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Med-Surge Exemplars
| Term | Definition |
|---|---|
| Manifestations of Hypoglycemia | *Reduced cognition *Tremors *Diaphoresis *Weakness *hunger *headache *irritability *Seizure *tachycardia *Restlessness *Depression |
| Manifestations of Hyperglycemia | *polyuria *polydipsia *dehydration *fatigue *fruity odor to breath *Kussmaul breathing *Weight loss *hunger *dry skin *blurry vision *infections heal more slowly than usual |
| Treatment of hypoglycemia | 15 grams of carbohydrates, protein, fat, glucose tabs |
| Treatment of hyperglycemia | Insulin (glargine, lispro, metformin, regular) |
| Glargine | long acting insulin (no peak) |
| Lispro | short acting insulin |
| Metformin | most common PO diabetes med |
| Regular | short acting insulin ordered IV; a prescription and very cheap |
| Labs & Diagnostics for Hypo/hyperglycemia: Random Blood Glucose | not fasting; below 140-150 |
| Labs & Diagnostics for Hypo/hyperglycemia Fasting Blood Glucose | no food 6-8 hours before testing; 70-100 |
| Labs & Diagnostics for Hypo/Hyperglycemia Post-Prandial Glucose | 2 hours after a meal; 70-100 |
| Labs & Diagnostics for Hypo/Hyperglycemia Oral Glucose Tolerance Test | before high carb meal and 30 mins to hour after, then 30 mins to hour after, etc |
| Labs & Diagnostics for Hypo/Hyperglycemia Hemoglobin A1C | shows how BS has been over 3 months; an average |
| Foot Care Do's (Diabetics) | *mild soap and water, pat dry *Nail care following bath or shower *Cotton wool separate overlapping toes *powder with cornstarch *socks are clean and absorbent *shoes need to be correct fit and leather *shake out shoes before putting on |
| Foot Care Don'ts (Diabetics) | *use commercial remedies for removing calluses or corns *wear open-toe or open heel shoes *go barefoot *wear plastic shoes *heating pads/hot water bottles *stand or sit long periods of time or cross legs |
| Sick Days for Diabetics | *Sports drinks, soups, fluids that replace electrolytes (high in carbs) *call Dr if unable to eat and replaced 4-5 meals with liquids *check glucose q 4-5 hours and urine for keystones *don’t be alone and get rest *no skipping meals |
| When do you go to the ER if you're Diabetic and Sick? | *Decreased LOC *sick for more than 2 days *temp over 102 and doesn’t respond to meds or lasts more than 12 hrs *high resp rate *can’t tolerate fluids *glucose more than 240 |
| How do you manage Type 1 Diabetes? | *balance carbs with insulin doses *Encourage patient to eat moderately and experiment with diets to see what works best for them |
| How do you manage Type 2 Diabetes? | *fewer, but healthier carbs *Encourage patient to eat moderately and experiment with diets to see what works best for them |
| What necessary/lifesaving skill should you teach a new Diabetic patient? | How to check blood sugars |
| Manifestations of Pancreatitis (Acute) | *Severe Pain (starts suddenly and becomes more severe with eating) *Nausea *Bloated *Distended *fever *increased HR *elevated BP *Cullen’s Sign *Grey Turner’s sign *low blood pressure *hypoxia *Pleural effusion/hypoxemia *steatorrhea |
| Manifestations of Pancreatitis (Chronic) | *Severe Pain (in LUQ and is often constant) *nausea *bloated *Distended *fever *increased HR *elevated BP *Cullen’s Sign *Grey Turner’s sign *low blood pressure *hypoxia *Pleural effusion/hypoxemia *steatorrhea *Oily stools *Weight Loss |
| Interventions of Pancreatitis | *NPO (TPN feeding) *Position for comfort *NG tube w/ suction for N/V (watch for metabolic acidosis & hypokalemia) *IV fluids |
| Treatment of Pancreatitis | *Antibiotics *Morphine/hydromorphone *PPIs/H2 blockers (pantoprazole/famotidine IV) *Monitor stools; number and consistency *Electrolyte managment *nutritional support and electrolyte managment |
