GENERAL MEDICAL CONDITIONS AND

SURGERIESMed Surg II

2

WOUNDS, INFECTIONS,

DEBRIDEMENT, GRAFTS

Integument ConditionsWounds, Incisions, Grafts, Debridement

Meds Antibiotics

Labs/Diagnostics WBC Pathology Cultures

Blood, urine, site Medical Equipment

IV Foley Wound Vac PICC

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

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

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

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

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

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

Hepatitis, Liver Failure

Precautions/Contraindications Jaundice: no heavy lifting, straining or

elevated activity (normal mobility is fine) I & O with fluid restrictions

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

Peptic Ulcer Disease

Precautions/Contraindications Universal Precautions Isolation

Pain Pain at night (supine position) Pain associated with eating patterns

1-3 hours post meal

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

Cholecystectomy

Precautions/Contraindications Log roll for comfort

Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed

MedsAntibiotic: Ciprofloxin, FlagylAnalgesic: PentazocineSulfasalazine, 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

Diverticulitis, Ulcerative Colitis,Bowel Obstruction, GI Bleed

Precautions/Contraindications NPO – Nothing per os (Nothing by mouth)

19

BARIATRIC SURGERY

Bariatric Surgery

Meds Antibiotics Fluid imbalances Analgesics

Labs/Diagnostics CBC with WBC for infections Specific cultures

Medical Equipment IV Foley NG for feeding

Bariatric Surgery

Precautions/Contraindications Universal Precautions Psychosocial Issues Weight limitations on equipment

22

GENITOURINARY

UTI

Meds UTI – TMP-SZM, Ciprofloxicin

Labs/Diagnostics Urine analysis Blood cultures

Medical Equipment IV for meds Foley for specimen Clean catch

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)

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

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

Renal Insufficiency/Failure

Meds Volume control System conditions

Labs/Diagnostics Electrolytes

Medical Equipment PAS stockings or foot pumps

Renal Insufficiency/Failure

Precautions/Contraindications Cardiac System vital signs BP post dialysis

29

PREGNANCYPOST PARTUM

Pregnancy, Post Partum

Meds Fluid volumes HTN (preclampsia, eclampsia)

Labs/Diagnostics CBC Ultrasound

Medical Equipment PAS stockings or foot pumps IV

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

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

Pregnancy – Pre-Birth

Activity orders: ABR, limited sitting, Bathroom Privileges

Limit the activity of the abdominals DVT prophylaxis Breathing exercises Coughing with guarding