Med-Surge Exemplars
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| Manifestations of Hypoglycemia | *Reduced cognition
*Tremors
*Diaphoresis
*Weakness
*hunger
*headache
*irritability
*Seizure
*tachycardia
*Restlessness
*Depression
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| 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
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| Treatment of hypoglycemia | 15 grams of carbohydrates, protein, fat, glucose tabs
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| Treatment of hyperglycemia | Insulin (glargine, lispro, metformin, regular)
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| Glargine | long acting insulin (no peak)
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| Lispro | short acting insulin
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| Metformin | most common PO diabetes med
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| Regular | short acting insulin ordered IV; a prescription and very cheap
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| Labs & Diagnostics for Hypo/hyperglycemia: Random Blood Glucose | not fasting; below 140-150
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| Labs & Diagnostics for Hypo/hyperglycemia Fasting Blood Glucose | no food 6-8 hours before testing; 70-100
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| Labs & Diagnostics for Hypo/Hyperglycemia Post-Prandial Glucose | 2 hours after a meal; 70-100
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| 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
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| Labs & Diagnostics for Hypo/Hyperglycemia Hemoglobin A1C | shows how BS has been over 3 months; an average
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What necessary/lifesaving skill should you teach a new Diabetic patient? | How to check blood sugars
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| 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
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| 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
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| Interventions of Pancreatitis | *NPO (TPN feeding)
*Position for comfort
*NG tube w/ suction for N/V (watch for metabolic acidosis & hypokalemia)
*IV fluids
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| Treatment of Pancreatitis | *Antibiotics
*Morphine/hydromorphone
*PPIs/H2 blockers (pantoprazole/famotidine IV)
*Monitor stools; number and consistency
*Electrolyte managment
*nutritional support and electrolyte managment
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| 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)
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| Teaching about Pancreatitis | *Small, frequent meals
*No smoking
*don't chew pancreatic enzymes
*Referral to Alcoholics Anonymous if needed
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| Manifestations of Bacterial Skin infection (non-necrotizing cellulitis) | *Erythema
*Warmth
*localized pain
*Edema
*Exudate that contains pus/odor
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| Manifestations of Bacterial Skin infection (necrotizing soft tissue infections) | *Fever
*Tachycardia
*Pain disproportionate to clinical findings
*Disorientation
*Lethargy
*hypotension
*firmness
*ischemia
*tissue necrosis
*sepsis
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| Treatments of Bacterial Skin infections | *Surgical Debridement
*Bactoban ointment (if MRSA)
*Antibiotic
*Debridement
*Decolonization strategies
*Appropriate dressing
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| 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
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| Teaching about Bacterial Skin infections | *Hand washing
*How to care for their wound
*Manifestations of infection
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| Manifestations of Superficial Surgical Site infection | *Purulent drainage
*Organisms isolated from sterile culture from wound
*pain and tenderness
*localized swelling
*erythema
*Heat
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| Treatment of Superficial Surgical site infection | *antibiotics
*adequate nutrition status
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| 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
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| 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)
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| 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
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| Dehiscenence | Total separation of wound edges, with no bowels/organs showing
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| Evisceration | protrusion of intestinal contents
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| Treatment of Dehiscenece | Cover with NS soaked pad and notify physician
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| Treatment of Eviceration | Cover with NS gauze and prepare them for emergency surgery! (NPO, call surgeon, etc)
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| When is dehiscenence and Evisceration likely? | in elderly, obese, malnourished, on steroids, and later in post-op period (days 5-10)
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| 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
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| 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
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| 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)
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| 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
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| 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)
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| 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)
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| Simple Partial Seizure manifestations | Consciousness not impaired, labored speech/inability to speak, symptoms are subjective and vary greatly. This can lead to generalized seizure
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| 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
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| Absence Seizure | brief loss of consciousness that lasts 5-10 seconds, minimal to no alteration of muscle tone, no recall of incident
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| Myoclonic Seizure | No postictal phase, brief contraction of muscle, one side of the body or can be both sides
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| Tonic-clonic seizure | rigidity, rhythmic jerking of extremities, incontinent of urine/stool, lasts 1-2 minutes, postictal phase lasts several hours
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| Atonic Seizures | head drop to severe fall to the ground with brief loss of consciousness, may require a helmet (high risk for falling/injury)
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| 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
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| 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
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| What are the interventions for status epilepticus? | Airway, breathing, circulation. ABGs monitored. Give benzos first
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| Diagostics/Labs for seizures | *CT
*MRI
*Electroencephalogram (EEG)
*sleep test
*CBC
*BMP (infection)
*Cortisol (stress levels could cause it)
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| 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
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| Relapsing-remitting Multiple Sclerosis | new symptoms appear and old ones worsen/relapse
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| Secondary progressive Multiple Sclerosis | initially relapsing-remitting, now has gradual worsening of the disease
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| Progressive relapsing Multiple sclerosis | progressive with gradual onset of symptoms from the onset, relapses may or may not recover
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| Primary progressive Multiple Sclerosis | gradual progression with no remissions, may have temporary plateaus
