Upload
marc-imhotep-cray-md
View
216
Download
0
Embed Size (px)
Citation preview
7/28/2019 IVMS ICM-Common Signs and Symptoms
1/53
Marc Imhotep Cray, M.D.
Common Physical Symptoms
1
Website: http://www.imhotepvirtualmedsch.com/medical-history-and-
physicial-examination.php
Prepared and presented by:
Marc Imhotep Cray, M.D.
Basic Medical Sciences and CK/CS Teacher
http://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.scribd.com/drimhotep_IVMShttp://www.scribd.com/drimhotep_IVMShttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/medical-history-and-physicial-examination.phphttp://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
2/53
Marc Imhotep Cray, M.D.
Common Physical SymptomsCompanion Online Folder:
IVMS-Physical Diagnosis Notes PowerPoints and Reference Resources
http://www.scribd.com/collections/4219078/IVMS-INTRO-TO-CLINICAL-MEDICINE-e-Notes-and-PowerPointshttp://www.scribd.com/collections/4219078/IVMS-INTRO-TO-CLINICAL-MEDICINE-e-Notes-and-PowerPointshttp://www.scribd.com/collections/4219078/IVMS-INTRO-TO-CLINICAL-MEDICINE-e-Notes-and-PowerPointshttp://www.scribd.com/collections/4219078/IVMS-INTRO-TO-CLINICAL-MEDICINE-e-Notes-and-PowerPointshttp://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
3/53
Marc Imhotep Cray, M.D.
Objectives
Know general guidelines for managing
nonpain symptoms
Understand how the principles of intended /
unintended consequences and double effect
apply to symptom management
Know the assessment, management of
common physical symptoms
3
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
4/53
Marc Imhotep Cray, M.D.
General management guidelines . . .
History, physical examination Conceptualize likely causes
Discuss treatment options, assist with decision
making
4
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
5/53
Marc Imhotep Cray, M.D.
Breathlessness(dyspnea) . . .
May be described as
shortness of breath
a smothering feeling
inability to get enough air
suffocation
5
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
6/53
Marc Imhotep Cray, M.D.
. . . Breathlessness (dyspnea)
The only reliable measure is patient self-
report Respiratory rate, pO2, blood gas
determinations DO NOT correlate with the
feeling of breathlessness Prevalence in the life-threateningly ill: 12
74%
6
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
7/53
Marc Imhotep Cray, M.D.
Causes of breathlessness
Anxiety
Airway obstruction Bronchospasm
Hypoxemia
Pleural effusion
Pneumonia
Pulmonary edema
Pulmonary embolism
Thick secretions Anemia
Metabolic
Family / financial / legal
/ spiritual / practical
issues
7
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
8/53
Marc Imhotep Cray, M.D.
Management
of breathlessness
Treat the underlying cause
Symptomatic management
oxygen
opioids
anxiolytics
nonpharmacologic interventions
8
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
9/53
Marc Imhotep Cray, M.D.
Oxygen
Pulse oximetry not helpful
Potent symbol of medical care
Expensive Fan may do just as well
9
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
10/53
Marc Imhotep Cray, M.D.
Opioids
Relief not related to respiratory rate
No ethical or professional barriers
Small doses Central and peripheral action
10
http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
11/53
Marc Imhotep Cray, M.D.
Anxiolytics
Safe in combination with opioids
lorazepam
0.5-2 mg po q 1 h prn until settled
then dose routinely q 46 h to keep settled
11
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
12/53
Marc Imhotep Cray, M.D.
Nonpharmacologic interventions . ..
Reassure, work to manage anxiety
Behavioral approaches, eg, relaxation,distraction, hypnosis
Limit the number of people in the room
Open window
12
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
13/53
Marc Imhotep Cray, M.D.
Nonpharmacologic interventions . . .
Eliminate environmental irritants
Keep line of sight clear to outside
Reduce the room temperature
Avoid chilling the patient
13
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
14/53
Marc Imhotep Cray, M.D.
