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(continued) TABLE 2 Vaccines for Adults by Health Condition Pneumococcal Meningococcal Flu (Influenza)Td/Tdap (Tetanus, Diphtheria, Pertussis)Shingles (Zoster) PCV13 PPSV23 Men ACWY or MPSV4 Men B Pregnancy Yearly Recommended DO NOT GET VACCINE May be recommendeda May be recommendeda Weakend immune system Yearly Recommended DO NOT GET VACCINE Recommended Recommended May be recommendeda May be recommendeda HIV: CD4 Count less than 200Yearly Recommended DO NOT GET VACCINE Recommended Recommended Recommended May be recommendeda HIV: CD4 Count 200+Yearly Recommended Recommended Recommended Recommended Recommended May be recommendeda Kidney disease Yearly Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda Asplenia Yearly Recommended Recommended Recommended Recommended Recommended Recommended Heart disease/chronic lung disease/ alcoholism Yearly Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda Diabetes (Type 1 and 2)Yearly Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda Chronic liver disease Yearly Recommended Recommended May be recommendeda Recommended May be recommendeda May be recommendeda Get flu vaccine every year Get Td booster every 10 years. You also need 1 dose of Tdap vaccine. Women should get Tdap vaccine during EVERY pregnancy You should get shingles vaccine if you are 60 + years even if you have previously had shingles You should get 1 dose of PCV13 and at least 1 dose of PPSV23 depending on your age and health condition HPV MMR For Women For Men Chickenpox(Varicella) Hepatitis A Hepatitis B Hib Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda May be recommendeda Recommended Recommended May be recommendeda Recommended May be recommendeda May be recommendeda May be recommendeda Recommended Recommended May be recommendeda May be recommendeda May be recommendeda Recommended May be recommendeda May be recommendeda May be recommendeda Recommended May be recommendeda May be recommendeda May be recommendeda MMR/HPV/Chickenpox/Hep A/Hep B:Youshouldgetthisvaccineifyoudidnotgetitwhenyouwereachild. HPV:Youshouldget HPVvaccineifyouareawomanthroughtheageof26oramanthroughtheageof2 and did not already complete the series. (continued ) Special Topics: Health Prevention and Screening1471Vaccines for Adults by Age: 19 +Years | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Special Topics: Health Prevention and Screening (continued) TABLE 2 Vaccines for Adults by Health Condition HPV MMR For Women For Men Chickenpox(Varicella) Hepatitis A Hepatitis B Hib DO NOT GET VACCINE DO NOT GET VACCINE May be recommendeda May be recommendeda DO NOT GET VACCINE Recommended Recommended DO NOT GET VACCINE May be recommendeda May be recommendeda Recommended DO NOT GET VACCINE Recommended Recommended DO NOT GET VACCINE May be recommendeda Recommended May be recommendeda Recommended Recommended Recommended Recommended May be recommendeda Recommended May be recommendeda Recommended Recommended Recommended Recommended May be recommendeda Recommended May be recommendeda Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda Recommended Recommended Recommended Recommended May be recommendeda May be recommendeda May be recommendeda Recommended Recommended Recommended Recommended May be recommendeda Recommended May be recommendeda Recommended Recommended Recommended Recommended Recommended Recommended May be recommendeda MMR/HPV/Chickenpox/Hep A/Hep B: You should get this vaccine if you did not get it when you were a child. HPV, You should get HPV vaccine if you are a woman through the age of 26 or a man through the age of 221 and did not already complete the series. You should get Hib vaccine if you have sickle cell disease, had a bone marrow transplant, or you do not have a spleen Note: Recommended—This is recommended unless a healthcare provider tells you that you do not need it or should not get it. a May be recommended—This vaccine may be for you if you have certain risk factors such as age, health condition, or other. Discuss with your healthcare provider. Hib, haemophilus influenzae type b; HPV, human papillomavirus; Men ACWY, serogroups A, C, W, and Y meningococcal vaccine; Men B, serogroup B meningococcal vaccine; MMR, measles, mumps, rubella; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine. 472 Vaccines for Adults by Age: 19 +Years | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) Meningococcal There are two meningococcal vaccines that immunize against serogroups A, C, W, and Y meningococcal vaccine (Men-ACWY) and serogroup B meningococcal vaccine (Men B). Men ACWY is given in either one or two doses and is indicated for patients who have: A. Anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies). B. HIV infection. C. Persistent complement component deficiency. D. Eculizumab use. E. Travel to or live in countries where meningococcal disease is hyperendemic or epidemic. F. At-risk from a meningococcal disease outbreak attributed to serogroup A, C, W, or Y. G. Microbiologists routinely exposed to Neisseria meningitides. H. Military recruits. I. First-year college students who live in residential housing. Men B can be given in a two or three dose series, depending on manufacturer, and is indicated for patients with the following characteristics. A. Anatomical or functional asplenia (including sickle cell disease). B. Persistent complement component deficiency. C. Eculizumab use. D. At-risk from a meningococcal disease outbreak attributed to serogroup B. E. Microbiologists routinely exposed to Neisseria meningitidis. Evidence of immunity occurs with documented administration of the vaccine for most patients. Tetanus The Td (tetanus and diphtheria toxoids)/Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine) vaccinations should be given once every 10 years to all patients 19 years and older. Tdap is generally recommended for all patients at approximately 11 years of age. If this was not completed, or status is unknown, all adults should receive Tdap once in adulthood, followed by Td immunization every 10 years. Adults with an unknown or incomplete history of a three-dose primary series with tetanus and diphtheria toxoid-containing vaccines should complete the primary series that includes one dose of Tdap. All pregnant women should receive one dose of Tdap regardless of previous immunization. PNEUMONIA There are two different types of immunizations used to help prevent pneumonia: PPSV23 and PCV13. The APP should consider the patient's age, lifestyle, and any medical conditions the patient has to determine which vaccination to admin-ister. PPSV23 vaccine is typically administered to all adults older than 65 years. These adults should receive 13-valent pneu-mococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after PCV13. If PPSV23 was previously administered but not PCV13, administer PCV13 at least 1 year after PPSV23. When both are indicated, PCV13 should be given before PPSV23 whenever possible. Administering PPSV23 may be indicated in patients younger than 65 years if the patient has the following conditions or lifestyle factors. A. Chronic heart or lung disease. B. DM. C. Alcoholism. D. Chronic liver disease. E. Adults who smoke cigarettes. (continued ) Special Topics: Health Prevention and Screening473 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) The previously noted patients should receive PPSV23 at the age of onset of the earlier conditions. Then, administer one dose of PCV13 at 65 years or older. This dose should be given at least 1 year after PPSV23. Administer one more dose (the final dose) of PPSV23 at 65 years or older. This dose should be given at least 1 year after PCV13 and at least 5 years after the most recent dose of PPSV23. Both PPSV23 and PCV13 may be indicated before the age of 65 for adults with the following conditions. A. Cerebrospinal fluid (CSF) leaks. B. Cochlear implants. C. Sickle cell disease or other hemoglobinopathies. D. Congenital or acquired asplenia. E. Congenital or acquired immunodeficiencies. F. HIV infection. G. Chronic renal failure. H. Nephrotic syndrome. I. Leukemia. J. Lymphoma. K. Hodgkin disease. L. Generalized malignancy. M. Iatrogenic immunosuppression. N. Solid organ transplant. O. Multiple myeloma. For those who have not received any pneumococcal vaccines, or those with unknown vaccination history, the APP should administer one dose of PCV13, and then administer one dose of PPSV23 at least 8 weeks later. Administer a second dose of PPSV23 at least 5 years after the previous dose. Please note, a second dose is not indicated for those with CSF leaks or cochlear implants. The APP also should administer one final dose of PPSV23 at 65 years or older. This dose should be given at least 5 years after the most recent dose of PPSV23. Evidence of immunity occurs with documented administration of the vaccine. Varicella All adults without evidence of immunity should receive two doses of the varicella vaccine, 4 weeks apart. Vaccination should be especially emphasized for those with high-risk contacts, such as healthcare workers, childcare workers, and workers in an institutional setting. This vaccination is contraindicated in pregnancy. Evidence of immunity includes the following. A. Documentation of four doses at least 4 weeks apart. B. U. S. born before 1980; except healthcare workers and pregnant women. C. History of herpes zoster. D. Laboratory evidence of immunity. Zoster As of October 2017, recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥50 years. RZV is a two-dose vaccine given 2 to 6 months apart. Prior to this variation of the vaccine, zoster vaccine live (ZVL) was the only vaccine available to prevent herpes zoster in adults over 50 years. It is recommended to administer two doses of RZV 2 to 6 months apart to adults who previously received ZVL at least 2 months after ZVL. CDC guidelines state that RZV is preferred over ZVL for the prevention of herpes zoster and related complications. Both vaccines are contraindicated in patients who are pregnant or in patients with severe immunodeficiency, such as patients with AIDS or who are undergoing cancer treatment. Evidence of immunity occurs with documented administration of the vaccine. (continued )Special Topics: Health Prevention and Screening474 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) SCREENING AND PREVENTION FOR CVD The CDC reports that 633,842 deaths were attributed to heart disease, making it the leading cause of death in the United States. There are many screening and prevention methods that the APP should consider when assessing and caring for patients who exhibit risk factors for CVD. USE OF CV RISK CALCULATOR An appropriate initial step in screening patients for CVD is to use a CV risk calculator. The CV risk calculator that is based on the ACC/AHA 2013 Cholesterol Guidelines is the most commonly used, and it is available on the ACC's website. It is a form of pooled risk assessment that considers a patient's risk factors, including age, race, weight, cholesterol levels, and blood pressure. The calculator was based on multiple community-based population studies and considers stroke risk as well as risk of MI. HYPERTENSION There is clear evidence that controlling HTN will decrease one's risk for developing CVD. As such, it is vital to screen all adults who are 18 years and older for high blood pressure. The APP should recommend annual screening for those deemed at-risk based on results of the CVD risk calculator. Readings of blood pressure should be obtained outside of the clinic setting prior to definitive diagnosis. Please refer to Chapter 3 in this book for more information on diagnosis and management of HTN. CAROTID ARTERY STENOSIS Approximately 15% of strokes are caused by large artery atherothrombotic disease, which includes carotid artery stenosis (CAS). The presence of asymptomatic CAS ( >70% stenosis) in the population is estimated to be 1. 7%. However, most ischemic strokes are not caused by CAS. Therefore, the burden of CAS causing stroke among the general population is low. The risks of intervention through performing a carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAAS) are high, and include stroke, MI, pulmonary embolus, and death. Typically, screening for this occurs in patients by performing a carotid duplex ultrasonography. According to the USPSTF, the AHA, and the American Stroke Association, there is no clear benefit for screening via ultrasound or auscultation in asymptomatic patients. Patients who are at high risk for the disease include: Patients with a carotid bruit heard on auscultation, those with confirmed atherosclerotic disease, and those age 65 years or older with a history of one or more of the following atherosclerotic risk factors: Coronary artery disease, smoking, or hypercholesterolemia. For these patients it is a reasonable expectation to consider screening. However, for many of these patients, optimal medical therapy has already been initiated to treat their known atherosclerotic disease. LIPIDS Evidence has linked high cholesterol levels with increased risk of CVD. As such, the USPSTF recommends that all men older than 35 years and all women older than 45 years be screened with a serum lipid profile. Men 20 to 35 years and women 20 to 45 years with increased risk should also be screened for elevated lipid levels (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides). For patients with no history of CV events, there is no clear end date for when to END screening. ECG There is no clear evidence that resting ECG is helpful for low-or high-risk patients in looking for coronary heart disease in asymptomatic patients. Therefore, the USPSTF does not recommend using an ECG as a method to screen for CVD for patients with no symptoms. DIABETES The APP should screen for diabetes as a part of a cardiovascular risk assessment in all adults aged 40 to 70 years who are overweight or obese. All patients with abnormal blood glucose results should be offered intensive behavioral counseling on diet and exercise. ABDOMINAL AORTIC ANEURYSM It is recommended that men aged 65 to 75 years who have ever smoked should undergo one-time screening for abdominal aortic aneurysm. Evidence seems to show a small benefit exists for screening men aged 65 to 75 years who have never smoked; however, evidence is inconclusive regarding screening for women aged 65 to 75 years who have ever smoked. It is not necessary to screen women aged 65 to 75 years who have never smoked as there is a very low possibility of diagnosis. (continued ) Special Topics: Health Prevention and Screening475 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) TOBACCO USE The U. S. Surgeon General reports that one-third of deaths from CVD are caused by smoking. It is important that the APP ask all adult patients about nicotine and tobacco use. All adult tobacco users and all pregnant women who use tobacco should be advised to stop. These patients should also be offered both pharmacologic and nonpharmacologic/behavioral interventions for tobacco cessation. OBESITY All adults should be screened for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2or higher to intensive, multicomponent behavioral interventions. Weight loss can improve blood pressure, glycemic control, and decrease overall cardiovascular risk. CANCER SCREENING AND PREVENTION Cancer is attributed as the cause of 595,930 deaths annually, making it the second-leading cause of death in the United States. The highest rates of cancer are cancer of the female breast, prostate cancer, lung and bronchus cancer, colon and rectal cancer, and corpus and uterine cancer. The greatest number of deaths from cancer is due to lung, colorectal, breast, and pancreatic cancers, respectively. Of these, pancreatic cancer has the highest mortality rate (6% survival rate in 5 years). The United States has not met goals for screening for breast, cervical, prostate, and colorectal cancer as set by Healthy People 2020. Cancer prevention includes measures such as tobacco cessation counseling for all patients due to its association with multiple cancers. The following sections outline leading prevention and screening recommendations from the USPSTF, the ACS, and other expert recommendations for each type of the most common forms of cancer. BREAST When considering which screening and prevention recommendation is appropriate, it is important for the clinician to determine the patient's risk of breast cancer. There are multiple models used to determine risk of developing breast cancer. One of the most commonly accepted and used tools for determining risk is the Breast Cancer Risk Assessment Tool as developed by the National Cancer Institute. Factors considered in this model include: A. Family history. B. Age. C. Ethnicity. D. Previous history of abnormal breast biopsy. E. Obstetric history. Women with family or personal history of breast, ovarian, or peritoneal cancer, genetic predisposition, and women with a history of radiation to the chest are all considered higher risk. USPSTF Recommendation The USPSTF recommends that in women 40 to 49 years, the decision to screen should be an individual one. Screen-ing should be considered in higher risk women. In women 50 to 74 years, screening reduces mortality and should be performed every 1 to 2 years. In women older than 75 years, evidence is insufficient to make a definitive screening rec-ommendation. ACS Recommendation The ACS recommends that women aged 40 to 44 years should have the opportunity to begin annual screening if they chose to and in discussion with a healthcare provider. Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years. Annual screening should continue in women until they are 54 years old. Women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. Women who have a life expectancy greater than 10 years and are in good health may continue screening with mammography. Women who are at high risk should undergo annual screening mammography and MRI starting at age 30 years. High-risk women are those with a known BRCA mutation; women who are untested, but have a first-degree relative with a BRCA mutation; or women with an approximately 20% to 25% or greater lifetime risk of breast cancer based upon risk-estimation models. (continued )Special Topics: Health Prevention and Screening476 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) Other Expert Recommendation The ACP has the following age-specific recommendations for women of average risk. A. 40 to 49 years: Discuss risks/benefits; biennial mammogram if informed woman requests. B. 50 to 74 years: Biennial mammogram. C. Younger than 40 years or older than 75 years ORlife expectancy less than 10 years: No screening. The American Congress of Obstetricians and Gynecologists (ACOG) recommends that women 40 years and older receive annual screening with mammogram. Prevention Mastectomy may be indicated as a preventive measure for very high-risk patients. CERVICAL USPSTF Recommendation The USPSTF recommends that women who are younger than 21 years do not need to be screened for cervical cancer, and women younger than 30 years do not need to have human papillomavirus (HPV) testing. Women 21 to 65 years receive screening every 3 years with cytology (PAP). Women aged 30 to 65 years should be screened every 5 years with cytology (PAP) in combination with HPV testing. Women who are 65 years of age and have had adequate screening need no further testing. The APP should not screen women with hysterectomy who do not have a history of cervical cancer or high grade precancerous lesion. ACS Recommendation The ACS recommends that women who are 21 to 29 years should have a PAP test every 3 years. Women who are 30 to 64 years should have a PAP test with HPV every 5 years, or every 3 years with PAP alone. Women who are older than 65 years should no longer be screened for cervical cancer if they have had three consecutive negative cytology results or two consecutive negative cytology with negative HPV test results within 10 years, with the most recent test done within 5 years. Other Expert Recommendation The American College of Physicians (ACP) does not recommend screening average-risk women younger than 21 years. Average-risk women should be screened for cervical cancer beginning at age 21 years, and once every 3 years with cytology (PAP tests without HPV tests). Average-risk women should not be screened for cervical cancer with cytology more often than once every 3 years. Clinicians may choose to use a combination of PAP testing and HPV testing once every 5 years in average-risk women who are 30 years or older. However, clinicians should not perform HPV testing in average-risk women younger than 30 years. The ACP recommendations are largely in line with the ACS recommendation: Women older than 65 years who have had three consecutive negative cytology results or two consecutive negative cytology plus HPV test results within 10 years, with the most recent test done within 5 years, should no longer be screened for cervical cancer. They do not recommend screening average-risk women of any age who have had a hysterectomy with removal of the cervix. Also, clinicians should not perform cervical cancer screening with a bimanual pelvic examination. Prevention The leading cause of cervical cancer is HPV. As such, preventing HPV infection is a primary form of prevention for cervical cancer. Interventions to prevent HPV infection may include: A. Vaccinating against HPV (see Tables IV. 1 and IV. 2 for age-appropriate vaccination recommendations). B. Encouraging the patient to use a barrier method during sexual intercourse. Treatment and/or assessment of abnormal cells on cytology and treatment and/or assessment of HPV are also important preventive measures. (continued ) Special Topics: Health Prevention and Screening477 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) COLORECTAL USPSTF Recommendation Patients age 50 to 75 years with an average risk should be screened for colorectal cancer. The test for screening chosen will determine the frequency of screening. Screening may begin earlier for patients with increased risk. Patients with a personal or family history of colon cancer are considered at increased risk. The APP should make an individualized decision in whether to screen patients older than 75 years. The overall health of the patient should be considered as well as the patient's ability to tolerate treatment, if diagnosed, and if previously screened. There is no superior test; however, if less invasive tests are positive, then direct visualization with colonoscopy is necessary. Tests may also be indicated. Tests that detect cancer and colorectal polyps are as follows. A. Flex sig: Perform every 5 years. If abnormal, proceed to colonoscopy. B. Colonoscopy: Perform every 10 years. C. Double contrast barium enema: Perform every 5 years. If abnormal, proceed to colonoscopy. D. CT colonography: Perform every 5 years. If abnormal, proceed to colonoscopy. Tests that detect cancer are as follows. A. Guaiac-based fecal occult testing: Perform annually. If abnormal, proceed to colonoscopy. B. Fecal immunochemical test: Perform annually. If abnormal, proceed to colonoscopy C. Stool DNA test: Perform at uncertain interval. If abnormal, proceed to colonoscopy. ACS Recommendation The ACS recommends that both men and women with average risk who are older than 50 years should start cancer screening. Refer to the USPSTF for type of testing recommendations. Prevention It is recommended that the APP perform early screening for abnormal tissue that could become cancer. LUNG USPSTF Recommendation Current or former smokers with a history of smoking 30 packs per year should be screened for lung cancer from 50 to 74 