Summary
Summary Medical Surgical Full Set of Notes
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Medical surgical full set of notes, in depth and well written. Common pathologies, lab values, interventions.
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FundamentalsLow income ppl: Medicaid: Medicare if disabled:
Primary prevention: immunization: health ed
Secondary: diagnosis and treatment: screening
Tertiary: provision of care
APs can reapply a condom catheter
Communicable diseases: TB- hepatitis A
Adolescents need iron, calcium, and vitamins A & C: need lots of protein
Preventing foot drop: keep foot dorsiflexed and use a trochanter roll
Perineal care: privacy; cleansing from front to back: drying thoroughly: retract penis foreskin
Working with an interpreter: speak directly to patient: tell interpreter purpose of convo:
Appropriate documentation:factual: accurately and concise: SOAP: PIE:DAR
Revising plan of care(pressure ulcers, wounds): hydration: wound cleansing: dehiscence- rupture
of wound: call for help: infection: purple by drainage: rest: antibiotic therapy:
Maintaining Aseptic technique: hand hygiene: masks, gowns, gloves, eyewear: don't shake
linens:
Crutch Safety: don't alter crutches: support body weight with elbows flexed at 30;
Confirming placement of NG tube in jejunum: aspirate stomach content to test pH: x-Ray
initially:
Peripheral catheter insertion: change sites every 72 hours; wipe ports with alcohol swab: check
distal veins first: advance the Catheter through the skin and into the vein: flashback should
occur: thread catheter into vein: pull back needle; release tourniquet: remove needle:
Gentamicin and furosemide: ototoxic
Fundamentals
Dietary Preferences
Buddhism- lacto-ovo: no alcohol
Hinduism: vegetarians or no beef/pork
,Islam: only meat that's ritually slaughtered
-body facing Mecca
Judaism: kosher diet or animals that are herbivores: can't eat milk and meat together
-24 HR fast for Yom Kippur: no shellfish
Asians: yin(cold) & yang(hot)
-thalassemia
Native American: TB & gallbladder
Herbs
-black cohosh: estrogen
-echinacea: immune system
-feverfew: anti inflammatory: migraines: fever: arthritis
-garlic: lower cholesterol
-ginger: antiemetic
-ginkgo- memory
-ginseng: stress and fatigue: increase endurance and stamina
Kava: antianxiety and muscle relaxant: sedative
-saw palmetto- antiestrogen: UTI & BPH
ST. JOHNS: antibacterial. Antiviral. Antidepressant.
HTN risk: native Americans. Latino Americans. Hispanics. AA
Paternalism: HCP decides what is best for the client and encourages the client to act against
his/her own choices
Fidelity: promise
Veracity: tell the truth
Ca2+: coagulation of blood; 8.6-10
Compensation=normal pH
Mg2*:1.6-2.6: clotting: neuromuscular
Metabolic acidosis: kidney failure. Toxins. Aspirin. Lactic acid. DK
Metabolic alkalosis: hypovolemia. Loss of gastric fluid. Excessive bicarbonate intake.
Transfusion. Hyperaldosteronism
Phosphorus: needed for bony tissue: 2.7-4.5
,Febrile transfusion: antibodies directed against WBC
Bacterial transfusion: transfusion of contaminated blood products
Third spacing: accumulation and sequestration of trapped extracellular fluid in an actual or
potential body space
Fluid volume deficit: increased HCT, BUN, NA, specific gravity, osmolality
Fluid volume overload: decreased HCT, BUN, NA, specific gravity, osmolality; crackles,
Isotonic overhydration: IV therapy. Kidney disease. Long term steroid use
Hypertonic overhydration: NA ingestion. Rapid infusion. Excessive bicarbonate
Hypotonic overhydration: early kidney disease. HF. SIADH. IV. wound irrigation
Decreased sodium excretion: steriods. Cushing's. Kidney disease. Hyperaldosteronism
HypoK: hypoactive bowel sounds: ST depression: shallow, flat, inverted T wave, U wave
HyperK: peaked T waves. Flat p waves. Wide QRS. Prolonged PR
Take liquid K with juice due to bad taste
-only give K PO or IV continuous infusion:NEVER IV push
-no more than 10-20HR
-always dilute:1/10 mL
HyperK: tissue damage. Acidosis. Hyperuricemia. Hypercatabolism
-Kayexalate: IV Ca2+: hypertonic glucose w/ insulin: fresh blood
HypoCa: Crohn's: steatorrhea; wound drainage:pancreatitis: alkalosis: decreased HR.
Hypotension. Diminished pulses: twitching
-warm injection to body temp: aluminum hydroxide. Vitamin D
HyperCA: thiazides diuretics: steriods: phosphorus. Calcitonin. Bisphosphonates. NSAIDs.
Dialysis: flank or abdominal pain=urinary stones
HypoMg: hyperglycemia; sepsis: insulin: Crohn's. Celiac. Tachy. HTN. Shallow respirations.
Twitches. Hyperreflexia
-fix Ca2+ levels
HyperMg: Brady. Hypo. Absent reflexes.
-calcium gluconate
-avoid laxatives and antacids
, Phosphorous:2.7-4.5
Hypo: hyperglycemia: respiratory alkalosis: decreased contractility
-weakness: confusion: seizures: decreased platelet aggregation
Hyper: tumor lysis syndrome: avoid laxatives and enemas.: take phosphate binding Meds with
meals
Acidosis: K moves out cell=hyperK
Respiratory -hypoventilation: high CO2
-endotracheal intubation or mechanical ventilation
-Metabolic: diabetes. Aspirin. High fat diet. Carbohydrates(lactic acidosis) Malnutrition. Renal
insufficiency. Diarrhea.
:Kussmaul's respiration
Alkalosis: K moves into cell=hypoK
-respiratory : hyperventilation: hysteria. Fever. Pain. Overventilation hypoxia
-decrease in CO2
: Metabolic: diuretics. Vomiting hyperaldosteronism. Excess bicarbonate. Transfusion:
suctioning
Allen's test: determines presence of collateral circulation: if pinkness doesn't return in 6-7
s=ulnar artery is insufficient and to not use radial artery
Respiratory
Elevated pH=decreased CO2: alkalosis
Decreased pH=elevated CO2: acidosis
Metabolic
Elevated pH=increased HCO3: alkalosis
Decreased pH=decreased CO2: acidosis
:Look at HCO3 for respiratory to determine compensation
:Look at CO2 for metabolic to determine compensation
Ileostomy: metabolic acidosis
Kussmaul's respirations: abnormally deep, regular, and increased in rate
Na:15 mEq/day: don't get from area of IV
K: high WBC & platelets=false elevated K
aPTT: clotting: plasma: 20-36 (60-80 Thera)
PT: clotting: 11-12.5(18-24 therapeutic)
INR:0.5-1;(2-3 therapeutic)
D-dimer test: measures clot formation and lysis that results from degradation of fibrin
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