health mod 2

fever class

38, 39.4, 40

oral thermom

don’t eat/drink in 5 min, >4

tympanic

>6 months, pull ear back or straight up + back

axillary

>3 mon, not accurate

temporal

all ages, environ affected

tylenol dose >2yr

<12 10-15mg/kg q4-6, max 75/3g >12 325-500mg q4-6, rx max = 4g

ibu doses >6m

<12 5-10mg/kg q6-8 max 40/1.2g, >12 200-400mg q6-8h, rx 2.4g

aspirin doses >12 (reyes)

325-650mg q4-6 max 4g

fever self care exclusions

3 days, <6month, immuno comp, seizure, infect, dehydrated, high grade

secretory diarrhea

fasting no help, bacteria

osmotic diarrhea

due to solutes, stops with fasting

exudative

inflammation and mucus/blood

diarrhea exclusions

<6 month, fever, preg, >2day, dehydrated, fluids, chronic

ors dosing

10ml/kg diarrhea, 2ml/kg vomit or 60-120 if <10kg, 120-240. Rehydrate 50-100ml/kg over 2-4 hr

ors contraindict

<6m, blood in stool,intestine obstruct, severe

antimotility (diphen/atropine)

avoid in dysentry/elderly

loperamide, antimotility

4mg once, 2mg per stool (8/16 limit), don’t use for cdiff, may cause torsades

polycarbophil-adsorbent

take with water, separate with other meds, only for good swallowing

bismuth-antisecretory

avoid in chicken pox + aspirin/nsaid, causes black stool + tinnitus

const exclusion

<2yr, lax for 1 wk, blood, surgery, nv, ab pain, known condition

Concerning const symptoms

blood, nv, anorexia, wt loss, anemia

nonpharm const manage

fiber, fluid, fruit juice, workout

bulk form (constipate)

72 hrs to work, separate from meds, drink with water, >6 only

docusate = emollient, prevent straining

not monotherapy or with mineral oil, 3-5 days

Mineral oil, lub, prevent water loss

take with fat vitamins, 6-8 hr or 5-15 min (rectal), don’t use with reflux

magnesium osmotics

.5-3hr, not for renal, use citrate with water

sod phos osmotic

2-5 min rectal or 3-6 hr, dont use with renal or ht fail

glycerin osmotic

15-30 min, not chronic or immunosupressed

PEG

2-4 days to work, first line with chronic, not for bowel obstruct

PEG + electrolytes

works in 1-2 hr for bowel cleansing

senna/bisacodyl -stim

6-12hr rescue therapy. Enema/Suppository work in 5 min to 1 hr. Avoid antacid + dairy, ppi

secretagogues

lubiprostone,linaclotide, plecanatide

prokinetic

prucalopride, chronic

prevent const

bulk, emollient, lube

acute

sod phos, mag, saline,stim, glycerin/mineral oil enema, peg+electro

maintenance/chronic

peg, lactulose, bulk, secretagogue, prokinetic

opioid cons

start with senna/doc, alvimopan acute surgery

smoking death

major risk COPD, about 1/3 cardio, ½ lung cancer/pulm each,

smoking consequences

increased infect,diabetes, fractures,ulcers, reproductive, pneumonia

nicotine absopotion

weak base, 1mg in 10-20sec

withdrawal timeline

start 1-2 days, resolve in 4 wks except cravings,appetite,weight

5As

Ask, advise to quit, assess willing, assist, arrange follow-up

Precontemplation

NOt ready to quit in a month, risk reward, roadblock, relevance, repeat

Contemplation

Thinking to quit in a month, assess current history

contraind nrt

recent mi, arrythmia,angina

nicotine gum-20min to peak threshold, min 9

25cig or in first 30 min = 4mg

nicotine gum dosing

q1-2 hr for first 6 wk, then2-4h, then 4-8h max 24 per day

lozenge side fx, min 9

can cause heartburn, hiccup, nausea, headache, max 20 daily

nicotrol 1 dose = 2 spray

1-2 dose per hour, up to 5 hourly, don’t sniff or inhale

patch side effects - can use 16hr

insomnia, vivid dreams, skin reactions (use hydrocortisone)