years of age. Screening includes a low dose/helical CT (LDCT) scan of the lung. Informed and shared decision-making discussion should occur between the patient and provider. Screening should stop once the patient is no longer willing to undergo treatment with curative lung surgery. Experts have not agreed about the frequency of screening. Providers should use their own clinical judgment to determine the frequency of screening with LDCT. ACS Recommendation Current or former smokers with a history of smoking 30 packs per year should be screened annually from age 50 to 74 years. Screening should include an LDCT scan of the lung. An informed and shared decision-making discussion should occur between patient and provider. Other Expert Recommendation The American Association for Thoracic Surgery recommends that patients who are 55 to 79 years old and who have a history of smoking 30 packs per year should be screened with LDCT. Lung cancer survivors should be screened with LDCT starting 5 years after treatment. Patients who are younger than 50 years and who have a 20 pack per year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. Prevention Since cigarette smoking is the leading cause of lung cancer, smoking cessation is the primary form of prevention. (continued )Special Topics: Health Prevention and Screening478 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) PROSTATE USPSTF Recommendation The USPSTF recommends that the decision to screen for prostate cancer should be an individual one. The main modality for screening is a serum prostate-specific antigen (PSA) test. Before undergoing screening, men should have the chance to discuss the benefits of screening as well as weighing the risks of diagnosis and treatment. Complications of diagnosis and treatment include infection, erectile dysfunction, and incontinence. Prostate cancer is common. Many men have no symptoms of the disease, and are only diagnosed through screening. Risk factors for the disease include men of older age, men who are African American, and men with a family history of prostate cancer. Only men who have been counseled on their own risk for the disease, and the risks and benefits of screening and treatment, should be offered testing. ACS Recommendation Informed decision making with a healthcare provider about whether to be screened for prostate cancer is indicated for patients considered to have average risk, are older than 50 years of age, and have at least a 10-year life expectancy. The APP should provide information to the patient about the potential benefits, risks, and uncertainties associated with prostate cancer screening. Screening should not happen in the absence of an informed decision-making process. Screen-ing may be indicated for men who are 45 years and older who are at higher risk, including African American men and men with a first-degree family member (father or brother) who was diagnosed with prostate cancer before age 65 years. Men who are 40 years and older should consider screening if they are at appreciably higher risk. This may include men who have had multiple family members diagnosed with prostate cancer before age 65 years. Other Expert Recommendation The American Urological Association recommends against PSA screening for men younger than 40 years, and also does not recommend screening for patients who are 40 to 54 years old. They recommend that patients who are 55 to 69 years engage in the shared decision-making process (see also the Affordable Care Act [ACA] recommendation for this age range). For those men who do elect screening after a shared decision-making process with their providers, screening should only occur at an interval of every 2 years or longer in between screenings. The American Urological Association does not recommend screening for patients who are older than 70 years or for any man with less than a 10-to 15-year life expectancy. The ACP recommends that clinicians should have a one-time discussion (more if the patient requests them) with average-risk patients aged 50 to 69 years that inquire about PSA-based prostate cancer screening. This discussion should inform the patient about the limited potential benefits and substantial harms of screening for prostate cancer using the PSA test. For men who have average risk and are aged 50 to 69 years who have not had an informed discussion and do not express a clear preference for screenings, no screening should be performed. Clinicians should not screen for prostate cancer using the PSA test in average-risk men younger than 50 years, those older than 69 years, or people whose life expectancy is less than 10 years. SEXUALLY TRANSMITTED INFECTION SCREENING AND PREVENTION The CDC and USPSTF have provided specific guidance on sexually transmitted infection (STI) screenings for adults based upon risk and specific STIs. Understanding STI risk and prevention is especially important in caring for any patients that may present in the acute care setting with a new STI, be unaware of the source of infection, or have a complication from an STI. All STI prevention includes counseling patients on having protected intercourse with a condom, and avoiding high-risk behaviors, such as sharing injection drug paraphernalia. The act of screening is also considered a prevention method as identifying asymptomatic patients and treating their infection will prevent the spread of disease to other persons. HIV Patients can present in the acute phase of HIV infection. However, they also may present with an opportunistic infection or complication of HIV, and HIV screening would be warranted. All adults between the ages of 13 to 65 should be screened for HIV at least once. Anyone who has unprotected intercourse and/or shares injection drug equipment should be screened for HIV annually. Sexually active gay and bisexual men should be screened for HIV more frequently (every 3-6 months). All pregnant women should also be screened for HIV. Also, sex partners of persons who are HIV positive or are injection drug users should be screened. (continued ) Special Topics: Health Prevention and Screening479 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued ) CHLAMYDIA AND GONORRHEA All sexually active women under the age of 25 should be screened for chlamydia and gonorrhea. Women over age 25 who are higher risk should also be routinely screened. At-risk women are those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a STI. Young men (younger than 25 years) who are presenting in a high-prevalence clinical setting should also be screened. MSM should be screened annually, or every 3 to 6 months, for higher risk MSM. MSM are considered high risk if they or their partners have multiple partners. HEPATITIS B High-risk and women should be screened annually. Those who are high risk include: A. MSM. B. Persons born in areas of high occurrence ( >2% population). C. Persons on immunosuppressant medications. D. Patients on hemodialysis. E. Patients who are HIV positive. F. Patients who are injection drug users. Pregnant women should also be screened at their first prenatal visit. HEPATITIS C All men and women born between 1945 and 1965 should have a one-time screening for hepatitis C. Higher risk MSM should also be screened for hepatitis C. All patients with HIV should also be screened for hepatitis C annually. SUMMARY The APP in acute care may not always be the clinician who is offering prevention and screening initiatives to his or her patients. However, many patients treated in the acute care setting will have limited access to healthcare and may not have been offered important screening and prevention measures. While the acute care environment is not the setting to offer many of these interventions, the clinicians working in these settings need to know which of these measures these patients have missed. This may help when both diagnosing current conditions and planning for any appropriate outpatient follow-up. BIBLIOGRAPHY American Diabetes Association. (2017). 3. Comprehensive medical evaluation and assessment of comorbidities. Diabetes Care, 40 (Suppl. 1), S25-S32. doi:10. 2337/dc17-S006 The American Heart Association & American College of Cardiology. (n. d. ). 2013 prevention guidelines tools—CV risk calculator. Retrieved from http://professional. heart. org/professional/Guidelines Statements/Prevention Guidelines/UCM_457698_Prevention-Guidelines. jsp Carter, H. B., Albertsen, P. C., Barry, M. J., Etzioni, R., Freedland, S., Greene, K., & Zietman, A. (2013). Early detection of prostate cancer: AUA guideline. Retrieved from https://www. auanet. org/education/guidelines/prostate-cancer-detection. cfm Centers for Disease Control and Prevention. (n. d. ). What are the risk factors for lung cancer? Retrieved from https://www. cdc. gov/cancer/ lung/basic_info/risk_factors. htm Centers for Disease Control and Prevention. (2015). Screening recommendations and considerations referenced in treatment guidelines and original sources. Retrieved from https://www. cdc. gov/std/tg2015/screening-recommendations. htm Centers for Disease Control and Prevention. (2019). Table 1. Recommended adult immunization schedule for ages 19 years or older, United States, 2019. Retrieved from https://www. cdc. gov/vaccines/schedules/hcp/adult. html Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Houston Miller, N., Hubbard, V. S.,... Yanovski, S. Z. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation, 129 (25 Suppl. 2), S76-S99. doi:10. 1161/01. cir. 0000437740. 48606. d1 Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D'Agostino, R. B., Gibbons, R.,... Wilson, P. W. F. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. Circulation, 129 (25 Suppl. 2), S49-S73. doi:10. 1161/01. cir. 0000437741. 48606. 98 Hesse, B. W., & Gaysynsky, A., Ottenbacher, A., Moser, R. P., Blake, K. D., Chou, W.-Y. S.,... Beckjord, E. (2014). Meeting the Healthy People 2020 goals: Using the Health Information National Trends Survey to monitor progress on health communication objectives. Journal of Health Communication, 19, 1497-1509. doi:10. 1080/10810730. 2014. 954084 (continued )Special Topics: Health Prevention and Screening480 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Jaklitsch, M. T., Jacobson, F. L., Austin, J. H., Field, J. K., Jett, J. R., Keshavjee, S.,... Sugarbaker, D. J. (2012). The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. The Journal of Thoracic and Cardiovascular Surgery, 144 (1), 33-38. doi:10. 1016/j. jtcvs. 2012. 05. 060 Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A.,... Yanovski, S. Z. (2014). 2013 AHA/AC-C/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/Ameri-can Heart Association Task Force on Practice Guidelines and the Obesity Society. Circulation, 129 (25 Suppl. 2), S102-S138. doi: 10. 1161/01. cir. 0000437739. 71477. ee Jonas, D. E., Feltner, C., Amick, H. R., Sheridan, S., Zheng, Z.-J., Watford, D. J.,... Harris, R. (2014). Screening for asymptomatic carotid artery stenosis: A systematic review and meta-analysis for the U. S. Preventive Services Task Force. Retrieved from https: //www. ncbi. nlm. nih. gov/books/NBK223227/#__NBK223227_dtls__ National Cancer Institute. (n. d. ). The breast cancer risk assessment tool. Retrieved from https://www. cancer. gov/bcrisktool National Center for Health Statistics. (2017). Leading causes of death. Retrieved from https://www. cdc. gov/nchs/fastats/leading-causes-of-death. htm National Cancer Institute. (2019, March 1). HPV and cancer. Retrieved from https://www. cancer. gov/about-cancer/causes-prevention/ risk/infectious-agents/hpv-fact-sheet#q2 Oeffinger, K. C., Fontham, E. T. H., Etzioni, R., Herzig, A., Michaelson, J. S., Shih, Y.-C. T.,... Wender, R. (2015). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. 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A., Lortet-Tieulent, J.,... Wender, R. C. (2016). Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians, 66, 95-114. U. S. Cancer Statistics Working Group. (2016). United States cancer statistics: 1999-2013 incidence and mortality web-based report. Atlanta, GA: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Retrieved from https://www. cdc. gov/cancer/npcr/pdf/uscs_factsheet. pdf U. S. Preventive Services Task Force. (2013). Final update summary: Human immunodeficiency virus (HIV) infection: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/human-immunodeficiency-virus-hiv-infection-screening?ds=1&s=hiv U. S. Preventive Services Task Force. (2015). Final update summary: Coronary heart disease: Screening using non-traditional risk factors. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/coronary-heart-disease-screening-using-non-traditional-risk-factors U. S. Preventive Services Task Force. (2016a). Final recommendation statement: Lung cancer: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Recommendation Statement Final/lung-cancer-screening U. S. Preventive Services Task Force. (2016b). Final update summary: Abdominal aortic aneurysm. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/abdominal-aortic-aneurysm-screening U. S. Preventive Services Task Force. (2016c). Final update summary: Breast cancer: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/breast-cancer-screening1 U. S. Preventive Services Task Force. (2016d). Final update summary: Breast cancer: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/breast-cancer-screening1?ds =1&s=breast U. S. Preventive Services Task Force. (2016e). Final update summary: Cervical cancer: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/cervical-cancer-screening?ds =1&s=cervical U. S. Preventive Services Task Force. (2016f). Final update summary: Colorectal cancer: Screening. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/colorectal-cancer-screening2?ds =1&s=colorec U. S. Preventive Services Task Force. (2016g). Final update summary: Coronary heart disease: Screening with electrocar-diography. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/coronary-heart-disease-screening-with-electrocardiography U. S. Preventive Services Task Force. (2016h). Final update summary: High blood pressure in adults: Screening. Retrieved from https: //www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/high-blood-pressure-in-adults-screening U. S. Preventive Services Task Force. (2016i). Final update summary: Obesity in adults: Screening and management. Retrieved from https: //www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/obesity-in-adults-screening-and-management U. S. Preventive Services Task Force. (2017). Final update summary: Abnormal blood glucose and type 2 diabetes mellitus: Screen-ing. Retrieved from https://www. uspreventiveservicestaskforce. org/Page/Document/Update Summary Final/screening-for-abnormal-blood-glucose-and-type-2-diabetes?ds=1&s=diabetes Wender, R., Fontham, E. T., Barrera, E., Colditz, G. A., Church, T. R., Ettinger, D. S.,,... Smith, R. A. (2013). American Cancer Society lung cancer screening guidelines. CA: A Cancer Journal for Clinicians, 63 (2), 106-117. doi:10. 3322/caac. 21172 Wilt, T. J., Harris, R. P., & Qaseem, A. (2015). Screening for cancer: Advice for high-value care from the American College of Physicians. Annals of Internal Medicine, 162 (10), 718-725. doi:10. 7326/M14-2326 Wolf, A., Wender, R., Etzioni, R., Thompson, I., D'Amico, A., Volk, R.,,... Smith, R. (2010). American Cancer Society guideline for the early detection of prostate cancer: Update 2010. CA: A Cancer Journal for Clinicians, 60, 70-98. doi:10. 3322/caac. 20066 Special Topics: Health Prevention and Screening SPECIAL TOPICS HEALTH PREVENTION AND SCREENING (continued )481 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
482 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES Heather Meissen and Alison M. Kelley Disclosure: Healthcare equipment is continuously developing. It is the responsibility of the provider to stay abreast to new products and evolving technology. The provider must ensure that the products they choose are validated with sufficient, unbiased evidence, and are safe for patient care. This author does not promote or recommend any particular product. This chapter is strictly an overview of current technology at the time of this writing. OVERVIEW OF CONDITION Hemodynamic instability is one of the leading causes of admission to the ICU. Hemodynamic collapse, considered to be any instability in a patient's blood pressure (BP), can lead to inadequate arterial blood flow to organs. It often results from the mismatch between oxygen demand and oxygen consumption, which leads to tissue hypoxia and cell death. Patients who experience hemodynamic instability are at risk for organ damage and possibly death. Hemodynamic instability requires physiological and mechanical support to ensure there is adequate cardiac input and output, or BP. The goal of the critical care provider is to quickly identify the type of hemodynamic collapse present and to treat the condition appropriately to improve survival. See Box 1 for a list of definitions and abbreviations commonly use in reference to hemodynamic monitoring equipment. BOX 1: EQUIPMENT DEFINITIONS AND ABBREVIATIONS ■Calibration: Refers to the process of modifying equipment to ensure optimal precision and accuracy of measurements.-Calibrated devices perform continuous measurements and should be recalibrated at frequent intervals to ensure accuracy.-Noncalibrated devices use patient demographics, such as age and ideal body weight, to derive and deter-mine measurements. Note: When using noncalibrated devices, the provider is responsible for understanding that the accuracy of these products diminishes when preload, afterload, or contractility are significantly altered, such as in cases of high vasopressor support or significant cardiovascular collapse. ■Commonly used abbreviations.-CO: Cardiac output.-CI: Cardiac index.-SV: Stroke volume.-SVV: Stroke volume variance.-PPV: Pulse pressure variance.-CVP: Central venous pressure.-SVR: Systemic vascular resistance. INDICATIONS In the past, providers have followed vital signs, such as heart rate (HR), BP, and decreased urine output (UOP), to determine if shock is present. Unfortunately, these symptoms develop late in the disease process, and alterations in these vital signs can occur due to a myriad of causes. This makes diagnosis difficult and delayed. Many providers are now searching for new technologies to aid the diagnosis of cardiovascular collapse. This chapter will outline many devices that will assist the provider in identifying specific parameters related to hemodynamic instability. NONINVASIVE MONITORING Noninvasive hemodynamic monitoring may be indicated for patients who are stable but still require monitoring, patients who are prone to infections, or patients and their families who do not desire invasive lines. There are no inherent precau-tions for noninvasive monitoring. There are several different types of noninvasive hemodynamic monitoring devices that may be used. TRANSTHORACIC ECHOCARDIOGRAPHY Transthoracic echocardiography ( TTE) provides information on: A. Left ventricular function. B. Right ventricular function. C. Inferior vena cava (IVC) dimensions. Measurements that can be obtained through this type of monitoring include: Preload, cardiac output (CO), ejection fraction, and IVC compressibility, which can be calculated as a measurement determining fluid status. (continued )Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) NONINVASIVE PULSE CONTOUR ANALYSIS Noninvasive pulse contour analysis is performed through the use of devices that calculate stroke volume (SV) and/or CO from analysis of the arterial pressure waveform. This analysis of the arterial pressure waveform is completely noninvasive. It may be achieved through noninvasive finger pressure that tracks changes in the intra-arterial wall. DEVICES Several different devices can be used to achieve noninvasive pulse contour analysis. Many of these devices use pho-toplethysmography via a finger probe. Once in use, the devices can estimate CO/cardiac index (CI), SV, stroke volume variance (SVV), systemic vascular resistance (SVR), and pulse pressure variance (PPV), and can provide continuous BP monitoring. Although these devices have variable accuracy, they are sometimes indicated for use in patients undergoing moderate to high risk surgeries who may not have an arterial line and in patients where determining fluid responsiveness is informative. THORACIC BIOIMPEDANCE AND THORACIC BIOREACTANCE Thoracic bioimpedance is a noninvasive form of monitoring that uses skin electrodes to send a high frequency current across the thorax and measures the amplitude of that current against the returning current. This form of monitoring estimates ventricular ejection fraction, SV, HR, and CO. Thoracic bioreactance is an advancement on bioimpedance. This form of monitoring measures the phase shift in voltage through four electrodes that send alternating voltage of known frequency through the thorax. Sensors then calculate time delay, referred to as phase shift. Thoracic bioreactance devices can measure SV, SVI, CO/CI, and total peripheral resistive index. ESTIMATED CONTINUOUS CO MONITORING Estimated continuous CO monitoring determines CO by pulse oximetry and pulse wave transit time, and can also incor-porate pulse oximetry and ECG signals. This is a noncalibrated system. PASSIVE LEG RAISE Fluid responsiveness can also be determined using a passive leg raise. This simple bedside test involves a leg raise that, by way of gravity, will return an estimated 150 to 300 m L of blood back to the heart. Changes in BP and HR should be analyzed by the healthcare provider to determine if the patient would respond to fluid administration. ULTRASONOGRAPHY Ultrasonography is another form of noninvasive monitoring that can be used to evaluate volume status. To assess the IVC, the probe in ultrasound is held in the subcostal longitudinal view (see Figure 1). An average IVC is approximately 1. 5 to 2. 5 cm in diameter. If the IVC diameter is less than 1. 5 cm, this may indicate volume depletion. In trauma, a diameter less than 1. 0 cm is likely related to hemorrhage. If the IVC is greater than 2. 5 cm, then the patient likely will not respond to more fluids as this diameter suggests fluid overload. It is also important to be aware of IVC compressibility. The IVC typically collapses 50% during inspiration. A collapse less than 50% typically suggests fluid overload. A collapse greater than 50% typically suggests intravascular volume depletion. FIGURE 1 Subcostal window to visualize IVC. IVC, inferior vena cava. Source: Reproduced with permission from Mayo Foundation for Medical Education and Research. (continued )483 Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
