  • Condition at discharge
  • Disposition
  • Discharge medications
  • Discharge instructions and F/U
  • Problem list
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35
Q

what 3 systems are required for male sexual function?

A
  • Endocrine: normal testosterone levels
  • Vascular: adequate arterial blood supply- internal iliac arteries
  • Nervous: intact alpha-adrenergic and cholinergic pathways
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36
Q

3 causes of decreased libido

A
  1. Psychogenic- depression, anxiety, self-image of self or partner
  2. Biological- endocrine disorders- diabetes, hypothyroidism
  3. Medication side-effects- beta blockers, anticholinergics, smoking cessation
37
Q

causes of erectile dysfunction

A

• Psychogenic: inquire about morning erection- indicates physiologic functioning
• Biological:
− Inadequate testosterone
− Decreased hypogastric arterial flow (internal iliac) i.e. smokers
− Impaired neural innervation (i.e. spinal cord injury or diabetes)
• Medical: secondary to underlying medical problem
• Should consider vascular disease, smoking, DM and ejaculatory dysfunction

38
Q

intravaginal testicular torsion

A

rotates INSIDe tunica vaginalis

39
Q

which age group is premature ejaculation more common? causes?

A

young men; usually psychogenic

40
Q

decreased or absent ejaculate causes

A

medications, surgery, neurological deficit or lack of androgen

41
Q

• Penile Discharge: what color?
− Gonococcal
− Non-Gonococcal

A

− Gonococcal- Yellow (“the clap”)

− Non-Gonococcal- Clear or white

42
Q

what do these rashes indicate?
− painful, clear vesicles on an erythematous base
− painless ulceration- chancres

A

− painful, clear vesicles on an erythematous base- herpes

− painless ulceration- chancres (shane-ker) in syphilis

43
Q

important sexual history questions

A
  • Don’t assume that all patients share the same sexual practices
  • Inquire about oral and anal intercourse
  • Assess for multiple partners or symptomatic partners
  • Ask about history of STDs and precautionary measures
44
Q

most common STDs

A
  1. Chlamydia
  2. Gonorrhea
  3. Trichomonas
  4. Non-specific urethritis (non gonococcal)
45
Q

• For HIV/AIDS, consistent and careful condom use can lower risk of infection by ____

A

90%.

46
Q

• A 2006 study by University of Washington researchers found that women whose partners consistently used condoms were ___ as likely to be infected with human papillomavirus.

A

half

47
Q

testicualr self exam should be done ____ for those in the age group _____

A

• All men, especially those between 15 and 35 should check monthly.

48
Q

these sx should make you think of what?

  1. Painless lump (hard or firm), swelling, or enlargement of either testicle
  2. Pain or discomfort in the testicle or scrotum
  3. Feeling of heaviness or sudden fluid collection in the scrotum
  4. Dull ache in the lower abdomen or groin
A

testicular cancer

49
Q

3 causes of testicular cancer

A

unknown, undescended testes (cryptorchidism), prior testicular cancer

50
Q

most common symptom in testicular cancer

A

swelling in part of one testicle
− usually painless
− may be painful, mimicking epididymitis or less likely, testicular torsion
− may possibly notice ache in lower abdomen or in the affected testicle
− may be a feeling of “heaviness” in the scrotum
− sudden collection of fluid in scrotum

51
Q

if you feel a mass in the scrotum, what’s the next step?

A

ultrasound

52
Q

if US detects a mass, what do you do?

A

remove the testicle

53
Q

always get a ____ if doing a sensitive exam and you have reason to believe they are uncomfortable with just you in the room

A

chaperone

54
Q

inspection of penis

A

development, foreskin, glans (lesions, scars, ulcerations), urethral meatus (hypospadias, discharge)

55
Q

phimosis

A

foreskin cannot be retracted over glans

56
Q

how many lobes can you feel on prostate exam?

A

2 out of 3

57
Q

most commonly diagnosed male malignancy

A

prostate

58
Q

how much of prostate not palpable?

A

25-35%

59
Q

signs and sx suggestive of urethral obstruction

A
  • Difficulty starting or stopping stream? Weak flow?
  • Frequency, especially at night?
  • Blood in urine or semen?
  • Pain or stiffness in lower back, hips or upper thighs?
  • Discomfort or heaviness in the prostate or at the base of the penis associated with malaise, fever or chills suggests prostatitis.
  • May also be tender on exam
60
Q

PSA can be elevated by

A

ejaculation, prostate biopsy, urinary retention, digital rectal exam (manipulating prostate)

61
Q

for which populations should PSA be tested at 40 (instead of 50?)

A

for african americans and those with positive family history

62
Q

top 10 reasons people go to primary care

A
  1. Screening/health maintenance exams
  2. Cough
  3. Throat complaints
  4. Back pain
  5. Ear pain
  6. Abdominal pain
  7. Hypertension-related problems
  8. Required exams (sports, employment)
  9. Rash
  10. Headache
63
Q

goal of primary prevention is to

A

prevent new disease cases by reducing risk factors.

64
Q

goal of secondary prevention is to

A

detect disease as early as possible, leading to early treatment and improved prognosis.

