Summary Medical Surgical Nursing Reviewer

MEDICAL SURGICAL NURSING 1
Man  TOTALITY
 Suprasystem ADRENAL CORTEX
o Individual, family, community, society Glucocorticoids/Steroids
 Subsystem  Gluconeogenesis (formation of new glucose from fats and
proteins)  increased CHON catabolism (breakdown) 
Stress Response/SMR (Sympatho-medullary Response/ SAMR (-) nitrogen balance (catabolism>anabolism)
(Sympatho-adreno-medullary response)/GAS (General Adaptation o Positive nitrogen balance (more protein
Response) anabolism)
 Diaphoresis Mineralocorticoid/Aldosterone
 Increased B  Fluid and sodium retention
 Increased PR o Oliguria <400 ml /24 hrs.
 Increased rate/depth resp. o Anuria <100 ml /24 hrs.
 Pallor  Potassium excretion
 Cold clammy
 Weight loss NEUROHYPOPHYSEAL (Hypophysis Cerebri/Sella Turcica)
 Weakness Anterior (Adenohypophysis)
 Anorexia  TSH
 Diarrhea  ACTH
 Constipation  FSH
 Urinary frequency  LH
 Oiguria  MSH (Melanocyte-Stimulating Hormone)
 Anuria  SH (Somatotrophic Hormone)
 Transient hyperglycemia  GH
 Increased in visual acuity Posterior (Neurohypophysis)
 ADH
 Hypothalamus  Oxytocin
o Sympatho-adrenal medullary
o Adreno-cortical ENDOCRINE
o Neurohypophyseal Hypoactivity
 Congenital absence of glands
Adrenal glands  Surgical removal of gland
 On top of kidneys  Idiopathic atrophy of glands
 Adrenal medulla Hyperactivity
o Inner portion  Tumor within or outside the gland
o Secretes catecholamines:  Failure of kidneys to secrete hormones
EPINEPHRINE/ADRENALINE  Failure of liver to deactivate of hormones
 Vasodilator (coronary artery, cerebral
artery, peripheral blood vessels) DECREASED APG ACTIVITY
 Vasoconstrictor (peripheral arterioles) Pituitary dwarfism
 Glycogenolysis (breakdown of  Dwarf (doubled size of infant)
glycogen in liver) Frohlicks Syndrome
NOREPINEPHRINE/NORADRENALINE  Dwarf, obese, mentally retarded, genital atrophy
 Vasoconstrictor Simmonds disease/ Pituitary Cachexia
 Wizened old man, mental lethargy, teeth start to fall,
ADRENAL MEDULLA amenorrhea, absence of spermatogenesis
Epi/Norepi (Sympathetic/Adrenergic)
 Dilated coronary arteries  increased myocardial INCREASED APG ACTIVITY
perfusion  increased myocardial contraction  Gigantism
increased PR  Before closure of epiphyseal line
 Dilated peripheral blood vessels  Rapid growth of long bones
 Relaxation of smooth muscular bronchioles o Prolongation/elongation of long bones
bronchodilation  increased rate/depth respiration Acromegaly
 Constricted peripheral arterioles  increased  After closure of epiphyseal line
peripheral resistance  increased BP  Increased in bone thickness and hypertrophy of soft tissues
 Constricted arteries of skin  decreased blood supply o Enlargement of cartilages
 pallor  Nose
 Increased glycogenolysis  transient hyperglycemia  Ears
 Sweat glands  stimulation o Enlargement of larynx
 GIT  decreased gastric secretion  decreased  Deepened voice
gastric motility o Progmathism/protrusion of jaw
 No urine  Separation of teeth
o Urinary bladder muscles relaxes o Thickening of lips and oral mucous membrane
o Urinary sphincter  close o Lengthening of chin
 Pupils  dilation  increased visual acuity o Broad hands/spade-like fingers
o Enlargement of visceral organs

,MEDICAL SURGICAL NURSING 2
o Calcium preparations (after meals)
 Calcium carbonate
 Management  Calcium Lactate
o Cobalt therapy  Calcium Chloride 10%
 Radiation  Calcium gluconate
o Surgical removal
 Hypophysectomy o Given with vit. D (tachysterol)
o Inhibit production of growth hormone  Dihydrotachysterol
(subcutaneously)  Hytakerol
o Somatostatin  Calciferol
 Sandostatin  Calcifediol
 Octreotide/actreotide  Calcidiol
ADRENAL CORTEX
DIABETES INSIPIDUS 1. Glucocorticoid/steroid – gluconeogenesis
 Disorder in water metabolism  decreased ADH   Fat  increased lipolysis  abnormal fat distribution
prevent renal tubules reabsorption of water  polyuria = 5-  CHON  increased CHON catabolism  tissue
29 L/24 hrs.  Polydipsia  diluted (decreased specific starvation & muscle wasting
gravity = 1.010-1.025)  increased Na (135-145 mEq/L) 2. Mineralocorticoid/aldosterone
 All electrolyte testing do not require NPO 3. Androgen