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| 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
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| 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
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| 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
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| Labs/diagnostics of Multiple Sclerosis | *Diagnosis of exclusion
*repeated MRIs looking for lesions
*CSF analysis
*Genetics/Hx
*nerve conduction studies
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| Teaching about Multiple Sclerosis | *Avoid stress
*avoid overheating
*medication adherence
*promote independence
*S/S of exacerbation
*disease process and prognosis
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| Cardinal Symptoms of Parkinson's Disease | *bradykinesia
*resting tremors
*rigidity
*postural instablility
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| Manifestations of Parkinson's Disease | *stooping posture
*slow, shuffling gait
*pill rolling
*dysphagia
*drooling
*depression
*mask-like face
*hypophonia
*rapid mood swings
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| 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
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| 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
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| 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)
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| 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
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| 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
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| 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
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| 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
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| Labs/Diagnosis of BPH | *Digital rectal examination
*prostate-specific antigen (PSA) level
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| 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
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| 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
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| Treatments/Interventions of Colorectal Cancer | *chemotherapy
*radiation therapy
*colectomy/hemicoloectomy
*abdominoperineal resection
*Colostomy
*Screening
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| 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
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| 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
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| 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
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| 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.
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| 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
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| Treatment/Interventions of Prostate Cancer | *Radiation & Brachytherapy (radioactive seeds/pellets placed in prostate)
*Cryotherapy
*ablative hormone therapy
*Radial prostatectomy
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| Diagnostics/Labs of Prostate Cancer | *Prostate Specific Antigen (PSA) test for detection of early prostate cancer
*Digital Rectal Examinations
*Prostatic Biopsy
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| 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
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| Manifestations of Urolithiasis | *Severe pain (colicky pain with nausea and vomiting)
*Bladder distention
* obstruction of urine flow
*hematuria
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| 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
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| 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)
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| 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
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| 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
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| 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.
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| Manifestations of Ulcerative Colitis | large intestine; diarrhea 15 or more/day; blood mucus and pus, LLQ pain; teresmus (bowel urgency)
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| 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
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| Manifestations of IBD | *Uveitis, scleosing cholangitis, nephrolithiasis, cholelithiasis, joint disorders, skin disorders, and oral ulcerations
*Malnutrition is very common
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| Complications of Crohn's | fistulas and bowel obstruction
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| Labs/Diagnosis of IBD | colonoscopy
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| Does Crohn's or Ulcerative Colitis have worse diarrhea? | Ulcerative Colitis (15 or more a day)
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| Teaching about IBD | *avoid crowds
*get a TB test every year
*importance of regular follow-ups and colonoscopy
*medication teaching
*importance of adequate nutrition
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| Obesity Comorbidities | diabetes, hypertension, hyperlipidemia, cardiac disease
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| Class 1 BMI | 30.0-34.9
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| Class 2 BMI | 35.0-39.9
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| Extreme BMI | greater than 40
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| 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
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| 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
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| 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
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| S/S of Dumping Syndrome | nausea, vomiting, diarrhea, diaphoresis, tachycardia, salivation, fatigue, dizziness
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| 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
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| McBurney's Point | where someone has pain with appendicitis during the later stages; it’s a hallmark sign
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| 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
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| Labs/Diagnostics of Apendicitis | *Diagnosis by CT scan (gold standard)
*WBC > or = 20,000 indicates perforation
*ultrasound
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| 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
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| 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
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| 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
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| 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
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| 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
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| Manifestations of Peptic Ulcer Disease | *PAIN is most common
*duodenal ulcers and gastric ulcers
*remissions and exacerbations
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| Which type of Peptic Ulcer is aggravated by fasting and improved with food and antacids? | Duodenal Ulcer
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| Which type of Peptic Ulcer is worsened with eating and there is no relief from antacids? | Gastric Ulcer
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| 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
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| 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
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| 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
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If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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haley.tomlinson15
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