Med Surg Final exam review

Final exam review with content from each chapter

Med-Surg Final Exam Review


Fluid and Electrolyte

Sodium: 135-145

Potassium: 3.5-5.0

Calcium: 8.6-10.2

Magnesium: 1.3-2.3

Chloride: 97-107

Hypernatremia > 145

 : excess fluid/water loss, too much Na+, heat str Causes oke, DI

 S&S : thirst, elevated temp., dry swollen tongue, stick mucosa, neuro signs, restlessness and

weakness, Inc. HR/BP

 Management : hypotonic, isotonic (D5W), adequate tube feeding

Hyponatremia < 135

 : overuse diuretics, adrenal insufficiency, SIADH Causes , N/V/D, anticonvulsants

 S&S : poor skin turgor, dry mucosa, headaches, decreased salivation, low BP, N, abdominal cramping,

neuro changes (AMS, seizures and coma), edema, anorexia

 Management : water restriction and sodium replacement

Hypercalcemia > 10.2

 : Malignant tumor, hyperparathyroidism, immobilit Causes y

 S&S : muscle weakness, constipation, anorexia, N/V, dysrhythmias, decreased DTR, bone pain,

dehydration, mental changes

 Management : ambulation, encourage fluids, fiber for constipation

Hypocalcemia < 8.6

 : post thyroidectomy, pancreatitis, hypoparathyro Causes idism, renal failure, corticosteroids, antacids

w/ aluminum

 S&S : tetany, increased DTR, numbness/tingling, Trousseaus/Chvostek sign, seizures, respiratory

depression, SOB, D, decreased HR/BP

 Management : vitamin D and calcium supplements, increased calcium in diet, IV calcium gluconate,

weight bearing exercises

Hyperkalemia > 5.0

 : kidney injury, K sparring diuretics, metabolic Causes acidosis, Addison's disease, burns and certain

medications

 S&S : peaked T, muscle weakness, tachycardia, dysrhythmias, paralysis, colic, cramps, abdominal

distension, anxiety

 Management : K+ diet restriction, monitor HR, lungs, urine and ABGs

Hypokalemia < 3.5

 : D/V, gastric suctioning, diuretics, GI loss, po Causes or intake, digoxin toxicity

 S&S : fatigue, anorexia, N/V, dysrhythmias, muscle weakness/cramps, paresthesia, glucose

intolerance, dec. muscle strength/DTR

 Management : cardiac monitoring, kidney functioning (BUN, creatinine), UO

Fluid volume deficit (FVD) dehydration from loss of water and increased sodium

 Clinical manifestations: increased temp, poor capillary refill, pale skin, tachycardia, poor skin turgor,

weak pulse, postural hypotension, hypovolemia, confusion, weight loss, dry mucous membranes,

oliguria, concentrated urine, weakness, muscle cramps, sunken eyes

 Labs:

o ↑ Hemoglobin∧h emotocrit

o ↑ serum∧urine osmo∧specific gravity

o ↑ BUN∧creatinine

o ↓urine sodium

Hypokalemia occurs with GI and renal loss, Hyperkalemia occurs with adrenal insufficiency

Hyponatremia occurs with increased thirst and ADH release, hypernatremia results from increased insensible

losses and DI

Respiratory

Asthma

 S&S : chest tightness, cough, wheezing, dyspnea

 Medications

o Quick-relief medications

 - albuterol SABA

 Anticholinergics - ipratropium (Atrovent)

o Long-acting control medications

 - prednisone, Medrol Corticosteroids

 - Salmeterol LABA

 Mast cell stabilizers - Cromolyn

 Potential complications: status asthmaticus, respiratory failure, pneumonia & atelectasis

o S&S of status asthmaticus- labored breathing, prolonged exhalation, engorged neck veins,

wheezing

o Rising CO2 levels can lead to respiratory acidosis which could lead to respiratory failure