 ADH Cushing’s
o Oily preparations (Deep IM)  lipodystrophy (rotate  Increased GMA
route of administration)  Increased 3S
 Pitressin Tannate o Sugar
 Vasopressin – vasoconstrictor  HPN  Hyperglycemia
o Nasal sprays (clear nasal passages)  Moon facies
 Desmopressin Acetate  Buffalo hump
 Lypressin  Truncal obesity
 Anti-lipidemic o Salt
o Clofibrate/Atromid S/Clo 5  Fluid retention  Increased BP
 Hypernatremia
SIADH  Hypokalemia
 Increased ADH o Sex
 Fluid retention  Virilism
o Increased IV volume (hypervolemia)  Masculinization
 Increased BP  Hirsutism
 Increased renal perfusion   Management
enhance/increased GFR/ increased o Cobalt therapy
UO  no leg edema o Adrenalectomy
o Electrolyte dilution  Dilutional hyponatremia  o Cortisol inhibitors
fluid move into the cell  Aminogluthetemide
 Cerebral edema  Increased ICP  Trilostane
 Cellular overhydration  Metyrapone
 Management  Metotane
o Hypophysectomy Addison’s
o Inhibit production of ADH  Decreased GMA
 Demeclocyline/Declomycin PO  Decreased 3S
o Sugar
Parathormone  Hypoglycemia
 Promote reabsorption of Ca in the renal tubules and  Stimulate anterior pituitary gland 
excretion of P, essential for blood coagulation, regulate increased ACTH  MSH  tan
cardiac rhythmicity complexion  bronze-skinned
Hypoparathyroidism o Salt
 Hypocalcemia = hyperphosphatemia  Decreased IV volume  hypotension
o 4.5-5.5 mEq/L  Hyponatremia
o 8-11 mg/dL  Hyperkalemia  myocardial irritability
o High calcium diet  altered electrical conduction 
 Tetany dysrhythmias  heart arrest
o (+) Chvostek – tap the Facial nerve (below the o Sex
temporals)  muscle twitching of face  Management
o Trousseau – occlude blood flow of an extremity o Steroids
for 1-2 minutes  carpopedal spasm
 Management Conns/Primary aldosteronism
o Can be given sea foods but not milk, dairy  Adenoma of adrenal cortex (benign)
products and egg (rich in phosphorus) so check  Hyperactivity
levels of phosphorus if among the choices, all is Pheochromocytoma
with calcium  Adenoma of adrenal medulla (benign)

,MEDICAL SURGICAL NURSING 3
 Hyperactivity o Evaluate amount of radioactive iodine 131
 5H accumulated by the thyroid gland and excreted
o Hypertension by the kidneys
o Headache o No intake of iodine
o Hyperglycemia o Uptake = 15-40%
o Hypermetabolism o Urine = 40-80%
o Hyperhidrosis o PO RAI 131 cocktail (with brassy taste)  24 hr.
 Management urine  2-4 hr. scanner
o Cobalt therapy o E.g. 11am PO RAI 131 6 millicuries  24 hr.
o Surgical removal of adrenal medullary urine  1pm scanner
 Assessment  N: 0.9%-2.4 millicuries
o VMA (Vanillylmandellic Acid)  Low: 0.67
 Level of catecholamine  High: 3.6
 Blood 0.2-0.9 mg% o Directly proportional to uptake
 Urine 0.2-7 mg/24 hrs. o Inversely proportional to urine
 Thyroid Scan
Thyroid glands o Evaluate RAI 131 stored by thyroid gland to
 Isthmus – connects the two lobes of the thyroid glands determine size, shape, location of thyroid gland
 Thyroid hormones
o T3 – tri-iodothyronine HYPOTHYROIDISM
o T4 – Thyroxine  Onset of symptoms
o Thyrocalcitonin o Cretinism - childhood
 Plasma iodide + tyrosine (amino acid) = thyroglobulin o Myxedema - adulthood
(storage form)  T3, T4  Cause
o Level of hormones are related to feedback o Primary – failure of thyroid gland to secrete T3 T4
mechanism o Secondary – failure of anterior pituitary gland to
secrete TSH
Anterior pituitary gland  trophic hormone  target organ  S/sx
 TSH  thyroid gland  T3 T4 o Stunted growth
 ACTH  Adrenal cortex  SSS o Delayed onset of puberty
o Low VS
Assessments o Mentally sluggish
 PBI (Protein Bound Iodine) o Cold intolerant
o Evaluate amount of iodine attached to the protein o Hypometabolic = weight gain
molecule of the blood  Management
o 4-8 ug % o Supplement thyroid extract
o No intake of iodine for 3-4 days  Proloid
 Sea foods  Cytomel
 Iodized salt  Synthroid
 Cough syrup  Euthroid
 Salicylate (ASA)  Thyrolar
 Estrogenic preparations  Thyrax
 Dyes  Ectroxine
 T3 T4 Determination  Thyroxine
o T3 70-170 ug %  Levo-thyronine
 More potent than T4  Lio-thyronine
 Will not bind with iodine
 Can readily/penetrate a cell to HYPERTHYROIDISM
stimulate metabolism  Grave’s/Basedoue/Parry’s disease/ Thyroitoxicosis/Toxic
o T4 4.7-11 ug % Goiter
o No special preparations  Theories:
 TSH Test o LATS (Long-acting thyroid stimulator)
o 0.4-6.11 ug/ml  Gammaglobulin
o Decreased T3 T4  APG  stimulate TSH  Cause iodine accumulation and
o Increased T3 T4  APG  inhibit TSH thyroid hyperplasia
o Inversely proportional to thyroid function  Triad Symptoms
 BMR  Goiter
o Evaluate O2 consumption when at rest  Eye signs
o NPO 12 hrs. and good night sleep  Hyperthyroidism
o o Elevated T3 T4
 TBMR o EPS
o Theoretical basal metabolic rate  Anterior pituitary gland will release an
o 20-30 exophthalmos producing substance
o Pulse pressure + PR/min – 111  Exophthalmos (protrusion
o Not definitive of eyeball)
 RAIU (Radioactive Iodine Uptake)