484 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) ULTRASONIC CO MONITORING Ultrasonic CO monitoring can be used to calculate the aortic and pulmonary outflow tracts to estimate CO. It is important to note that patients with structural heart disease may provide false values. Clinical correlation is warranted and more invasive testing may be indicated for further evaluation. Values obtained in this form of monitoring are: A. CO/CI. B. SV. C. SVR. D. HR. MINIMALLY INVASIVE MONITORING Forms of minimally invasive monitoring use some combination of noninvasive and invasive monitoring to provide the most accurate information about the patient's hemodynamic status with the most minimal use of invasive devices possible. For example, the pulmonary artery catheter (PAC), an invasive centrally placed catheter, was used to provide critical information. It has been replaced largely by waveform analysis using an arterial catheter, which is considered minimally invasive. Minimally invasive monitoring is preferred over invasive monitoring whenever appropriate. ESOPHAGEAL DOPPLER (TRANSESOPHAGEAL ECHOCARDIOGRAM) Esophageal Doppler (transesophageal echocardiogram [TEE]) is a Doppler device that is placed into the mid-esophagus to obtain ultrasound views of the heart from within the body. Some TEE devices allow for frequent or continuous monitoring and allow the provider to visualize heart chambers, valves, blood flow, and any abnormalities that may exist. These abnormalities may include pericardial effusion or wall motion abnormalities. TEE also allows the provider to measure blood flow velocity, CO, and ejection fraction. DEVICES Several devices can be used for TEE that calculate the SV, and subsequently the CO, from measuring the arterial pulse pressure via an indwelling arterial catheter. Values obtained are: A. CO/CI. B. HR. C. SV. D. SVR. E. SVV. Using an indwelling arterial catheter for TEE allows for providers to obtain measurements by estimating the SV by mea-suring the area under the curve of the systolic phase. This is a noncalibrated measurement that obtains the following. A. CO/CI. B. SV. C. HR. D. PPV. E. SVV. Other devices determine SV, and subsequently CO, by measuring the area under the curve of the entire cardiac cycle, both systolic and diastolic. These are calibrated devices that deliver predetermined amounts of lithium chloride to the patient through a central or peripheral line. The remaining concentration of lithium is then measured at the arterial catheter site. Values obtained using these devices are: A. CO/CI. B. SV. (continued )Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
485 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) C. HR. D. SVR. E. SVV. MINIMALLY INVASIVE PULSE CONTOUR ANALYSIS Several types of minimally invasive devices can calculate SV and/or CO from analysis of the arterial pressure waveform. The devices use proprietary algorithms to calculate pressure-volume relationships based on SVR, arterial compliance, and/or aortic impedance from the arterial line waveform (see Figure 2). Most of these devices provide loose accuracy when patients become significantly unstable. Stroke volume is derived from the area under the pulse pressure curve Calibration factor is derived from thermodilution CO = (Calibration factor) x (Heart rate) x (Stroke volume) FIGURE 2 Example of minimally invasive pulse contour analysis. TRANSPULMONARY THERMODILUTION Transpulmonary thermodilution is the method of injecting cold saline into a central access point and measuring the change in temperature at the arterial access point. Calculations used in this method are derived from the thermodilution equation, which is: CO ={. Tb-Ti/×K} {∫∞ 0∆Tb. t/dt} Tb = Blood temperature Ti=Injectate temperature K= Computed constant(1) DEVICES Several devices can be used to achieve transpulmonary thermodilution to obtain the following values. A. CO/CI. B. HR. C. SV. D. SVR. (continued ) Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
486 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) E. SVV. F. PPV. G. Global end diastolic volume (GEDV), which can estimate preload. H. Intrathoracic blood volume (ITBV). I. Pulmonary vascular permeability index (PVPI). J. Global ejection fraction (GEF). ULTRASOUND FLOW DILUTION The final minimally invasive form of monitoring is ultrasound flow dilution, which can be used to measure CO. This can be achieved using a machine that calculates CO via transpulmonary ultrasound dilution technology by measuring changes in blood ultrasound velocity and blood flow after saline injection. The device requires a central line and arterial line as well as an extracorporeal arteriovenous (AV loop) tube set. This calibrated device obtains the following values. A. CO/CI. B. SV/SVI. C. Total ejection fraction. D. SVR/SVRI. E. Total end diastolic volume index. F. Central blood volume index. INVASIVE MONITORING Invasive monitoring is a relative term that typically includes central vein access and arterial monitoring, but can also refer to devices on a continuum. For instance, a radial arterial line is technically an invasive procedure, but is considered minimally invasive when compared to the placement of a brachial arterial line. Central lines are invasive, but less invasive than PACs when used with noninvasive cardiac monitoring devices. Patients who require invasive monitoring are typically hemodynamically unstable with indications that the use of minimally invasive or noninvasive methods would be unreliable or ineffective. Precautions vary based on the form of monitoring. Arterial monitoring precautions include: A. Hemorrhage. B. Thrombosis. C. Pseudoaneurysm formation. D. Infection. Central monitoring precautions include: A. Infection. B. Damage to surrounding structures. C. Thrombosis. D. Arterial puncture. CENTRAL VENOUS PRESSURE MONITORING Central venous pressure (CVP) is the measurement of the pressure of the right atrium. In this form of monitoring, CVP is obtained from a central venous catheter that is placed in the subclavian or internal jugular vein and terminates in the superior vena cava at the right atrium. Although CVP is commonly used as a marker of fluid status, many studies have shown that CVP does not correlate to circulating blood volume, and that CVP cannot predict fluid responsiveness in many clinical scenarios. Therefore, CVP monitoring is not useful in guiding fluid management in most cases; however, it should be noted that CVP monitoring could guide management of the right ventricle and prove beneficial in patients who have right ventricular dysfunction from either myocardial infarct or pulmonary embolism. (continued )Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
487 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) PULMONARY ARTERY CATHETER A PAC is a flow-directed catheter that is fed through a central venous introducer. The catheter is guided through the introducer to the right atrium, through the right ventricle, and to the pulmonary artery. At one point, this device was the gold standard tool for measurement of fluid status, but its use has recently fallen out of favor. Many studies have found no mortality benefits with the use of PAC, and some studies even show a risk of increasing mortality. Many reports have shown misinterpretation of data and user error as leading to the inaccuracy of the values obtained. For these reasons, less invasive tools are now being utilized more frequently. However, PAC can still be a beneficial measurement tool in right ventricular heart failure or pulmonary hypertension. Values obtained with this form of monitoring are: A. CVP. B. Pulmonary artery pressure (PAP). C. Pulmonary artery occlusion pressure (PAOP). EVALUATION AND RESULTS Use of hemodynamic monitoring should be tailored and interpreted carefully for each patient. Critically ill patients may have confounding factors that make absolute interpretations difficult. Noninvasive monitoring may be limited by patient cooperation or body habitus. Invasive monitoring may be limited by poor circulation or misplacement of lines. It is essential that the healthcare provider provide careful interpretation in each individual case. CLINICAL PEARLS When using hemodynamic monitoring devices, the advanced practice provider (APP) should keep the following in mind. A. Positioning is the key to optimal visualization in noninvasive monitoring using echocardiography. B. Arterial lines may become dampened if the BP is very low. However, this may also be caused by air pockets in the transducer. Flushing the lines may resolve this issue. C. Always use optimal view on the monitor. D. Invasive monitoring can provide significant information about the patient's condition, but information must be inter-preted with caution. BIBLIOGRAPHY Bender, J. S., Smith-Meek, M. A., & Jones, C. E. (1997). Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: Results of a prospective, randomized trial. Annals of Surgery, 226, 229-237. doi:10. 1097/00000658-199709000-00002 CNSystems Medizintechnik. (n. d. ). CNAP monitor 500 HD. Retrieved from http://www. cnsystems. com/products/cnap-monitor-500 Hadian, M., & Pinsky, M. (2006). Evidence-based review of the use of the pulmonary artery catheter: Impact data and complications. Critical Care, 10 (Suppl. 3), S8. doi:10. 1186/cc4834 Ilies, C., Bauer, M., Berg, P., Rosenberg, J., Hedderich, J., Bein, B.,... Hanss, R. (2012). Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. British Journal of Anaesthesia, 108, 202-210. doi:10. 1093/bja/aer394 Marik, P. E. (2013). Noninvasive cardiac output monitors: A state-of the-art review. Journal of Cardiothoracic Vascular Anesthesia, 27, 121-134. doi:10. 1053/j. jvca. 2012. 03. 022 Marik, P. E., Baram, M., & Vahid, B. (2008). Does central venous pressure predict fluid responsiveness?: A systematic review of the literature and the tale of seven mares. Chest, 134 (1), 172-178. Retrieved from http://www. sciencedirect. com/science/article/pii/ S0012369208601634 Mimoz, O., Rauss, A., Rekik, N., Brun-Buisson, C., Lemaire, F., & Brochard, L. (1994). Pulmonary artery catheterization in critically ill patients: A prospective analysis of outcome changes associated with catheter-prompted changes in therapy. Critical Care Medicine, 22, 573-579. doi:10. 1097/00003246-199404000-00011 Monnet, X., & Teboul, J. L. (2015). Minimally invasive monitoring. Critical Care Clinics, 31, 25-42. doi:10. 1016/j. ccc. 2014. 08. 002 Murdoch, S. D., Cohen, A. T., & Bellamy, M. C. (2000). Pulmonary artery catheterization and mortality in critically ill patients. British Journal of Anaesthesia, 85, 611-615. doi:10. 1093/bja/85. 4. 611 Rajaram, S. S., Desai, N. K., Kalra, A., Gajera, M., Cavanaugh, S. K., Brampton, W., & Rowan, K. (2013). Pulmonary artery catheters for adultpatientsinintensivecare. Cochrane Databaseof Systematic Reviews,2013(2),CD003408. doi:10. 1002/14651858. CD003408. pub3 Renner, J., Grünewald, M., & Bein, B. (2016). Monitoring high-risk patients: Minimally invasive and non-invasive possibilities. Best Practice & Research Clinical Anaesthesiology, 30, 201-216. doi:10. 1016/j. bpa. 2016. 04. 006 Richard, C., Warszawski, J., Anguel, N., Deye, N., Combes, A., Barnoud, D., & Teboul, J.-L. (2003). Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome. Journal of the American Medical Association, 290, 2713-2720. doi:10. 1001/jama. 290. 20. 2713 (continued ) Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
488 SPECIAL TOPICS HEMODYNAMIC MONITORING DEVICES (continued ) Roth, S., Fox, H., Fuchs, U., Schulz, U., Costard-Jä ckle, A., Gummert, J.,... Bitter, T. (2018). Noninvasive pulse contour analysis for determination of cardiac output in patients with chronic heart failure. Clinical Research in Cardiology, 107, 395-404. doi:10. 1007/ s00392-017-1198-7 Sangkum, L., Liu, G. L., Yu, L., Yan, H., Kaye, A. D., & Liu, H. (2016). Minimally invasive or noninvasive cardiac output measurement: An update. Journal of Anesthesia, 30, 461-480. doi:10. 1007/s00540-016-2154-9 Saugel, B., Cecconi, M., Wagner, J. Y., & Reuter, D. A. (2015). Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. British Journal of Anaesthesia, 114, 562-575. doi:10. 1093/bja/aeu447 Shah, M. R., Hasselblad, V., Stevenson, L. W., Binanay, C., O'Connor, C. M., Sopko, G., & & Califf, R. M. (2005). Impact of the pulmonary artery catheter in critically ill patients. Journal of the American Medical Association, 294, 1664-1670. doi:10. 1001/jama. 294. 13. 1664 Vincent, J. L., Rhodes, A., Perel, A., Martin, G. S., Della Rocca, G., Vallet, B., & Singer, M. (2011). Clinical review: Update on hemodynamic monitoring—a consensus of 16. Critical Care, 15, 229. doi:10. 1186/cc10291Special Topics: Hemodynamic Monitoring Devices | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
489 SPECIAL TOPICS TELEMEDICINE IN ACUTE CARE Ruth Anne Skinner INTRODUCTION As technology evolves, so does its role in the provision of healthcare. For centuries, technology has helped enable healthcare providers to streamline patient care and improve health outcomes. In more recent years, technology has alsohelpedprovidersexpandthecaretheyprovideaswellashelpedprovidersreachmedicallyunderservedpopulations through the use of telemedicine. Telemedicine refers to the process of providing medical care, such as diagnosis and treatment, remotely through technology. Telemedicine continues to rapidly grow, become more widely used, and helps healthcareprovidersprovidecaretomoreandmorepeople. Althoughguidelinesforappropriateusesoftelemedicineare notyetstandardizedforadvancedpracticeproviders(APPs),itisimportantforthe APPtohaveafirmgrasponchallenges this evolving specialty poses, such as patient security and privacy. Consideration of such challenges will help APPs to createguidelines as the field of telemedicine progresses. HISTORY Theinventionofthetelephonewasthefirststeptowardconnectingindividualstoahealthcareproviderremotely. Afterits invention,obstetriccallswereoneofthemostcommonsourcesofearlytelemedicineusage. Thesecallsusuallyincluded giving directionto midwives who werehelping mothers laboring at home. Later in April 1924, Radio News magazine created an article called, “The Radio Doctor, maybe. ” In the article, the writer notes the next step in telemedicine—using television to provide healthcare. The article described an attachment to a televisionscreenthatenabledcommunicationandassessmenttechniques,suchahearingaheartbeat. Thefirsttelevision transmission did not occur until 1927, so this article was a visionary approach to treating remote patients. This marked the first conceptual idea of telemedicine as we know it today. Althoughthe Radio News articleintroducedtheideaofremotetreatmentandassessmentin1924,itwasnotuntilroughly two decades later that the University of Nebraska was credited for actually performing the first telemedicine consult. In 1959,expertsatthe Universityof Nebraskausedtwo-way,closed-circuit,microwavetelevisionformedicaltreatmentand education. Duringthisexchange, theysuccessfullycompleted aneurologicalexamination remotelywiththe accuracyof an assessment done in person. Over the next few decades, healthcare providers continued to find new ways to use technology to expand how they delivered medicine. In the 1970s, a project named the Space Technology Applied to Rural Papago Advanced Health Care(STARPAHC)wasfirstintroduced. Thisprogram,runbythe National Aeronauticsand Space Administration(NASA) with the support of Lockheed Missiles and Space Corporation (LMSC) and Indian Health Services (IHS), increased the availabilityofhealthcareto Papago Indians,whowerelocatedonan Indianreservationinsouthwest Arizona. The Papago Reservation lacked the medical resources to diagnose and manage patients. Additionally, NASA wanted to ensure that they could adequately respond to medical concerns for their astronauts in space. This unique partnership reinforced theimportanceofadvanceplanning,clearobjectives,andactivecommunityinvolvement. Inthe1990s,radiologybegan using and interpreting digital reports on a regular basis. Teleradiologists, who were often called “nighthawks,” originally providedthis form of medicine for emergenciesor night coverage. THE INTERNET AND MODERN TELEMEDICINE Although each of the aforementioned technological advances played an important role in furthering telemedicine technology, few advancements parallel the enduring effect of the Internet. The Internet provides a global network of information and communication, which has revolutionized how APPs deliver healthcare. The linked communication has createdmoreopportunitiesfortelemedicinethananyothertechnologytodate,andhasimprovedavailabilityofhealthcare to remote patients. For example, patients can now use at-home monitoring devices that send data to a clinical decision supportdatabase. Furthermore,providersindermatologycanreviewuploadedimagesandcasescenarios,allowingthem to treat double their current patient load. Phone applications (apps) are also being created and used to remind patients when to take their medications. The Internet, along with other medical technologies, enables healthcare providers to engage in many differenttypes of telemedicine, including Tele ICU,Tele Psych,and Telemonitoring. Tele ICU Tele ICU refers to the remote management and monitoring of patients in the ICU. Using Tele ICU monitoring, healthcare providerscanremotelymonitorchangesinpatientconditions. Thiscareapproachimprovespatientoutcomes,especially in remoteareasthat do not have access to an intensivist. Tele Psych Tele Psych refers to the remote management and consultation for psychological disorders. Care provided in this setting may include consultation, cognitive behavioral therapy, and emergency psychiatric care. In addition to expanding the numberofpatientsserved,Tele Pyschcanreducetheburdenof EDswaitingforinpatientpsychiatricrooms. Tele Psychhas reducedemergencyholdingtimeforpatientswithbehavioralhealthconcernswhoarewaitingforanavailablepsychiatrist. (continued ) Special Topics: Telemedicine in Acute Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
490 SPECIAL TOPICS TELEMEDICINE IN ACUTE CARE (continued ) Telemonitoring Telemonitoringreferstoanyformofmonitoringpatientsremotely. Thiscanincludemonitoringapatient'sheartrate,blood pressure,glucoselevel,orothervitalindicators. Thisformoftelemedicinemaybeusedtopreventreadmissionofcertain patients. Forexample,healthcareprovidersmayremotelymonitorpatientswithcongestiveheartfailure(CHF)whowere recentlydischargedfromthe hospital to evaluate and treatexacerbations as an outpatient. TELEMEDICINE IN ACUTE CARE Various forms of telemedicine have a significant effect on improving acute care delivery as well as improved quality of acute care. For example, healthcare providers may help prevent readmission by remotely monitoring patients. One example of this is remotely monitoring patients in skilled nursing facilities (SNFs) to manage concerns typically sent to the ED at night. Telemedicine may also be used to enhance performance initiatives. An example of this is providers who performventilatorroundingtooptimizeventilatorsettingsandcompleteventilatorbundleordersets. Providersremotely roundonpatientstoensurequalitymeasures,likedeepveinthrombosisprophylaxisandstressulcerprophylaxis,aremet. Telemedicinemayalsohelpincreasethenumberofavailableproviders. Telemedicineproviderstakecallandcanassess patientsovernightwhennocturnalprovidersarelimited. Furthermore,remotehospitalsmaynotalwayshaveanintensivist to manage the intensive care patients. Telemedicine intensivist providers can offer expert advice and management no matter wherethey arelocated. It can also be used to decrease ED visits. Urgent care consults can be conducted via smartphone application or other Internetapplication. Afterhourstelemedicineconsultscanbeconductedtotreatandmanagepatients. Whenappropriate, patients can be encouraged to go to the brick and mortar ED. PRIVACY AND SECURITY As technology evolves and telemedicine practice expands, new challenges emerge with regard to maintaining patient confidentiality and privacy. These challenges often require solutions that involve legislative action as well as adopting certain technology use and information sharing practices. Health Insurance Portability and Accountability Act Likelythemostrecognizablelegislativemeasureineffectisthe Health Insurance Portabilityand Accountability Act(HIPAA) Security Rule(SR). HIPAAprotectsthepatientandhisorher electronic protected health (e PHI) record. Ane PHIisany protectedhealthinformationthatcanbeproducedorsavedinelectronicform. Thereare16HIPAAidentifiersthatrequire special careand protection. They include the following. Special Topics: Telemedicine in Acute Care A. Names. B. Phone numbers. C. Fax numbers. D. Email addresses. E. Social Security numbers. F. Medical records. G. Health plan beneficiaries. H. Account numbers. I. License numbers. J. Vehicleidentifiers. K. Device identifiers. L. Universal resourcelocators (URLs). M. Internet protocol(IP) addresses. N. Biometrics. O. Photographic images. P. Any other unique identifying number or characteristic. Currently, there is no regulatory body for HIPAA compliance. HIPAA compliance is regulated by self-governance, third-party audits, or by using softwarethat is built into your processesthat ensurecompliance. (continued ) | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
491 SPECIAL TOPICS TELEMEDICINE IN ACUTE CARE (continued ) Store and Forward Store and forward is a telecommunications technique in which information is stored prior to being forward to the final destination. Thisallowsinformationtomeetregulatorystandards. Emailisnotconsidered HIPAAcompliant,sostoreand forward is the method of choice for electronic communication. Some states allow email and text with expressed written consent on file. Legislative Regulations Telemedicinelegislationandregulationsvaryfromstatetostate. Forexample,somestatesdifferintheservicesthatmay be reimbursed,such as: A. Medicaid reimbursedservices. B. Services providedvia live video. C. Remote patient monitoring (RPM) services. Otherdifferencesintelemedicinelegislationmayrelatetostoreandforwardservices. Notallstateregulatorshavegranted unrestricted licensure. Several state medical boards even require special telemedicine licenses or certification. Specifi-cally,nursepractitionersprovidingtelemedicinearesubjectedtothestateboardofnursingforwhichthepatientresides. Nursepractitionersmustbelicensedinthestatewherethepatientresides. Therefore,therehasbeenanadditionalpush forthecreationofthe COMPACTAPRNlicense,whichwouldallow APRNstoholdasinglemultistatelicense. Thescope of practice, licensure, and regulatory restrictions for other APPs also depends on the current state where the patient resides. All APPs should revieweach state'sspecific laws. TELEMEDICINE AND HEALTHCARE QUALITY In addition to making healthcare more widely available to underserved populations, telemedicine also has the ability to improvethequalityofhealthcareprovided. The Healthand Medicine Division(HMD)ofthe National Academiesof Science, formerly called the Institute of Medicine (IOM), is a nonprofit organization that has published a series of evidence-based researchrecommendationsonqualityandsafetyinhealthcare. In1996,beforethegeneralknowledgeandacceptanceof telemedicine,the HMDpublishedareportencouragingtheuseoftelemedicinetoincreaseavailabilityofcareandimprove patient outcomes. Since that time, telemedicine has become an important part of measuring and improving healthcare quality. This acknowledgment of the importance of telemedicine in improving healthcare is evident in the Department of Health and Human Service's Healthy People 2020 initiative. Healthy People 2020 sets several national health goals, which areto: A. Improvepreventabledisease. B. Eliminate health disparities. C. Createenvironmentsto promotegood health. D. Promotequality of life. One specific goal of Healthy People 2020 is to use health information strategies to improve patient outcomes, quality, and equity. Thosewhopracticetelemedicinearenotonlyconcernedwithimprovingaccesstohealthcare,butalsotomaintainingand improvingthequalityofhealthcareprovidedthroughtelemedicine. Specifically,thosewhoprovidetelemedicineoftenrefer to the National Quality Measures Clearinghouse (NQMC). The NQMC is a public database for healthcare providers that contains summaries of evidence-based research guidelines and measures. Telemedicine operation centers use NQMC measuresto roundon patients in the hospital and optimize treatmentplans. LOOKING AHEAD Electronic Medical Record Electronic medical records provide easy access to records remotely. Remote access to medical records expands the ability of an interprofessional team of healthcare providers to seamlessly manage and treat patients. Electronic medical records work hand-in-hand with electronic health information exchanges (HIEs), which improve the efficiency of patient information sharing to ensuremorethoroughtelemedicine consults due to the increasein patient past medical history. (continued ) Special Topics: Telemedicine in Acute Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
