Med Surg/Adult Health 1 Study Notes
Topic 1 – Endocrine
Conditions:
● Diabetes Mellitus Type 1 & 2
● Hyperthyroidism (Graves’ disease)
● Hypothyroidism (Hashimoto’s disease)
I. Key Labs for Endocrine Disorders
Lab Normal Range Clinical Significance
Fasting Blood
Glucose 70–99 mg/dL Elevated in DM
HbA1C 4–6% ≥6.5% = diabetes
TSH 0.4–4.2 µU/mL ↑ in hypothyroidism, ↓ in hyperthyroidism
Free T4 0.8–2.8 ng/dL ↓ in hypothyroidism, ↑ in hyperthyroidism
Free T3 260–480 pg/dL ↑ in hyperthyroidism
Sodium 135–145 mEq/L ↓ in SIADH, ↑ in DI
Potassium 3.5–5.0 mEq/L Abnormal in DKA, adrenal disorders
II. Pathophysiology & Clinical Manifestations
A. Diabetes Mellitus
● Type 1: Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency.
Usually childhood onset.
● Type 2: Insulin resistance + impaired secretion. Usually adult onset, linked to obesity
and lifestyle.
S/S:
● 3 Ps: Polyuria, Polydipsia, Polyphagia
● Fatigue, blurred vision, slow wound healing, recurrent infections
● DKA (Type 1): Hyperglycemia, ketones, metabolic acidosis, fruity breath
● HHS (Type 2): Severe hyperglycemia, dehydration, no ketones
,B. Hyperthyroidism (Graves’)
● Patho: Excess thyroid hormone → hypermetabolic state.
● S/S: Weight loss despite ↑ appetite, heat intolerance, tachycardia, exophthalmos, tremor,
anxiety, warm/moist skin.
● Thyroid storm: Life-threatening; high fever, tachycardia, agitation, confusion.
C. Hypothyroidism (Hashimoto’s)
● Patho: Autoimmune destruction or iodine deficiency → ↓ thyroid hormone.
● S/S: Fatigue, weight gain, cold intolerance, bradycardia, constipation, dry skin,
depression.
● Myxedema coma: Severe hypothyroidism; decreased LOC, hypothermia, hypotension,
bradycardia, hypoventilation.
III. Diagnostic Studies
● DM: FBG ≥126 mg/dL, HbA1C ≥6.5%, random glucose ≥200 mg/dL with symptoms
● Thyroid: TSH, Free T4, Free T3, radioactive iodine uptake scan
IV. Nursing Process Applications
Assessment
● Monitor vital signs, weight, fluid balance
● Assess for hypo/hyperglycemia
● Check for thyroid storm or myxedema signs
● Evaluate patient’s ability to manage disease (med adherence, diet, monitoring)
Interventions
● DM: Administer insulin/oral hypoglycemics as ordered, monitor blood glucose before
meals/bedtime, treat hypoglycemia (15g carb rule).
● Hyperthyroidism: Administer antithyroid drugs (methimazole, PTU), beta-blockers for
symptom control, prepare for thyroidectomy if indicated.
● Hypothyroidism: Administer levothyroxine in AM on empty stomach, lifelong therapy,
avoid abrupt discontinuation.
Evaluation
● Blood glucose within target range, A1C improvement
● Normalization of TSH/T4 levels
● Absence of hypo/hyper symptoms
1
, V. Medications – Classification, MOA, Adverse Effects, Nursing Considerations
Key Adverse Nursing
Condition Class Example MOA Effects Considerations
Replaces
Rapid-acting endogenous Give within 15 min of
DM insulin Lispro insulin Hypoglycemia meal
Long-acting Basal insulin Do not mix, given
DM insulin Glargine coverage Hypoglycemia (rare) once daily
↓ hepatic
glucose
production, ↑
insulin Lactic acidosis, GI Hold before contrast,
DM Biguanide Metformin sensitivity upset monitor renal function
Inhibits thyroid
hormone Agranulocytosis, Monitor WBC, liver
Hyperthyroidism Thioamides Methimazole synthesis hepatotoxicity enzymes
Hyperthyroidism
Synthetic T4 symptoms if Take AM on empty
Hypothyroidism Thyroid hormone Levothyroxine replacement overdose stomach
VI. NCLEX Priority Cues & Safety
● For insulin: Peak times = highest hypoglycemia risk (e.g., Lispro peaks in 1–2 hrs).