, MEDICAL SURGICAL NURSING 4
 Proptosis (downward  Radical/Total thyroidectomy
displacement of eyeball) o Collar-line/Curvilinear
 Lid lag  Partial/Sub-total thyroidectomy – 5/6 of 2 lobes
 Infrequent blinking  Thyroid lobectomy
 Fixed stare  Isthmusectomy
 Peri-orbital edema
 Von Graefe (failure of Post-thyroidectomy management
eyelids to follow movement  Promote patent airway
of eyes when the patient o Position Semi-Fowler’s
looks down) o Not High-Fowler’s – cause strain on neck muscle
 Dalyrimple sign (infrequent which causes tension on suture line (bleeding)
blinking and fixed stare)  Turn to sides
o S/sx  Promote adequate nutrition and fluid and electrolytes
 Increased T3 T4 o As soon as fully awake and with gag reflex
 Diarrhea (Elevation of palate and contraction of
 Voracious increase T3 T4 (Grave’s) pharyngeal muscle)
 Over-excitability SNS (no  Promote adequate bowel-bladder elimination
management sought) o 6-8 hrs. after surgery
o Diaphoresis o If not within 6-8 hrs., palpate presence of bladder
o Tremors distention
o Nervousness  Encourage early ambulation
o Palpitation o Shorten convalescence period
o Constipation o Boost patient’s moral
o Simple goiter/Endemic goiter/ Iodine-deficiency o Get out of bed as soon as VS are stable
goiter/ Non-toxic goiter  Support the head and neck to prevent
o Goiter – enlargement of thyroid gland flexion and hyperextension
 Hormone levels  Complications
 May be normal, o Tetany
above/below normal  Occurs upon accidental removal of
because goiter is simply parathyroid glands
enlargement o 2 recurrent laryngeal nerves
Treatment Modalities  Hoarseness (edema of glottis)
 Anti-thyroid preparation  Aphonia
 Prevent synthesis T3 T4 by blocking utilization of o Bleeding
iodine  Failure to tie/ligate the bleeders
 Example  Check for dampness at the nape
o Tapazole/methimazole  Check for feeling of choking
o PTU (Propylthiouracil)  Evaluate VS
 Differential count  Rapid, weak, feeble,
o Neomercazole/Carbimazole thready pulse
 Adverse effects (prolonged use)  Rapid but shallow
o Agranulocytosis – infection respiration
 Fever o Respiratory obstruction
 Complaint of sore throat  Secondary to bleeding
 Dyspnea  Accumulation of tracheo-bronchial
 Iodine Preparation secretion
 Lugol’s solution/KISS (Potassium Iodide  Laryngospasm
Saturated Solution)  Laryngeal edema
o Reduce vascularity o Thyroid crises/storm
o Increase firmness of gland  High anxiety level pre-op
o Promote storage of T3 T4  Increased T3 TT4  anti-thyroid
 Adrenergic-blocking preparation for 3 months  euthyroid
 Control symptoms of over-excitability of state, normal T3 T4  operation 
SNS post-op stress, infection  increased
 RAI 131 T3 T4 (over-excitability of SNS)
 Surgery  Fever with tachycardia
 Management  Anti-thyroid preparation
o High caloric diet
o No colas/caffeinated beverages DIABETES MELLITUS
o Monitor weight Assessments
o Provide physical mental rest  FPG, RBS, PPBS, OGTT, Hgt
o Provide calm/restful environment
HHNK Coma/HHNS
o Elevate head to promote drainage and reduce
 Hyperglycemia  hyperosmolar diuresis  glycosuria &
peri-orbital edema
polyuria  ECF dehydration  cerebral dehydration 
CNS depression  HHNK
Surgeries
DKA
 Sistrunk’s – thyroglossal cyst