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    Morport 12 Des 17

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    Cindhy Karania Metta Silavatto
    This document contains a morning report on a patient named Mrs. H, who presented with fatigue. The report includes details on her identity, chief complaints, physical exam findings, therapy plan, and references acute gastroenteritis and approaches to diagnosis and treatment. The patient was given IV fluids and antibiotics and planned for hospitalization.

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    Morport 12 Des 17

    Uploaded by

    Cindhy Karania Metta Silavatto
    22 views31 pages
    This document contains a morning report on a patient named Mrs. H, who presented with fatigue. The report includes details on her identity, chief complaints, physical exam findings, therapy plan, and references acute gastroenteritis and approaches to diagnosis and treatment. The patient was given IV fluids and antibiotics and planned for hospitalization.

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    morport

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    This document contains a morning report on a patient named Mrs. H, who presented with fatigue. The report includes details on her identity, chief complaints, physical exam findings, therapy plan, and references acute gastroenteritis and approaches to diagnosis and treatment. The patient was given IV fluids and antibiotics and planned for hospitalization.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    22 views31 pages

    Morport 12 Des 17

    Uploaded by

    Cindhy Karania Metta Silavatto
    This document contains a morning report on a patient named Mrs. H, who presented with fatigue. The report includes details on her identity, chief complaints, physical exam findings, therapy plan, and references acute gastroenteritis and approaches to diagnosis and treatment. The patient was given IV fluids and antibiotics and planned for hospitalization.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    Morning Report

    Tuesday, 12th December of 2017

    2nd Team
    Identity
     Name: Mrs. H
     Age : 60 Years Old
     Address: Naasir Street No.12, Cawang
     Educational Background : High School
     Status : Married
     Nation : Indonesian/Javanese
     Religion : Moslem
    Chief Complain : Fatigue since 3 hours ago.
    Chief Complain : Fatigue since 3 hours ago.
    Physical Examination
     LOC: E4 M6 V5
     BP: 120/80 mmHg
     HR: 110x/min
     RR: 23x/min
     T: 37,7°C
    General Examination
     Head: Normocephaly
     Eye: conjunctiva anemic -/-
     sclera icteric -/-
     ENT: normal
     Mouth: normal
     Neck: No lymph node enlargement
     Thorax:
     Ins: Symmetrical respiratory movements
     Pal: Symmetrical vocal fremitus
     Per: Sonor sounds all over lung platform
     Aus: lungs sounds vesicular
    Rhonchi -/-, Wheezing -/-, Heart sound I & II regular, Murmur -
    /-, Gallop -/-
    Continued…
     Abdominal:
     Ins: Appeared flat
     Aus: Intestinal sounds (+), 7x/min
     Per: Timpanic, percussion pain (-), acites (-)
     Pal: Pressure pain (-), release pain (-), defense muscular (-)
    Therapy
     IVFD:
     III RL / 24 hours
     MM/
     Pumpitor inj 1x1 IV
     Ondansentron 4mg 2x1 IV
     Ceftriaxone 2gr 1x1 IV
     New Diatabs 2 tabs every diarrhea
    Planning
     Pro-hospitalized
    References
    Acute Gastroenteritis
    Acute Abdomen

