Med Surg 1 final SG
Med Surg 1 final SG 2023 A+
• Comprehensive Adult Concepts and Exemplars (no select all that apply)
o Hypertension (3)
▪ See handout (thanks a lot mila great review)
▪ Ace inhibitor sfx: cough, hyperkalemia
▪ Calcium channel blockers: edema,
▪ Nitroprusside: vasodilates/ for chest pain and hypertension
o Renal Calculi (3)
o UTI (1)
o Gallbladder (2)
o Endocrine (3)
▪ Common sfx for corticosteroids: hyperglycemia, insomnia, weight gain,
needs to be tapered down
▪ Diseases for corticosteroids: Addison's, crohn's, UC, any inflammation,
autoimmune diseases, nephrotic syndrome (MCNS)
▪ Addisons vs cushings (see handout ugh)
o Renal (4)
▪ Lasix assessments: K level, BP, Urine Output
o Fluid and Electrolytes (4)
▪ see handout :/
▪ Extracellular fluid imbalances: deficit, excess (causes/manifestations)
ECF Volume Deficit ECF Volume Excess
Causes
• Incr. insensible water loss or perspiration • Excessive isotonic or
(high fever, heatstroke) hypotonic IV fluids
• Diabetes insipidus • HF
• Osmotic diuresis • Renal failure
• Hemorrhage • Primary polydipsia
• GI loss: vomiting, NG suction, diarrhea, • SIADH
fistula drainage • Cushing syndrome
• Overuse of diuretics • Long term use of
• Inadequate fluid INTAKE corticosteroids
• 3rd space fluid shift (burns, pancreatitis)
Manifestations
• Restlessness, drowsiness, lethargy, confusion • Headache, confusion, lethargy
• Thirst, dry mucous membranes • Peripheral edema
• Cold clammy skin • Jugular venous distention
• Decreased skin turgor, decr. Cap refill • S3 heart sound
• Postural hypotension • Bounding pulse
• Incr. HR and CVP • Incr. HR and CVP
• Decr. urine output, concentrated urine • Polyuria
• Incr. RR • Dyspnea, crackles, pulmonary
1|Page
, Med Surg 1 final SG
• Weakness, dizziness edema
• Weight loss • Muscle spasms
• Seizures, coma • Weight gain
• Seizures
• coma
▪ Sodium imbalances: hyper/hypo (causes/manifestations)
Hypernatremia (>145) Hyponatremia (<135)
Causes
Excessive sodium INTAKE Excessive sodium LOSS
• IV fluids: hypertonic NaCl, excessive • GI loss: diarrhea, vomiting, fistulas, NG
isotonic NaCl, IV sodium bicarb suction
• Hypertonic tube feedings w/o water • Renal loss: diuretics, adrenal insufficiency,
supplements Na wasting renal disease
• Near drowning in salt water • Skin loss: burns, wound drainage
Inadequate water INTAKE Inadequate sodium INTAKE
• Unconscious or cognitively impaired • Fasting diets
Excessive water LOSS (increased Na conc) Excessive water GAIN (decr. Na conc.)
• Incr. insensible water loss (high fever, • Excessive hypotonic IV fluids
heatstroke, prolonged hyperventilation) • Primary polydipsia
• Osmotic diuretic therapy
• diarrhea
Diseases
• Diabetes insipidus • SIADH
• Primary HYPERaldosteronism • HF
• Cushing syndrome • Primary HYPOaldosteronism
• Uncontrolled diabetes mellitus • cirrhosis
Manifestations
Decr. ECF volume
• Restlessness, agitation, lethargy, • irritability , apprehension, confusion,
seizures, coma dizziness, personality changes, tremors,
• Intense thirst, dry swollen tongue, seizures, coma
sticky mucous membranes • Dry mucous membranes
• Postural hypotension • Postural hypotension
2|Page
Med Surg 1 final SG 2023 A+
• Comprehensive Adult Concepts and Exemplars (no select all that apply)
o Hypertension (3)
▪ See handout (thanks a lot mila great review)
▪ Ace inhibitor sfx: cough, hyperkalemia
▪ Calcium channel blockers: edema,
▪ Nitroprusside: vasodilates/ for chest pain and hypertension
o Renal Calculi (3)
o UTI (1)
o Gallbladder (2)
o Endocrine (3)
▪ Common sfx for corticosteroids: hyperglycemia, insomnia, weight gain,
needs to be tapered down
▪ Diseases for corticosteroids: Addison's, crohn's, UC, any inflammation,
autoimmune diseases, nephrotic syndrome (MCNS)
▪ Addisons vs cushings (see handout ugh)
o Renal (4)
▪ Lasix assessments: K level, BP, Urine Output
o Fluid and Electrolytes (4)
▪ see handout :/
▪ Extracellular fluid imbalances: deficit, excess (causes/manifestations)
ECF Volume Deficit ECF Volume Excess
Causes
• Incr. insensible water loss or perspiration • Excessive isotonic or
(high fever, heatstroke) hypotonic IV fluids
• Diabetes insipidus • HF
• Osmotic diuresis • Renal failure
• Hemorrhage • Primary polydipsia
• GI loss: vomiting, NG suction, diarrhea, • SIADH
fistula drainage • Cushing syndrome
• Overuse of diuretics • Long term use of
• Inadequate fluid INTAKE corticosteroids
• 3rd space fluid shift (burns, pancreatitis)
Manifestations
• Restlessness, drowsiness, lethargy, confusion • Headache, confusion, lethargy
• Thirst, dry mucous membranes • Peripheral edema
• Cold clammy skin • Jugular venous distention
• Decreased skin turgor, decr. Cap refill • S3 heart sound
• Postural hypotension • Bounding pulse
• Incr. HR and CVP • Incr. HR and CVP
• Decr. urine output, concentrated urine • Polyuria
• Incr. RR • Dyspnea, crackles, pulmonary
1|Page
, Med Surg 1 final SG
• Weakness, dizziness edema
• Weight loss • Muscle spasms
• Seizures, coma • Weight gain
• Seizures
• coma
▪ Sodium imbalances: hyper/hypo (causes/manifestations)
Hypernatremia (>145) Hyponatremia (<135)
Causes
Excessive sodium INTAKE Excessive sodium LOSS
• IV fluids: hypertonic NaCl, excessive • GI loss: diarrhea, vomiting, fistulas, NG
isotonic NaCl, IV sodium bicarb suction
• Hypertonic tube feedings w/o water • Renal loss: diuretics, adrenal insufficiency,
supplements Na wasting renal disease
• Near drowning in salt water • Skin loss: burns, wound drainage
Inadequate water INTAKE Inadequate sodium INTAKE
• Unconscious or cognitively impaired • Fasting diets
Excessive water LOSS (increased Na conc) Excessive water GAIN (decr. Na conc.)
• Incr. insensible water loss (high fever, • Excessive hypotonic IV fluids
heatstroke, prolonged hyperventilation) • Primary polydipsia
• Osmotic diuretic therapy
• diarrhea
Diseases
• Diabetes insipidus • SIADH
• Primary HYPERaldosteronism • HF
• Cushing syndrome • Primary HYPOaldosteronism
• Uncontrolled diabetes mellitus • cirrhosis
Manifestations
Decr. ECF volume
• Restlessness, agitation, lethargy, • irritability , apprehension, confusion,
seizures, coma dizziness, personality changes, tremors,
• Intense thirst, dry swollen tongue, seizures, coma
sticky mucous membranes • Dry mucous membranes
• Postural hypotension • Postural hypotension
2|Page
