summary med surg 1 reviewmed surg 2 review texas aampm university
corpus christi nurs 3628 |med surg 2 final hesi review complete solution guide latest 20202021
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Chamberlain College Of Nursing
NURS 3628 (NURS3628)
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Med surg 1 review/Med surg 2 review:
Renal assessment
Bun 8 – 25
Creatinine 0.6 – 1.3
Uric acid 2.5 – 8
Potassium 3.5 - 5
GFR 125/min (>60 is good for kidney pt)
Specific gravity – 1.003 – 1.02
AST: 0 – 35
ALT: 10 – 35
Albumin: 3.5 – 5.5 (same as potassium)
Bilirubin: 0.1 – 1.2 mg/dl
Amylase: 25-150
Lipase: 10 – 140
Thyroid
Hypothyroid- high TSH (trying to stimulate thyroid to work), low T3 and T4
o Everything slows down (bowel movements), hair falls out, dry skin,
fat, fatigue, Puffy face
o Give synthroid in morning before meals (at same time)
o Myxedema (opposite of thyroid storm) – decrease mental status,
hypothermia, slowing of organ function
o After a thyroidectomy, a client is at risk for developing hypocalcemia.
Trousseau sign (carpal spasm w BP cuff)
Hyperthyroid- TSH is low (thyroid already working too much)
o Thyroid storm, inc BP, diarrhea, weight loss, exopthalamous, heat
intolerance, nausea
o Thryorid storm - fever, hyperreflexia, abdominal pain, diarrhea,
dehydration rapidly progressing to coma, severe tachycardia,
extreme vasodilation
Radioactive iodine- stay away from pregnant people and
chidren for 24 hours
Thyroidectomy- watch for hypothyroid, HOB raised (incision),
watch for blood. Watch for thyroid storm.
Graves disease is the result of increased thyroid, not
parathyroid, activity.
, Hyperparthyroidism
o calcium = too high bone pain (kidney stones, concentration
problems)
o Elevated serum calcium levels produce osmotic diuresis and thus
polyuria.
This diuresis leads to dehydration (weight loss rather than
weight gain).
Calcium is being pulled from the bones aka excess bone
reabsorption bone pain
Hypoparathyroidism (hypo LOW calcium)
o Parathyroid removed- calcium will drop (brittle nails, cataracts, dry
skin)
SIADH - edema, fluid volume overload,
give diuretics, replace fluids (keep a balance so not dehydrated)
doctors restrict fluids, not nurses
SS:
1. High urine osmolality
2. Low serum osmolality
3. Hypotonicity of body fluids
4. Continued release of antidiuretic hormone
5. hyponatremia
Diabetes Insipidis – not enough ADH; pee a lot; super thristy
s/s- low specific gravity of urine, dehydration
Treatment: desmopressin
give them an antidiuretic increase urine concentration
Type 1 Diabetes – no insulin production
keytones in urine, Dx very young
, Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15
minutes. Insulin aspart should be administered when the client's tray is
available
Type 2 diabetes- not enough insulin production
HHNS
o The primary goal of treatment in hyperglycemic hyperosmolar state
(HHS) is to rehydrate the client to restore fluid volume and to correct
electrolyte deficiency. Intravenous fluid replacement is similar to that
administered in diabetic ketoacidosis (DKA) and begins with IV
infusion of normal saline
o Insulin stimulates cellular uptake of glucose and also stimulates the
sodium/potassium pump, leading to the influx of potassium into
cells. The resulting hypokalemia is offset by parenteral administration
of potassium
o Potassium moves from the extracellular intracellular (not lost in
urine)
o Type 2 cardiac catherization for percutaneous coronary contrast
used watch creatinine and BUN!!!
D5W administration – watch potassium (3.5 – 5)
Gabapentin an antiepileptic drug, but it is also used to treat diabetic
neuropathy
Hypoglycemia
Shakiness. Palpitations, lightheaded (tremors, irritability, nervousness)
HANGRY
Treatment: simple sugar (such as two packets of sugar), followed by a
complex carbohydrate (such as a slice of bread), and finally a protein (such
as milk);
o the simple sugar elevates the blood glucose level rapidly;
o the complex carbohydrates and protein produce a more sustained
response.
Hyperglycemia
polyuria, blurred vision, kussmal
Cardiac
Hypertension
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