| What is the diet of pancreatitis? | when diet is resumed, avoid alcohol, caffeine, spicy foods, fatty foods and eat: bland, low fat/high protein food, high carbs (unless glucose issues) |
| Teaching about Pancreatitis | *Small, frequent meals *No smoking *don't chew pancreatic enzymes *Referral to Alcoholics Anonymous if needed |
| Manifestations of Bacterial Skin infection (non-necrotizing cellulitis) | *Erythema *Warmth *localized pain *Edema *Exudate that contains pus/odor |
| Manifestations of Bacterial Skin infection (necrotizing soft tissue infections) | *Fever *Tachycardia *Pain disproportionate to clinical findings *Disorientation *Lethargy *hypotension *firmness *ischemia *tissue necrosis *sepsis |
| Treatments of Bacterial Skin infections | *Surgical Debridement *Bactoban ointment (if MRSA) *Antibiotic *Debridement *Decolonization strategies *Appropriate dressing |
| Labs/Diagnosis of Bacterial Skin infections | *blood culture/sensitivity *CBC with differential *serum electrolytes *C-reactive protein *Wound tissue biopsy *identification of gas in subcutaneous tissues by CT scan |
| Teaching about Bacterial Skin infections | *Hand washing *How to care for their wound *Manifestations of infection |
| Manifestations of Superficial Surgical Site infection | *Purulent drainage *Organisms isolated from sterile culture from wound *pain and tenderness *localized swelling *erythema *Heat |
| Treatment of Superficial Surgical site infection | *antibiotics *adequate nutrition status |
| Interventions of Superficial Surgical site infection | *Ensure sterile technique *Report S/S of infection or dehiscence immediately *Frequently assess wound site *Sterile dressing change *prevent hypothermia during surgery *Know risk factors of infection *Record output and characteristics of drainage |
| Labs/Diagnostics of superficial surgical site infection | *blood culture/sensitivity *CBC with differential *serum electrolytes *C-reactive protein *identification of gas in SC tissues by CT scan *Wound tissue biopsy (All of this is at a Surgical site) |
| Teaching about Superficial Surgical Site infection | *Medication schedule and side effects (including pain meds) *follow up with physician *wound care instructions *Drain care instructions *Recommended activity level *Diet *Potential complications *Call Dr with: excessive bleeding, S/S of infection |
| Dehiscenence | Total separation of wound edges, with no bowels/organs showing |
| Evisceration | protrusion of intestinal contents |
| Treatment of Dehiscenece | Cover with NS soaked pad and notify physician |
| Treatment of Eviceration | Cover with NS gauze and prepare them for emergency surgery! (NPO, call surgeon, etc) |
| When is dehiscenence and Evisceration likely? | in elderly, obese, malnourished, on steroids, and later in post-op period (days 5-10) |
| What should you teach patient to do to prevent dehiscence and evisceration? | When you cough/laugh hold a pillow over the site to stabilize/brace it |
| Manifestations of Ischemic Stroke | *headache *mental changes *aphasia *respiration issues *reduced cough/swallow reflex *agnosia *incontinence *seizures *hemiparesis/hemiplagia *emotional liability *Horner's syndrome *visual changes *hypertension *vomiting *Apraxia |
| Treatments of Ischemic Stroke | Thrombolytic therapy (recombinant tissue plasminogen activator) Lorazepam/antiepileptics Calcium channel blockers stool softeners analgesics antianxiety drugs Surgery (angioplasty with stenting, endarterectomy, extracranial-intracranial bypass) |
| Interventions of Ischemic Stroke | *Neural assessment/vitals q 1-2 hrs *Monitor ICP *emotional support *improve mobility *communication/swallowing *ECG & cardiac enzymes *serum electrolyte (na+) *I&O *HOB >30 degrees *aspiration/bleeding precautions *frequent repositioning |