. . . Nonpharmacologic interventions
Introduce humidity
Reposition
elevate the head of the bed
move patient to one side or other
Educate, support the family
14
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
15/53
Marc Imhotep Cray, M.D.
Nausea / vomiting
Nausea
subjective sensation
stimulation
gastrointestinal lining, CTZ, vestibular apparatus,
cerebral cortex
Vomiting
neuromuscular reflex
15
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
16/53
Marc Imhotep Cray, M.D.
Causes
of nausea / vomiting
Metastases
Meningeal irritation
Movement
Mental anxiety
Medications
Mucosal irritation
Mechanical
obstruction
Motility
Metabolic
Microbes
Myocardial
16
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
17/53
Marc Imhotep Cray, M.D.
Pathophysiology
of nausea / vomiting
Chemoreceptor
Trigger Zone (CTZ)
Neurotransmitters
Serotonin
Dopamine
Acetylcholine
Histamine
Vomiting center
17
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
18/53
Marc Imhotep Cray, M.D.
Management
of nausea / vomiting
Dopamine antagonists Antihistamines
Anticholinergics
Serotonin antagonists
Prokinetic agents
Antacids
Cytoprotective agents
Other medications
18
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
19/53
Marc Imhotep Cray, M.D.
Dopamine antagonists
Haloperidol
Prochlorperazine
Droperidol
Thiethylperazine
Promethazine
Perphenazine
Trimethobenzamide
Metoclopramide
19
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
20/53
Marc Imhotep Cray, M.D.
Histamine antagonists(antihistamines)
Diphenhydramine
Meclizine
Hydroxyzine
20
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
21/53
Marc Imhotep Cray, M.D.
Acetylcholine antagonists
(anticholinergics) Scopolamine
21
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
22/53
Marc Imhotep Cray, M.D.
Serotonin antagonists
Ondansetron
Granisetron
22
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
23/53
Marc Imhotep Cray, M.D.
Prokinetic agents
Metoclopramide
Cisapride
23
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
24/53
Marc Imhotep Cray, M.D.
Antacids
Antacids
H2receptor antagonists
cimetidine famotidine
ranitidine
Proton pump inhibitors omeprazole lansoprazole
24
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
25/53
Marc Imhotep Cray, M.D.
Cytoprotective agents
Misoprostol
Proton pump inhibitors (omeprazole,
lansoprazole)
25
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
26/53
Marc Imhotep Cray, M.D.
Other medications
Dexamethasone
Tetrahydrocannabinol
Lorazepam
Octreotide
26
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
27/53
Marc Imhotep Cray, M.D.
Constipation
Medications opioids
calcium-channel
blockers anticholinergic
Decreased motility
Ileus
Mechanical
obstruction
Metabolic
abnormalities
Spinal cord
compression
Dehydration
Autonomic
dysfunction Malignancy
27
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
28/53
Marc Imhotep Cray, M.D.
Management
of constipation
General measures
establish what is
normal
regular toileting
gastrocolic reflex
Specific measures
stimulants
osmotics detergents
lubricants
large volumeenemas
28
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
29/53
Marc Imhotep Cray, M.D.
Stimulant laxatives
Prune juice
Senna
Casanthranol Bisacodyl
29
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
30/53
Marc Imhotep Cray, M.D.
Osmotic laxatives
Lactulose or sorbitol
Milk of magnesia (other Mg salts)
Magnesium citrate
30
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
31/53
Marc Imhotep Cray, M.D.
Detergent laxatives(stool softeners)
Sodium docusate
Calcium docusate
Phosphosoda enema prn
31
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
32/53
Marc Imhotep Cray, M.D.
Prokinetic agents
Metoclopramide
Cisapride
32
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
33/53
Marc Imhotep Cray, M.D.
Lubricant stimulants
Glycerin suppositories
Oils
mineral
peanut
33
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
34/53
Marc Imhotep Cray, M.D.
