The Washingtong Manual of Medical Therapeutics Patient Care in Internal Medicine Jianan Wang MD PhD Second Affiliated Hospital Zhejiang University School Of Medicine General Care of the Hospitalized Patient GENERAL PRINCIPLES Individualization based on Evidence Medicine Careful Explanation( benefits, risks and alternative) Basic measures minimizing risks Use of standardized abbreviations and dose designations munication between physicians and other caregivers Institution of appropriate prophylactic precautions Prevention of ial infections, including attention to hygiene and discontinuation of unnecessary catheters Medicine reconciliation at all transfers of care Hospital Orders Admission Order following ADC VANDALISM
Admitting service, location, and physician responsible for the patient Diagnoses Condition of the patient Vital signs with frequency Activity limitations Nursing instructions (., Foley catheter to gravity drainage, wound care, daily weights) Diet. Remember that “npo” may preclude oral medications unless specified Allergies, sensitivities, and previous drug reactions Laboratory tests and radiographic studies IV fluids, position and rate Sedatives, analgesics, and other PRN medications Medications, including dose, frequency, route, and indication. State “First dose now” when appropriate Prophylactic Measures Venous Thromboembolism Prophylaxis Most preventable cause of death in Hosp. Drugs for prevention of DVT Heparine LMWH 10a antagonist: fondaparinux, rivaroxaban (拜瑞妥) Mechanical prophylaxis with intermittent pression or pression stockings Aspirin is not indicatied 外科病人静脉血栓危险分层 ACCP 共识会议对外科手术病人静脉血栓的危险分层 低危: 年龄< 40 岁小手术无其他危险因素 中危: 年龄> 40 岁大手术无其他危险因素 高危: 年龄> 40 岁大手术合并一个其他危险因素 (MIs 或 VTE 过去史肿瘤高凝状态) 极高危: 年龄> 40岁大或小手术合并多个其他危险因素 (VTE 或 IS 过去史肿瘤高凝状态) 全髋或全膝关节置换术髋部骨折 严重创伤脊柱损伤 1 0 2 3 Low risk Increased risk 0 1 2 3 Class of predisposing risk Dehydration Polycythaemia or thrombocytosis Varicosis VTE in family HRT