TB

 S&S : fatigue, malaise, anorexia, weight loss, low grade temperature (late afternoon), night sweats,

chronic cough (productive), hemoptysis in advanced stage

 Transmitted airborne, diagnosis with Mantoux test, interferon y release essay or chest x-ray; TB blood

test preferred for those who received the BCG vaccine

 Treatment is for 6 to 12 months, ensure ratification and prevent relapse

 Education: important hygiene measures, including mouth care, covering the mouth and nose when

coughing and sneezing, proper disposal of tissues, and hand hygiene

Pneumonia

 S&S : sudden onset of chills, rapidly rising fever (101-105°), pleuritic chest pain that is aggravated by

deep breathing and coughing, tachypnea (25-45 breaths/min) the pt. is in respiratory distress with SOB

and use of accessory muscles

o Other: fatigue, bradycardia, upper respiratory tract infection (nasal congestion and sore

throat), orthopnea, headache, rash, myalgia, pharyngitis

 Diagnosis is made by: history of recent URTI, psychical exam, chest x-ray, blood culture (bacterium),

sputum culture

 Management:

o Antibiotics- not used for viral

o Hydration- b/c fever & tachypnea lead to fluid loss

o Antipyretics- treats headache & fever

o Antitussives- cough

o Oxygen- w/ hypoxemia, nebulizer treatments

 Recommendations- proper nutrition, hand washing, cough/sneeze into elbows, identify at risk

patients, monitor condition

 Nursing interventions : TREATMENT RESPONSE IN 24 TO 48 HOURS

o Help improve airway patency- remove secretions, hydration, humidification, deep breathing

w/incentive spirometer, chest physiotherapy "chest cupping" (percussion and postural draining),

oxygen therapy

o Promote rest and conserve energy, avoid overexertion

o Increase fluid intake (at least 2 L/day) monitor closely in HF

o Nutrition with small frequent meals or oral nutritional supplements

o Monitor for complications- physical status and recurrent fever (med allergy) and resistance

could be lung cancer

 Assess older adults for altered mental status, dehydration, fatigue, HF

COPD

 S&S : chronic cough, sputum production and dyspnea

 Interventions : corticosteroids, antibiotic agents, oxygen therapy, intensive respiratory interventions

o Nursing interventions- breathing exercises, activity pacing, self-care activities, physical

conditioning, oxygen therapy, nutritional therapy, coping measures, palliative care

 Medications: SABA (albuterol), LABA (servient), Corticosteroid (Solumedrol IV) or Inhaled (Flovent)

o Grade I (mild) → SABA broc h odilators

o Grade II and III → SABA bronc h odilators∧reg .treatment wit h 1∨more LABA

o Grade III and IV

→reg .treatment wit h 1∨more BD∧¿∈h aled corticosteriods for repeated exacerbations

Pulmonary arterial hypertension S&S: dyspnea, fatigue, angina, near-syncope, edema and palpitations

GI

 Perforation S&S: rigid abdomen, low BP, rebound tenderness, tachycardia, pain in R shoulder,

vomiting blood, sudden/sharp pain

 Peritonitis

o S&S : fever, tachycardia, rebound tenderness and hypotension

o Nursing interventions : analgesics, antibiotics, fluid and electrolyte replacement, oxygen

therapy, antiemetics, intestinal intubation and suction, identify source of infection, watch for

septic shock, monitor vitals, softening abdomen, bowel sounds

 Ileostomy & colostomy

o Maintain fluid and electrolyte status (Na & K), colostomy more formed stools, ileostomy

needs more fluids

o NG suction during post-op, with frequent irrigation

 N and abdominal distention may indicate intestinal obstruction

 Diverticular disease

o S&S : C/D, N, anorexia, bloating and abdominal distention

o Manage through NG decompression (monitor output) and NPO, increase fiber in diet

