Case studies

quickster2008's version from 2015-06-22 13:43

Section 1

Question Answer
want blood sugar btw140-180
sliding scaleblood glucose <200mg/dl do not give insulin; if blood glucose is greater than 400
prescribe NorcoNorco 5/325 mg q4hrs PRN pain
RRRregular, rate, rhythm
no MGRmurmors,gallops, rhyms
WRRwheezing rales, rhonchi
CTAclear to estate
NT, ND, NBSx4normal tender, normal distension, normal bowl sounds
stages severe, moderate, etc
when would u manage a pt as in input?gas gangrene, open fx, compartment syndrome, shock
wet vs dry gangrene vs gasdry-necrosis that develops in ischemic tissue where blood supply is inadequate; wet-infected characterized by bacteriagas-produces gas within tissue
what dressing would du use for osteomyelitis betadine
xray for gas gangrene1. quality-good 2. soft tissue-inc ST density and contour, ST emphysema in 4th interspace, bone-good, jt space-good, biotech stage 3 hallux various
pt on metformin and hydrochlorothiazide, u are taking them to surgery what do u dokeep on hydrochlor but don't give it to him now; give him apart or saline fluids to bring glucose down; give him ISOTONIC solution to replace fluid
prescribe a medication for MRSAvanco
prescribe medication fo pseudo, gram +, gram -zosyn
prescribe medication for nauseazolfran
SCIPsurgical care improvement program(vancomycin, cleocin, kefzol)
how would staph and strep appear on wound gram stain2+ gram + cocci in pairs and chains
conservative tx for gas gangrene or pressure necrosisarterial leg pumps, HBO therapy, IV antibiotics
surgical tx for pressure necrosisshort term: surgical resection of infect tissue, long term: definitive amputation of limbs at functional level
SIRSsystemic inflammatory response syndrome
SOIsigns of infection
onset and peak of insulinonset 30min-1hr; peak 2-5hrs
onset and peak of NPH; determireonset 1-1.5, peak 8-12; onset-4-8, peak 10-30

Section 2

Question Answer
carvedilolbeta blocker
plavixblood thinner
lasixloop diuretic
heparinblood thinner that can be put on for dialysis
synthroidthyroid hormone
tacrolimus immunosuppressantkidney transplant
gold tx for onychomycosisoral terbinafine

Section 3

Question Answer
contaminated woundbacteria on wound bed but bacteria has not replicated. It will not impede wound healing
colonizationnot impeding healing but higher level of bacteria
critical colonizationcritical impeding that is impeding healing
biofilmorganized type of bacteria in glycolyx. Colony of bacteria that will not respond to antibiotics

Section 4

Question Answer
stop coumadin/warfin ? days before surgery4-7 days
stop aspirin or plavix ? days before surgerystay on aspirin plavix lovenox
best way to see if there is in infection?excise tissue
how to telldif btw inflame and infectbone scan
national pressure ulcer panel1. red non broken skin 2. epidermal breakdown, 3. breakdown thr dermis and sub cut 4. breakdown of m, or bone, +necrotic tissue, + drainage, unstable-eschar
risk of amputation in DMarterial insuff,
tx for venous wound vs ischemia vs vasculitis vs malignancy vs infectionvenous-venous duplex w/reflex, ischemia-arterial doppler, vasculitis-skin iopsy, malignancy-wound biopsy, infection wound cx, CBC