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Extra info for The Nerd's Guide to Pre-Rounding: A Medical Student's Manual to the Wards
A PCA can reduce pressure on the nurses to respond to repeated requests for breakthrough pain doses and can improve total pain control. 10 Riley, TR 3rd, Bhatti, AM. Preventive strategies in chronic liver disease: Part I. Alcohol, vaccines, toxic medications and supplements, diet and exercise. Am Fam Physician. 2001;64:1555–1560. Erratum in: Am Fam Physician. 2002;65:2438. 24 The Nerd’s Guide to Pre-Rounding Special note on chronic pain and methadone patients. , sustained-release morphine or oxycodone) will go into withdrawal if you neglect to write for these meds.
To create a problem list, it’s helpful to think in terms of all the issues that have arisen on the patient. , “1. Neurologic function, blah blah. 2. ” On most services, however, problem items should be specific problems, not organ systems. Notice in the Jones example, some items were diseases (wound or infection) and others were symptoms (pain and nausea). What constitutes a unique problem item is a subjective call. In a patient with ESRD (endstage renal disease) and hyperkalemia (K), docs who are “splitters” might number each of those as separate issues (one chronic, the other acute), whereas “lumpers” would put them as one problem, since the K problem is due to the ESRD.
It mostly applies to patients accepted direct to the floor, who may not have had common baseline tests often done in the ED. Of course, some patients may not get all needed baseline tests even when they do come through the ED. Specifically, consider whether your patient needs a baseline ECG CXR (chest x-ray), and/or UA (urinalysis). You don’t always have to order such tests, but having baseline studies can be helpful. One example: I had a patient with leukemia who developed hypoxia and tachycardia.