 Leaking amount of stool may indicate bowel obstruction

 Peptic Ulcer Disease

o S&S : GI bleeding, midepigastric pain, indigestion, heartburn, N/V, bloating and acid reflux,

weight loss

o Risk factors : Zollinger-Ellison Syndrome (ZES), family history, blood type O, smoking/alcohol

o : H. Pylori, NSAID use & excessive hydrochloric a Common causes cid

 H. Pylori treated with triple therapy- 2 antibiotics and PPI for 10-14 days

o Monitor CBC for active bleed, assess for malnutrition and weight loss, complications are

hemorrhage, perforation or gastric outlet obstruction

o Patient education: smoking cessation and diet modification, avoid extreme temp. foods,

avoid caffeine & alcohol, small meals and no NSAIDs

 Crohn's Disease (IBD)

o S&S : D, C or both, pain, bloating, abdomen distension

 Abdomen pain, can occur anywhere in GI tract, inflammation in separate lesions,

prone to fistulas

o Promote bowel rest, might need TPN

o : Labs

 CBC and c reactive protein

 ↓ H ∧H ,WBC

 ↑ ESR

 Medications for GI:

o H2 blockers- Famotidine (Pepcid), Ranitidine (Zantac), Cimetidine (Tagamet)

 Risk for C. Diff

o PPIs- Pantoprazole (Protonix) and Omeprazole (Prilosec)

 Risk for hip fractures and interfere with vitamins and mineral absorption

o Prokinetic agents risk for TD

Biliary/Pancreas

 Cholelithiasis

o S&S : fever, palpable abdominal mass, biliary colic, pain in URQ that radiates to the back or R

shoulder, N/V these are noticed after a heavy meal or fatty meal

o Pt. may have jaundice & dark colored urine and grey/clay colored stool, may be deficient in

fat soluble vitamins

o Nursing interventions : avoid morphine, promote rest, IV fluids, NPO, give antibiotics,

analgesics, and NG suction

 Open and laparoscopic cholecystectomy

o ERCP are done to explore the duct, assess cough & gag reflexes post-op

o Laparoscopic - pt. may be in the hospital 1-2 days, cannot lift more than 5 lbs. till a week

later, manage pain and report signs of abdominal complications (N/V, distension and fever), if

they have pain in the R shoulder or scapula area they can use a heating pad 15-20 min hourly this

is because the CO2 has migrated

o - drain placed normal for small amount of serosan Open guineous fluid in the first 24 hours

after surgery

 Have patient cough, deep breathing, incentive spirometer, ambulate, splint incision

 Diet low in fat and high in carb and protein

 Pancreatitis

o : gallbladder disease and chronic alcoholism Causes

o S&S : severe abdominal pain in midepigastric area, acute pain that occurs 24 to 48 hours after

a heavy meal or alcohol ingestion that is unrelieved by antacids

 Others: absent bowel sounds (if ileus present), N/V, systemic inflammation (fever,

tachycardia, leukocytosis)

 If hemorrhagic (severe pancreatitis) GREY TURNER & CULLEN sign

 Mild jaundice, anxious and agitation

o : Labs

 ↑ AST ∧WBC

 ↑ serum amylase∧lipase

 ↓Ca h ypocalcemia=tetany , + Trousseaus & Chvostek

 ↑ h yperglycemia

 Monitor H&H for active bleeding

o Nursing management : manage pain can position knee flex, H2 and PPI medications, oral feedings

low in fat and protein, monitor respiratory to avoid pulmonary infiltrations and place pt. in semifowlers, incentive spirometer, NPO, NGT, bedrest, monitor fluid and electrolyte with skin turgor,

I&Os, and daily weight

o : Treatment

 Avoid alkaline foods, meds are to reduce gastric acid, low fat diet, give pancreatic enzymes

with meals

 Long term alcohol abuse can cause chronic pancreatitis which could lead to recurrent attacks

of epigastric pain with N/V, exocrine insufficiency (steatorrhea= fatty D), endocrine

insufficiency (diabetes), and weight loss

Heart Failure

Right Sided HF Left Sided HF

Viscera and peripheral congestion Pulmonary congestion crackles

Jugular vein distension (JVD) S3 "Ventricular Gallop"

Dependent edema Dyspnea on exertion (DOE)