492 SPECIAL TOPICS TELEMEDICINE IN ACUTE CARE (continued ) Health Information Technology for Economic and Clinical Health The Health Information Technologyfor Economicand Clinical Health(HITECH)Act,createdunderthe Recoveryand Rein-vestment Act of 2009, funds the expansion of health information technology. It established meaningful use of electronic medical records to encourage adoption. Meaningful use provides incentives for adoption of electronic medical records and associated improvements in care. Adoption prior to 2015 was voluntary, and a 1% penalty was applied after that to eligible providers and eligible hospitals. After 2017, a 3% penalty was applied. Additional meaningful use components include the following. A. Electronicprescribing. B. Electronicexchange of health information. C. Clinical quality improvements,such as clinical decision support system (CDSS). Continual Improvement and Key Factors Moving Forward in Telemedicine Reimbursement Currently, telemedicine is a risk-based reimbursement, which rewards providers for improved patient outcomes. In the future,it is anticipated that therewill be moreopportunities for reimbursement. Similarly, Medicare and Medicaid continue to increase items that can be reimbursed. This is made possible through the standardizationofhowhealthcareservicesaredocumented. The U. S. Centersfor Medicareand Medicaid Services(CMS) funded the Current Procedural Terminology (CPT) and the International Classification of Diseases 10th revision ( ICD-10). ICD-10included telemedicine, and telemedicine services codes arecontinually added to the CPT database. BIBLIOGRAPHY Bashshur, R. (1980). Technology serves the people: The story of a co-operative telemedicine project by NASA, the Indian health service and the Papago people. Washington,DC: U. S. Government Printing Office. Field, M. (1996). Telemedicine: A guide to assessing telecommunications in health care. Washington,DC: National Academies Press. Freiburger, G., Holcomb, M., & Piper, D. (2007). The STARPAHC collection: Part of an archive of the history of telemedicine. Journal of Telemedicine Telecare, 13 (5), 221-223. doi:10. 1258/135763307781458949 Goran, S. (2010). A second set of eyes: An introductionto Tele-ICU. Critical Care Nurse, 30,46-55. doi:10. 4037/ccn2010283 Lyuboslavsky,V. (2015). Telemedicine and telehealth 2. 0: A practical guide for medical providers and patients. Chicago, IL: NCSBN. National Council of State Boardsof Nursing. (2015). APRN compact. Retrieved fromhttps://www. ncsbn. org/aprn-compact. htm U. S. Department of Health and Human Services. (2014). Healthy People 2020. Retrieved fromhttps://www. healthypeople. gov/Special Topics: Telemedicine in Acute Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
493 SPECIAL TOPICS TRANSITIONAL CARE Amy Blake INTRODUCTION Caretransitionsarereceivingwidespreadfocusinacademia,clinicalpractice,andexecutiveandregulatoryforums. The Hospital Readmissions Reduction Program, created under the Affordable Care Act (ACA) in 2012, has imposed finan-cial penalties for higher-than-expected readmissions for acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, and total hip and knee arthroplasties. Higher-than-expected readmissions come with additional costs and can be associated with increased mortality and poor outcomes. This has inspired institutions to focus on the development of programsdedicated to improvinga patient'stransition fromone setting to another. Healthcarecanappeartobefastpaced,fragmented,andconfusingtoboththelayobserverandtothosewhoparticipate inhealthcaredelivery. Understandinghowthevariousbranchesofhealthcaresituatethemselvesamongthekaleidoscope of options available to a consumer can be a challenge for anyone. Navigating a patient's healthcare path is a complex process that is becoming a specialty unto itself. Finding the safest, most cost-effective continuum is currently one of healthcare'shottest topics. CARE TRANSITIONS DEFINED Efforts to define transitional care have focused on determining a set of actions to minimize known risks, such as frag-mentation, poor communication, and poor coordination, that can lead to unfavorable outcomes. Fragmentation of care has been associated with increased hospital readmissions. The 2003 position statement from the American Geriatrics Society defined transitional care as a set of actions designed to ensure the coordination and continuity of healthcare as patientstransfer betweendifferentlocations orbetween differentlevelsof carewithin the samelocation. Representative locations include (but arenot limited to) the following. A. Hospitals. B. Subacute and postacute nursing facilities. C. The patient'shome. D. Primary and specialty careoffices. E. Long-term care(LTC)facilities. Inthisdefinition,transitionalcareisbasedonseveralfactorsthatencompassboththesendingandreceivingaspectsof care,including: A. A comprehensiveplan of care. B. Theavailabilityofhealthcarepractitionerswhoarewell-trainedinchroniccareandhavecurrent,clearlycommunicated information about the patient'sproblems,goals, preferences,and clinical status. C. Definedlogisticalarrangements,educationofthepatientandfamily,andcoordinationamongallhealthprofessionals involved in the transition. Naylor and Keating (2008) note that transitional careencompasses a broadrange of time-limited services designed to: A. Ensurehealthcarecontinuity. B. Avoidpreventablepoor outcomes. C. Ensuretimely transfer of patients fromone level of careto another or fromone type of setting to another. Communication as Cornerstone It is important to remember that no matter the exact definition, the cornerstone to effective transitional care is commu-nication. Communication must be embedded in an easily accessible platform throughout each phase of the continuum to allow for effective coordination and delivery of appropriate care. Lack of communication leads to poor understanding ofpriorities,fragmentation,unnecessaryduplicationoftests,and,attimes,omissionofimportantfollow-up. The Society for Post-Acute and Long-Term Care Medicine (AMDA) stresses that communication is key to improving care transitions between nursing facilities and acute carehospital settings. Specific recommendationsinclude the following. A. Informationaboutthepatient,includingmedicationandcareplans,shouldbecollectedthroughthehospitalstayand be available well in advance of any transfer. (continued ) Special Topics: Transitional Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
494 SPECIAL TOPICS TRANSITIONAL CARE (continued ) B. Professionals involved in the care of LTC patients and other frail, at-risk patients should actively work with other relevant professionals and each site of care to create and improve policies and procedures that assure timely and accurate communication. C. When possible, information about transfers should be communicated from professional to professional in different sites of care. D. The sending and receivingprofessionalsshould have reliablecontact information for each other. Whenconsideringtransitionalcare,itisalsoimportanttorememberthattransitionsoccurnotonlyfromsettingtosetting, butalsofromprovidertoprovider. Forexample,anelderlypatientwithahistoryofchronicobstructivepulmonarydisease and congestive heart failure could be hospitalized after a fall for an acute hip fracture. The patient may undergo repair, have his or her diuretic held for mild kidney injury, experience elevated blood pressure due to pain, and transition to a skilled rehab center to focus on strength and mobility. In the new setting, the patient will be at risk should a chronic comorbidity decompensate, thus potentially shifting the balance and priorities of care. This shifting continuum will recur inadynamicfashionamongallsettingsfromhospitaltopostacutecaretohome,andbackagainasadifferentcondition demands priority. INTERIM RISKS IN TRANSITIONAL CARE Multipletransitionsthroughdifferentsettingswithdifferentprovidersandmanagingshiftingprioritiescausedbydynamic comorbiditiesleavesamultitudeofavenuesforfragmentationandcarebreakdown. Interimrisksincludeseveraldifferent factors. Medication Changes and Errors Medication errors are a common area of communication breakdown. Medication lists are reconciled numerous times fromsettingtosetting,andnewchangesandformularysubstitutionsareaccommodated. Forsteretal. (2003)estimates that approximately one in five patients experience adverse drug events in the weeks following hospitalization, and up to one-third of these adverse events are considered to be preventable or ameliorable. Medications with higher rates of adverse effectsinclude: A. Antibiotics. B. Corticosteroids. C. Cardiovascularmedications. D. Anticoagulants. E. Antiepileptics. F. Analgesic medications, including narcotics. New, changed, and discontinued medications should be clearly noted in the discharge summary along with important reasonsfor the change, such as an adverse reactionor complication that promptedthe change. Unclear Follow-Up Instructions Unclearfollow-upinstructionsareanothercommonareaofriskintransitionalcare. Incompletelycommunicatedinstruc-tionsforfollow-upcareandpendingorincompletediagnosticandlaboratorystudiesleaveabundantspaceforimportant aspects of care to fall through the cracks. A higher margin for miscommunication exists in patients with long hospi-talizations, during which multiple specialists see the patient and order multiple diagnostic tests. Strategies to increase communication of follow-up instructions include the following. A. Important diagnostic studies, procedures, and lab values should be clearly documented in discharge instructions along with and pending resultsthat requirefollow-up. B. Providersthat a patient should follow-up with should also be clearly documented along with contact information. C. Information regarding durable medical equipment (DME) required at discharge such as noninvasive ventilators (con-tinuous positive airway pressure [C-pap], bilevel positive airway pressure [bi Pap], average volume assure pressure support[AVAP])shouldbeincludedalongwithsettingsandtheequipmentprovider'snameandcontactnumber. Itis helpful to include whether the equipment is rented or if the patient requires a qualification process or further testing in orderto have the equipment at home. 1. Example:Ifapatientwithrespiratoryfailurerequires Bi Papor AVAPathome,heorsherequiresspecialqualification processesinordertohaveahomemachine. Askillednursingfacilitymayrentaninterimmachineforthepatient,but (continued )Special Topics: Transitional Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
495 SPECIAL TOPICS TRANSITIONAL CARE (continued ) ifcareisnottakentoqualifyandattainapprovalfortheequipment,apatientcouldultimatelyendupathomewithout acrucialnoninvasiveventilator,renderinghimorherathighriskforreadmissionfromhypercapnicrespiratoryfailure. Poorly Communicated or Unaddressed Advance Directives Poorlycommunicatedorunaddressedadvancedirectivesandcodestatusputapatientatriskfortreatmentsandresus-citation he or she may have decided for or against. It is important for the advanced practice provider (APP) to take the following actions. A. Ensure a discussion has taken place regarding advance directives and the identification of a healthcare proxy or durable power of attorney for healthcare. B. Ensurethateachpatientisaskedaboutalivingwillorsimilardocument. Thisdocumentdescribesindetailthepatient's wishes with regardto resuscitation,hospitalization, treatmentgoals and limits, and a healthcareproxy. C. Thegoalofadvancedirectivesistoprovidethepatientautonomyindecisionsregardinghisorhermannerandlocation of death as well as relieving family burden and conflict whilethe older individual is mentally competent to do so. 1. The Five Wishes Form is useful to guide choices. The Five Wishes Form is a document that assists individuals in makingpreferencesandcarewishesinthecaseofanemergencyorincapacity. Thisformwillhelpthedesignated decisionmakertomakeinformedchoicesonthepatient'sbehalf. Theformasksthepatienttoindicatethefollowing. a. The person I want to make caredecisions for me when I cannot. b. The kind of medical treatment I want or do not want. c. How comfortable I want to be. d. How I want people to treatme. e. What I want my loved ones to know. 2. Many states have a MOSTform ( medical orders for scope of treatment) or POLSTform ( physician order for life sustaining treatment). The exact type of form varies from state to state. The APP should become familiar with the formusedinhisorherownstate. Thisisalegaldocumentthatspecifiesthetypeofcareapersonwouldlikeinhis or her final year of life and provides orders, signed by a provider, whereas the advance directive provides general wishes. D. Clearlycommunicateapatient'sadvancedirectivedesiresandcodestatusinthedischargesummaryandensurethe appropriate MOST or POLST forms arecompleted beforetransfers take place. Complex Problem Lists Problem lists are specified in the discharge summary by priority. Recall that priorities remain dynamic and can shift unexpectedly. Clearly delineate primary and secondary problem lists with the associated plan, if helpful. Consider the following notes that may appear in the chart of the aforementionedpatient. Primary Dx. A. Acute hip fx or if continue PT/OT. B. AKI—mild:Homedosesof Lasixandlisinoprilheldforcreatebumpincreatinineto2. 0frombaseline1. 3. Monitor creatinineclosely and restartwhen closer to baseline. C. HTN stable on beta-blocker,note ACE inhibitor and diureticon hold secondary to #2. D. Pain management: Vicodin every 4 to 6 hours as needed. E. Chronicbiventricularheartfailurewith EF30%anddiastolicdysfunction. Stable. Continuebeta-blocker. Restart loop diureticand ACE inhibitor when able. Monitor daily weight and fluid balance closely. AKI, acute kidney injury; EF,ejection fraction; fx, fracture;HTN, hypertension; OT,occupational therapy; PT,physical therapy. Consider the scenario that a receiving facility is out of Vicodin, and no one is immediately available to substitute a pain medication. Thepatient'sbloodpressureelevatesfrompainoverthenext24to48hoursinthesettingofbiventricularheart failure. The information regarding the patient's heart failure was not communicated since it was “stable. ” The patient's family is happy she is finally out of the hospital and brings her all of her favorite drinks and a nice ham dinner. The informationpertainingtothetemporarycessationofherdiureticandangiotensin-convertingenzyme(ACE)inhibitorwas not clearly communicated. She is at risk for decompensated heart failure, hypertensive urgency, and pulmonary edema. Clear communication is key. Ideally,a clear,well-constructed problemlist might appear as the following. (continued ) Special Topics: Transitional Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
496 Special Topics: Transitional Care SPECIAL TOPICS TRANSITIONAL CARE (continued ) Current Problem Diagnosis Tracking Heartfailure Heart failurebiventricular with EF 30% Ongoing Cardiacdisease Old myocardialinfarction Ongoing Hypertension Hypertension Ongoing EF,ejection fraction. Varying Medical Record Systems Differentprovidershaveprivilegesallowingaccesstodifferentmedicalrecordsystems,whethertheyareelectronicmed-icalrecords(EMRs)orpaperbased. Differentfacilitiesandofficescanhavemanydifferentbrandsof EMRs. Unlessthere is a functional unifying accessible electronic medical system that is capable of pulling from all of these varied systems and documents, chances are limited that a provider will view a complete, up-to-date picture of a patient's plan of care. This makes communication an ongoing challenge. Geriatric Needs Frail, elderly patients are routinely transferred from setting to setting multiple times, often with a sense of urgency. This vulnerable population may have limited ability to communicate their needs, expectations, complex comorbidities, and recent circumstances, let alone navigate the overwhelming continuum of healthcare they are experiencing. They remain atriskforpooroutcomesanddecompensationfromavarietyoftransitionalriskperspectives. Itisofvitalimportancefor the APP to consider these challenges when providing transitional care to geriatric patients, and to consider the special communication needs of these patients to ensurecontinuity of care. ACTIONS TO MITIGATE RISKS IN TRANSITIONAL CARE It cannot be stated enough: Good communication is the cornerstone to improving care transitions. However, communi-cation in a fast-paced world is often more difficult in reality than postulated. Phone calls can go unanswered or result in return calls that arrive outside of a crucial evaluation window. Messages logged and passed via computer can be brief and lackluster in clarifying complexity, and messages passed via word of mouth may not ultimately reach the assessing provider. Such messages may not even contain the originally communicated content. Faxes may not transmit. Routine texting is not Health Insurance Portability and Accountability Act (HIPAA) compliant. Complete medical records may not arrivewithapatientorinatimelymanner. EMRsystemsmaynotcommunicatewitheachother. Manystateshavemade progressinthisareabyimplementingstatewide EMRhousingsystems. Securetextingplatformsarenowavailable;how-ever,they may not be uniformly utilized by all systems, organizations,or providersin a community. Bridging Gaps Specificactionshavebeenrecommendedtobridgetheknowngapsintransitionalcare. Strategiesfocusedonpopulation health are being trialed, such as placing a hospitalist in postacute and LTC settings. Specialists, such as cardiologists, pulmonologists, and wound care experts, are being deployed to postacute settings to enhance and direct the care of patients with congestive heart failure,chronicobstructive pulmonary disease, and complex wounds. The Care Transitions Intervention Another approach is referred to as the Care Transitions Intervention. This nationally recognized program is led by Eric Coleman from the University of Colorado. Within this program, Coleman developed four pillars, also called domains, of transitional careinterventions. These pillars are: A. Medication self-management. B. Maintenance of a personal health record. C. Close follow-up with a primary careprovider. D. The identification of redflags that should promptevaluation. Whenimplemented,theprogramisledbyatransitionscoachwhooverseesthetransitionofthepatientfromhospitaliza-tion to home. The coach identifies patient goals and assists in the development of self-management skills. In summary, key components of a successful transitional careplan involve the following. (continued ) | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
497 SPECIAL TOPICS TRANSITIONAL CARE (continued ) A. Firming up the pitfalls that can lead to poor outcomes. B. Providinguniformity acrossthe continuum of settings. C. Paying close attention to medication reconciliationand delineating any medication changes or substitutions. D. Developing clear,legible dischargetemplates that identify important featuresof the hospitalization, including: 1. Pertinent diagnostic and laboratory tests. 2. Pending diagnostic and laboratory tests. 3. Futureplan of care. 4. Providersinvolved in the hospitalization and the providersthat areneeded for follow-up. E. Clearly defining and continuously reviewinggoals of care,advance directives,and code status in every setting. This approach implements evidence-based practices that utilize dedicated, focused transitional providers to improve outcomes and reducehospitalizations. Providersarmed with evidence-based strategies can do the following. A. Bridge the information and communication gap between settings. B. Set goals among patients and the healthcareteam. C. Educate patients and families to self-manage. D. Simultaneously provide complex monitoring, evaluation, and early intervention for decompensating dynamic comor-bidities. MOVING FORWARD Futureeffortsintransitionalcareshouldseektointegrateandimprovecareacrosscontinuumsinsteadofinisolatedcir-cumstancesandsettings. Sucheffortswillreducestressandincreasethehealthandwell-beingofoursocietyasawhole. Populationhealthstrategiesthatfocuson medicalhomemodelsandtransitionalcaremanagementareexcitingalterna-tivestofragmentedtraditionalcare. Medicalhomeswithoutwallsandtelemedicinealsoprovidepromisingalternativesby bringing advanced care providers and technology into the patient's home. Advances in unified, accessible health infor-mation databases will also improve care and reduce unnecessary duplication and overuse of health services. Advanced practice studies should include focus on the broadened responsibility and complex communication skills required to advance transitional careand, in doing so, increasethe satisfaction of patients and providersalike. BIBLIOGRAPHY Aging With Dignity. (2011). Five wishes. Retrieved from https://fivewishes. org/docs/default-source/default-document-library/product-samples/fwsample. pdf?sfvrsn=2 American Medical Directors Association. (2010). Transitions of care in the long-term care continuum clinical practice guideline. Columbia, MD: Author. Retrieved fromhttps://www. nhqualitycampaign. org/files/Transitions_of_Care_in_LTC. pdf Bixby, M. B., & Naylor, M. D. (2010). The transitional care model (TCM): Hospital discharge screening criteria for high risk older adults. Medsurg Nursing, 19 (1), 62-63. Cohen-Mekelburg, S., Rosenblatt, R., Gold, S., Scherl, E., Burakoff, R., Steinlauf, A., & Unruh, M. (2018). Fragmented care is prevalent among IBDhospitalizationsandisassociatedwithworseoutcome. Gastroenterology, 154 (1Suppl. ),S101. doi:10. 1053/j. gastro. 2017. 11. 239 Coleman,E. A. (2001,November2). Infusing true person centered care into improving the quality of transitional care. Paperpresentedat Transitionsof Care:Improving Care Across Settings, Cincinnati, OH: Greater Cincinnati Health Council. Coleman,E. A. (2003). Fallingthroughthecracks:Challengesandopportunitiesforimprovingtransitionalcareforpersonswithcontinuous complex careneeds. Journal of the American Geriatrics Society, 51 (4), 549-555. doi:10. 1046/j. 1532-5415. 2003. 51185. x Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patientsafterdischargefromthehospital. Annals of Internal Medicine, 138 (3),161-167. doi:10. 7326/0003-4819-138-3-200302040-00007 Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. The New England Journal of Medicine, 360 (14),1418-1428. doi:10. 1056/NEJMsa0803563 Jha, A. K., Joynt, K. E., Orav, E. J., & Epstein, A. M. (2012). The long-term effect of premier pay for performance on patient outcomes. The New England Journal of Medicine, 366 (17),1606-1615. doi:10. 1056/NEJMsa1112351 Joynt, K. E., & Jha, A. K. (2012). Thirty-day readmissions—truth and consequences. The New England Journal of Medicine, 366 (15), 1366-1369. doi:10. 1056/NEJMp1201598 Naylor,M. D.,Aiken,L. H.,Kurtzman,E. T.,Olds,D. M.,&Hirschman,K. B. (2011). Theimportanceoftransitionalcareinachievinghealth reform. Health Affairs, 30 (4),746-754. doi:10. 1377/hlthaff. 2011. 0041 Naylor, M. D., & Keating, S. A. (2008). Transitional care. American Journal of Nursing, 108 (Suppl. 9), 58-63. doi:10. 1097/01. NAJ. 0000336420. 34946. 3adoi:10. 1097/01. NAJ. 0000336420. 34946. 3a Nelson, J., & Pulley, A. (2015). Transitional care can reduce hospital readmissions. American Nurse Today, 10 (4). Retrieved from https://www. americannursetoday. com/transitional-care-can-reduce-hospital-readmissions Transitional Care Model. (n. d. ) Retrieved fromhttp://www. nursing. upenn. edu/ncth/transitional-care-model/index. php Special Topics: Transitional Care | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