65
Q

goal of tertiary prevention to

A

manage an existing disease, goals: restore patient to highest function, minimize the negative consequences of the disease, and prevent disease-related complications.

66
Q

indications for MMR vaccine

A

Ages 19-49: 1-2 doses if no evidence of immunity. Contraindicated in pregnant women and adults with immunocompromised (EXCEPT HIV).

67
Q

indications for td or DTAP vaccine

A

Every 10 years or every 5 years if grossly contaminated wound

68
Q

indications for pneumococcal vaccine

A

*With serious chronic disease such as heart disease, lung disease (asthma), diabetes, liver disease (including cirrhosis), abnormal immune system or cochlear implants
*Residents of nursing homes and other long-term care facilities
*Age 65 or older
A one-time revaccination after 5 years for persons:
*With chronic renal failure or abnormal immune system
*Age 65 or older and were vaccinated ≥ 5 years previously and were age

69
Q

varicella vaccine indications

A

All adults without evidence of immunity should receive 2 doses. Contraindicated in pregnant women and adults with immunocompromising conditions (excluding HIV).

70
Q

herpes zoster vaccine indications

A

Single dose for adults > 60. Contraindicated in pregnant women and adults with immunocompromising conditions (excluding HIV).

71
Q

hep A vaccine indications

A

2 doses, persons with chronic liver disease and/or who receive clotting factor concentrates or traveling to where it’s endemic

72
Q

hep B vaccine indications

A

3 doses, persons with end-stage renal disease, HIV infection, chronic liver disease, and those receiving hemodialysis, routine for kids

73
Q

meningococcal vaccine indications

A

Adults with anatomic or functional asplenia or terminal complement component deficiencies or living in close living quarters

74
Q

what should be evaluated at every PE?

A

BP, diet and exercise, smoking, ethos and drug use, STI education if RFs, skin cancer screening

75
Q

how often should pE with height/weight/BMI be tested?

A

18-29 q5 years, 30-49 q2-3 years, > 50 q year

76
Q

who should geT AAA screening?

A

between 65-75 if smoked

77
Q

vision screening recomendations

A

Every 2 years after age 40 or as directed by eye care physician
Yearly for diabetics (dilated eye exam)
Glaucoma screening annually after age 60

78
Q

what should be included in the general survey?

A

• Note your patient’s approximate age, their general state of health, estimate their BMI, note any obvious asymmetry or injuries.

79
Q

what should you look at skin for in comprehensive pe?

A

signs of systemic disease:jaundice, abnormal pigmentation, broken/sparse hair or brittle/pitted nails, nicotine staining; abnormalities of sun exposed areas: actinic keratoses, suspicious moles

80
Q

PE for eyes in comprehensive physical exam

A
  • Visual acuity- Nurse can perform during rooming procedures
  • Conjunctivae/sclerae paleness in anemia
  • EOM’s measures 3 CNs!
  • PERRLA
  • Fundoscopy: red reflex (cataracts), cup/disc (increased ICP, malignant HTN, vessels-HTN), macula/retina/fovea (DM, macular degeneration)
81
Q

PE for ears in comprehensive physical exam

A
  • Inspect external ear- if not done when assessing skin
  • Hearing: finger rub/ watch tick/ whisper- be prepared to do Weber/Rinne if abnormal
  • Assess canals/TM’s
82
Q

PE for nose in comprehensive physical exam

A
  • Test patency of each naris.
  • Inspect nose if any complaints or abnormal air flow.
  • Especially if snoring in ROS
83
Q

mouth PE

A
  • Inspect buccal mucosa, teeth, tongue, tonsils and pharynx. Palpate if necessary, look at side of tongue for leukoplaki
  • Say AHHH
  • Stick out tongue
84
Q

NECK pe

A
  • AROM
  • Shoulder shrug, turn head against resistance
  • Lymph nodes
  • Thyroid gland
  • ?Carotid bruits
  • ?JVP
85
Q

chest PE

A
  • Do back first with skin, lung, CVA tenderness then supine for front
  • 4 cardiac areas (4 valves), consider palpating PMI
  • for normal S1, S2, PMI in mid clavicular line in 5th-6th intercostal space, no murmurs or rubs
  • 4 (+) pulmonary areas per lung, anterior and posterior.
  • Be prepared to do “special tests” if abnormalities are defined.
86
Q

abdomen pE

A
  • Inspection
  • Auscultate before palpation/percussion.
  • Palpate liver edge.
  • Palpate for spleen/ kidneys (not normally felt).
  • Palpate abdominal aorta- if in the right age group
  • Femoral pulses if indicated.
  • Be prepared to do special tests if indicated.
87
Q

exremities pE

A
  • Inspect for symmetry and fluidity of movement.
  • Watch patient walk to assess back, lower extremities and assess neuro.
  • Assess AROM in major joints.
  • Palpate joints.
  • Assess strength/symmetry of function.
  • Assess distal pulses/ sensory function.
  • Special tests as indicated.
88
Q

neuro PE

A

MMSE if indicated
CN if not already completed
R and L sided findigns symmetrical?
motor and sensory bilaterally

H and P (4 decks)

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