| Labs/Diagnostics of Ischemic Stroke | *CT scan *MRI *Dopplar Ultrasound of cartoid arteries *cerebral angiography *echocardiography (TEE and TTE) *Hypercoagubility (lupus anticoagulant, anticardiolipin antibodies, protein C activity, protein S activity, and factor V Leiden mutation) |
| Teaching about Ischemic Stroke | how to be involved in care/what diagnosis means What to look for/when to activate EMS patient-specific/family risks for stroke Smoking cessation Medications for secondary prevention of stroke (reduce BP/hypercholestrolemia, prevent blood clotting) |
| Simple Partial Seizure manifestations | Consciousness not impaired, labored speech/inability to speak, symptoms are subjective and vary greatly. This can lead to generalized seizure |
| Complex partial seizure manifestations | Always a loss of consciousness, lip smacking and drooling, chewing, precipitated by aura during which patient is unaware of environment and can't respond to stimuli |
| Absence Seizure | brief loss of consciousness that lasts 5-10 seconds, minimal to no alteration of muscle tone, no recall of incident |
| Myoclonic Seizure | No postictal phase, brief contraction of muscle, one side of the body or can be both sides |
| Tonic-clonic seizure | rigidity, rhythmic jerking of extremities, incontinent of urine/stool, lasts 1-2 minutes, postictal phase lasts several hours |
| Atonic Seizures | head drop to severe fall to the ground with brief loss of consciousness, may require a helmet (high risk for falling/injury) |
| Treatments of Seizures | *give medications consistently to maintain therapeutic levels *Keppra or Klonopin for prevention *DON'T administer warfarin with phenytoin *Vagal nerve stimulation *anterior lobe resection *partial corpus callostomy |
| Interventions of Seizures | *Seizure precautions (airway, oxygen mask, suction equipment, IV access, side rails up and padded, get rid of clutter) *LEFT side during & after seizure *Check for patient airway *Calm/Dark environment *Patient safety highest priority! *Low carb diet |
| What are the interventions for status epilepticus? | Airway, breathing, circulation. ABGs monitored. Give benzos first |
| Diagostics/Labs for seizures | *CT *MRI *Electroencephalogram (EEG) *sleep test *CBC *BMP (infection) *Cortisol (stress levels could cause it) |
| Teaching for Seizures | Social service resources for medication evaluation of employee safety Vocational rehabilitation may be subsidized Can't drive until 6 month after last seizure & physician & driving department both have to clear you medication management medical alert |
| Relapsing-remitting Multiple Sclerosis | new symptoms appear and old ones worsen/relapse |
| Secondary progressive Multiple Sclerosis | initially relapsing-remitting, now has gradual worsening of the disease |
| Progressive relapsing Multiple sclerosis | progressive with gradual onset of symptoms from the onset, relapses may or may not recover |
| Primary progressive Multiple Sclerosis | gradual progression with no remissions, may have temporary plateaus |
| Manifestations of Multiple Sclerosis | *Blurred vision (diplopia) *numbness or weakness in one or more limbs *tingling or pain *electric shock with head movement *dizziness *muscle tremors/spasticity *lack of coordination *unsteady gait *fatigue |
| Treatment of Multiple Sclerosis | *NO CURE; manage symptoms *NSAIDs *steroids *opioids *stool softeners *Gabapentin (nerve pain) *bronchodialators *neurotin (nerve pain) *physical therapy (water therapy) *manage anxiety |
| Interventions of Multiple Sclerosis | rest periods balance exercise/rest/nutrition provide easy to swallow food free clutter family support facilitate communication Assess neuromuscular function Assess vision/eye movement assess skin integrity assess ADLs/bowel/bladder walker/cane |