Large-volume enemas
Warm water
Soap suds
34
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
35/53
Marc Imhotep Cray, M.D.
Constipation
from opioids . . .
Occurs with all opioids
Pharmacologic tolerance developed slowly, or
not at all
Dietary interventions alone usually not
sufficient
Avoid bulk-forming agents in debilitated
patients
35
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
36/53
Marc Imhotep Cray, M.D.
. . . Constipation
from opioids
Combination stimulant / softeners are useful
first-line medications
casanthranol + docusate sodium
senna + docusate sodium
Prokinetic agents
36
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
37/53
Marc Imhotep Cray, M.D.
Causes of diarrhea
Infections
GI bleeding
Malabsorption Medications
Obstruction
Overflow incontinence Stress
37
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
38/53
Marc Imhotep Cray, M.D.
Management of diarrhea
Establish normal bowel pattern
Avoid gas-forming foods
Increase bulk
Transient, mild diarrhea
attapulgite
bismuth salts
38
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
39/53
Marc Imhotep Cray, M.D.
Management
of persistent diarrhea
Loperamide
Diphenoxylate / atropine
Tincture of opium
Octreotide
39
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
40/53
Marc Imhotep Cray, M.D.
Anorexia / cachexia
Loss of appetite
Loss of weight
40
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
41/53
Marc Imhotep Cray, M.D.
Management
of anorexia / cachexia . . .
Assess, manage comorbid conditions
Educate, support
Favorite foods / nutritional supplements
41
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
42/53
Marc Imhotep Cray, M.D.
. . . Management
of anorexia / cachexia
Alcohol
Dexamethasone
Megestrol acetate
Tetrahydrocannabinol (THC)
Androgens
42
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
43/53
Marc Imhotep Cray, M.D.
Management
of fatigue / weakness . . .
Promote energy conservation
Evaluate medications
Optimize fluid, electrolyte intake
Permission to rest
Clarify role of underlying illness
Educate, support patient, family Include other disciplines
43
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
44/53
Marc Imhotep Cray, M.D.
. . . Management
of fatigue / weakness
Dexamethasone
feeling of well-being, increased energy
effect may wane after 4-6 weeks
continue until death
Methylphenidate
44
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
45/53
Marc Imhotep Cray, M.D.
Fluid balance / edema . . .
Frequently associated with advanced illness
Hypoalbuminemiadecreased oncotic
pressure
Venous or lymphatic obstruction may
contribute
45
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
46/53
Marc Imhotep Cray, M.D.
. . . Fluid balance / edema
Limit or avoid IV fluids
Urine output will be low
Drink some fluids with salt
Fragile skin
46
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
47/53
Marc Imhotep Cray, M.D.
Skin
Hygiene
Protection
Support
47
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
48/53
Marc Imhotep Cray, M.D.
Pressure (decubitus) ulcers
Prolonged pressure
Inactivity
Closely associated with mortality
Easier to prevent than treat
48
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
49/53
Marc Imhotep Cray, M.D.
Odors
Topical and / or systemic antibiotics
metronidazole
silver sulfadiazine
Kitty litter
Activated charcoal
Vinegar
Burning candles
49
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
50/53
Marc Imhotep Cray, M.D.
Insomnia
Assessment of sleep
Other unrelieved symptoms
Use family to help assess
50
M t
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
51/53
Marc Imhotep Cray, M.D.
Management
of insomnia . . .
Regular sleep schedule, avoid staying in bed
Avoid caffeine, assess alcohol intake
Cognitive / physical stimulation
Avoid overstimulation
Control pain during the night
Relaxation, imagery
51
M t
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
52/53
Marc Imhotep Cray, M.D.
. . . Management
of insomnia
Antihistamines
Benzodiazepines
Neuroleptics
Sedating antidepressant (trazodone)
Careful titration
Attention to adverse effects
52
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/7/28/2019 IVMS ICM-Common Signs and Symptoms
53/53
THE END, THANK YOU
Visit:
http://www.imhotepvirtualmedsch.com/
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/