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V Appendix Normal Laboratory Values | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
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Appendix: Normal Laboratory Values Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Laboratory Tests Reference Ranges 1,25-Dihydroxyvitamin D (1,25-Dihydroxycholecalciferol),serum Seevitamin D metabolites 17-Hydroxyprogesterone,serum Female,follicular <80ng/d L Female,luteal <285ng/d L Female,postmenopausal <51ng/d L Male(adult) <220ng/d L 5-Hydroxyindoleaceticacid, urine 2-9mg/24 hr 6-Thioguanine,whole blood 230-400pmol/8 ×108RBCs ANC 2,000-8,250/ 𝜇L 25-Hydroxyvitamin D (25-Hydroxycholecalciferol), serum Seevitamin D metabolites ACE,serum 8-53U/L Acidphosphatase, serum Prostaticfraction 0. 1-0. 4unit/m L Total 0. 5-2. 0(Bodansky) units/m L ACTH,plasma 10-60pg/m L a PTT 25-35sec ADAMTS13activity >60% ACTH,plasma 10-60pg/m L Albumin,serum 3. 5-5. 5g/d L Albumin,urine <25mg/24 hr Albumin-to-creatinineratio, urine <30mg/g Aldolase,serum 0. 8-3. 0IU/m L Aldosterone,plasma Supineorseated Upto 10 ng/d L Standing <21ng/d L Lowsodium diet (supine) Upto 30 ng/d L Aldosterone,urine 5-19mcg/24 hr Alkalinephosphatase, bone specific 5. 6-18. 0mcg/L for premenopausalwomen Alkalinephosphatase, serum 30-120U/L AAT,serum 150-350mg/d L Alpha2-antiplasminactivity,plasma 75%-115% Alpha-aminonitrogen,urine 100-290mg/24 hr (continued )501 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Alpha-fetoprotein,serum <10ng/m L Aminoacids, urine 200-400mg/24 hr Aminotransferase,serum alanine (ALT,SGPT) 10-40U/L Aminotransferase,serum aspartate (AST,SGOT) 10-40U/L Ammonia,blood 40-70mcg/d L Amylase,serum 25-125U/L (80-180 [Somogyi] units/d L) Amylase,urine 1-17U/hr Androstenedione,serum Female:30-200 ng/d L; male: 40-150 ng/d L Aniongap, serum 7-13m Eq/L Antibodiesto double-stranded DNA 0-7IU/m L Anticardiolipinantibodies Ig G <20GPL Ig M <20MPL Anti-cycliccitrullinated peptide, antibodies to <20units Antideoxyribonuclease B <280units Anti-F-actinantibodies, serum 1:80or less Antihistoneantibodies <1:16 Anti-LKMantibodies <1:20 Antimitochondrialantibodies 1:5or less Anti-myelinassociated glycoproteinantibody <1:1,600 Antimyeloperoxidaseantibodies <1U Antinuclearantibodies 1:40or less Anti-smoothmuscle antibodies 1:80or less Antistreptolysin O titer <200Toddunits Antithrombinactivity 80%-120% Antithyroglobulinantibodies <20U/m L Antithyroidperoxidaseantibodies <2. 0U/m L Anti-tissuetransglutaminase antibodies Seetissue transglutaminase antibody Arterialblood gas studies (patient breathingroomair): p H 7. 38-7. 44 Pa CO2 38-42mm Hg Pa O2 75-100mm Hg Bicarbonate 23-26m Eq/L Oxygensaturation 95%or greater Methemoglobin 0. 5%-3. 0% Ascorbicacid (vitamin C), blood 0. 4-1. 5mg/d L Ascorbicacid, leukocyte 16. 5±5. 1mg/d L of leukocytes (1,3)-Beta-D-glucan, serum <60pg/m L Betasubunit chorionic gonadotropin,urine <2m IU/24 hr Beta2-glycoprotein I antibodies: Ig G <21SGU Ig M <21SMU Beta-hydroxybutyrate,serum <0. 4mmol/L Beta2-microglobulin,serum 0. 54-2. 75mg/L Bicarbonate,serum 23-28m Eq/L (continued )(continued)502 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Bilirubin,serum Total 0. 3-1. 0mg/d L Direct 0. 1-0. 3mg/d L Indirect 0. 2-0. 7mg/d L Bleedingtime (template) <8min BUN,serum or plasma 8-20mg/d L B-typenatriureticpeptide, plasma <100pg/m L Cpeptide, serum 0. 8-3. 1ng/m L Calcitonin,serum Female:5 pg/m L or less; male: 10 pg/m L or less Calcium,ionized, serum 1. 12-1. 23mmol/L Calcium,serum 8. 6-10. 2mg/d L Calcium,urine Female: <250mg/24 hr; male: <300mg/24 hr Carbohydrateantigens, serum CA19-9 0-37U/m L CA27-29 <38. 0U/m L CA125 <35U/m L Carbondioxide content, serum 23-30m Eq/L Carboxyhemoglobin,blood <5% Carcinoembryonicantigen, plasma <2. 5ng/m L Carotene,serum 75-300mcg/d L Catecholamines,plasma Dopamine <30pg/m L Epinephrine Supine <50pg/m L Standing <95pg/m L Norepinephrine Supine 112-658pg/m L Standing 217-1,109pg/m L Catecholamines,urine Dopamine 65-400mcg/24 hr Epinephrine 2-24mcg/24 hr Norepinephrine 15-100mcg/24 hr Total 26-121mcg/24 hr CD4T-lymphocytecount 530-1,570/ 𝜇L Cellcount, CSF: Leukocytes(WBCs) 0-5cells/ 𝜇L Ceruloplasmin,serum (plasma) 25-43mg/d L Chloride,CSF 120-130m Eq/L Chloride,serum 98-106m Eq/L Chloride,urine Spot m Eq/L;varies 24-hrmeasurement m Eq/24hr; varies with intake Cholesterol,serum (continued )(continued)503 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Total Desirable <200mg/d L Borderline-high 200-239mg/d L High >239mg/d L High-densitylipoprotein Low Female: <50mg/d L; male: <40mg/d L Low-densitylipoprotein Optimal <100mg/d L Near-optimal 100-129mg/d L Borderline-high 130-159mg/d L High 160-189mg/d L Veryhigh >189mg/d L Cholinesterase,serum (pseudocholinesterase) 0. 5or morep H units/hr Packedcells 0. 7or morep H units/hr Chorionicgonadotropin, beta-human (beta-h CG), serum Female,premenopausalnonpregnant: <1. 0U/L; female, postmenopausal: <7. 0U/L; male: <1. 4 U/L Chromogranin A, serum <93ng/m L Citrate,urine 250-1,000mg/24 hr Clottingtime (Lee-White) 5-15min Coagulationfactors, plasma Factor I (fibrinogen) 200-400mg/d L Factor II (prothrombin) 60%-130% Factor V (accelerator globulin) 60%-130% Factor VII (proconvertin) 60%-130% Factor VIII (antihemophilic globulin) 50%-150% Factor IX (plasma thromboplastin component) 50%-150% Factor X (Stuart factor) 60%-130% Factor XI (plasma thromboplastin antecedent) 60%-130% Factor XII (Hageman factor) 60%-130% Factor XIII 57%-192% Coldagglutinin titer >1:64positive Complementcomponents, serum C3 100-233mg/d L C4 14-48mg/d L CH50 110-190units/m L Copper,serum 100-200mcg/d L Copper,urine 0-100mcg/24 hr Coproporphyrin,urine 50-250mcg/24 hr Cortisol,free,urine 4-50mcg/24 hr Cortisol,plasma 8:00a. m. 5-25mcg/d L 4:00p. m. <10mcg/d L 1hr after cosyntropin 18mcg/d L or greater Overnight suppressiontest (1-mg) <1. 8mcg/d L (continued )(continued )504 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Overnight suppressiontest (8-mg) >50%reductionin cortisol Cortisol,saliva, 11 p. m. — midnight <0. 09mcg/d L C-reactiveprotein,serum 0. 8mg/d L or less C-reactiveprotein(high sensitivity), serum Lowrisk = <1. 0mg/L; average risk =1. 0-3. 0mg/L; highrisk =morethan 3. 0 mg/L Creatinekinase, serum Total Female:30-135 U/L; male: 55-170 U/L MBisoenzymes <5%of total Creatine,urine Female:0-100 mg/24 hr; male: 0-40 mg/24 hr Creatinineclearance, urine 90-140m L/min Creatinine,serum Female:0. 50-1. 10 mg/d L; male: 0. 70-1. 30 mg/d L Creatinine,urine Spot mg/d L;varies 24-hrmeasurement 15-25mg/kg body weight/24 hr Cyclosporine,whole blood (trough) Therapeutic 100-200ng/m L 0-3mo posttransplantation 150-250ng/m L Morethan 3 mo posttransplantation 75-125ng/m L D-dimer,plasma <0. 5mcg/m L DHEA-S,serum Female:44-332 mcg/d L; male: 89-457 mcg/d L Delta-aminolevulinicacid, serum <20mcg/d L Digoxin,serum Therapeutic:1. 0-2. 0ng/m L( <1. 2ng/m Lforpatients withheart failure) Dihydrotestosterone,serum Adultmale: 25-80 ng/d L Dopamine,plasma <30pg/m L Dopamine,urine 65-400mcg/24 hr D-Xyloseabsorption (afteringestion of 25 g of D-xylose) Serum 25-40mg/d L Urinaryexcretion 4. 5-7. 5g during a 5-hr period Electrolytes,serum Sodium 136-145m Eq/L Potassium 3. 5-5. 0m Eq/L Chloride 98-106m Eq/L Bicarbonate 23-28m Eq/L Epinephrine,plasma Supine <110pg/m L Standing <140pg/m L Epinephrine,urine <20mcg/24 hr Erythrocytecount 4. 2-5. 9million/ 𝜇L Erythrocytesedimentation rate (Westergren) Female:0-20 mm/hr; male: 0-15 mm/hr Erythrocytesurvival rate (51Cr) T1/2=28d Erythropoietin,serum 4-26m U/m L (continued )(continued )505 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Estradiol, serum Female,follicular 10-180pg/m L Mid-cyclepeak 100-300pg/m L Luteal 40-200pg/m L Postmenopausal <10pg/m L Male 20-50pg/m L Estriol,urine >12mg/24 hr Estrogenreceptorprotein Negative: <10fmol/mg protein Estrone,serum 10-60pg/m L Ethanol,blood <0. 005%(<5mg/d L) Comalevel Morethan 0. 5% (morethan 500 mg/d L) Intoxication 0. 08%-0. 1% or greater(80-100 mg/d L or greater) Euglobulin clot lysis time 2-4hr at 37. 0 C Everolimus,whole blood (trough) Therapeutic: 3. 0-8. 0 ng/m L Factor XIII, B subunit, plasma 60-130U/d L Fecalfat <7g/24 hr Fecalnitrogen <2g/24 hr Fecalp H 7. 0-7. 5 Fecalpotassium <10m Eq/L Fecalsodium <10m Eq/L Fecalurobilinogen 40-280mg/24 hr Fecalweight <250g/24 hr Ferritin,serum Female:11-307 ng/m L; male: 24-336 ng/m L Fibrin(ogen) degradation products <10mcg/m L Fibrinogen, plasma 200-400mg/d L Fibroblastgrowthfactor-23, serum 30-80RU/m L Flecainide, serum Therapeutic: 0. 2-1. 0 mcg/m L Folate,redcell 150-450ng/m L of packed cells Folate,serum 1. 8-9. 0ng/m L Follicle-stimulating hormone, serum Female,follicular/luteal 2-9m IU/m L (2-9 U/L) Female,mid-cycle peak 4-22m IU/m L (4-22 U/L) Female,postmenopausal >30m IU/m L ( >30U/L) Male(adult) 1-7m IU/m L (1-7 U/L) Children,Tannerstages 1, 2 0. 5-8. 0m IU/m L (0. 5-8. 0 U/L) Children,Tannerstages 3, 4, 5 1-12m IU/m L (1-12 U/L) Freekappa light chain, serum 3. 3-19. 4mg/L Freekappa-to-freelambda light chain ratio, serum 0. 26-1. 65 Freelambda light chain, serum 5. 7-26. 3mg/L Fructosamine, serum 175-280mmol/L Gammaglobulin, CSF 6. 1-8. 3mg/d L Gamma-glutamyl transpeptidase, serum Female:8-40 U/L; male: 9-50 U/L Gastricsecretion Basalacid analysis 10-30units of freeacid Basalacid output Female:2. 0±1. 8m Eq of HCl/hr; male:3. 0 ±2. 0m Eq of HCl/hr (continued )(continued)506 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Maximaloutput after pentagastrin stimulation 23±5m Eq of HCl/hr Gastrin,serum <100pg/m L Gentamicin,serum Therapeutic:peak 5. 0-10. 0 mcg/m L; trough: <2. 0mcg/m L Glucose,CSF 50-75mg/d L Glucose,plasma (fasting) 70-99mg/d L Glucose-6-phosphatedehydrogenase,blood 5-15units/g of hemoglobin Glycoprotein 𝛼-subunit,serum <1ng/m L Growthhormone, serum Atrest <5ng/m L Responseto provocativestimuli >7ng/m L Haptoglobin,serum 83-267mg/d L Hematocrit,blood Female:37%-47%; male: 42%-50% Hemoglobin A1C 4. 0%-5. 6% Hemoglobin,blood Female:12-16 g/d L; male: 14-18 g/d L Hemoglobinfractionation Hb A 96%-98% Hb A2 1. 5%-3. 5% Hb F <1% Hemoglobin,plasma <5. 0mg/d L Heparin-anti-factor Xa assay, plasma 0. 3-0. 7IU/m L (therapeutic range for standard [unfractionated]heparin therapy) Heparin-plateletfactor 4 antibody,serum Positive: >0. 4optical density units Hepaticcopper 25-40mcg/g dry weight Hepaticironindex <1. 0 Histamineexcretion,urine 20-50mcg/24 hr Homocysteine,plasma 5-15 𝜇mol/L Beta-h CG, serum Female,premenopausalnonpregnant: <1. 0U/L; female,postmenopausal: <7. 0U/L; male: <1. 4U/L Hydroxyproline,urine 10-30mg/m2ofbody surface/24 hr Immatureplatelet fraction 1%-5%of platelet count Immunecomplexes, serum 0-50mcg/d L Immunoglobulins,serum Ig A 90-325mg/d L Ig E <380IU/m L Ig G 800-1,500mg/d L Ig M 45-150mg/d L Immunoglobulinfreelight chains, serum Kappa 3. 3-19. 4mg/L Lambda 5. 7-26. 3mg/L Kappa-to-lambdaratio 0. 26-1. 65 Insulin,serum (fasting) <20𝜇U/m L IGF-1 (somatomedin-C), serum Ages16-24 182-780ng/m L Ages25-39 114-492ng/m L Ages40-54 90-360ng/m L Ages55 and older 71-290ng/m L (continued )(continued)507 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Iodine,urine Spot mcg/L;varies Iron,serum 50-150mcg/d L Iron-bindingcapacity,serum (total) 250-310mcg/d L Lactate,arterial blood <1. 3mmol/L ( <1. 3m Eq/L) Lactate,serum or plasma 0. 7-2. 1mmol/L Lactate,venous blood 0. 6-1. 8m Eq/L; 6-16 mg/d L Lactatedehydrogenase,serum 80-225U/L Lacticacid, serum 6-19mg/d L (0. 7-2. 1 mmol/L) Lactosetolerance test, GI Increasein plasma glucose: >15mg/d L Lead,blood 15-40mcg/d L Lead,urine <80mcg/24 hr Leukocytecount 4,000-11,000/ 𝜇L Segmentedneutrophils 50%-70% Bandforms 0%-5% Lymphocytes 30%-45% Monocytes 0%-6% Basophils 0%-1% Eosinophils 0%-3% Lipase,serum 10-140U/L Lipoprotein(a),serum Desirable: <30mg/d L Lithium,plasma Therapeutic 0. 6-1. 2m Eq/L Toxiclevel >2m Eq/L LH,serum Female,follicular/luteal 1-12m IU/m L (1-12 U/L) Female,mid-cycle peak 9-80m IU/m L (9-80 U/L) Female,postmenopausal >30m IU/m L ( >30U/L) Male(adult) 2-9m IU/m L (2-9 U/L) Children,Tannerstages 1, 2, 3 <9. 0m IU/m L ( <9. 0U/L) Children,Tannerstages 4, 5 1-15m IU/m L (1-15 U/L) Lymphocytesubsets CD3 900-3,245/ 𝜇L CD4 530-1,570/ 𝜇L CD8 430-1,060/ 𝜇L CD19 208-590/ 𝜇L Magnesium,serum 1. 6-2. 6m Eq/L Magnesium,urine 14-290mg/24 hr Meancorpuscular hemoglobin 28-32pg Meancorpuscular hemoglobin concentration 33-36g/d L Meancorpuscular volume 80-98f L Meanplatelet volume 7-9f L Metanephrines,fractionated, plasma Metanephrine <0. 5nmol/L Normetanephrine <0. 9nmol/L (continued )(continued)508 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Metanephrines,fractionated, 24-hr urine Metanephrine <400mcg/24 hr Normetanephrine <900mcg/24 hr Myoglobin,serum <100mcg/L Norepinephrine,plasma Supine 70-750pg/m L Standing 200-1,700pg/m L Norepinephrine,urine 0-100mcg/24 hr Normetanephrine,fractionated, plasma <0. 9nmol/L Normetanephrine,fractionated, 24-hr urine <900mcg N-telopeptide, urine Female:11-48 nmol BCE/mmol creatinine;male: 7-68nmol BCE/mmol creatinine NT-pro-BNP,serum or plasma Ife GFR >60m L/min/1. 73 m2 18-49 y of age Heart failureunlikely: 300 pg/m L or less High probability of heart failure: 450 pg/m L or greater 50-75 y of age Heart failureunlikely: 300 pg/m L or less High probability of heart failure: 900 pg/m L or greater Older than 75 y of age Heart failureunlikely: 300 pg/m L or less High probability of heart failure: 1,800 pg/m L or greater Ife GFR <60m L/min/1. 73 m2 18 y of age or older High probability of heart failure: 1,200 pg/m L or greater Osmolality,serum 275-295m Osm/kg H2O Osmolality,urine 38-1,400m Osm/kg H2O Osmoticfragility of erythrocytes Increasedif hemolysis occurs in over 0. 5% Na Cl; decreasedif hemolysis is incomplete in 0. 3% Na Cl Osteocalcin,serum Male:11. 3-35. 4 ng/m L; female: 7. 2-27. 9 ng/m L Oxalate,urine <40mg/24 hr Oxygenconsumption 225-275m L/min Oxygensaturation, arterial blood 95%or greater Parathyroidhormone, serum C-terminal 150-350pg/m L Intact 10-65pg/m L Intact(dialysis patients only) Target:130-585 pg/m L Parathyroidhormone-related protein,serum <1. 5pmol/L Partialthromboplastintime (activated) 25-35sec p H,urine 4. 5-8. 0 Phenolsulfonphthalein,urine Atleast 25% excretedby 15 min; 40% by 30 min; 60%by 120 min Phenytoin,serum Therapeutic:10-20 mcg/m L Phosphatase(acid), serum Total 0. 5-2. 0(Bodansky) units/m L Prostaticfraction 0. 1-0. 4unit/m L (continued )(continued)509 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Phosphatase(alkaline), serum 30-120U/L Phospholipids,serum (total) 200-300mg/d L Phosphorus,serum 3. 0-4. 5mg/d L Phosphorus,urine 500-1,200mg/24 hr Plateletcount 150,000-450,000/ 𝜇L PFA-100: Collagen-epiephrineclosuretime 60-143sec Collagen-ADPclosuretime 58-123sec Plateletsurvival rate (51Cr) 10d Potassium,serum 3. 5-5. 0m Eq/L Potassium,urine Spot m Eq/L;varies 24-hrmeasurement m Eq/24hr; varies with intake Prealbumin,serum 16-30mg/d L Pregnanetriol,urine 0. 2-3. 5mg/24 hr Pressure(opening; initial), CSF 70-180mm CSF (70-180 mm H 2O) Procalcitonin,serum Lessthan or equal to 0. 10 ng/m L Progesterone,serum Female,follicular 0. 02-0. 9ng/m L Female,luteal 2-30ng/m L Male(adult) 0. 12-0. 3ng/m L Proinsulin,serum 3-20pmol/L Prolactin,serum <20ng/m L Prostate-specificantigen, serum ng/m L;no specific normal or abnormal level Protein C activity,plasma 65%-150% Protein C antigen, plasma 70%-140% Proteincatabolic rate, urine Goal:1. 0-1. 2 g/kg/24 hr Protein S activity,plasma 57%-131% Protein S antigen, plasma Total 60%-140% Free 60%-130% Protein,urine Spot mg/d L;varies 24-hrmeasurement <100mg/24 hr Proteins,CSF total 15-45mg/d L Proteins,serum Total 5. 5-9. 0g/d L Albumin 3. 5-5. 5g/d L Globulin 2. 0-3. 5g/d L Alpha1 0. 2-0. 4g/d L Alpha2 0. 5-0. 9g/d L Beta 0. 6-1. 1g/d L Gamma 0. 7-1. 7g/d L Protein-to-creatinineratio, urine <0. 2mg/mg Prothrombintime, plasma 11-13sec Pyruvicacid, blood 0. 08-0. 16mmol/L (continued )(continued)510 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Quinidine,serum Therapeutic:2-5 mcg/m L Redcell distribution width (RDW) 9. 0-14. 5 Redcell mass Female:22. 7-27. 9 m L/kg; male: 24. 9-32. 5 m L/kg Reninactivity (angiotensin-I radioimmunoassay) Peripheralplasma Normaldiet Supine 0. 3-2. 5ng/m L/hr Upright 0. 2-3. 6ng/m L/hr Lowsodium diet Supine 0. 9-4. 5ng/m L/hr Upright 4. 1-9. 1ng/m L/hr Diuretics +lowsodium diet 6. 3-13. 7ng/m L/hr Renalvein concentration Normalratio (high:low): <1. 5 Reptilasetime 10-12sec Reticulocytecount 0. 5%-1. 5%of redcells Reticulocytecount, absolute 25,000-100,000/ 𝜇L Rheumatoidfactor (nephelometry) <24IU/m L Rheumatoidfactor,latex test for 1:80or less Ristocetincofactor activity of plasma 50%-150% Russellviper venom time, dilute 33-44sec Salicylate,plasma Therapeutic:20-30 mg/d L Sexhormone-binding globulin Female,nonpregnant:18-144 nmol/L; male:10-57 nmol/L Sodium,serum 136-145m Eq/L Sodium,urine Spot m Eq/L;varies 24-hrmeasurement m Eq/24hr; varies with intake Specificgravity,urine 1. 002-1. 030 Spermdensity 10-150million/m L Sweattest for sodium and chloride <60m Eq/L T3resinuptake 25%-35% T-lymphocytecount, CD4 530-1,570/ 𝜇L Tacrolimus,whole blood (trough) Therapeutic:5-15 ng/m L (For transplant patients: 10. 0-15. 0ng/m L [0-3 mo posttransplantation]; 5. 0-10. 0ng/m L [morethan 3 mo posttransplantation]) Testosterone,bioavailable, serum Female,age 18-69 y: 0. 5-8. 5 ng/d L Testosterone,free,serum Male:70-300 pg/m L Testosterone,serum Female:18-54 ng/d L; male: 291-1,100 ng/d L Theophylline,serum Therapeutic:8-20 mcg/m L Thrombintime 17-23sec Thyroidfunction studies T3resinuptake 25%-35% Thyroglobulin,serum <20ng/m L Thyroidaliodine (123I)uptake 5%-30%of administereddose at 24 hr TSH,serum 0. 5-4. 0 𝜇U/m L(0. 5-4. 0 m U/L) TSI <130% Thyroxine-bindingglobulin, serum 12-27mcg/m L (continued )(continued)511 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Thyroxineindex, free(estimate) 5-12 Thyroxine(T 4),serum Total 5-12mcg/d L Free 0. 8-1. 8ng/d L Triiodothyronine(T3),serum Total 80-180ng/d L Reverse 20-40ng/d L Free 2. 3-4. 2pg/m L Tissuetransglutaminase antibody,Ig A (by chemiluminescencemethod)<20AU Tissuetransglutaminase antibody,Ig A (by ELISA) <4. 0U/m L Tissuetransglutaminase antibody,Ig G (by chemiluminescencemethod)<20AU Tissuetransglutaminase antibody,Ig G (by ELISA) <6. 0U/m L Totalproteins,CSF 15-45mg/d L Transaminase,serum glutamic oxaloacetic (SGOT) Seeaminotransferase,serumaspartate(AST,SGOT) Transaminase,serum glutamic pyruvic (SGPT) Seeaminotransferase, serum alanine (ALT,SGPT) Transferrinsaturation 20%-50% Transferrin,serum 200-400mg/d L Triglycerides,serum (fasting) Optimal <100mg/d L Normal <150mg/d L Borderline-high 150-199mg/d L High 200-499mg/d L Veryhigh >499mg/d L Troponin I, cardiac,serum 0. 04ng/m L or less Troponin T,cardiac,serum 0. 01ng/m L or less Tryptase,serum <11. 5ng/m L Ureaclearance, urine Standard 40-60m L/min Maximal 60-100m L/min Ureanitrogen,blood 8-20mg/d L Ureanitrogen,urine 12-20g/24 hr Uricacid, serum 3. 0-7. 0mg/d L Uricacid, urine 250-750mg/24 hr Uroporphyrin,urine 10-30mcg/24 hr Vanillylmandelicacid, urine <9mg/24 hr Venousoxygen content, mixed 14-16m L/d L Venousstudies, mixed, blood p H 7. 32-7. 41 PCO2 42-53mm Hg PO2 35-42mm Hg Bicarbonate 24-28m Eq/L Oxygensaturation (Sv O2) 65%-75% Viscosity,serum 1. 4-1. 8cp (continued )(continued )512 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Appendix: Normal Laboratory Values ABIM Laboratory Test Reference Ranges— January 2019 Vitamin A, serum: Adult 32. 5-78. 0mcg/d L Pediatric,age 1-2 y (retinol) 20-43mcg/d L Vitamin B12, serum 200-800pg/m L Vitamin D metabolites, serum 1,25-Dihydroxyvitamin D (1,25-Dihydroxycholecalciferol)15-60pg/m L 25-Hydroxyvitamin D (25-Hydroxycholecalciferol) 30-60ng/m L Vitamin E, serum: Adult 5. 5-17. 0mg/L Pediatric,age 1-2 y (alpha-tocopherol) 2. 9-16. 6mg/L Volume,blood Plasma Female:43 m L/kg body weight; male:44 m L/kg body weight Redcell Female:20-30 m L/kg body weight; male:25-35 m L/kg body weight von Willebrand factor antigen, plasma 50%-150% Zinc,serum 75-140mcg/d L AAT,alpha1-antitrypsin;ABIM, American Boardof Internal Medicine; ACE, angiotensin-converting enzyme; ALT,alanine aminotransferase; ANC, absolute neutrophilcount; anti-LKM, anti-liver-kidneymicrosomal;a PTT,activated partial thromboplastin time; AST,aspartate aminotransferase; beta-h CG, beta-human chorionic gonadotropin;BUN, blood ureanitrogen;CSF, cerebrospinalfluid; DHEA-S, dehydroepiandrosteronesulfate; GFR, glomerular filtration rate; GI, gastrointestinal;IGF-1, insulin-like growthfactor 1; LH, luteinizing hormone; NT-pro-BNP,N-terminal-pro-B-typenatriureticpeptide; PFA,platelet function analysis; RBC, redblood cell; RDW,redcell distribution width; SGOT,serum glutamic oxaloacetic transaminase; SGPT,serum glutamic pyruvic transaminase; TSH, thyroid-stimulatinghormone; TSI, thyroid-stimulatingimmunoglobulin. Source:Reproducedwith permission fromthe American Boardof Internal Medicine. Retrieved from https://www. abim. org/ ∼/media/ ABIM%20Public/Files/pdf/exam/laboratory-reference-ranges. pdf(continued)513 | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
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515 Index AAA. Seeabdominal aortic aneurysm ABCD Assessment Tool, 19 abdominal aortic aneurysm (AAA), 67, 69, 71, 237-239, 475 factors affecting risk of, 237 ABI. Seeankle-brachial index ABIM laboratory test reference ranges, 501-513 acanthosis nigricans, 168-169 ACE inhibitor, 495 acetaminophen, 84, 159, 180, 312, 378 acid-fast bacilli (AFB) testing, 231 acidosis, 103 ACS. Seeacute compartment syndrome; acute coronary syndromes ACTH. Seeadrenocorticotropic hormone activated partial thromboplastin time (a PTT), 236, 254 activities of daily living (ADLs), 338 acute abdomen, 67-71, 220 acute aortic regurgitation (AR), 61 acute bacterial prostatitis, 132 acute bacterial rhinosinusitis (ABRS), 10 acute care brain/central nervous system malignancies, 266 breast cancer, 268 chronic leukemias, 284 colorectal cancer, 271 endometrial cancer, 278 gastric cancer, 272 head cancer, 281 hepatic cancer, 274 lung cancer, 292 neck cancer, 281 non-hodgkin lymphoma, 295 telemedicine, 489-492 acute cholecystitis, 67, 69 acute compartment syndrome (ACS), 306, 307 acute confusional state, 335 acute coronary syndromes (ACS), 35-39 atherosclerotic-related, 35 evaluation of patients with, 38 acute cystitis algorithm, 135 acute endocarditis, 208 acute hyponatremia, 120, 122 acute joint pain, 308 acute kidney injury (AKI), 95-98 ABCDE-IT mnemonic, 97 renal vasculature, 97 treatment algorithm, 98 acute leukemias, 281-283 acute limb ischemia (ALI), 235-236 acute low back pain, 303 acute lung injury, 11 acute lymphoblastic leukemia (ALL), 282, 290 acute mesenteric ischemia, 67, 69acute migraine, 146 acute mitral regurgitation, 60, 61 acute myeloid leukemia (AML), 282, 287, 288, 290 acute neurological injury, 158 acute pancreatitis, 67, 70, 90 acute pharyngitis, 7 acute renal failure (ARF), 95, 374 acute respiratory distress syndrome (ARDS), 11-14, 391 acute rhinosinusitis (ARS), 10 acute tubular necrosis (ATN), 119 acute variceal hemorrhage, 73 acyclovir, 216 adamantane antivirals, 213 Addison's disease, 165 adduction and internal rotation of hip, 441 adenosine diphosphate receptor, 38 adjunct therapy, 304 adrenal crisis (AC), 165, 166 adrenal insufficiency (AI), 165-167 adrenocorticotropic hormone (ACTH), 165, 166, 365 advance directive, 495 advance transitional care, 497 advanced practice provider (APP), 307, 327, 361, 367, 461, 467, 489, 495. See also end-of-life care Advanced Trauma Life Support guidelines, 357 AED. Seeantiepileptic drug Aeromonas hydrophilis, 329 AFB testing. Seeacid-fast bacilli testing Affordable Care Act (ACA), 479, 493 ahronic rhinosinusitis (CRS), 10 airway edema, 373 AKI. Seeacute kidney injury albuminuria, 101, 103, 104 alcohol, 201, 361 alcoholic liver disease, 72 alginates, 377 ALI. Seeacute limb ischemia ALL. Seeacute lymphoblastic leukemia Allen's test, 244 allergic asthma, 14 allergic conjunctivitis, 5 Allis method, 440, 441 allopurinol, 128 alpha-blockers, 100 alpha fetoprotein (AFP), 274 alpha glucosidase inhibitors, 172 ᆀ-adrenergicreceptor, 181 ᆀ-methyl-paratyrosine, 181 alprazolam, 387 Alzheimer's disease (AD), 338, 339, 341 amantadine, 213 American Association for Thoracic Surgery, 478American College of Rheumatology (ACR), 317 American College of Surgeons, 357 American Congress of Obstetricians and Gynecologists (ACOG), 477 American Joint Committee on Cancer (AJCC), 268 American Society of Anesthesiologists (ASA), 342, 361, 362 amikacin, 26 amitriptyline, 146 AML. Seeacute myeloid leukemia amnesia, 367 amoxicillin, 11, 65, 140, 212 ampicillin, 140, 212, 216 amyloidosis, 297 anaerobic metabolism, 150, 352 analgesia, 262, 367 analgesics, 163 anastomotic leak, 272 anemia, 73, 102, 103, 251-254 anemia of chronic disease (ACD), 251, 252 anesthesia, 367, 409, 451 aneurysm, 238 of the aorta, 237-239 angina, 40-43 angiography, 79, 143 angiotensin-converting enzyme (ACE), 52, 96, 248, 318 angiotensin receptor blockers (ARBs), 96, 318 ankle-brachial index (ABI), 236, 247 interpretation of values, 382 measurement, 381-382 test, 382 ankles, reduction of, 435-436 ankylosing spondylitis, 314 anoxic brain injury, 141-142 anterior cerebral artery, 155 anterior cord syndrome, 355 anthracycline, 287 anti-cyclic citrullinated peptide (anti-CCP), 313 anti-inflammatory agents, 376 anti-muscarinic, 100 anti-nausea, 146 anti-TNF therapy, 228 antibiotic therapy, 26 septic arthritis, 229 antibiotics, 24, 494 anticardiolipin antibody, 317 anticholinergics, 21 anticoagulants, 24, 152, 156, 376, 494 anticoagulation (AC), 46, 250, 364 anticoagulation cessation, 364 anticoagulation therapy, 258, 342 anticonvulsants, 146, 378 antidepressants, 378 antidiuretic hormone (ADH), 162 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