| Labs/diagnostics of Multiple Sclerosis | *Diagnosis of exclusion *repeated MRIs looking for lesions *CSF analysis *Genetics/Hx *nerve conduction studies |
| Teaching about Multiple Sclerosis | *Avoid stress *avoid overheating *medication adherence *promote independence *S/S of exacerbation *disease process and prognosis |
| Cardinal Symptoms of Parkinson's Disease | *bradykinesia *resting tremors *rigidity *postural instablility |
| Manifestations of Parkinson's Disease | *stooping posture *slow, shuffling gait *pill rolling *dysphagia *drooling *depression *mask-like face *hypophonia *rapid mood swings |
| Treatment of Parkinson's Disease | *Drug therapy (anticholinergics, dopamine-receptor agonists, dopamine precursors) *Thalamotomy (surgery) *Drug holidays for patients on long term drug therapy when drug tolerance is reached *Deep brain stimulation |
| Interventions of Parkinson's Disease | *Fall precautions *Consults with PT/OT, speech, psychosocial, dietary *allow extra time for interventions *bowel/bladder regimen *assessment q 4 hrs (prn for anxiety/depression/sleepiness) *monitor for pressure ulcers |
| Labs/Diagnostics of Parkinson's Disease | *No specific diagnostics; we try to rule out other things *progressive decline in motor ability *2 or more cardinal symptoms in abscence of other causes CT/MRI PT/OT assessments CSF for dopamine levels PTET or SPECT scans (due to other health probs) |
| Teaching about Parkinson's Disease | *Family support/coping *keep room/house free of clutter *focus on patient's strengths *exercises to strengthen muscles *teach to use cane or walker if needed *facilitate independence *restrict caffeine |
| Manefestations of BPH | *difficulty starting flow of urine *weak stream *dribbling/interruptions during urination *bed-wetting *bladder infection/stones *increased pressure in kidney *incontinence *feeling that bladder not emptied *urinary retention |
| Treatments/interventions of BPH | *watchful waiting *Meds: 5 aplpha reductase inhibitors and alpha-adrenergic blockers *Herbal: Saw Palmetto, African Plumb, Cernilton, South African star grass *Surgeries |
| Surgeries to treat BPH | *Transurethral Resection of Prostate (TURP) *Continuous Bladder irrigation *Prosectomy *Laser surgery *Transurethral Needle Ablation (TUNA) *Prostatic stents *Water-induced Thermotherapy and transurethral Ethanol Ablation |
| Labs/Diagnosis of BPH | *Digital rectal examination *prostate-specific antigen (PSA) level |
| Teaching about BPH | *Avoid excess fluids in the evening *avoid tranquilzers and over-the-counter meds that contain decongestants *explain "watchful waiting" *drug therapy education *importance of follow-up *care of surgical/invasive treatment sites |
| Manifestations of Colorectal Cancer | *unexplained weight loss *change in bowel habits *rectal bleeding/blood in stools *persistant abdominal discomfort *feeling bowel doesn't empty completely *weakness *bowel obstruction |
| Treatments/Interventions of Colorectal Cancer | *chemotherapy *radiation therapy *colectomy/hemicoloectomy *abdominoperineal resection *Colostomy *Screening |
| Labs/Diagnostics of Colorectal Cancer | *EARLY DETECTION IS KEY *Colonoscopy (gold standard)/virtual colonoscopy *Biopsies taken/polyps removed *Fecal occult blood test *Lower GI series *Double-contrast barium enema *Sigmoidoscopy *Fecal DNA testing *Wireless capsule endoscopy |
| Teaching about Colorectal Cancer | Lifestyle factors/risk factors that contribute to risk of colorectal cancer preoperative teaching r/t ostomy care Bowel prep Pain/pain management prevent post-op complications |
