Griffith's Instructions for Patients E-Book , livre ebook

GRIFFITH’S INSTRUCTIONS for PATIENTS
Eighth Edition

Stephen W. Moore, M.D.
Tucson, Arizona
SAUNDERS
Copyright
SAUNDERS ELSEVIER
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
GRIFFITH’S INSTRUCTIONS FOR PATIENTS
EIGHTH EDITION
ISBN: 978-1-4377-0909-4
Copyright © 2011, 2005, 1998, 1994, 1989, 1982, 1975, 1968 by Saunders, an imprint of Elsevier Inc.
Copyright renewed 1996 by Jo A. Griffith
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher, except for the printing of complete pages, with the copyright notice, for instructional use and not for resale. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions .
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).


Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-1-4377-0909-4
Acquisitions Editor: Dolores Meloni
Editorial Assistant: Justin Hare
Publishing Services Manager: Patricia Tannian
Senior Project Manager: Sharon Corell
Design Direction: Steve Stave
With the assistance of Jo A. Griffith
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Preface to the Eighth Edition
As a practicing family physician, I place a tremendous amount of importance on my patients’ understanding of their particular ailments. I cannot stress enough how important it is to the healing process for patients to fully comprehend all aspects of their condition. Continuing with the work of H. Winter Griffith, MD, this, the eighth edition, revises and updates the topics from the seventh edition and includes 11 new topics. The majority of the written material is at grade 8 reading level or below (which is the recommended reading level for printed patient information).
With these patient instruction sheets available in your office, you have an opportunity to provide preplanned, printed materials to patients and their families at a time when they are most motivated to learn—when there is a problem and they have come to you for help. These handouts provide quick, inexpensive, and effective supplements to personal contact. If patients perceive the materials distributed to them as an extension of the physician, the instruction sheets become a powerful teaching tool. They help to reinforce oral instructions and refresh the patient’s memory with written material they can take home.
This book contains information on 432 medical disorders. Each medical disorder is on a single page. This makes it a simple process to copy a page on your office copy machine and then hand it out to your patient. There is space on each page for writing additional notes if appropriate.
A companion online website www.expertconsult.com contains the complete contents of this book plus information on 123 additional medical topics. Instruction pages are also available for 23 special diets that will help your patients follow any prescribed dietary changes. All of these patient instruction pages can be easily printed from the website and readily distributed to your patients.
I know that both you and your patients will find this type of patient instruction useful and beneficial.
I wish to thank Ruth M. Schaller, RN, FNP for editing the medical topics and Tracy E. Crane, MS, RD for editing the diet section.

Stephen W. Moore, MD
Table of Contents
Instructions for online access
Copyright
Preface to the Eighth Edition
Topics
A
B
C
D
E
F
G
H
I
K
L
M
N
O
P
R
S
T
U
V
W
Z
Diets
A
B
C
D
F
G
I
L
P
S
T
W
INDEX
Topics
A

ABRUPTIO PLACENTAE

BASIC INFORMATION

DESCRIPTION
Abruptio placentae is separation of the placenta (also called the afterbirth) from the uterine wall before the baby is born. The placenta carries all nutrients and oxygen to the fetus. A separation can cause complications for the mother and the fetus. With a small separation, there may be no or few symptoms. Larger separations usually cause symptoms.

FREQUENT SIGNS & SYMPTOMS

• Bleeding may be external (vaginal bleeding) or it may be concealed (bleeding remains in the uterus).
• Mild pain or discomfort, or there may be severe pain in the lower abdomen or back.
• Decreased fetal movement.
• Hard, tender abdomen. Uterine contractions.

CAUSES
The cause is unknown. Certain risk factors do exist.

RISK INCREASES WITH

• High blood pressure (hypertension).
• Smoking.
• Women over age 35 or younger than 20.
• Women who have had more than 4 or 5 pregnancies.
• A previous pregnancy with placental separation.
• Pregnancy with more than one fetus.
• Excess amniotic fluid (polyhydramnios).
• Chronic disorder (such as diabetes) or renal infection.
• Injury from motor vehicle accident, falls, or abuse.
• Short umbilical cord.
• Abnormal uterus or uterine tumor.
• Premature rupture of the membranes (water breaks before the onset of labor).
• Use of alcohol or drugs of abuse (such as cocaine).

PREVENTIVE MEASURES

• There is no sure way to prevent the problem.
• Avoid risk factors such as smoking, alcohol, or cocaine use. Get treatment for high blood pressure.

EXPECTED OUTCOMES
When the separation is less severe and with immediate medical care, the outlook for mother and fetus is good.

POSSIBLE COMPLICATIONS

• Premature delivery of the child. This may lead to other complications for the newborn.
• Intrauterine growth restriction (IUGR) of the fetus.
• Shock or life-threatening bleeding in the mother.
• Blood clotting problems for the mother (disseminated intravascular coagulopathy or DIC).
• Risk of abruptio placentae in a future pregnancy.
• Uncontrolled bleeding after delivery may lead to an emergency hysterectomy.
• Death of child and/or mother.

DIAGNOSIS & TREATMENT

GENERAL MEASURES

• Your obstetric provider will do a physical exam and ask questions about your symptoms. Medical tests will include blood studies and blood clotting tests. An ultrasound may be done.
• Treatment depends on the severity of the separation, the condition of the fetus, and the duration of the pregnancy. Hospital care is usually needed (except for mild cases) so the mother can be observed for any complications. If the placenta separation is slight, you may be able to return home for bed rest and close observation.
• In the hospital, fluids may be given through a vein (IV). A blood transfusion may be needed.
• Labor may be induced, if the pregnancy is at term or if there are signs of fetal distress.
• Surgery to deliver the unborn child by cesarean section, or vaginal delivery (sometimes).

MEDICATION
A drug to induce labor may be used if immediate delivery is required.

ACTIVITY
Whether you are in the hospital or have been able to return home, follow all medical instructions about any activity limits.

DIET

• A liquid-only diet may be prescribed until it is decided if surgery will be needed.
• If you are resting at home,