516 antiepileptic drug (AED), 153, 154 antiepileptics, 494 antihistamines, 329 antihypertensive therapy, 149, 248 antihypertensive treatment of acute cerebral hemorrhage (ATACH), 148 antilipid, 149 antimicrobial carrying dressings, 377 antimicrobial prophylaxis, 372 antimicrobial therapy, 226 antimuscarinics, 21 antineutrophil cytoplasmic antibodies (ANCA), 320-322, 323 antinuclear antibodies, 315 antiphospholipid antibodies, 257 antiphospholipid syndrome (APS), 257, 316, 317 antiplatelet medications, 149, 152, 156, 365 antiplatelet therapy, 240, 241 antipyretic agents, 158 antithyroid medications, 185 anxiety, 463 anxiolysis, 367 anxiolytics, 387 aortic aneurysm, 237 aortic regurgitation (AR), 61-62, 64 aortic stenosis (AS), 60-62, 64 aortic vessel diseases, 237-239 apixaban, 364 apnea test, 143 APP. Seeadvanced practice provider appendicitis, 67-68, 70 apremilast, 320 APS. Seeantiphospholipid syndrome ARDS. Seeacute respiratory distress syndrome ARF. Seeacute renal failure arrhythmias, 43-47, 411 arterial blood gas (ABG), 11, 15, 19, 25, 151, 347 arterial catheter, 484 arterial emboli, 235 arterial line, 148 arterial lines, 383-386 depicting femoral anatomy, 383-384 arterial thoracic outlet syndrome (a TOS), 249, 250 arterial thrombosis, 235, 257 arterial trauma, 235 arterial vasospasm, 243 arteriovenous pressure gradient theory, 306 arthroscopic surgery, 229, 312 ASA. See American Society of Anesthesiologists ascites, 73-75 aseptic technique, 370-371 Aspergillus spp., 219 aspirin, 152, 156, 325, 365 for acute coronary syndromes, 38 for angina, 42 for carotid artery disease, 241 for pericardial effusions, 59 for ST-segment elevation myocardial infarction, 37, 38 asthma, 14-17 medications, 16 stepwise approach for, 31-32 astrocytomas, 265 asymptomatic hyponatremia, 122 atherosclerosis, 48, 239, 243 atherosclerotic disease, 149, 242, 475 atherothrombotic disease, 475 atopic dermatitis, 327-329 atrial fibrillation (AF), 43, 44 CHA 2DS2VASc score, 45-46 atrial flutter, 43, 44atrial natriuretic peptide (ANP), 162 atrioventricular (AV), 43, 44 atropine, 46 attention deficit hyperactivity disorder, 193 auscultate, 235, 242, 244 autoimmune encephalitis, 206 autoimmune thyroid disorders, 184 autoregulatory, 147 AV. Seeatrioventricular AVAP, 494 axial skeleton, 314 azathioprine, 318, 320, 322 azithromycin, 21, 212, 331 aztreonam, 26 B-lymphocytes (B-ALL), 282 B-symptoms, 294 back pain, 303-305 bacteremia, 223-225, 432 bacterial conjunctivitis, 5 bacterial meningitis, 214, 216 bacterial or fungal encephalitis, 206 bacterial pharyngitis, 7 bactrim DS, 140 BAL. Seebronchoalveolar lavage baloxavir marboxil, 213 barbiturates, 153 bare metal stents (BMS), 37 basal ganglia/thalamus, 147, 148 basic metabolic panel, 133 basic metabolic profile (BMP), 362 Bedside Shivering Assessment Scale, 163 Behçet disease, 319-320 belimumab, 318 Benadryl (diphenhydramine), 199 benign prostatic hypertrophy (BPH), 99-101 benzodiazepine, 153 benzodiazepines, 74, 197 benzotropine (Cogentin), 146, 199 beta-blocker, 467, 495 beta hemolytic streptococci, 228 Betadine, 421, 451 Beurger test, 242 bicuspid aortic stenosis, 61 bilateral femoral veins, 412 Bi Pap, 494 bipolar depression, 191 bipolar disorder, 191-193 bispectral index (BIS), 367 bisphosphonates, 108 biventricular pacemakers, 47 bleeding, 364 clotting factors, 254 diatheses, 254-256 disorders, 254 blood loss anemia, 251 blood pressure (BP), 55, 151, 352 blood transfusions, 351 blood urea nitrogen (BUN), 92, 272 blue toe syndrome, 235 BMP. Seebasic metabolic profile body mass index (BMI), 179 bolus, 353 bone biopsy, 219 bone marrow aspiration and biopsy, 387-390 examination, 387 holding anticoagulation, 387-388 Jamshidi needle, 390 pelvic anatomy for, 389 bone pain crisis, 261 bone sarcoma, 298 bone scintigraphy, 229 bony injuries, 347-348 bowel changes, 270 bowel obstruction, 271BP. Seeblood pressure BPH. Seebenign prostatic hypertrophy brachial artery, 244 bradycardia, 44, 374, 411 bradypnea, 373-374 brain/central nervous system malignancies, 265-266 brain death, 142-144 brain MRI, status epilepticus, 153 brainstem functions, loss of, 142 brainstem reflexes, 143 BRCA mutation, 476 breast cancer, 266-269, 476-477 broad-spectrum antibiotics, 272 bromocriptine, 199 bronchoalveolar lavage (BAL), 392 bronchodilator, 22, 349 bronchoscopy, 391-393 endotracheal tube, 392 procedure, 392 Brown-Sequard syndrome, 355 Brudzinski test, 215 Buerger disease, 323, 324 bupivacaine, 368, 409 bupropion (Zyban), 201 Burch-Wartofsky Point Scale (BWPS), 188 buspirone, 181 C-reactive protein (CRP), 70, 228 CAD. Seecoronary artery disease calcitonin, 108 calcium channel blockers, 324 calcium stones, 128 calibrated devices, 482, 484 CAM-ICU, 336-337 cancer breast, 266-269, 476-477 cervical, 276-277, 478 colon, 269-271 colorectal, 269-271, 478 endometrial, 277-279 esophageal, 272 gastric, 271-273 gastrointestinal cancers. See gastrointestinal cancers head, 280-281 hepatic, 273-275 lung, 291-293, 478 neck, 280-281 ovarian, 279-280 pancreatic, 275-276 prostate, 479 skin, 299-301 Candida albicans, 219 Candida species, 223 capnography, 417 carbamazepine (Tegretol), 193 carcinoma, 276 carcinomatous diseases, 429 cardiac arrest, 141 hypothermia after, 160-164 cardiac biomarkers, 36, 41 cardiac catheterization, 52, 63 cardiac echocardiography, 36 cardiac enzymes, 347 cardiac function, 118 cardiac guidelines acute coronary syndromes, 35-39 angina, 40-43 arrhythmias, 43-47 dyslipidemia, 48-50 heart failure, 50-54 hypertension, 55-57 pericardial effusions, 57-60 valvular heart disease, 60-65 cardiac manifestations, infective endocarditis, 209Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
517 cardiac resynchronization therapy (CRT), 53 cardiac surgery, 407 for cardiogenic shock, 354 cardiac tamponade, 348 cardiac transplantation, 53 cardiogenic shock, 352, 353 cardiology, 180, 349 cardiopulmonary death, 142 cardiovascular disease (CVD), 179, 316, 475-476 cardiovascular medications, 365 cardiovascular system, 225 cardiovascular systems, 102, 411 Care Transitions Intervention, 496 carotid angioplasty and stenting (CAS), 240 carotid artery, 155, 239 carotid artery disease, 239-241 carotid artery stenosis (CAS), 239, 475 carotid duplex ultrasonography, 240 carotid endarterectomy (CEA), 152, 240, 241 carotids ultrasound, 151 carpometacarpal, 311 CAS. Seecarotid artery stenosis catastrophic APS (CAPS), 317 catecholamine, 180 catheter, 394, 487 catheter-directed thrombolysis, 236 cause vasculitis, 324 CBC. Seecomplete blood count CDI. See Clostridium difficile infection cefazolin, 331, 372 cefepime, 26 cefotaxime, 222 cefotetan, 372 cefoxitin, 372 ceftriaxone, 216 cefuroxime, 372 Celebrex, 310 cellulitis, 329-331 celphalexin, 331 Centers for Disease Control and Prevention (CDC), 318, 357, 432 central cord syndrome, 355 central line, 394 central line-associated bloodstream infection (CLABSI), 432 central nervous system (CNS), 116, 143, 145, 256, 283, 287, 316 central vascular catheter (CVC), 432 central venous access, 394-402 central venous catheter, 486 central venous catheter (CVC), 394-402 central venous pressure (CVP), 353, 486 cephalexin, 65, 140, 212 cephalosporin, 222, 372 cerebellar location, 147 cerebral amyloid angiopathy (CAA), 147 cerebral angiography, 151 cerebral edema, 123, 141, 266 cerebral infarction, 141 cerebral scintigraphy, 144 cerebrospinal fluid (CSF), 153, 214, 215, 324, 421, 429, 431 cerebrovascular accident (CVA), 150-152, 155-156 cerebrovascular pathology, 153 cervical cancer, 276-277, 477 cervix, 276 Chantix (varenicline), 201 Chapel Hill Consensus Conference (CHCC), 319, 320, 323, 324 chemotherapy, 266-270, 272, 274-278, 280, 281-283, 285-288, 292-295, 297-299, 301 chest CT angiography (CTA), 28, 29 chest radiography, 36, 41, 362chest trauma, 347-349 chest tube insertion, 404-406 patient positioning for chest, 404-405 chest tube removal, 407-408 chest x-ray (CXR), 11, 51, 59, 63 left pleural effusion, 23-24 tuberculosis, 231 chlamydia, 480 Chlamydia pneumoniae, 26 chlorhexidine, 396, 397, 405, 409, 429, 432 chlorpromazine, 146 chlorthalidone, 128 cholangiocarcinoma, 273 cholecystitis, 67 cholesterol, 48 choroidal melanoma, 300 chronic airway inflammatory disease, 14 chronic aortic regurgitation, 61 chronic bacterial prostatitis, 132 chronic conditions, 461 chronic foot pain, 246-247 chronic hemolysis, 261 chronic hypercalcemia, 107 chronic hypocalcemia, 117 chronic hyponatremia, 120, 122, 123 chronic inflammatory disease, 324 chronic joint pain, 308 chronic kidney disease (CKD), 95, 101-104, 140, 432 monitoring stages of, 103 stages of, 101 urinary tract infection algorithm, 139 chronic kidney disease versus acute kidney injury, 101 chronic leukemias, 284-287 chronic low back pain, 303 chronic lung disease, 25 chronic lymphocytic leukemia (CLL), 284, 285, 286, 290 binet staging, 285 rai staging, 284 chronic mitral regurgitation, 60, 61 chronic myeloid leukemia (CML), 284, 285, 286, 288, 290 chronic obstructive pulmonary disease (COPD), 17-22, 25, 28, 291 chronic osteomyelitis, 219 chronic processes, 153 chronic pruritic inflammatory skin disease, 327 chronic sinusitis, 11 ciclopirox, 332 cilostazol, 248, 365 cinacalcet, 108 cipro, 74 ciprofloxacin, 6, 140, 222 cirrhosis, 72-75 causes of, 72 patients management with, 73-74 cisatracurium, 367 CIWA-AR. See Clinical Institute for Withdrawal Assessment for Alcohol clarithromycin, 70, 331 classic migraine, 144 clean-contaminated wound, 371, 376 clean wound, 371, 375 clevidipine, 148 clindamycin, 65, 212, 218, 331, 372 Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-AR), 201 clinical opiate withdrawal scale (COWS), 201 CLL. Seechronic lymphocytic leukemia clonidine, 163 clopidogrel, 37, 152, 156, 241, 365 Clostridium difficile, 13, 203-206, 285Clostridium difficile infection (CDI), 203-206 clozapine (Clozaril), 199 Clozaril (clozapine), 199 cluster headache, 145, 146 CML. Seechronic myeloid leukemia CMV encephalitis, 208 CNS. Seecentral nervous system CNSS. Seeculture negative severe sepsis CO2detector, 417 coagulation factor inhibitors, 254 coagulopathy, 148, 257-258, 432 cocaine, 181 codeine, 378 Cogentin (benzotropine), 199 cognitive behavioral therapy, 489 colchicine, 60, 320, 376 cold diuresis, 162 colitis, 203-206 colloid, 368 colon cancer, 269-271 colonoscopy, 79, 87, 270, 271 colorectal cancer, 269-271, 478 coma, 141, 142 community-acquired CDI, 203 community-acquired pneumonia (CAP), 24 comorbid diseases, 322 complete blood count (CBC), 11, 51, 81, 96, 133, 146, 151, 204, 225, 268, 362 complete metabolic panel, 51 complex problem lists, 495 comprehensive metabolic panel (CMP), 274 computed tomographic urogram (CTU), 106 computed tomography (CT), 304 brain, 153 chest trauma, 347 encephalitis, 207 head, 142, 151 infective endocarditis, 209 meningitis, 215 necrotizing fasciitis, 217 noncontrast head, 148 penetrating chest injury, 348 penetrating intracranial injuries, 351 peritonitis, 222 septic arthritis, 229 spinal cord injury, 355 systemic inflammatory response syndrome, 226 traumatic brain injury, 358 tuberculosis, 231 computed tomography angiography (CTA), 79, 151, 240 computed tomography coronary angiography (CTCA) for acute coronary syndromes, 37 for angina, 41 computed tomography perfusion (CTP), 151 concomitant infections, 229 Confusion Assessment Method (CAM), 336-337 conjunctivitis, 5-7 connective tissue disorders, 237 constipation, 464 constitutional system, 228 contaminated wound, 371, 376 contiguous source, osteomyelitis, 218 continuous renal replacement therapy (CRRT), 123 convulsive status epilepticus, 153 COPD Assessment Test (CAT), 19 COPD Control Questionnaire (CCQ), 19 corneal abrasion, 6 coronary angiography, 52 coronary artery disease (CAD), 35, 40, 51, 61, 155, 160 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
518 cort-stim, 166 cortical brain function, 214 corticosteroids, 88, 226, 287, 313, 320, 322, 324, 365, 494 corticotropin-releasing hormone (CRH), 165 cortisol, 166 cortisol-binding globulin (CBG), 166 cosyntropin, 166 cosyntropin test, 166 cough, 18, 30 COWS. Seeclinical opiate withdrawal scale Coxiella burnetii, 210 cranial nerve assessment, 143 craniotomy, 149 critical limb ischemia, 243, 246, 307 Crohn's disease (CD), 86-88, 314 cronic hyponatremia, 120-123 CRP. See C-reactive protein cryoprecipitate, 368 cryotherapy, 274 crystalloid, 368 CSF. Seecerebrospinal fluid CT. Seecomputed tomography CT angiography (CTA), 342 CTU. Seecomputed tomographic urogram Cullen sign, 68 culture negative severe sepsis (CNSS), 224 Cunningham technique, 445 current procedural terminology (CPT), 492 cutaneous lymphoma, 329 cutaneous vasculitis, 316 CVA. Seecerebrovascular accident CVC. Seecentral venous catheter CVD. Seecardiovascular disease CVP. Seecentral venous pressure cyclophosphamide, 318, 320, 322, 324 cystine stones, 128 cystoscopy, 137 cytology, 228 cytotoxic therapy, 282 D-dimer, 28, 29 dabigatran, 364 dactylitis, 315 dantrolene, 199 dapsone, 318 DBP. Seediastolic blood pressure DCIS. Seeductal carcinoma in situ death pronouncement, 466 death rattle, 466 debridement, 218 decompressive hemicraniectomy, 149 deep vein thrombosis (DVT), 13, 27, 149, 258-260, 321, 375 degenerative disc disease, 304 degenerative joint disease (DJD), 308 delirium, 335-338, 374, 464 delta pressure, 306 dementia, 338-340 demyelinating diseases, 429 dental prophylaxis, 229 Depakote (valproate), 193 depolarizing agents, 367 depression, 464 dermatological system, 225 dermatology, 349 dermatology guidelines atopic dermatitis, 327-329 cellulitis, 329-331 seborrheic dermatitis, 331-333 stasis dermatitis, 333-334 dermatome map, 355 desmopressin, 368 dexamethasone, 146, 167, 185, 216, 287, 368 dexmedetomidine, 163, 367dextrose, 154 DHT. Seedihydrotestosterone diabetes, 361, 475 type 1, 167-170, 365 type 2, 170-175, 365 diabetic ketoacidosis (DKA), 175-177 in pregnancy, 155 diabetic medications, 365 Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 191, 335, 338 Diagnostic International Prognostic Scoring System (DIPSS), 290 Diagnostic International Prognostic Scoring System-plus (DIPSS-plus), 290 diarrhea, 203 diastolic blood pressure (DBP), 55 diazepam, 154, 163 diazepam IV, 163 diclofenac, 378 dicloxacillin, 331 diet, 373 diffuse cerebral hypoxia, 141 digital nerve blocks, 409-410 digital rectal examination (DRE), 99, 105 dignity, 462 digoxin, 53 dihydroergotamine, 146 dihydrotestosterone (DHT), 99, 100 DILI. Seedrug-induced liver injury dilutional hyponatremia, 120, 121 dipeptidyl peptidase 4 (DPP-4) inhibitors, 172 diphenhydramine, 146 diphenhydramine (Benadryl), 199 direct factor Xa inhibitors, 364 direct observation therapy (DOT), 232 direct oral anticoagulants (DOACs), 258, 260 direct thrombin inhibitor, 364 dirty/infected wounds, 371, 376 disc herniation, 303 discectomy, 305 disease-modifying antirheumatic drugs (DMARDs), 309, 313 disseminated intravascular coagulation (DIC), 251, 254, 256, 286 distal femur, 423 distal interphalangeal (DIP), 313 distal tibia, 423 distension, 221 distributive shock, 352, 354 diuretic therapy, 222 diuretics, 23, 24, 53 diverticulitis, 68, 70 DKA. Seediabetic ketoacidosis DMARDs. Seedisease-modifying antirheumatic drugs dnosumab, 108 Dobhoff tubes, 457 dopamine, 46, 180 dorsal dislocation reduction, 437 DOT. Seedirect observation therapy doxycycline, 11, 331 DRE. Seedigital rectal examination dressings, 377 droperidol, 146 drug eluting stents (DES), 37 drug-induced liver injury (DILI), 75-76 drug-induced meningitis, 214-216 drug-induced thrombocytopenia, 254 drug-resistant tuberculosis, 230 drug-drug interactions, bipolar disorder, 193 DSM-5. See Diagnostic and Statistical Manual of Mental Disorders dual antiplatelet therapy (DAPT), 37 dual-chamber pacemakers, 47 ductal carcinoma in situ (DCIS), 266duodenal stump leak, 272 duplex ultrasound, 247, 248 durable medical equipment (DME), 494 DVT. Seedeep vein thrombosis dying process preferences, 461 dysentery, 203 dyslipidemia, 48-50 dysphagia, 271 dysplasia, 281 dyspnea, 11-12, 14, 30, 463 dysrhythmias, 374 dystonic reactions, 199 echocardiogram, 52 infective endocarditis, 209 echocardiography, 59 pulmonary embolism, 28 ECMO. Seeextracorporeal membrane oxygenation ectopic pregnancy, 68, 70 edoxaban, 364 Ehlers-Danlos syndrome type IV, 237 electrocardiography (ECG), 146, 151, 475 for acute coronary syndromes, 36 for angina, 41 for arrhythmias, 45-46 for chest trauma, 347 for heart failure, 51 for pericardial effusions, 59 for valvular heart disease, 63 electrocardiography (EKG), 362 electroencephalogram (EEG), 142, 143, 151 encephalitis, 207 electrolytes, 204 electronic communication, 491 electronic medical records (EMRs), 491, 496 electronic protected health (e PHI), 490 electrophysiology, 142 elevated arm stress test (EAST), 250 elevated erythrocyte sedimentation rate (ESR), 303, 304, 311, 313, 315, 320, 325 elimination, bipolar disorder, 193 emotional support system, 462 emotional well-being, 462 empiric treatment, 229 EMRs. Seeelectronic medical records encephalitis, 206-208 encephalopathy, 73-75, 335 end-of-life care anxiety, 463 constipation, 464 death experience, 461 death pronouncement, 466 delirium, 464 delivering bad news, 464-465 depression, 464 dignity, 462 dying process preferences, 461 dyspnea, 463 emotional well-being, 462 fatigue, 464 final days and hours of life, 465-466 goal of, 461 good death, 461 hospice care, 464 life completion and spirituality, 462 pain, 462, 463 palliative care, 463 patient versus healthcare team, 462 Portable Orders for Life-Sustaining Treatment, 462-463 quality of life, 462 SPIKES, 465 support system, 462 treatment preferences, 462 U. S. medicare hospice eligibili, 464Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
519 end-stage renal disease (ESRD), 95, 111, 140, 432 end-tidal CO2detector, 417 endocarditis, 229 endocrine, 162 endocrine disorders, 192, 361 endocrine guidelines adrenal insufficiency, 165-167 diabetes mellitus—type 1, 167-170 diabetes mellitus—type 2, 170-175 diabetic ketoacidosis, 175-177 hyperglycemic hyperosmolar state, 177-178 metabolic syndrome, 179-180 pheochromocytoma, 180-181 prediabetes, 181-182 thyroid disorder—euthyroid sick syndrome, 183-184 thyroid disorder—hyperthyroidism, 184-185 thyroid disorder—hypothyroidism, 186-187 thyroid disorder—myxedema coma, 187-188 thyroid disorder—thyroid storm, 188-190 endocrinology, 180 endometrial cancer, 277-279 endoscopic retrograde cholangiopancreatography (ERCP), 91, 275 endoscopic ultrasound (EUS), 272 endothelial injury, 208 endotracheal extubation, 419-420 endotracheal intubation, 415-418 endotracheal tube (ETT), 415-416, 419, 458 endovascular aneurysm repair (EVAR), 238 enhanced recovery after surgery (ERAS), 373 ENT guidelines conjunctivitis, 5-7 pharyngitis, 7-9 rhinosinusitis, 10-11 enteric pathogens, 203 Enterobacter species, 223 enzyme immunoassay, 205 Epclusa, 86 ependymomas, 265 ephedra, 377 epidural analgesia, 307 epinephrine, 46, 180, 353, 437 epithelial tumors, 279 Epstein-Barr virus, 280 ERAS. Seeenhanced recovery after surgery Erysipelothrix rhusiopathiae, 329 erythrocyte sedimentation rate (ESR), 228 erythromycin, 6 Escherichia coli, 203, 220, 223, 228 esophageal cancer, 272 Esophageal doppler, 484 esophagogastroduodenoscopy (EGD), 79, 88, 272, 275 esophagus, 458 ESR. Seeerythrocyte sedimentation rate ESRD. Seeend-stage renal disease essential cryoglobulinemia, 319-320 essential thrombocythemia (ET), 289, 290 estimated blood loss (EBL), 371 etelcalcetide, 108 ethambutol, 232 ethanol injection, 274 ETT. Seeendotracheal tube euthyroid sick syndrome, 183-184 euvolemic hypernatremia, 112-114 exercise capacity, 361 external ventricular drain, 421-422 extra-pulmonary tuberculosis, 230, 231extracorporeal membrane oxygenation (ECMO), 411-414 connectors, 413 types, 411 veno-arterial, 411 veno-venous, 411 extraglomerular hematuria, 104 exudative pleural effusions, 23 Factor V Leiden, 257 falls, 340-343 familial syndromes, 270 fasting glucose, 51 fatigue, 464 fatty streaks, 35, 48 fecal microbiota, 206 Federation International de Gynecologue et d'Obstetrique (FIGO), 279 feeding tube, guidewire, 457 Felty syndrome, 313 FENa. See Fractional Excretion of Sodium and Urea fentanyl, 163, 378 fertility-sparing therapy, 278 fever, 157-159, 199, 373, 375 feverfew, 377 fiberglass bandage, 427 fibrin degradation products (FDPs), 254 fibrin deposition, 208 fidaxomicin, 205 final days and hours of life, 465-466 finasteride, 100 fine needle aspiration (FNA), 279 finger probe, 483 fingers reduction, 437-439 flail chest, 347 flank pain, 105 fluconazole, 216 fludrocortisone, 167 fluid therapy, 226 fluids, 363, 368 fluocinolone, 318 fluorescence in situ hybridization (FISH), 288 fluoroquinolones, 222 focal cerebral ischemia, 141 focal neurological deficits, 215 focal segmental glomerulosclerosis (FSGS), 129, 130 Food and Drug Administration (FDA), 197, 213 foodborne, 204 foot ulcer, 246-247 foraminotomy, 305 forced expiratory volume in 1(FEV 1), 14, 19 forced vital capacity (FVC), 19 fosfomycin, 139, 140 fosphenytoin, 154 Fowler's position, 370 Fractional Excretion of Sodium and Urea (FENa), 96 fragmentation of care, 493 free intraperitoneal rupture, 237 FSGS. Seefocal segmental glomerulosclerosis functional incontinence, 136 functional ischemia, 246 fungal meningitis, 214-216 furosemide, 131 GABA. Seegamma-aminobutyric acid gabapentin, 146, 310 gamma-aminobutyric acid (GABA), 192, 198 garlic, 377 gastric cancer, 271-273 gastric reflux, 76 gastric ulcers, 94gastroesophageal reflux disease (GERD), 76-78 gastrointestinal (GI), 62, 87, 91, 162, 255, 256 gastrointestinal bleeding (GIB), 78-80 cirrhosis, 73-75 gastrointestinal cancers cervical cancer, 276-277 colorectal cancer, 269-271 endometrial cancer, 277-279 gastric cancer, 271-273 hepatic cancer, 273-275 ovarian cancer, 279-280 pancreatic cancer, 275-276 gastrointestinal guidelines acute abdomen, 67-71 cirrhosis, 72-75 drug-induced liver injury, 75-76 gastroesophageal reflux disease, 76-78 gastrointestinal bleeding, 78-80 hepatitis A, 83-84 hepatitis-alcoholic, 81-82 hepatitis-autoimmune, 82-83 hepatitis B, 84-85 hepatitis C, 85-86 inflammatory bowel disease, 86-89 nonalcoholic fatty liver disease, 72 pancreatitis, 90-92 peptic ulcer disease (PUD), 67 gastrointestinal losses, 119 gastrointestinal system, 225, 228 GCSE. Seegeneralized convulsive status epilepticus generalized anxiety disorder, 193 generalized convulsive status epilepticus (GCSE), 153 genitourinary, 102 genitourinary (GU) systems, 87, 221, 225, 228, 255 gentamicin, 26, 134 GERD. Seegastroesophageal reflux disease geriatric, 170 systemic inflammatory response syndrome, 227 geriatric guidelines delirium, 335-337 dementia, 338-340 falls, 340-343 urinary incontinence, 343-346 geriatric needs, 496 germ cell tumors, 279 germline mutations, 180 GFR. Seeglomerular filtration rate Giardia, 203 gingko, 377 Glasgow Coma Scale (GCS), 147, 351, 358 glioblastomas, 265 gliomas, 265 high-grade, 266 low-grade, 266 global cerebral ischemia, 141 glomerular filtration rate (GFR), 101-104, 129-131 glucagon-like peptide-1 (GLP-1), 172, 182 glucocorticoid, 82, 83, 108, 317, 318, 356, 365 glucose, 227 glucose monitoring, 152 glutamic acid decarboxylase (GAD), 168 glycosylated hemoglobin (Hgb A1C), 168-170 GM ganglioside, 356 GOLD categories, airflow limitation, 19, 20 gold standard, bipolar disorder, 193 gonorrhea, 480 good death, 461 granulomatous vasculitis, 324 Graves'disease, 184, 185, 188 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