| Lifestyle factors that contribute to risk of colorectal cancer | lack of regular exercise, low fruit/vegetable intake, low fiber/high fat diet, being overweight, alcohol consumption, and tobacco use |
| Other risks that contribute to risk of colorectal cancer | Personal/family history of colorectal cancer, adenomatous polyps (also a family history of them), inflammatory bowel disease (IBD) for 10 years or more. |
| Manifestations of Prostate Cancer | *May not have any symptoms at first *trouble urinating *weak stream of urine *hesitancy *sensation of incomplete emptying of the bladder *frequency *urgency *urge incontinence *urinary tract infection |
| Treatment/Interventions of Prostate Cancer | *Radiation & Brachytherapy (radioactive seeds/pellets placed in prostate) *Cryotherapy *ablative hormone therapy *Radial prostatectomy |
| Diagnostics/Labs of Prostate Cancer | *Prostate Specific Antigen (PSA) test for detection of early prostate cancer *Digital Rectal Examinations *Prostatic Biopsy |
| Teaching about Prostate Cancer | Education of disease brachytherapy (absence of sex for 2 weeks after start & use condom) chemotherapy/radiation Signs of infection Prevention: increased foods with selenium Risk: consumption of calcium/ingestion of greater than 7 multivitamins/week |
| Manifestations of Urolithiasis | *Severe pain (colicky pain with nausea and vomiting) *Bladder distention * obstruction of urine flow *hematuria |
| Treatments/Interventions of Urolithiasis | Ureteroscopy percutaneous nephrolithotomy extracorporeal shock wave lithotripsy opioids Antiemetics Alpha-adrenergic blockers Strain urine&stone to lab surgery if causing obstruction/uncontrolled pain IV fluids <5mm pass naturally, >10mm=surgery |
| Labs/Diagnostics of Urolithiasis | *Noncontrast CT scan (diagnostic of choice) *Kidney Ureter bladder (KUB) x ray *Ultrasound (in children and pregnant females because you don’t want to expose them to too much radiation) |
| Teaching about Urolithiasis | *Increase fluids to 3L/day *Diet: limit sodium, increase intake of citrate, avoid foods high in oxalate *strain urine *call provider for fever or chills *Avoid fluids that could cause dehydration |
| Manifestations of IBD | persistent diarrhea, abdominal pain or cramps, fever, weight loss, fluid imbalances, malnutrition, mouth ulcers, anemia, blood from rectum, joint/skin/eye irritation, and delayed growth |
| Manifestations of Crohn's | RLQ pain, strictures and adhesions are common, can lead to fistula/abcess/peritonitis (large and small intestine); short bowel syndrome. Happens in "patches" in bowel. |
| Manifestations of Ulcerative Colitis | large intestine; diarrhea 15 or more/day; blood mucus and pus, LLQ pain; teresmus (bowel urgency) |
| Treatment/Intervention of IBD | *rest bowel and control inflammation *F&E regulation *medications, surgery, correction of nutritional deficit and psychosocial needs *aminosalicylates (sulfasalazine) * immunomodulators (inflizimab, adalimumab) * steroids |
| Manifestations of IBD | *Uveitis, scleosing cholangitis, nephrolithiasis, cholelithiasis, joint disorders, skin disorders, and oral ulcerations *Malnutrition is very common |
| Complications of Crohn's | fistulas and bowel obstruction |
| Labs/Diagnosis of IBD | colonoscopy |
| Does Crohn's or Ulcerative Colitis have worse diarrhea? | Ulcerative Colitis (15 or more a day) |
| Teaching about IBD | *avoid crowds *get a TB test every year *importance of regular follow-ups and colonoscopy *medication teaching *importance of adequate nutrition |
| Obesity Comorbidities | diabetes, hypertension, hyperlipidemia, cardiac disease |
| Class 1 BMI | 30.0-34.9 |
| Class 2 BMI | 35.0-39.9 |
| Extreme BMI | greater than 40 |
| Treatment/Interventions of Obesity | *Weight loss therapy *diet therapy *increased physical activity *behavior therapy *bariatric surgery: restrictive procedure, malabsorptive procedure, combination procedure *Orlistat *lorcaserin *phentermine topiramate |