patch contraindicate

recent mi, liver impairment

chantix

partial nic receptor ag, causes nv, insomnia, abnormal dreams

chantix dosing

start 1week before quit or 8-35 days or 50/25 taper in weeks 4 + 8

zyban contraind

seizure, eating disorder, maoi, no effect by week 7

anemia definition

decreased hb/rbc, <13 male, <12 fem

iron def risks

adolescent girls, preg, <2, >65

iron def cause

decrease absorb, increased need or loss

iron symptoms

tongue pain, pica, spoon nails, decreased saliva, hair loss

IDA labs

all low except tibc, ferritin starred

Taking iron

empty stomach or every other day or with vit c

drugs that decrease iron absorb

ppi, cyclines, pepcid, cholestyramine, antacid

drugs reduced by iron

dopa, synthroid, cipro, penicillamine

dont take food with iron

calcium, tea, cereal

b12/folic risks (folic has drugs)

vegan, alcohol, carb diet, metofmin, ppi, loss of IF

b12 issues

parasthesia, neuro stuff

ida peds causes

no cows milk before 12m, limit 24oz daily

ent benefits

stim liver/gallbladder, maintain gut flora+immune system, prevent bac translocation, give special nutrients

contraindicate enteral

distal fistula, malabsorption, short bowel, hemodynamic instable, heavy vom/diar

short term enteral

nasogastric, dobhoff(no suction), orogastric (if ventilator), nasoduo/jej

longterm enteral

PEG, PEJ/J-tube, gastrojejuno has big tube for suction, jej tube for food

continuous feed good for

crit ill, intube, refeeding, j tube, poor glyc control

cyclic benefits

transition to po, daytime mobility

gastric residual tips

lower infusion rate, avoid constipation

secretory diarrhea treatment

traeat infect + fiber

malabsorb diarrhea

semi elemental/fiber free

meds decrease absorb tube

carbmaz, phenytoin, quinolones, warfarin

complex vomit

fever, ab pain, weight loss, doesn’t self-resolve

adult nv exclusions dehydrate + gi

urine ketones/high blood gluc (dehydrate), 12hr food poison, jaundice/hematoemesis, ab/chest pain

adult nv exclusions pt 2

head injury, stiff neck, dizzy, 12-48hr, weight loss, preg, various contraind

ped nv exclusion

<1yr, 8hr vomit with colors, stiff neck, fever, headache, dehydrated

antacids (sodium issue in preg, old age, ht)

simple, also for heartburn/reflux, can cause chelation + acid rebound if chronic

mag adverse react

diarrhea + renal

calcium issues

hypercal + const

alum issues

renal + const

bismuth salts

simple, heartburn, coat GI tract and prevent prostaglandin

bismuth salicylate issues

black tongue, do not use <12 for reyes, interfere with antibiotics + warfarin

pepcid/cimetidine

simple, prevent gastric acid

h2 antag issues (limit to 14 days bid)

beers list, headache, cons/diar, hallucinate, drowsiness, thrombocyto, renal accumulate

Phenothiazine (azine)

simple, inhibit dop in CTZ brain, rx only

phenothiazine adverse

prolong qtc, no prometh <2yr or IV, avoid cns +antichol

antihist/chol

simple, for motion sickness

antihist/chol issues - take 30-60 min before activity

dry mouth, drowsiness, dizzy, urinary retention

antichol interfere conditions

asthma, glaucoma, bph

5ht3 receptor antag

complex, setrons

setron adverse (palono longest half life)

headache, fatigue, constipate, serotonin synd, prolonged qtc

pro motility/ sub benzamide (metoclopramide)

complex, blocks dop receptor, extrapyrimidal effects, can block sero, treat diab gastroparesis

motion sickness

antihist/chol, scopolamine patch

preg vom

vit b6 + doxyalamine (antihist), other antihist + phenothia also ok

peds nv treatment

pedialyte, zofran, benadryl can have paradox effect <6