1
NURS 201 Med Surge Final Review
Med Surge Final Review
Early signs and symptoms of internal bleeding:
Tachycardia, hypotension, urinary output, heart rate
- Abdominal pain
- Nausea
- Vomiting
- Difficulty swallowing
- Intestinal bleeding
Early signs of Hypoxia Late signs of Hypoxia
- Restlessness - Bradycardia
- Anxiety - Extreme Restlessness
- Tachycardia/Tachypnea - Dyspnea
***To confirm hypoxia we measure the O2, <87%
Main: elevate head rest
Anesthesia (MS book Ch. 94)
- All kind of anesthesia have something in common = Respiratory Depression
- Assess for family hx of herthermia
- Propofol is the most common anesthetic (watch for egg or soybean oil
allergies)
- Ensure client has signed consent form and has gone to the bathroom before
administering sedatives.
- Position bed at a low position with side rails up
- Monitor all labs, cardiac status, vitals signs, drains, tubes, catheters, IV’s, and
assess levels of sedation
- Post-procedure, monitor and document vital signs and ABC’s
- Under anesthesia patient is at risk for vomiting and aspiration.
- Assess that the gag reflex has returned.
- Assist with coughing and deep breathing at least every hour while awake
- Provide pillow or folded blanket for splinting for abdominal incision.
- Incentive spirometer every 1-2hrs for lung expansion and to prevent
atelectasis.
- Reposition client every 2hrs
- Ambulate regularly
- NO pillows under the knees.
- If wound evisceration occurs:
o Call for help
o Stay with the client
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NURS 201 Med Surge Final Review
o Cover the wound with a sterile towel or dressing that are moistened
with sterile saline.
o Do not attempt to reinsert organs.
o Place client in low-Fowlers position with hips and knees bent.
o Monitor for shock, and notify the provider immediately.
Opioids: Morphine, Fentanil, Alfentanil
Reversal Agent: Nalaxone
Benzodiazepine: Midazolam, Diazepam
Reversal Agent: Flumazemil
Diabetes Mellitus (MS book Ch. 82, 83)
“Poly” = excess Hyperglycemia
>250
- Polyuria: excess urine production
- Polydipsia: excess thirst
- Polyphagia: excess hunger
***To dx a patient with DM we must have two findings on separate days
Normal Levels
- Glucose level: 60-110
- A1C: 4%-6%, if client has DM 6.5%-8% is expected, the target goal is 7%
Hypoglycemia Signs and Symptoms
- Can kill a person - Headaches
- Mild shakiness - Lack of coordination
- Mental confusion - Blurred vision
- Sweating - Seizures
- Palpitations - Coma
Hypoglycemic episode on a conscious client: <70
- Instruct the client to take 15-20g of readily absorbed carbohydrate
o 4-6oz fruit or regular soft drink
o Glucose tablets
o Glucose gels
o 6-10 hard candies
o 1 tbsp. of honey
o Recheck blood glucose in 15 min
Hypoglycemic episode on an unconscious client: <70 or below
, 3
NURS 201 Med Surge Final Review
- Administer glucagon SubQ or IM and repeat in 10 min if client is still
unconscious
- Notify the provider
- Place client in lateral position to prevent aspiration
- Once the client is conscious (~20min) have them ingest oral carbohydrates.
Medications
Metformin/Oral
- Monitor significance of (GI) effects (flatulence, anorexia, nausea, vomiting)
- Monitor for lactic acidosis
- Stop 48hrs before test with dye and resume 48hrs after
- Teach clients to take with food
- Teach clients to supplement with Vit B12 and Folic Acid
Insulin/SubQ and IV
Rapid Acting: Lispro, Aspart, Glulisine
- Administer right before meals
- OK to combine with intermediate (NPH) and long acting
Onset Peak Duration
10-15min 1-2hrs 4-6hrs
Short Acting: Regular Insulin
U500
• Administer 30-60 min before meals
U100 (this is the only insulin given IV and in case of emergencies
Onset Peak Duration
30-60min 2-4hrs 6-8hrs
Intermediate Acting: NPH
- Administer between meals and at night
- Only mix with short acting
Onset Peak Duration
1-2hrs 4-6hrs 12hrs
Long Acting: Glaringe, Detemir
- Administer at any time of the day but always at the same time (every 24hrs)
- Lasts 24hrs. No peak
NG Tube (MS book Ch. 54)
NURS 201 Med Surge Final Review
Med Surge Final Review
Early signs and symptoms of internal bleeding:
Tachycardia, hypotension, urinary output, heart rate
- Abdominal pain
- Nausea
- Vomiting
- Difficulty swallowing
- Intestinal bleeding
Early signs of Hypoxia Late signs of Hypoxia
- Restlessness - Bradycardia
- Anxiety - Extreme Restlessness
- Tachycardia/Tachypnea - Dyspnea
***To confirm hypoxia we measure the O2, <87%
Main: elevate head rest
Anesthesia (MS book Ch. 94)
- All kind of anesthesia have something in common = Respiratory Depression
- Assess for family hx of herthermia
- Propofol is the most common anesthetic (watch for egg or soybean oil
allergies)
- Ensure client has signed consent form and has gone to the bathroom before
administering sedatives.