Hepatomegaly Orthopnea

Ascites Dry and nonproductive cough initially

Weight gain Oliguria

 Nursing interventions: monitor mental status, lung and heart sounds, monitor daily weight (report a

weight gain of 2 kg/day), I&Os, encourage exercise, restricted sodium diet (2g/day), monitor fluid and

electrolytes

o Hypokalemia with diuresis, hyperkalemia with ACE, ARBs, spironolactone

o Hyponatremia with prolonged diuretic therapy S&S of disorientation, weakness, muscle

cramps, anorexia

 Diuretics can also lead to increased creatinine and hyperuricemia

o Volume depletion can lead to dehydration and low BP with ACE & Beta Blockers

 Medications:

o - cause vasodilation that decrease afterload, mon ACE inhibitors itor for

hypotension/hyperkalemia, and altered renal function, SE are dry cough and angioedema

 Lisinopril (Zestril)

 - alternative to ACE, observe for hypotension, hy ARBs perkalemia, worsening renal

function

 Losartan (Cozaar)

 Hydralazine and Isosorbide dinitrate - vasodilators that can lower BP & afterload,

lowers systemic vascular resistance

 Beta Blockers - first line therapy, prescribed with ACE inhibitors, caution in asthma,

helps relax blood vessels, lowers BP and afterload and cardiac workload, SE include

dizziness, hypotension, bradycardia, fatigue and depression

 Atenolol (Tenormin)

 Diuretics - loop and aldosterone antagonists, monitor K may need supplements

 Potassium wasting: HCTZ and furosemide (Lasix)

 Digitalis - improves contractility, toxicity with hypokalemia, TOXICITY SE haloes and

yellowing of the sclera cannot give with HR under 60, and low BP

 Digoxin toxicity- vison changes, confusion, irregular pulse, N/V/D

 IV infusions

 Milrinone- SE hypotension and increased ventricular dysrhythmias, monitor BP and

ECG

 Dobutamine- improves contractility and UO, SE increased HR and dysrhythmias

 Pulmonary Edema

 LV cannot handle overload of blood volume, pressure increased causing fluid to

move out of capillaries and into the interstitial spaces of the lung and alveoli

 Early signs are cough and dyspnea

 S&S : restlessness, confusion, anxiety, dyspnea, cool and clammy skin, cyanosis, weak

and rapid pulses

 Treat with oxygen therapy, IV nitro, lab include ECG, ABG, electrolytes and creatinine

 Patient can reduce left ventricular load by sitting upright with their legs over the side

of the bed

 Medical management- oxygen therapy, diuretics and vasodilators (nitro)

Hypertension

BP= CO X R

Hypertension is defined as a BP > 140/90, need 2 high readings in 1-4 weeks apart

 : UA, blood chemistry looking at NA, K, creatinin Lab tests e, fasting glucose, total HDLs, 12-lead ECG

(looking at left ventricular hypertrophy), increased macroalbuminuria might have impacted kidneys

 Assess target organs

 Patient education :

o Weight reduction recommended BMI 18.5-24.9

o DASH diet, decreased sodium intake < 2400 mg/day

o Physical activity and exercise

o Moderate alcohol consumption (men 2, women 1)

 Medications

o Thiazide diuretics- HCTZ

o Loop diuretics- furosemide (Lasix)

o Potassium-sparing diuretics- Triamterene (Dyrenium)

o Aldosterone receptor blockers- Spirolactone (Aldactone)

o Alpha 2 agonists- Clonidine (Catapres)

o Beta Blockers- Propranolol (Inderal)

o Alpha 1 blockers- Doxazosin (Cardura)

o Combined alpha and beta blockers- Carvedilol (Coreg)

o Vasodilators- nitroglycerin

o ACE inhibitors- Lisinopril (Zestril)

o ARBS- Losartan (Cozaar)

o Calcium channel blockers- Verapamil (Calan) & Diltiazem (Cardizem)

 S&S target organ damage : angina, SOB, altered speech/vision/gait, nosebleeds, headaches. Dizziness,

nocturia

o Eye exam- vision, spots, diminished visual acuity, heart, NS & kidneys assessed

 Hypertensive crisis- emergency v. urgency

Anemia

 General Anemia

o S&S : fatigue, jaundice, paleness, fainting, weakness, changed stool color, low BP,

palpitations, rapid HR, chest pain, angina, MI, enlarged spleen

 Iron deficiency

o Most common causes in men and postmenopausal women are bleeding from ulcers,

gastritis, IBD or GI tumors, while menorrhagia and pregnancy are the most for premenopausal

women

o If deficiency is severe and prolonged: smooth red tongue, brittle and ridged nails and angular

cheilitis, restless leg syndrome

o Health history might show multiple pregnancies, GI bleeds and pica

o Patient education : encourage foods such as organ meats (beef, calf, chicken liver), beans,

leafy green vegetables, raisins and molasses, increase vitamin C and PO iron is best absorbed on

an empty stomach an hour before meals

 Pernicious anemia (Vitamin B12 deficiency)

o Inadequate intake such as vegans, faulty absorption in GI such as Crohn's, after bariatric

surgery or gastrectomy

o S&S: neurologic manifestations

 Sickle cell anemia

o Cold may cause vasoconstriction, hydration important during crisis, may need oxygen

Cancer

 S&S of chemo/radiation

o Fatigue, photosensitivity, low blood count, desquamation (wet and dry), possible

scarring/loss of tissue suppleness, irritation of mucous membranes and carcinogenicity

o How can it affect blood?

 Precautions

o For healthcare workers- shielding equipment, PPE proper disposal

 Thrombocytopenia

o Normal platelet count: 140-400 X 103 mm3

o petechiae, ecchymosis, spleen enlarged, headache S&S: s, melena, hematuria, tachycardia

 <10,000 platelets is life-threatening, bleeding precautions at <50,000

 Neutropenic sepsis: low neutrophil (WBC) can lead to infection

 Gender Specific

 Prostate Surgery and BPH

o BPH S&S : hematuria, urine incontinence, obstructive and irritative symptoms, urine

frequency, urgency, nocturia, hesitancy, decreased force of stream and not emptying, abdominal

straining, decreased volume, dribbling, recurrent UTIs

 TURP continuous bladder irrigation- monitor for hemorrhage, bladder training keep

on schedule, encourage Kegel exercises, keep catheter patent, monitor drainage, bladder

spasms and urge to void may indicate occlusion

 Medications for BPH

 Alpha adrenergic blockers- doxazosin (Cardura) & Tamsulosin (Flomax)

 5-alpha-reductase inhibitors- Proscar (Finasteride)

 Mastectomy

o Post-op care : Avoid BP/injections/blood draws in the affected extremity

o Patient education : wear sunsceen, avoid cutting cuticles and infection in general, hand

washing, insect repellent, do not lifet more than 5-10 lbs., ROM exercises (wall hand climbing,

rope turning, rod lifting, pulley tugging)

Vascular

 Peripheral arterial disease (PAD)

o Result from atherosclerosis, leading to inadequate blood flow

o S&S : cramping, leg numbness/weakness, coldness, change in color in the leg, hair loss, shiny

skin, sores that won't heal, no pulse/weak

o Nursing interventions : elevate extremities above heart level, avoid cold temp., walking and

crossing legs, vasodilators

 Promote good nutrition- vitamin A,C, protein and zinc

o Occlusive crisis- Bypass graft

 Antiplatelet medications: aspirin, Clopidogrel

o Heparin- monitor aPTT, platelet count, antidote is protamine sulfate

o Coumadin (Warfarin)- monitor PT and INR (range 2-3), antidote is vitamin K

 May take 3-4 days for effect

o Xarelto- SE include headache, swelling/bleeding, back pain, bleeding gums, bloody stool

complications can lead to blood clots, GI hemorrhage, spinal hematoma, stroke

 Peripheral venous disorders can cause blood stasis because of inadequate blood flow to the

extremities

o Virchow's triad: hypercoagulability, impaired blood flow, damage to blood vessels

o VTE blood clot from venous stasis ca cause thrombophlebitis, can lead to PE

 S&S : calf or groin pain, tender, edema, warmth

 SOB and chest pain = PE

o Venous insufficiency secondary to incompetent valves in deeper veins which cause blood

pooling and vein dilation

 S&S : brown discoloration, edema, stasis ulcers

 Avoid sitting or standing too long, elevate legs at least 20 min (4-5 times/day)

o Varicose veins

 S&S : muscle cramping and aches, pruritis

 Trendelenburg test

Arterial Ulcers Venous Ulcers

Cool to touch, no pulse, no edema Warm to touch, edema, pulse

Thin, dry, hairless skin (shiny) Thick, tough skin, brown color

Round smooth sores at the toes and feet Irregular borders at the ankles (medial malleolus)

Black eschar, gangrene Yellow slough and ruddy skin

ELEVATE LEGS/DANGLE, Intermittent claudication Dull achy pain

Endocrine

Hypothyroidism Hyperthyroidism

S&S: decreased metabolism, bradycardia,

lethargy, increased sensitivity to cold, dry skin

or hair, depression, weight gain , cardiac issues

S&S: heat intolerance, fever, diaphoresis, SOB,

weight loss, palpitations, muscle weakness, goiter,

eye protrusion, restlessness, amenorrhea

Causes: Myxedema, meds that decrease thyroid

hormone, iodine deficiency/radioactive

treatment

Causes: Grave's disease, autoimmune

Myxedema coma: when left untreated or

poorly managed, stressor

S&S: resp. failure, low BP, hypothermia,

bradycardia, dysrhythmia,

hyponatremia/glycemia, cool & dry skin

Thyroid storm/crisis: increased thyroid hormone in

blood or increased metabolism, monitor TEMP

CLOSELY

S&S: hyperthermia, HTN, delirium, abdominal pain,

D, chest pain, SOB, palpitations, seizures, coma

Thyroid hormone replacement therapy:

Levothyroxine watch for cardiac SE (with IV

form)

Thyroidectomy as treatment, pt. possible

hoarseness and support neck, monitor VS,

respiratory depression, tetany (hypocalcemia),

hemorrhage around the neck

 Post care after thyroidectomy:

o Patient may need thyroid hormone replacement therapy, diet high in protein and carbs,

support neck with deep breathing and coughing, neck incision with dressing with possible

drainage, hoarseness and sore throat after, ROM exercises of neck, semi-fowlers position, assess

for hemorrhage and tracheal compression (irregular breathing, neck swelling, frequent

swallowing, choking)

HIV/AIDS

 ART treatment decreased viral load

 S&S : fatigue, low-grade fever, flu-like symptoms, mouth sores, thrush, rash, myalgia, liver and spleen

enlargement

 Importance of medication adherence

o CD4 count of <200 = AIDS

 Opportunistic infections- Kaposi's sarcoma, TB, pneumocystis pneumonia, candidiasis, wasting

syndrome, HIV encephalopathy, lymphomas, peripheral neuropathy

Urinary

 Cystitis

o S&S of UTI: burning, urinary frequency, urgency, nocturia, incontinence, suprapubic/pelvic

pain, hematuria, back pain

o Urospesis- monitor WBC <10,000/uL

 Pyelonephritis S&S: chills, fever, leukocytosis, bacteriuria, low back pain, flank pain, N/V, headache,

malaise, painful urination, WBCs and bacteria in urine

 Renal calculi S&S: hematuria, colicky pain radiates downward

o Increase fluids, strain urine and send to lab, report UTI

 Nursing management: monitor I&Os, hydration 3-4L of fluids/day, assess temp

o Pt. education- hygiene and proper empty bladder/schedule (3-4 hour) cranberry juice,

urinating before and after intercourse, medication might turn urine orange, finish antibiotics

Diabetes

Hyperglycemia Hypoglycemia

S&S: dry mouth, increased thirst, weakness,

headache, blurred vision, frequent urination,

tingling and numbness, poor wound healing,

polyphagia

S&S: sweating, pallor, irritability, hunger, lack of

coordination, sleepiness, confusion, tremor,

tachycardia, nervousness, slurred speech, headache,

LOC

 Sick day management

o Try to eat normal meal (with increased glucose), don’t drink caffeine and keep hydrated,

keep a record of everything you eat, BS every hour and ketone readings every 4 hours (if taking

insulin), call doctor if sick

 Patient teaching: nutritional therapy (ADA diet- increase fiber, add carbs, fats and proteins), exercise,

monitoring of complications/insulin, limit alcohol, wear medic alert bracelets, rotate injection sites,

only use insulin syringes, monitor and assess feet daily, schedule regular eye exams

o Do not exercise is BS > 250 or ketones in urine

o Eat snack after workouts and at bedtime, 15g of simple carb

o Goal A1C: normal 4-6%, diabetes < 7%

 DKA

o Rapid onset (<24 hours), causes may be from decreased or missed insulin, illness/infection,

undiagnosed/untreated diabetes

o S&S : hyperglycemia, dehydration/electrolyte loss and acidosis, polyuria, polydipsia, fatigue,

orthostatic hypotension, weak pulse, N/V, abdominal pain, acetone breath, Kussmaul

respirations

 Can lead to dehydration, coma and brain swelling if not treated

o Diagnosed

 BS 300-800

 Ketoacidosis

 HC O3 0-15

 pH 6.8-7.3

 PC O2 10-30

 ↑ H ∧H , creatinine∧BUN( de h ydration)

o - correct dehydration, electrolyte and acidosis T Treatment HEN hyperglycemia

 Monitor BS every 3-4 hours, Na & K labs (hypokalemia), renal sufficiency, VS, lung,

I&Os, mental status, ABGs, ECGs

 Sick day rules: test BS and urine for ketones 3-4 hours, insulin as usual, stay

hydrated, report N/V/D

Type of Insulin Name of insulin: Brand name (Generic name) Onset Peak Duration

Rapid acting Novolog (Aspart), Apidra (Glulisine), Humalog

(Lispro)

15 min 30-90 min 3-5 hours

Short acting Humulin/Novolin (Regular) 30-60 min 2-4 hours 5-8 hours

Intermediate

acting

NPH 1-3 hours 8 hours 12-16

hours

Long acting Levemir (Detemir) & Lantus (Glargine) 1 hour NONE 20-26

hours

Peri-operative

 Post-op care

o Turn and cough, splinting, deep breathing, incentive spirometer, clear liquid diet first, control

pain, ambulation

 Nursing interventions- airway management, frequent assessments

 Place patients on side to prevent risk for aspiration, elevate legs and lower HOB if hypotensive or

shock develops

 Aldrete scoring for anesthesia, report UO < 30 mL/hr

Musculoskeletal

 Fractures

o External fixators- assess pin site every 8-12 hours, serous drainage expected

o Buck's traction- immobilize and prevent muscles spasms

 Hip fractures

o Prevent flexion, adduction and internally rotated

o Never flex more than 90 degrees, use high-seated chairs/toilet, pillow between legs

 Cast care

o Elevate extremity above heart level first 24-48 hours

o Rest, elevate, compression, cold therapy (ice), immobilize

 Complications

o Compartment syndrome

 6 P's- pain, Poikilothermia, pallor, pulselessness, paresthesia, paralysis

o Ulcers, disuse syndrome, foot drop syndrome, osteomyelitis, fat embolism

 OA

o Asymmetrical, non-inflammatory

 S&S: pain/stiffness, joint enlargement with decreased ROM, crepitus, pain with

activity, nodes

 Lupus

o S&S: systemic (fever, malaise, weight loss and anorexia), butterfly rash, Raynaud's

o History, physical exam (skin, heart, neuro assessment) and blood test

 Antinuclear antibody (ANA) test diagnosis Lupus, skin biopsies, will have increased

ESR