520 great vessel injuries, 348 Grey Turner sign, 68 gross hematuria, 104 group A beta-hemolytic streptococcus, 7, 8, 329 group A Streptococcus, 223 gunshot wounds (GSW), 350 Haemophilus influenzae, 26 Haemophilus influenzae type B, 467 hand-off communication, 373 handheld doppler, 236, 244 Harvoni, 86 Hashimoto's disease, 184, 186 HDL. Seehigh-density lipoprotein head and neck squamous cell carcinoma (HNSCC), 280, 281 head cancers, 280-281 head, ear, eyes, nose, and throat (HEENT) gastroesophageal reflux disease, 77, 79, 87 headaches, 144-147 cluster, 145 tension-type, 145 Health and Medicine Division (HMD), 491 Health Information Technology for Economic and Clinical Health (HITECH) Act, 492 Health Insurance Portability and Accountability Act (HIPAA), 490, 496 health prevention and screening, 467-480 abdominal aortic aneurysm, 475 cervical cancer, 477 colorectal cancer, 478 lung cancer, 478 obesity, 476 prostate cancer, 479 healthcare versus patient, 462 quality, 491 treatment, 461 healthcare-acquired CDI, 203 heart failure (HF), 50-54 evaluation of, 51 New York Heart Association classification of, 50, 53 physical examination findings, 51-52 heart failure with reduced ejection fraction (HFr EF), 50 HEENT, 238 Helicobacter pylori, 70, 79, 93, 271 hemarthrosis, 451 hematocrit, 362 hematogenous source, osteomyelitis, 218 hematology guidelines anemia, 251-254 bleeding diatheses, 254-256 coagulopathies, 257-258 deep vein thrombosis, 258-260 sickle cell crisis, 261-263 hematopoiesis, 281 hematopoietic stem cells, 387 hematuria, 104-107 hemicraniectomy, 152 hemisphere, stroke symptoms based, 151 hemodynamic monitoring devices, 482-487 hemoglobin, 362 Hemoglobin A1C (Hgb A1C), 172 hemolytic anemia, 251 hemolytic uremic syndrome (HUS), 251 hemophilia A, 255 hemostasis, 254 hemothorax, 348 Henöch-Schonlein purpura, 320-322 heparin, 414 hepatic cancer, 273-275 hepatic function panel, 81 hepatitis A, 83-84, 468hepatitis-alcoholic, 81-82 hepatitis-autoimmune, 82-83 hepatitis B, 84-85, 468, 480 hepatitis C, 85-86, 320, 468, 480 hepatocellular carcinoma (HCC), 273, 274 hepatorenal syndrome (HRS), 73-75 hepatosplenomegaly (HSM), 282, 283 heritability, major depressive disorder, 194 herpes simplex virus (HSV), 206 HF. Seeheart failure HFr EF. Seeheart failure with reduced ejection fraction HHS. Seehyperglycemic hyperosmolar state high-density lipoprotein (HDL), 48-49, 179 high-dose chemotherapy, 294 high-dose steroids, 296 high fever, 157 high-grade gliomas, 266 high-output HF, 50 high T4 syndrome, 183 hip adduction and internal rotation of, 441 reduction, 440-441 HIPAA. See Health Insurance Portability and Accountability Act HIV encephalitis, 208 hodgkin lymphoma (HL), 293-294 holmium laser enucleation of the prostate (Ho LEP), 100 hormone deficiency, 165 hormone therapy, 268, 278 hospice care, 464 hospital-acquired pneumonia (HAP), 24 HPA. Seehypothalamus-pituitary-adrenal axis HPV. Seehuman papilloma virus HRS. Seehepatorenal syndrome HSM. Seehepatosplenomegaly HSV. Seeherpes simplex virus HSV/VZV encephalitis, 208 HTN. Seehypertension human immunodeficiency viruses (HIV), 479 human papilloma virus (HPV), 276, 280, 477 hydrochlorothiazide, 128 hydrocodone, 378 hydrocolloids, 377 hydrocortisone, 108, 166, 167, 318, 332 hydrogels, 377 hydromorphone, 378 hydroxychloroquine, 318 hydroxymethylglutaryl-coenzyme A (HMG-Co A), 48 hydroxyurea, 287 hyperactivity, 192 hypercalcemia, 107-109, 297 hypercholesterolemia (FH), 48 hypercoagulability, 257, 258 hyperglycemia, 178 hyperglycemic hyperosmolar state (HHS), 177-178 hyperkalemia, 109-111 hyperlipidemia, 48, 55 hypermagnesemia, 111-112 hypernatremia, 112-114 hyperoxia, 141 hyperoxygenate, 419 hyperphosphatemia, 115-116 hypertension (HTN), 55-57, 103, 148, 361, 374, 475 hypertensive, 147 hyperthermia, 141 hyperthyroidism, 184-185 hypertriglyceridemia, 91 hyperviscosity syndrome, 297 hypervolemic hypernatremia, 113, 114hypocalcemia, 116-117 hypoglycemia, 142, 152 hypokalemia, 117-119 hypomagnesemia, 119-120 hypomanic episode, 191, 192 hyponatremia, 73, 120-124 hypophosphatemia, 124-125 hypoprothrombinemia, 256 hypotension, 221, 225, 352, 374 hypothalamus-pituitary-adrenal axis (HPA axis), 165, 197 hypothermia, 142 after cardiac arrest, 160-164 hypothyroidism, 186-187 hypovolemia, 204 hypovolemic hypernatremia, 112-114 hypovolemic shock, 352, 353 hypoxic-ischemic encephalopathy (HIE), 160 IBC. Seeinflammatory breast cancer IBD. Seeinflammatory bowel disease ibuprofen, 378 ICH. Seeintracerebral hemorrhage ICP. Seeincreased intracranial pressure; intracompartmental pressure IDC. Seeinvasive ductal carcinoma idiopathic pulmonary fibrosis, 30 idiopathic type 1 diabetes, 167 IGRA. Seeinterferon gamma release assays IJ. Seeinternal jugular ILC. Seeinvasive lobular carcinoma ileus, 204 iliopsoas sign, 68 illicit drug use, 361 imipenem, 216 immune-mediated diabetes, 167 immune thrombocytopenic purpura (ITP), 254 immunization, 467-473 Haemophilus influenzae type B, 467 hepatitis A, 468 hepatitis B, 468 influenza, 468 measles, mumps, and rubella, 468 meningococcal, 473 tetanus, 473 vaccines for teenagers, 469-472 immunodeficiency syndromes, 205 immunoglobulin G4 (Ig G4), 91 immunoglobulin G (Ig G), 317 immunoglobulin M (Ig M), 317 immunosuppressants, 88 immunosuppression, 329 impaired autoregulation, 141 implantable cardiac defibrillator (ICD), 39, 47, 53 increased intracranial pressure (ICP), 351 indapamide, 128 infection guidelines colitis, 203-206 encephalitis, 206-208 infective endocarditis, 208-212 influenza, 212-214 meningitis, 214-216 necrotizing fasciitis, 217-218 osteomyelitis, 218-220 peritonitis, 220-223 septic arthritis, 227-229 systemic inflammatory response syndrome, 223-227 tuberculosis, 230-233 infectious diseases, 192, 320, 339 infectious fevers, 157 infective endocarditis, 208-212 antimicrobial coverage in, 211-212 microorganisms in, 209Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
521 inferior vena cava (IVC) filter, 29, 260, 365, 412 inflammation, 203 conjunctiva, 5 of conjunctiva, 5 pharynx, 7 sinuses, 10 inflammatory arthritis, 314 inflammatory arthropathy, 311 inflammatory bowel disease (IBD), 86-89, 270 inflammatory breast cancer (IBC), 267 inflammatory markers, 228 influenza, 212-214, 468 inhaled corticosteroid (ICS), 16, 21 initiate intravenous (IV), 119 inpatient treatment, 467 INR. Seeinternational normalized ratio Institute of Medicine (IOM), 491 insulin, 167, 172, 176, 365 insulin-dependent diabetes, 167 insulin resistance syndrom, 179 integumentary system, 221 intensive blood pressure reduction in acute cerebral hemorrhage (INTERACT), 148 Intensive care delirium screening checklist (ICDSC), 336, 338 interferon gamma release assays (IGRA), 231, 232 internal jugular (IJ) vein, 395, 397-399, 412 International Federation of Gynecology and Obstetrics (FIGO), 278 International Headache Society, 144 international normalized ratio (INR), 81, 151, 256, 362, 364, 432 International Prognostic Scoring System (IPSS), 290 intervention radiology (IR), 272, 432 intestinal obstruction, 68, 70 intra-arterial t PA, 152 intracerebral hemorrhage (ICH), 147-150 mortality risk, 149 score of, 149 intracompartmental pressure (ICP), 306 intracranial hemorrhage (ICH), 157 intracranial pressure (ICP), 145 intramuscularly (IM), 108, 166 intraocular melanoma, 300 intraosseous vascular access, 423-424 intravenous (IV) drug, 84, 85, 419, 423 intraventricular hemorrhage (IVH), 157 invasive ductal carcinoma (IDC), 267 invasive lobular carcinoma (ILC), 267 invasive monitoring, 486 involuntary leakage of urine, 343-346 IO. Seeintraosseous iodine, 409 iris melanoma, 300 iron deficiency anemia, 251, 252 ischemic heart disease, 35 ischemic stroke, 150-152 isoniazid, 232 issue perfusion, 226 IV albumin, 222 IV antimicrobials, 226 IV benzodiazepine, 199 IVC filter. Seeinferior vena cava filter jackknife position, 370 Jamshidi needle, bone marrow, 390 joint arthrocentesis, 451 joint aspiration, 451 joint effusion, 451 joint pain, 308-310 joint space, 452 joints guidelinesback pain, 303-305 lower leg, compartment syndrome, 305-307 osteoarthritis, 311-312 rheumatoid arthritis, 312-314 spondyloarthropathies, 314-315 systemic lupus erythematosus, 315-318 vasculitis-large vessel, 324-325 vasculitis-medium vessel, 323-324 vasculitis-small vessel, 320-322 vasculitis-variable vessel, 319-320 jugular venous distention (JVD), 36, 59, 62 juvenile diabetes, 167 Kawasaki disease, 323, 324 Kernig test, 215 ketamine, 154, 367 ketoconazole, 332 ketorolac, 146, 378 Klebsiella pneumoniae, 220, 228 Klebsiella species, 223 Kocher's point, 421, 422 kyphoplasty, 297, 305 labetalol, 148, 180 lactate dehydrogenase (LDH), 23 lactic acidosis, 352 lactic dehydrogenase (LDH), 91 lactulose, 74 Lamictal (lamotrigine), 193 lamotrigine (Lamictal), 193 laninamivir, 213 laparoscopy, 272, 415-417 large bowel, 68 laryngospasm, 373 Lasix, 74, 495 latent tuberculosis infection (LTBI), 230, 232 lateonset asthma, 14 lateral joint dislocation reduction, 438 LBP. Seelow back pain LCIS. Seelobular carcinoma in situ LDCT. Seelow dose/helical CT LDH. Seelactic dehydrogenase LDL. Seelow-density lipoprotein left lower quadrant (LLQ), 67, 69 left-sided heart failure (HF), 50 leg ulcers, 246-247 Legionella, 26 lethargy, 215 leukemias acute leukemias, 281-283 chronic leukemias, 284-287 myelodysplastic syndromes, 287-289 myeloproliferative neoplasms, 289-290 leukocytosis, 204, 205 leukoplakia, 280 leukostasis, 286 leukotriene receptor antagonist (LTRA), 16 levetiracetam, 146, 154 levofloxacin, 26 levonorgestrel, 278 LFTs. Seeliver function tests LGIB. Seelower gastrointestinal bleeding lidocaine, 349, 368, 387, 398, 409, 421, 429, 430, 432, 435, 437, 442 linezolid, 26, 331 lipid panel, 49 lipids, 475 lisinopril, 495 lithium, 146 toxicity and side effects, 193 lithotomy position, 370 livedo reticularis, 316 liver biopsy, 73, 76, 82 liver-directed therapy, 274liver function panel, 51 liver function tests (LFTs), 91, 233 liver injury. Seedrug-induced liver injury liver tumor biopsy, 274 LLQ. Seeleft lower quadrant LMWH. Seelow molecular weight heparin lobectomy, 292 lobular carcinoma in situ (LCIS), 267 localized disease, 267, 273 localized symptoms, 259 locked-in syndrome, 142 Loeys-Dietz syndrome, 237 logistical arrangements, 493 long-acting beta 2agonist (LABA), 15, 16, 20, 21 long-acting muscarinic antagonist (LAMA), 21 long arm posterior splint, 447 long leg casting, 425-428 long-term antibiotics, 432 long-term anticoagulation, 260 long-term diuretic therapy, 119 long-term therapy, 317 lorazepam, 146, 154 low-adherent wound contact layers, 377 low back pain (LBP), 303-304 low-density lipoprotein (LDL), 48-49, 55 low dose/helical CT (LDCT), 478 low-grade gliomas, 266 low high-density lipoprotein (HDL), 181 low molecular weight heparin (LMWH), 29, 260, 365 low T3/low T4 syndrome, 183 lower esophageal sphincter (LES), 76 lower extremity, 242-243 lower gastrointestinal bleeding (LGIB), 78-80 lower leg, compartment syndrome, 305-307 lower leg sugar-tong splint, 449 lower urinary tract symptoms (LUTS), 99, 100 LTBI. Seelatent tuberculosis infection lumbar puncture, 146, 266, 429-431 anatomical landmarks, 430 depicting placement of lumbar puncture needle, 430 encephalitis, 207 meningitis, 215 lumbar puncture needle anatomical landmarks for, 430 depicting placement of, 430 lung cancer, 291-293, 478 lung function, 14 lung injuries, 348 lupus nephritis (LN), 317 LUTS. Seelower urinary tract symptoms Lyme disease, 313 lymph nodes, 268 lymphadenopathy, 281, 293 lymphomas hodgkin lymphoma, 293-294 non-hodgkin lymphoma, 294-296 macrocytic anemias, 251 maddrey discriminant function (DF), 81-82 magnesium sulfate, 146 magnetic resonance angiography (MRA), 146, 247 magnetic resonance imaging (MRI), 268, 278, 297, 299, 304 brain, 142, 146, 153 encephalitis, 207 endocarditis, 209 infective endocarditis, 209 necrotizing fasciitis, 217 osteomyelitis, 219 septic arthritis, 229 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
522 magnetic resonance imaging (MRI) ( cont. ) spinal cord injury, 355 systemic inflammatory response syndrome, 226 magnetic resonance urography (MRU), 106 major depressive disorder, 193, 194-196 Malassezia furfur, 331 malignant neoplasm, 271 malignant tumors, 266 mallampati classification, 363 malnutrition, 361 manic episode, 191, 192 manometer, 429 mantoux tuberculosis skin test, 231 manubrium, 423 MAOIs. Seemonoamine oxidase inhibitors MAP. Seemean arterial pressure Marfan's syndrome, 237 Mavyret, 86 MDS. Seemyelodysplastic syndromes mean arterial pressure (MAP), 352 measles, mumps, and rubella (MMR), 468 mechanical ventilation, 226 medical home models, 497 medical orders for scope of treatment (MOST), 495 medical record systems, 496 medical therapy, 250 Medicare hospice eligibility, 464 medication class box warning, 199 medication errors, 494 medications delivery of pain, 378 meglitinides, 172 melanoma, 299, 300 melatonin, 146 men who have sex with men (MSM), 480 meningiomas, 265 meningitis, 214-216 meningitis/encephalitis, 429 meningococcal, 473 meperidine, 163, 262 meropenem, 26 metabolic acidosis, 125-126 metabolic equivalents (METs), 361 metabolic syndrome, 179-180 metastatic brain tumors, 265 metformin, 172 methicillin-resistant Staphylococcus aureus (MRSA), 26, 220 methicillin-susceptible Staphylococcus aureus (MSSA), 329 methimazole (Tapazole), 185, 189 methotrexate, 70, 313, 315, 318, 322, 325 methylprednisolone, 146, 318, 324, 325 methylxanthines, 21 methysergide, 146 metoclopramide, 146 metronidazole, 70, 205, 372 METs. Seemetabolic equivalents metyrosine, 181 MF. Seemyelofibrosis microcytic anemia, 251 microdiscectomy, 305 microorganisms infective endocarditis, 209 osteomyelitis, 219 microscopic hematuria, 104 microscopic polyangiitis, 320, 321 microvascular dysfunction, 141 midazolam, 154, 163, 367, 387 middle cerebral artery, 155 midodrine, 74 migraine, 144-145 prophylaxis, 146 mineralocorticoid, 167 antagonists, 53 mini mental, 336minimal consciousness, 141 minimally invasive monitoring, 484, 485, 486 minimally invasive pulse contour, 485 minocycline, 331 mitral regurgitation (MR), 60-62, 64 mitral stenosis (MS), 60-64 mixed urinary incontinence, 136 MM. Seemultiple myeloma MMR. Seemeasles, mumps, and rubella modified centor criteria, 8 mometasone, 332 monitored anesthesia care (MAC), 367 monoamine oxidase (MAO), 181 monoamine oxidase inhibitors (MAOIs), 196 monoarticular, 308 monoclonal antibody, 315 monotherapy, 313 mood disturbance, 191 morphine, 163, 310 intravenous, 378 motor vehicle collisions (MVC), 347, 357 MPNs. Seemyeloproliferative neoplasms (MPNs) MRI. Seemagnetic resonance imaging MRSA. Seemethicillin-resistant Staphylococcus aureus MSM. Seemen who have sex with men mucolytics, 21 mucosal inflammation, 203 mucositis, 281 multidrug resistant (MDR), 26 multiple endocrine neoplasia (MEN), 180 multiple myeloma (MM), 296-298 Murphy's sign, 68 muscle compartment, 305 musculoskeletal system, 225, 228, 235, 242 Mycobacteria spp., 219 Mycobacterium tuberculosis, 230 mycophenolate, 318, 325 Mycoplasma pneumoniae, 26 myelodysplastic syndromes (MDS), 287-289 myelofibrosis (MF), 290 myeloproliferative neoplasm symptom assessment form (MPN-SAF), 289 myeloproliferative neoplasms (MPNs), 289-290 myocardial infarction (MI), 95, 146 myoclonic status epilepticus, 153 myxedema coma, 187-188 N-acetylcysteine, 76 N-methyl-D-aspartate (NMDA), 163, 340 receptor antagonists, 378 NAFLD. Seenonalcoholic fatty liver disease naloxone, 356 narcotics, 494 narrow empiric antimicrobials, 226 nasal cavity, 10 NASH. Seenonalcoholic steatohepatitis nasogastric tubes, 457 Na SSA. Seenoradrenergic and specific serotonergic antidepressant National Cancer Institute, 476 National Comprehensive Cancer Network (NCCN), 280 National Institute of Health Stroke Scale (NIHSS), 151 National Institutes of Health (NIH), 151 National Kidney Foundation, 129 National Quality Measures Clearinghouse (NQMC), 491 natriuretic peptides, 51 NCSE. Seenonconvulsive status epilepticus NDRI. Seenorepinephrine dopamine reuptake inhibitorneck cancers, 280-281 necrotizing fasciitis, 217-218 negative pressure pulmonary edema, 373 negative pressure wound therapy, 307 Neisseria gonorrhoeae, 228 Neisseria meningitidis, 473 neoadjuvant therapy, 275 nephrolithiasis, 127-129 nephrology guidelines acute kidney injury, 95-98 benign prostatic hypertrophy, 99-101 chronic kidney disease, 101-104 hematuria, 104-107 hypercalcemia, 107-109 hyperkalemia, 109-111 hypermagnesemia, 111-112 hypernatremia, 112-114 hyperphosphatemia, 115-116 hypocalcemia, 116-117 hypokalemia, 117-119 hypomagnesemia, 119-120 hyponatremia, 120-124 hypophosphatemia, 124-125 metabolic acidosis, 125-126 nephrolithiasis, 127-129 nephrotic syndrome, 129-131 prostatitis, 131-132 pyelonephritis, 133-135 urinary incontinence, 135-137 urinary tract infections, 138-140 nephrotic syndrome (NS), 129-131 nerve sheath tumors, 265 neuraminidase inhibitors, 213 neurochemical imbalance, major depressive disorder, 194 neurogenic (n TOS), 249, 250 neurogenic claudication, 303 neuroleptic malignant syndrome (NMS), 199 neuroleptics, 146 neurological deficit, 145 neurological disorders, 192 neurological system, 225 neurology, 349 neurology guidelines anoxic brain injury, 141-142 brain death, 142-144 headaches, 144-147 intracerebral hemorrhage, 147-150 ischemic stroke/cerebrovascular accident, 150-152 status epilepticus, 152-154 transient ischemia attack, 155-156 neuromuscular blockade, 367 neuromuscular blocking agents (NMBAs), 163 neuropathic pain, 377 neuropeptides, 203 neutropenia, 268 New York Heart Association (NYHA), 50, 53 NHL. Seenon-hodgkin lymphoma nicardipine, 148 nicotine, 201, 377 nifidipine, 245 nitrofurantoin, 139, 140 NMS. Seeneuroleptic malignant syndrome nociceptive pain, 377 nomenclature, 319, 320, 323, 324 non-hodgkin lymphoma (NHL), 290, 293, 294-296 non-insulin-dependent diabetes, 170, 174. See also diabetes mellitus—type 2 non-small cell lung cancer (NSCLC), 291, 292 non-ST-segment elevation myocardial infarction (NSTEMI), 35, 37-39Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
523 nonalcoholic fatty liver disease (NAFLD), 72, 89-90, 273 nonalcoholic steatohepatitis (NASH), 89 nonarteritic anterior ischemic optic neuropathy (NAAION), 325 noncalibrated devices, 482 noncardiac manifestations, infective endocarditis, 209 noncontrast head CT, 148 nonconvulsive status epilepticus (NCSE), 153 nondepolarizing agents, 367 noninvasive monitoring devices, 482 noninvasive pulse contour, 483 noninvasive ventilators, 494 nonmelanoma, 299 nonopioids, 378 nonpharmacologic treatment headaches, 146 pain, 463 nonpharmacological management of pain, 377 nonselective beta blocker, 222 nonsteroidal anti-inflammatory drugs (NSAIDs), 53, 59, 67, 78, 93, 95-97, 146, 158, 251, 255, 262, 305, 309, 310, 312, 313, 318, 322, 349, 365, 378 nonvariceal hemorrhage, 78 noradrenergic and specific serotonergic antidepressant (Na SSA), 195 norepinephrine, 180, 353 norepinephrine dopamine reuptake inhibitor (NDRI), 195 norfloxacin, 222 normal saline (NS), 176 normocarbia, 162 normocytic anemia, 251 NQMC. See National Quality Measures Clearinghouse NRS. Seenutritional risk screening NS. Seenephrotic syndrome NSAIDs. Seenonsteroidal anti-inflammatory drugs NSCLC. Seenon-small cell lung cancer NSTEMI. Seenon-ST-segment elevation myocardial infarction nuchal rigidity, 215 nuclear medicine bone scan, 304 numerical rating scale, 377 nutrition, 227, 363 nutritional risk screening (NRS), 363 NYHA. See New York Heart Association OA. Seeosteoarthritis obesity, 361, 476 obstructive shock, 352, 354 obstructive sleep apnea, 361 obturator sign, 68 octreotide, 74 OI. Seeoverflow incontinence oligoarticular, 308 oligodendrogliomas, 265 oliguria, 352 oncology guidelines acute leukemias, 281-283 brain/central nervous system malignancies, 265-266 breast cancer, 266-269 cervical cancer, 276-277 chronic leukemias, 284-287 colorectal cancer, 269-271 endometrial cancer, 277-279 gastric cancer, 271-273 head cancers, 280-281 hepatic cancer, 273-275 hodgkin lymphoma, 293-294 lung cancer, 291-293multiple myeloma, 296-298 myelodysplastic syndromes, 287-289 myeloproliferative neoplasms, 289-290 neck cancers, 280-281 non-hodgkin lymphoma, 294-296 ovarian cancer, 279-280 pancreatic cancer, 275-276 sarcoma, 298-299 skin cancer, 299-301 ondansetron, 368 open biopsy, 229 ophthalmology, 467 opioids, 153, 163, 201, 367, 378 optimal medical therapy, 475 oral agents, diabetes, 172-174 oral anticoagulation, 248 oral corticosteroids (OCS), 16 oral fluoroquinolones, 205 oral hypoglycemics, 365 orbitomeatal line, 144 organ donation brain death, 144 cardiac death, 144 organ dysfunction, 223 oseltamivir (Tamiflu), 213 osmotic diuretics, 351 osteoarthritis (OA), 308, 311-312 osteomyelitis, 218-220 otolaryngology, 281 ova and parasites (O&P), 204 ovarian cancer, 279-280 over-the-counter (OTC), 6, 9, 11 overactive bladder, 343 overflow incontinence (OI), 136 oxybutynin, 100 oxycodone, 378 oxygen delivery device, 419 oxygen therapy, 13 PAC. Seepulmonary artery catheter packed red blood cells (PRBCs), 368 PACU. Seepostanesthesia care unit PAD. Seeperipheral artery disease padding extends beyond cast, 427 PADSS. Seepostanesthetic discharge scoring system pain, 221, 462, 463 assessment of, 377 management, 377-378 medication options, 378 medications delivery, 378 nonpharmacological management, 377 pharmacological management, 378 types, 377 pain, agitation, and delirium (PAD) guidelines, 337 palliative care, 463 anxiety, 463 constipation, 464 delirium, 464 depression, 464 dyspnea, 463 fatigue, 464 pain, 463 palpable purpura, 321 palpate, 236, 242, 244 pancreatic cancer, 275-276 pancreaticoduodenectomy, 276 pancreatitis, 67, 90-92 papilledema, 215 paracentesis, 222, 223 paradoxical emboli, 235 paranasal sinuses, 10 paraneoplastic encephalitis, 206 parathyroid hormone (PTH), 102 parenteral therapy, 129 parietal pericardium, 58Parkinson disease, 341 paroxetine (Paxil), 197 paroxysmal supraventricular tachycardia (PSVT), 43-46 partial thromboplastin time (PTT), 151, 362, 432 Pasteurella multocida, 329 patella reduction, 442-443 patellar dislocations, 443 pathogens, 203 patient assessment, 373 patient-controlled analgesia (PCA), 262, 349, 378 patient positioning, 370 patient versus healthcare team, 462 patient's death experience, 461 Paxil (paroxetine), 197 PCA. Seepatient-controlled analgesia PCI. Seepercutaneous coronary intervention PCR. Seepolymerase chain reaction PCV13. Seepneumococcal conjugate vaccine PE. Seepulmonary embolism peak expiratory flow (PEF), 14 pelvic anatomy, bone marrow, 389 pelvic exenteration, 277 pelvic inflammatory disease, 280 pelvic radiation therapy, 278 penetrating chest injuries, 349-350 penetrating intracranial injuries, 350-351 penicillin, 11 pentobarbital, 154 peptic ulcer disease, 272, 275 peptic ulcer disease (PUD), 67, 93-94 peramivir (Rapivab), 213 percocet, 310 percutaneous coronary intervention (PCI), 37-39 perforated duodenal ulcer, 68, 70 perforation, 271 pericardial effusions, 57-60 pericardiocentesis, 59 periodontal disease, 280 perioperative and intraoperative management care principles, 370-371 considerations, 367-369 medication, 372 perioperative antithrombotic therapy, 241 perioperative bridging, 364 peripheral artery disease (PAD), 245-247, 381 lower extremity, 242-243 upper extremity, 243-245 peripheral insulin resistance, 170 peripheral vascular disease (PVD), 245-248 stages of, 246-247 peripheral vascular guidelines acute limb ischemia, 235-236 aneurysms of the aorta, 237-239 carotid artery disease, 239-241 lower extremity, 242-243 peripheral vascular disease, 245-248 thoracic outlet syndrome, 249-250 upper extremity, 243-245 peripherally inserted central catheter (PICC), 432-433 peritoneal cavity, 237, 279 peritoneal-dialysis-associated peritonitis, 221 peritonitis, 204, 220-223, 223 permanent pacemaker, 432 permanent vegetative state (PVS), 141 pernicious anemia, 251, 271 persistent vegetative state, 141 personality disorders, 193 petechial rash, 215 peudohyperkalemia, 108 pharmacologic intervention, 308 pharmacologic therapy, 297 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
