Oral hygiene

* Oral mucositis, Oral Hygiene

- cleansing the mouth w/ N/S after meals & at bed time

- use of a soft-bristle toothbrush

- application of prescribed viscous lidocaine HCI(xylocaine) to pain ↓

- water-soluble lubricating agents to mosten mouth tissues 

- hot liquids & spicy/acidic foods X

- antiseptic mouthwast w/ alcohol X

 

* Hip fractures includes..

- Ecchymosis & tenderness (can result in blood loss > 1000ml)

- Groin & hip pain w/ weight bearing 

- muscle spasm

- shortening of the affected extremity 

- abduction or adduction , externally rotated

 

* Peripheral artery disease risk factors

- HTN, DM, Hyperlipidemia, smoking 

(estrogen lv ↓, (by oral contraceptive pregnancy...), prolonged standing -> venous insufficiency)

 

* Cardiomyopathy

do: low O2, EKG, blood test

don't: NTG, IV bolus, (volume up -> pulmo edema...) NTG -> hypotension ↑)

 

* Mnemonic for metabolic syndrome "We Better Think High Glucose"

Waist circumference (>40in,102cm in men, >35in,89cm in women)

Blood pressure (>130, >85)

Triglyceride (>150)

HDL (<40 in men, <50 in women)

Glucose (>100, FBS)

 

* Hyperthyroidism (T3, T4 ↑), metabolic rate ↑

- ↑ calories (4~5,000 cal / day)

- 6 times eating / day (protein, carbohydrates, vit, minerals..)

- high-fiber food X (변비 있는 경우 제외)

- stimulating substances X (coffee, tea, soft drinks..)

- spicy food X

 

* Acute pancreatitis

- severe pain in the left upper quadrant or midepigastric area often radiates to the back

- pain ↑ leaning forward / pain ↓ lying flat

- N/V

- risk of: hypovolemia, acute respiratory distress syndrome, hypocalcemia

 

* Cholecystitis : pain in the right upper quadrant, radiates to the right shoulder area

 

* Rheumatic Fever (RF) : acute inflammatory disease of the heart 

- occurs 2-3 wks after a streptococcal pharyngitis (Throat infection)

- autoimmune reaction 

- affects the heart skin, joints, CNS

 

* Anaphylaxis *

Triggers 

- food (nuts, shelfish..)

- medications ( β -lactam antibiotics..)

- insect stings

 

Clinical Manifestations 

- cardiovascular : vasodilation -> hypotension & tissue edema, tachycardia

- Respiratory : upper airway edema -> stridor & hoarseness , Bronchospasm -> wheezing

- Cutanesous: urticaral rash, pruritus, flushing 

- Gastrointestinal : N/V, abdominal pain 

- shock, dizziness, LOC

 

Treatment 

- intramuscular epinephrine

- Airway management & volume resuscitation 

- Adjunctive therapy (ex.antihistamines, glucocoricoids)

 

* Colostomy irrigation

- use 500-1000ml & lukewarm water, hang the bag 18-24 inches above the stomy, use the cone-tipped irrigator to slowly infuse the solution and allow stool to drain through the sleee into the toilet

 

* Jugular venous Distension (JVD)

- head of bed at a 30-45 degree angle

 

* Ovarian Cancer

- abdominal bloating, pelvic pain or pressure, abdominal girth ↑, early satiety, abdominal back leg pain, urinary urgency / frequency, GI disturbance

 

* Anaphylactic shock manage

1. call for help

2. maintain airway & breathing, highflow O2 mask

3. IM Epinephrine

4. leg up

5. Volume resuscitation w/ IV fluids

6. bronchodilator (albuterol

7. Antihistamine (diphenhydramine)

8. Corticosteroids (methylprednisolone = solu-medrol)

 

* Volkmann contracture (medical emergency)

- occurs as a result of compartment syndrome associated with distal humerus fractures, swelling of antecubital tissue -> pressure muscle coompartment -> restricting arterial blood flow (brachial artery) -> tissue damage, wrist contractures -> inability to extend figers 

 

* Septic shock 

- fever of hypothermia (>38 degree (100.4F), <36 (96.8F))

- hypotension (<90mmHg or meat arterial pressure <65)

- prolonged capillary refill (>3-4 sec)

- Tachycardia (HR > 90/min)

- WBC count >12,000/mm3 or immature neutrophils (bands) of > 10%

 

* Diabetic Ketoacidosis

- Patient characteristics : type 1 diabetics usually, younger age 

- clinical symptoms : less pronounced altered mentation, more rapid onset of hyperglycemic symptoms, hyperventilation & abdominal pain common

- laboratory studies : glucose 250~500mg/dl (13.9-27.8mmol/L), bicarbonate < 18mEg/L (18mmol/L), Elevated anion gap

positive serum ketones, serum osmolality < 320 (320mmol/kg)

 

* Hyperosmolar hyperglycemic stone

- Patient characteristics : Type 2 diabetes usually, older age

- clinical symptoms : more pronounced altered mentation, Gradual onset of hyperglycemic symptoms. Hyper ventilation & abdominal pain less common

- laboratory studies : Glocus > 600mg/dl (33.3mmol/L), Bicarbonate >18mEq/L (18mmol/L), Normal anion gap, negative or small serum ketones, serum osmolality > 320mOsm/kg

 

* SIADH (Syndrome of Inappropriate antidiuretic hormone)

ADH ↑ 

→  total body water  ↑ 

 serum osmolality ↓

urine output ↓

urine specific gravity  ↑ 

serum sodium ↓