- Position bed at a low position with side rails up
- Monitor all labs, cardiac status, vitals signs, drains, tubes, catheters, IV’s, and
assess levels of sedation
- Post-procedure, monitor and document vital signs and ABC’s
- Under anesthesia patient is at risk for vomiting and aspiration.
- Assess that the gag reflex has returned.
- Assist with coughing and deep breathing at least every hour while awake
- Provide pillow or folded blanket for splinting for abdominal incision.
- Incentive spirometer every 1-2hrs for lung expansion and to prevent
atelectasis.
- Reposition client every 2hrs
- Ambulate regularly
- NO pillows under the knees.
- If wound evisceration occurs:
o Call for help
o Stay with the client
,2
NURS 201 Med Surge Final Review
o Cover the wound with a sterile towel or dressing that are moistened
with sterile saline.
o Do not attempt to reinsert organs.
o Place client in low-Fowlers position with hips and knees bent.
o Monitor for shock, and notify the provider immediately.
Opioids: Morphine, Fentanil, Alfentanil
Reversal Agent: Nalaxone
Benzodiazepine: Midazolam, Diazepam
Reversal Agent: Flumazemil
Diabetes Mellitus (MS book Ch. 82, 83)
“Poly” = excess Hyperglycemia
>250
- Polyuria: excess urine production
- Polydipsia: excess thirst
- Polyphagia: excess hunger
***To dx a patient with DM we must have two findings on separate days
Normal Levels
- Glucose level: 60-110
- A1C: 4%-6%, if client has DM 6.5%-8% is expected, the target goal is 7%
Hypoglycemia Signs and Symptoms
- Can kill a person - Headaches
- Mild shakiness - Lack of coordination
- Mental confusion - Blurred vision
- Sweating - Seizures
- Palpitations - Coma
Hypoglycemic episode on a conscious client: <70
- Instruct the client to take 15-20g of readily absorbed carbohydrate
o 4-6oz fruit or regular soft drink
o Glucose tablets
o Glucose gels
o 6-10 hard candies
o 1 tbsp. of honey
o Recheck blood glucose in 15 min
Hypoglycemic episode on an unconscious client: <70 or below
, 3
NURS 201 Med Surge Final Review
- Administer glucagon SubQ or IM and repeat in 10 min if client is still
unconscious
- Notify the provider
- Place client in lateral position to prevent aspiration
- Once the client is conscious (~20min) have them ingest oral carbohydrates.
Medications
Metformin/Oral
- Monitor significance of (GI) effects (flatulence, anorexia, nausea, vomiting)
- Monitor for lactic acidosis
- Stop 48hrs before test with dye and resume 48hrs after
- Teach clients to take with food
- Teach clients to supplement with Vit B12 and Folic Acid
Insulin/SubQ and IV
Rapid Acting: Lispro, Aspart, Glulisine
- Administer right before meals
- OK to combine with intermediate (NPH) and long acting
Onset Peak Duration
10-15min 1-2hrs 4-6hrs
Short Acting: Regular Insulin
U500
• Administer 30-60 min before meals
U100 (this is the only insulin given IV and in case of emergencies
Onset Peak Duration
30-60min 2-4hrs 6-8hrs
Intermediate Acting: NPH
- Administer between meals and at night
- Only mix with short acting
Onset Peak Duration
1-2hrs 4-6hrs 12hrs
Long Acting: Glaringe, Detemir
- Administer at any time of the day but always at the same time (every 24hrs)
- Lasts 24hrs. No peak
NG Tube (MS book Ch. 54)