524 pharmacologic treatments, 463 pharmacological agents, 163 pharmacological management of pain, 378 pharmacology, hypothyroidism, 186 pharmacomechanical thrombectomy, 236 pharmacotherapy for acute abdomen, 71 for acute coronary syndromes, 38 for acute kidney injury, 97 for acute respiratory distress syndrome, 13 for adrenal insufficiency, 166-167 for anemia, 252 for aneurysms of aorta, 238 for angina, 42 for arrhythmias, 45-46 for asthma, 16 for atopic dermatitis, 328 for back pain, 305 for benign prostatic hypertrophy, 100 for bipolar disorder, 193 for carotid artery disease, 241 for cellulitis, 331 for chest trauma, 348, 349 for chronic kidney disease, 103 for chronic obstructive pulmonary disease, 20-21 for cirrhosis, 74 for coagulopathies, 258 for colitis, 205 for compartment syndrome of the lower leg, 307 for conjunctivitis, 6 for diabetes mellitus—type 1, 169 for diabetes mellitus—type 2, 172 for drug-induced liver injury, 76 for dyslipidemia, 49 for encephalitis, 208 for gastroesophageal reflux disease, 77 for heart failure, 52-53 for hematuria, 106 for hepatitis A, 84 for hepatitis-alcoholic, 81-82 for hepatitis-autoimmune, 83 for hepatitis B, 85 for hepatitis C, 86 for hypertension, 56-57 for hyperthyroidism, 185 for infective endocarditis, 211 for inflammatory bowel disease, 88 for influenza, 213 for insulin requirement changes, 170 for intracerebral hemorrhage, 149 for joint pain, 308-310 for lower extremity, 243 for major depressive disorder, 195 for meningitis, 216 for metabolic acidosis, 125 for nephrotic syndrome, 131 for neuroleptic malignant syndrome, 199 for Nonalcoholic Fatty Liver Disease, 90 for osteoarthritis, 312 for osteomyelitis, 220 for pancreatitis, 92 for penetrating intracranial injuries, 351 for peptic ulcer disease, 94 for pericardial effusions, 59-60 for pharyngitis, 9 for pleural effusion, 24 for posttraumatic stress disorder, 197 for prediabetes, 182 for prostatitis, 132 for pulmonary embolism, 29 for pyelonephritis, 134 for rhinosinusitis, 11 for seborrheic dermatitis, 332 for septic arthritis, 229 for sickle cell crisis, 262for spinal cord injury, 356 for spondyloarthropathies, 315 for stasis dermatitis, 334 for systemic lupus erythematosus, 318 for thoracic outlet syndrome, 250 for thyroid storm, 189 for transient ischemia attack, 156 for traumatic brain injury, 358 for tuberculosis, 232 for upper extremity, 245 for urinary incontinence, 137 for urinary tract infection, 139-140 for valvular heart disease, 64 for vasculitis-large vessel, 325 for vasculitis-small vessel, 322 for vasculitis-variable vessel, 320 pharyngitis, 7-9 phase contrast microscopy, 105 phenylephrine, 353 phenytoin (PHT), 154 pheochromocytoma (PCCs), 180-181 phosphodiesterase inhibitors, 42 phosphodiesterase 4inhibitors, 21 phosphorus in humans, 115 phototherapy, 329 PHT. Seephenytoin physical therapy, 308 physician order for life sustaining treatment (POLST), 495 PICC. Seeperipherally inserted central catheter pink eye, 5 piperacillin-tazobactam (Zosyn), 26 pituitary tumors, 265 plantigrade with toes pointing, 425, 426 plasma cell, 296 plasmacytoma, 297 plasminogen activator inhibitor-type 1 (PAI-1), 254 platelets, 368 count, 362 response, acute coronary syndromes, 35 pleural effusions, 22-24, 407 chest x-ray, 23-24 PMN. Seepolymorphonuclear leukocytes pneumococcal conjugate vaccine (PCV13), 473, 474 pneumococcal polysaccharide vaccine (PPSV23), 473, 474 pneumocystis pneumonia (PCP), 343 pneumonectomy, 292 pneumonia, 24-27, 473-474 pneumonia severity index (PSI), 26 pneumothorax, 348, 457 POLST. See Portable Orders for Life-Sustaining Treatment polyarteritis nodosa, 323, 324 polyarticular, 308 polycythemia vera (PV), 289, 290 polymerase chain reaction (PCR), 205, 213 polymorphonuclear leukocytes (PMN), 222 polymorphonucleocytes (PMNs), 203 polyurethane foams, 377 polyuria, 113 Portable Orders for Life-Sustaining Treatment (POLST), 462-463 positive end-expiratory pressure (PEEP), 13, 413 positive fecal markers, 203 Post-Acute and Long-Term Care Medicine (AMDA), 493 post cardiac arrest, 162 post void residual, 99 postanesthesia care unit (PACU), 373 postanesthetic discharge scoring system (PADSS), 374 posterior cord syndrome, 355posterior iliac crest, 388 posterior lumbar fusion, 305 postoperative bleeding, 256 postoperative complications, 373-375 postoperative evaluation and management medication management, 377-378 outcomes, 373-375 wound management, 375-377 postoperative nausea and vomiting (PONV), 368 postoperative pain control, 374 postoperative urinary retention (POUR), 374 posttraumatic stress disorder (PTSD), 193, 196-198 posttreatment, 16 POUR. Seepostoperative urinary retention povidone-iodine, 405, 429 PPSV23. Seepneumococcal polysaccharide vaccine pramlintide, 167 prasugrel, 365 prazosin, 197 prediabetes, 181-182 prednisone, 83, 108, 287, 313, 317, 318, 322, 324, 325, 329 pregnancy bipolar disorder, 193 diabetes mellitus—type 1, 170 diabetic ketoacidosis, 155 systemic inflammatory response syndrome, 227 premature ventricular contractions (PVCs), 43 preoperative antibiotics, 372 preoperative checklist, 365 preoperative evaluation and management care principles, 362-363 considerations, 361 medication, 364-365 preoperative nutritional assessment, 363 presence of peptic ulcer disease (PUD), 71 preventive therapy, 146 primary adrenal insufficiency (PAI), 165, 166 primary angiitis of the central nervous system, 323, 324 primary brain injury, 141 primary brain tumors, 265 primary central nervous system (CNS), 265 primary intention closure, dressings, 377 primary myelofibrosis (PMF), 289 primary peritonitis, 220-222 prinzmetal angina, 40, 42 probe cover, 432 procalcitonin, 226 prochlorperazine, 146, 368 promethazine, 368 prophylaxis, 222 propofol, 154, 163, 367 propoxyphene, 378 propranolol, 146 propylthiouracil (PTU), 185, 189 prostate cancer, 479 prostate specific antigen (PSA), 99, 100, 479 prostatitis, 131-132 prosthetic heart valves, 364 prosthetic joint infections, 229 protein, 363 protein C, 257 protein S deficiency, 257 proteinuria, 317 prothrombin complex concentrate (PCC), 256 prothrombin time (PT), 151, 254, 362 proton pump inhibitors (PPIs), 80, 318 provision healthcare, 489Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
525 proximal humerus, 423 proximal interphalangeal (PIP), 313 joint dislocation, reduction of, 438 PSA. Seeprostate specific antigen pseudohematuria, 106 pseudohyponatremia, 120, 121 pseudomembranous colitis, 203 pseudomonal infection, 26 Pseudomonas aeruginosa, 223, 228, 286, 329 psoralen and ultraviolet A (PUVA), 315 psoriatic arthritis, 314 PSVT. Seeparoxysmal supraventricular tachycardia psychiatric guidelines bipolar disorder, 191-193 major depressive disorder, 194-196 posttraumatic stress disorder, 196-198 psychiatric patient medical clearance, 201-202 schizophrenia, 198-199 substance use disorders, 200-201 psychiatric patient medical clearance, 201-202 psychogenic pain, 377 PT. Seeprothrombin time PTSD. Seeposttraumatic stress disorder PTT. Seepartial thromboplastin time PUD. Seepresence of peptic ulcer disease pulmonary artery catheter (PAC), 484, 485 pulmonary contusion, 348 pulmonary disease, 322, 493, 496 pulmonary edema, 11 pulmonary embolism (PE), 27-29, 321, 373 pulmonary embolism severity index (PESI), 28 pulmonary function testing, 362 pulmonary guidelines acute respiratory distress syndrome, 11-14 asthma, 14-17 chronic obstructive pulmonary disease, 17-22 pleural effusions, 22-24 pneumonia, 24-27 pulmonary embolism, 27-29 restrictive lungdisease, 30-32 pulmonary tuberculosis, 231 pulse oximetry, 483 pulseless electrical activity (PEA), 160 PVCs. Seepremature ventricular contractions PVD. Seeperipheral vascular disease PVS. Seepermanent vegetative state pyelonephritis, 133-135 pyrazinamide, 232 q SOFA. Seequick SOFA score quality of life, 462 quick SOFA score (q SOFA), 223 quinacrine, 318 RA. Seerheumatoid arthritis radial arterial, ultrasound-guided insertion, 385 radial artery, 244 radiation therapy, 266, 280, 281, 294, 301 radical hysterectomy, 277 radioactive iodine-131 therapy, 185 radioembolization, 274 rapid antigen detection testing (RADT), 8 rapid antigen tests, 213 Rapivab (peramivir), 213 Raynaud's phenomenon, 244, 316 RBC. Seered blood cells reactive arthritis, 229, 314 rebound tenderness, 221 recombinant zoster vaccine (RZV), 474 Recovery and Reinvestment Act, 492red blood cells (RBC), 104, 215, 251, 317 reduction of ankles, 435-436 Reed-Sternberg cell, 293 refractory status epilepticus, 153 refractory therapy, 154 regurgitation, 60, 61 Relenza (zanamivir), 213 renal disease, 322 renal function, 51 renal papilla, 127 renal potassium loss, 118 renal replacement therapy (RRT), 227, 432 renal ultrasound, 96 reperfusion therapy, 306 respiratory system, 225 restrictive lung disease (ILDs), 30-32 reticular activation system (RAS), 335 retinopathy, 170 retroperitoneal leak or rupture, 237 return of spontaneous circulation (ROSC), 160 revascularization, 236 reverse trendelenburg, 370 rheumatic heart disease, 61 rheumatoid arthritis (RA), 312-314 rhinosinusitis, 10-11 rib fractures, 347 ribavirin, 86, 213 rifampin, 232 rifapentine, 232 right lower quadrant (RLQ), 67, 69 right-sided heart failure, 50 right upper quadrant (RUQ), 67, 69 right ventricular (RV) dilation, 28 rigidity, 221 riluzole, 356 rimantadine, 213 risk-based reimbursement, 492 rituximab, 318, 320, 322 rivaroxaban, 364 RLQ. Seeright lower quadrant rocuronium, 367 Roos test, 250 rovsing sign, 68 RT sequelae, 281 RUQ. Seeright upper quadrant RZV. Seerecombinant zoster vaccine Saccharomyces boulardii, 206 “saddle nose,” 321 Salmonella, 203 sarcoma, 298-299 “sausage toe” or “sausage finger,” 315 SBIRT. Seescreening, brief intervention, and referral to treatment SBP. Seespontaneous bacterial peritonitis; systolic blood pressure SCD. Seesickle cell disease schizophrenia, 193, 198-199 SCI. Seespinal cord injury sciatica, 303 SCLC. Seesmall cell lung cancer scopolamine, 368 screening, brief intervention, and referral to treatment (SBIRT), 200 SE. Seestatus epilepticus seborrheic dermatitis, 331-333 second-line antibiotics, 140 secondary adrenal insufficiency (PAI), 165 secondary intention closure, dressings, 377 secondary peritonitis, 220-222 sedation, 351 SEER data, 273 seizure prophylaxis, 266, 351 seizures, 142, 148, 162, 208, 266 selective serotonin reuptake inhibitors (SSRIs), 195, 197selenium sulfide, 332 semipermeable films, 377 sepsis, 223-225 septic arthritis, 227-229 septic shock, 223 sequential organ failure assessment (SOFA), 223, 224 seronegative spondyloarthropathies, 314 serosanguineous, 407 serotonin norepinephrine reuptake inhibitors (SNRIs), 195, 197 serotonin syndrome, 195 sertraline (Zoloft), 197 serum electrolytes, 278 severe disease, 324 sex cord stromal tumors, 279 sexually transmitted infection (STI), 479-480 Shigella, 203 shivering, 162-163 shock, 352-354 hemodynamic profile of, 352 types of, 352 short-acting beta 2agonist (SABA), 15, 16, 20 short-acting muscarinic antagonist (SAMA), 21 short arm ulnar gutter, splinting, 446-447 short leg posterior splint, 449 short-term joint pain, 308 short-term therapy, venous thromboembolism, 260 shortness of breath (SOB), 317 shoulder reduction, 444-445 sick sinus syndrome (SSS), 43-44 sickle cell disease (SCD), 261-263 sigmoidoscopy, 87 single-chamber pacemakers, 47 single photon emission CT (SPECT), 266 sinuses, 10 SIRS. Seesystemic inflammatory response syndrome skilled nursing facilities (SNFs), 490 skin biopsy, 327, 332 skin cancer, 299-301 SLE. Seesystemic lupus erythematosus small bowel, 68 small cell lung cancer (SCLC), 291, 292 small vessel vasculitis, 321 smoking, 361 sniffing position, 418 SNRIs. Seeserotonin norepinephrine reuptake inhibitors sodium glucose cotransporter-2 (SGLT2) inhibitors, 172 SOFA. Seesequential organ failure assessment soft tissue sarcoma, 298 solumedrol, 318 somatic pain, 377 somatosensory evoked potential (SSEP), 142, 143 sotalol, 180 SPIKES method, 465 spinal cord compression, 297 spinal cord injury (SCI), 354-356 spinal fusion, 305 spinal laminectomy, 305 spinal osteomyelitis, 219 spinal stenosis, 303 spinal tap, 429 splenosis, 222 splinting, 229, 446-450 spondyloarthropathies, 314-315 spondylolisthesis, 303 spontaneous bacterial peritonitis (SBP), 73-75, 220, 221 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
526 spurious hypokalemiapseudohypokalemia, 118 SSI. Seesurgical site infections SSRIs. Seeselective serotonin reuptake inhibitors SSS. Seesick sinus syndrome ST-segment elevation myocardial infarction (STEMI), 35-39 stable angina, 40 stable disease, 315 staphylococcal bacteremia, 224 Staphylococcus, 222 Staphylococcus aureus, 26, 210, 219, 224, 228 Staphylococcus epidermidis, 286 stasis dermatitis, 333-334 statins, 238 status epilepticus (SE), 152-154 steatorrhea, 275 STEMI. See ST-segment elevation myocardial infarction stenosis, 60, 61 sterile gloves, 409 steroids, 60, 159, 376, 378 Stimson technique, 444, 445 stockinette, 425, 426 straight-leg test, 304 Streptococcus bovis, 210 Streptococcus pneumoniae, 25, 26 Streptococcus pyogenes, 329 stress testing, 41, 45 stress urinary incontinence (SUI), 136, 137 stroke, 374 struvite stones, 128 stryker pressure monitoring device, 306 sub-acute low back pain, 303 subacute endocarditis, 208 subarachnoid hemorrhage (SAH), 157 substance abuse, 201 substance-induced mood disorder, 193 substance use disorders, 200-201 SUI. Seestress urinary incontinence sulfamethoxazole, 222 sulfonylureas, 172 sumatriptan, 146 superior vena cava (SVC), 295, 394, 412 supine chest film, 348 supine position, 370 supraventricular tachycardias, 43 surgical first assistant, 371 surgical glue, 377 surgical revascularization, 248 surgical risk calculator, 361 surgical site infections (SSI), 375 surgical wounds, 375-376 SVC. Seesuperior vena cava swelling, 451 sympathomimetics, 181 symptomatic therapy, 88 synovial fluid, 313, 452, 453 synovial fluid aspiration, 228, 451-453 systemic inflammatory response syndrome (SIRS), 223-227 systemic lupus erythematosus (SLE), 315-318 systolic blood pressure (SBP), 55, 161, 352 T-lymphocytes (T-ALL), 282 tachycardia, 221, 225, 374 tachypnea, 373 tadalafil, 100 takayasu arteritis, 324, 325 Tamiflu (oseltamivir), 213 tamsulosin, 100 Tapazole (methimazole ), 185 tardive dyskinesia, 199 targeted temperature management (TTM) criteria for, 160fever management, 157-159 hypothermia after cardiac arrest, 160-164 stages of, 161 TB. Seetuberculosis TBI. Seetraumatic brain injury TCAs. Seetricyclic antidepressants Tdap (vaccine), 473 tedizolid, 331 TEE. Seetransesophageal echocardiogram Tegretol (carbamazepine), 193 Tele ICU, 489 telemedicine in acute care, 489-492 healthcare quality, 491 types of, 489 Telemonitoring, 490 Tele Psych, 489 temperature monitoring methods, 158 temperature, peritonitis, 221 tenofovir, 85 tension-type headache, 145, 146 tertiary adrenal insufficiency (PAI), 165 tertiary peritonitis, 220 tetanus, 473 tetanus-diphtheria (Td), 473 THA. Seetotal hip arthroplasty thalassemia, 254 thalidomide, 318, 320 therapeutic hypothermia. Seetargeted temperature management therapeutic range, bipolar disorder, 193 thiamine, 154 thiazide diuretics, 56, 128 thiazolidinediones, 172 thoracentesis, 24, 454-456 thoracic aortic aneurysm and dissection (TAAD), 237 thoracic aortic aneurysms, 237 thoracic bioimpedance, 483 thoracic bioreactance, 483 thoracic injuries, 349 thoracic outlet syndrome (TOS), 249-250 thoracoabdominal aortic aneurysms, 237 thrombin gel, 368 thrombocytopenia, 73, 256 thrombocytosis, 257 thromboembolic event, 364 thrombolytic therapy, 29, 260 thrombolytics, 39, 152, 156 thrombophilia, 257 Thrombosis in Myocardial Infarction (TIMI) score, 37 thrombotic thrombocytopenic purpura (TTP), 251, 254 thumb spica splint, 448 thyroid disorder euthyroid sick syndrome, 183-184 hyperthyroidism, 184-185 hypothyroidism, 186-187 myxedema coma, 187-188 thyroid storm, 188-190 thyroid gland, 183, 184, 186 thyroid peroxidase (TPO), 184, 185 thyroid-stimulating hormone (TSH) euthyroidsicksyndrome, 183 hyperthyroidism, 184 hypothyroidism, 186 myxedema coma, 187 thyroid-stimulating immunoglobulin (TSI), 184, 185 thyroid storm, 188-190 thyroidectomy, 189 thyrotoxicosis, 188 TIA. Seetransient ischemia attack ticagrelor, 365 tick-and mosquito-borne illnesses, 213 ticlopidine, 241, 365time-limited services, 493 TIMI. See Thrombosis in Myocardial Infarction tinea pedis, 329, 333 tiopronin, 129 tirilazad, 356 tissue factor, 208 titrate, 154 tobacco use, 476 tobramycin, 26 tomosynthesis, 268 tonometry, 146 topiramate, 146 Toradol, 310 toradol, 349 total body water (TBW), 113, 114 total cholesterol (TC), 48-49 total hip arthroplasty (THA), 309 total knee arthroplasty (TKA), 307 total parenteral nutrition (TPN), 432 tramadol, 378 tranexamic acid, 368 trans-tubular potassium gradient (TTKG), 118 transarterial chemoembolization (TACE), 274 transesophageal echocardiogram (TEE), 45, 63, 209, 484 transfusions, 368 transient ischemia attack (TIA), 155-156 CHA2DS2-VASc Score, 152 transient ischemic attack, 374 transitional care, 493-497 advance directives, 495 bridge the gaps, 496 care plan, 496 communication, 493 complex problem lists, 495 define of, 493 geriatric, 496 interim risks, 494 medical record systems, 496 medication errors, 494 poorly communicated, 495 unclear follow-up instructions, 494 transparent polyurethane dressings, 377 transpulmonary thermodilution, 485 transpyloric feeding tube placement, 457-459 feeding tube with guidewire, 457 transthoracic echocardiogram (TTE), 63, 161, 209 transthoracic echocardiography (TTE), 155, 482 transudative pleural effusions, 23 transurethral resection of the prostate (TURP), 100 transvaginal ultrasound, 278 trauma guidelines chest trauma, 347-349 penetrating chest injuries, 349-350 penetrating intracranial injuries, 350-351 shock, 352-354 spinal cord injury, 354-356 traumatic brain injury, 357-358 traumatic brain injury (TBI), 157, 357-358 trendelenburg position, 370 triamcinolone, 312, 318, 334 tricyclic antidepressants (TCAs), 181, 196 triglycerides (TG), 48-49, 179 trimethoprim, 222 trimethoprim-sulfamethoxazole, 331 TST. Seetuberculosis skin test TTE. Seetransthoracic echocardiogram TTKG. Seetrans-tubular potassium gradient TTM. Seetargeted temperature management tuberculosis (TB), 230-233Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
527 tuberculosis skin test (TST), 230 tumor lysis syndrome (TLS), 286, 295, 297 tumor necrosis factor (TNF), 313, 315 Tylenol, 305, 309, 322, 349 type 1 diabetes, 167-170 type 2 diabetes, 170-175 tyrosine kinase inhibitors (TKIs), 285 UA. Seeunstable angina UGIB. Seeupper gastrointestinal bleeding UI. Seeurgency incontinence ulcerative colitis (UC), 86-88 ulnar artery, 244 ultrasonic CO monitoring, 484 ultrasonography, 483 pulmonary embolism, 28 ultrasound, 432 ultrasound guided biopsy, 229 unclear follow-up instructions, 494 unstable angina (UA), 35, 37-38, 40 upper extremity, 243-245 upper extremity sugar-tong splint, 447-448 upper gastrointestinal bleeding (UGIB), 78-80 upper limb ischemia, 235 upper respiratory infections (URIs), 213 upper respiratory tract, 321 urethritis, 138 urgency incontinence (UI), 136, 137 uric acid stones, 128 urinalysis, 51 urinary incontinence, 135-137, 343-346 urinary infection, 374 urinary stream, 105 urinary tract infections (UTIs), 128, 129 urine cytology, 105 urine pregnancy test, 362 URIs. Seeupper respiratory infections uroflowmetry, 99 urology, 100 U. S. Preventive Services Task Force (USPSTF), 49, 467, 475-479 USPSTF. See U. S. Preventive Services Task Force UTIs. Seeurinary tract infections uveal melanomas, 300 vaccines, for teenagers, 469-472 valproate (Depakote), 193 valproic acid, 146, 154 valvular heart disease (VHD), 60-65 vancomycin, 26, 205, 206, 216, 229, 372 varenicline (Chantix), 201 variceal hemorrhage, 78 varicella, 474 vascular diseases, 339 vascular injury, 35 vascular laboratory, 245 vasculitis, 222 large vessel, 324-325 medium vessel, 323-324 small vessel, 320-322 variable vessel, 319-320 vaso-occlusive crisis (VOC), 261, 262 vasoactive agent therapy, 226 vasodilators, 24 vasopressin, 353 vasopressors, 226, 351, 353, 368, 432 vecuronium, 367 vegetative state, 141 venous stasis, 258 venous thoracic outlet syndrome (v TOS), 249 venous thromboembolism (VTE), 29, 257, 258 ventilation/perfusion (V/Q) lung scan, 28, 29 ventilator-acquired pneumonia (VAP), 26 ventricular arrhythmias, 43 ventricular fibrillation (VF), 43-46 ventricular tachycardia (VT), 43-46, 160, 161 verapamil, 146 verbal rating scale, 377 vertebroplasty, 297, 305 VHD. Seevalvular heart disease vibrio species, 329 videolaryngoscope, 143, 415viral conjunctivitis, 5 viral encephalitis, 206, 207 viral meningitis, 214, 216 viral pharyngitis, 7 Virchow's triad, 258 Viridans streptococci, 210 visceral pain, 377 visceral pericardium, 58 vital signs, 272 volar dislocation reduction, 437 volar wrist splint, 448 von Willebrand disease (VWD), 255, 256 von Willebrand factor (v WF), 254, 258 Vosevi, 86 warfarin, 241, 248, 260, 364 WBC. Seewhite blood cells webril/synthetic undercast padding, 426 Wernicke's aphasia, 336 wheezing, algorithm for, 14-15, 18, 30 whipple procedure, 276 white blood cells (WBC), 204, 215, 222, 317 WHO. See World Health Organization Wilson's disease, 273 Wong-Baker visual analog scale, 377 World Health Organization (WHO), 378 wound assessment, 377 classifications, 371 healing, 371, 376-377 xerostomia, 281 Xifaxan, 74 zanamivir (Relenza), 213 Zepatier, 86 zinc oxide, 328 Zoloft (sertraline), 197 zoster, 474 zoster vaccine live (ZVL), 474 Zosyn (piperacillin-tazobactam), 26 ZVL. Seezoster vaccine live Zyban (bupropion), 201 Index | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |