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