| Labs/Diagnostics of Obesity | *BMI *ECG if they are at risk for cardiac disease *overnight sleep test if they have apnea *RUQ ultrasound to identify fatty liver disease *transvaginal ultrasonography for ovarian cysts |
| Teaching about Obesity | *diet teaching *post op teaching *medications side effects *wound care *S/S to report (SOB, tachycardia, severe abd pain, s/s of infection, rigors) *dumping syndrome *Available support groups |
| S/S of Dumping Syndrome | nausea, vomiting, diarrhea, diaphoresis, tachycardia, salivation, fatigue, dizziness |
| Manifestations of Apendicitis | *peritonitis and gangrene (life-threatening) firm, ridged, board-like abdomen *abrupt change in pain, BP, HR *highest occurrence in 10-19 year olds; affects males more than females *McBurney’s point |
| McBurney's Point | where someone has pain with appendicitis during the later stages; it’s a hallmark sign |
| Treatments/Interventions of Apendicitis | *appendectomy *no management for acute *temp & HR, intake & output post surgery, pain, rebound tenderness, WBC/differential *position supine w/ HOB at 30-40 degress *comfort measures *provide ice to right lower quadrant post surgery |
| Labs/Diagnostics of Apendicitis | *Diagnosis by CT scan (gold standard) *WBC > or = 20,000 indicates perforation *ultrasound |
| Teaching about Apendicitis | *avoid the use of laxatives and enemas *take full course of antibiotics *teach wound care *turn, cough, deep breathe and use of incentive spirometer 10 times every hour *encourage early ambulation |
| Manifestations of Diverticulitis | *perforation (complication) *abd pain over area *fever/leukocytosis *a mass @ involved area *increased flatus, anorexia, abdominal bloating &distention, diarrhea/constipation *stools w/mucus and blood *bleeding near vessels |
| Treatment/Interventions of Diverticulitis | *broad spectrum antibiotics for uncomplicated diverticulitis *pain medications prn *IV antibiotics, bowel rest, IV fluids, check CBC *monitor vitals, serum potassium (may be low), pain and mental status *NG suction/provide oral care *Low fiber diet |
| Labs/Diagnostics of Diverticulitis | *plain flat-plate abdominal x-rays and a CT scan *WBC monitored for elevations initially related to inflammation and possible infection |
| Teaching about Diverticulitis | *avoid laxatives and enemas *increasing fiber from new fruits and veggies in diet *avoid straining, bending, and lifting *weight reduction *complete antibiotic therapy as prescribed |
| Manifestations of Peptic Ulcer Disease | *PAIN is most common *duodenal ulcers and gastric ulcers *remissions and exacerbations |
| Which type of Peptic Ulcer is aggravated by fasting and improved with food and antacids? | Duodenal Ulcer |
| Which type of Peptic Ulcer is worsened with eating and there is no relief from antacids? | Gastric Ulcer |
| Treatment/Interventions of Peptic Ulcer Disease | *pain relief, ulcer healing, prevent recurrence, and reduction of complications *antibiotics and PPI for H. pylori *acid suppression (antacids and H2 receptor agonist) *surgical interventions w/ nonhealing and bleeding ulcers |
| Lab/Diagnostics of Peptic Ulcer Disease | *serum antibody testing *urease breath testing *stool antigen testing *CBC to rule out ulcer perforation/peritonitis (increased WBC)/anemia (low hematocrit) *diagnosed during upper endoscopy, lab and radiological testing |
| Teaching about Peptic Ulcer Disease | *advise to avoid aspirin/NSAIDs, spicy foods, and beverages with caffeine *take meds as prescribed *avoiding eating within two hours of bedtime |
Created by:
haley.tomlinson15
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