    Intraluminal Extraluminal Gastrointestin Paralytic Blunt Miscellaneous


    Obstruction Obstruction al Ileus Trauma
    Disease

    Foreign Body Hernia Appendicitis Sepsis Accident Lead poisoning


    Bezoar Intussusceptio Crohn disease Pneumonia Battered child Sickle cell
    Fecalith n Ulcerative Pyelonephritis syndrome disease
    Gallstone Volvulus colitis Peritonitis Familial
    Parasites Duplication Vasculitis Pancreatitis Mediterranean
    Stenosis Peptic ulcer fever
    Cystic fibrosis Cholecystitis
    Tumor disease Porphyria
    Tumor Renal stones
    Mesenteric cyst Meckel’s DKA
    Fecaloma Gallstones
    SMA syndrome AGE Addisonian
    PID crisis
    Pyloric stenosis Lymphadenitis Testicular
    torsion
    Ovarian Torsion
    Approach
     History
     Symptoms
     Nausea, emesis, retching
     Abdominal pain
     Bowel movements
     Timing
     Age
     Onset
     Relation to feeds
     Focus of infection, other affected individuals
    Approach
     Physical examination
     Temperature, heart rate, blood pressure, pain
     Abdominal examination
     Auscultation before palpation
     Palpation
     Masses
     Tenderness
     Auscultation for bowel sounds
    Approach
     Objectives
     Assess the degree of dehydration
     Prevent spread of the enteropathogen
     Selectively determine etiology and provide specific therapy
    Dehydration
     Mild (3-5%)
     Normal or increased pulse
     Decreased urine output
     Thirsty
     Normal physical exam
    Dehydration
     Moderate (7-10%)
     Tachycardia
     Little/no urine output
     Irritable/lethargic
     Sunken eyes/fontanelle
     Decreased tears
     Dry mucous membranes
     Skin- tenting, delayed cap refill, cool, pale
    Dehydration
     Severe (10-15%)
     Rapid, weak pulse
     Decreased blood pressure
     No urine output
     Very sunken eyes/fontanelle
     No tears
     Parched mucous membranes
     Skin- tenting, delayed cap refill, cold, mottled
    Dehydration
     Treatment
     Calculate deficits
     Water: % dehydration x weight
     Sodium: water deficit x 80 mEq/L
     Potassium: water deficit x 30 mEq/L
     Treat mild-moderate dehydration with oral rehydration
    solutions
     May treat severe dehydration with intravenous fluids
     Hyponatremic v. isotonic v. hypernatremic
    Etiology
     Enteropathogens
     Non-inflammatory vs. inflammatory diarrhea
     Non-inflammatory
     Enterotoxin production
     Destruction of villi
     Adherence to GI tract
     Inflammatory
     Intestinal invasion
     Cytotoxins
    Etiology
     Chronic diarrhea
     Giardia lamblia
     Cryptosporidium parvum
     Escherichia coli: enteroaggregative, enteropathogenic
     Immunocompromised host
     Non-infectious causes: anatomic, malabsorption,
    endocrinopathies, neoplasia
    Etiology
     Bacterial
     Inflammatory diarrhea
     Aeromonas
     Campylobacter jejuni
     Clostridium dificile
     E. coli: enteroinvasive, O157:H7
     Plesiomonas shigelloides
     Salmonella
     Shigella
     Vibrio parahaemolyticus
     Yersinia enterocolitica
    Etiology
     Bacterial
     Non-inflammatory
     E. coli: enteropathogenic, enterotoxigenic
     Vibrio cholerae
     Viral
     Rotavirus
     Enteric adenovirus
     Astroviruus
     Calcivirus
     Norwalk
     CMV
     HSV
    Etiology
     Parasites
     Giardia lamblida
     Entamoeba histolytica
     Strongyloides stercoralis
     Balantidium coli
     Cryptosporidium parvum
     Cyclospora cayetanensis
     Isospora belli
    Diagnosis
     History
     Stool examination
     Mucus
     Blood
     Leukocytes
     Stool culture
    Diagnosis
     Examination for ova and parasites
     Recent travel to an endemic area
     Stool cultures negative for other enteropathogens
     Diarrhea persists for more than 1 week
     Part of an outbreak
     Immunocompromised
     May require examination of more than one specimen
    Antimicrobial therapy
     Aeromonas
     TMP/SMZ
     Dysentery-like illness, prolonged diarrhea
     Campylobacter
     Erythromycin, azithromycin
     Clostridium dificile
     Metronidazole, vancomycin
     E. coli
     TMP/SMZ
    Antimicrobial therapy
     Salmonella
     Cefotaxime, ceftriaxone, ampicillin, TMP/SMZ
     Infants < 3 months
     Typhoid fever
     Bacteremia
     Dissemination with localized suppuration
     Shigella
     Ampicillin, ciprofloxacin, ofloxacin, ceftriaxone
     Vibrio cholerae
     Doxycycline, tetracycline
    Therapy
     Antidiarrheal medication
     Alter intestinal motility
     Alter adsorption
     Alter intestinal flora
     Alter fluid/electrolyte secretion
     Antidiarrheal medication generally not recommended
     Minimal benefit
     Potential for side effects
    Prevention
     Contact precautions
     Education
     Mode of acquisition
     Methods to decrease transmission
     Exclusion from day care until diarrhea subsides
     Surveillance
     Salmonella typhi vaccine

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