● Never stop levothyroxine abruptly (risk of myxedema coma).
● In thyroid storm → ABCs, reduce fever, prevent cardiovascular collapse.
● In DKA/HHS → priority is fluid replacement before insulin.
VII. Patient Education
● DM: Glucose monitoring, carb counting, exercise safety, foot care, sick day rules (check
glucose q4h).
● Hyperthyroidism: Avoid stimulants, high-calorie high-protein diet, protect eyes in
exophthalmos.
● Hypothyroidism: Lifelong medication, monitor for chest pain/palpitations with dose
changes.
Topic 2, Perioperative Nursing and Fluid and Electrolyte Imbalances
High yield objectives: preop to postop nursing process with safety and consent, central line
care, medication education, self-care teaching, recognition and initial management of fluid
volume excess and deficit, and sodium, potassium, calcium, magnesium, phosphate disorders,
plus IV medication calculations.
2
, A. Rapid preop to postop framework
Preoperative essentials
● Verify identity, allergies, procedure, site, consent is signed by the provider and voluntary,
patient capable, interpreter used when needed.
● Assessment focus: airway history, OSA, difficult intubation, dentures, loose teeth,
recent respiratory infection, cardiac history and devices, meds including anticoagulants,
hypoglycemics, steroids, herbal supplements, last PO intake, pregnancy possibility,
substance use.
● Key labs and tests: CBC, BMP, coagulation panel, type and screen or crossmatch,
pregnancy test when applicable, ECG with cardiac history, chest X-ray if indicated.
● Medication holds:
○ Oral hypoglycemics on day of surgery unless otherwise ordered.
○ Metformin 24 to 48 hours before contrast studies and until renal function is
verified post study.
○ Anticoagulants per protocol, often bridge with heparin if high risk.
○ ACE inhibitors or ARBs morning of surgery are often held if hypotension risk,
follow facility policy.
● Preop teaching: incentive spirometer, cough and deep breathe with splinting, early
ambulation, DVT prevention, pain scale and PCA basics, tubes and drains that may be
present. Teaching reduces anxiety and improves outcomes.
Day of surgery
● NPO status verified, last solids and clear liquids times documented.
● Remove jewelry, piercings, contact lenses, dentures if required.
● Preop meds as ordered, for example antibiotic within 60 minutes of incision, beta blocker
continuation when indicated.
● Safety checks: site marking, time out, warm blankets to prevent hypothermia.
Intraoperative priorities
● Sterile field, positioning injury prevention, temperature management, glucose monitoring
for diabetics, accurate I and O, blood loss tracking.
● Malignant hyperthermia recognition, rapidly rising CO2, rigidity, tachycardia,
hyperthermia late, give dantrolene, apply 100 percent oxygen, active cooling, treat
acidosis and hyperkalemia, call for help.
Postoperative, PACU to floor
● First priorities: airway, breathing, circulation, neuro status, surgical site, drains, urine
output, pain, nausea.
● Criteria to transfer from PACU, stable vitals, adequate ventilation and oxygenation,
minimal nausea, controlled pain, minimal bleeding, level of consciousness appropriate.
● Common early complications and actions:
○ Airway obstruction from tongue or secretions, position head tilt and jaw thrust,
suction, consider oral airway.
○ Hypoventilation from opioids or residual anesthetics, stimulate, apply oxygen,
consider naloxone per protocol.
3
Topic 1 – Endocrine
Conditions:
● Diabetes Mellitus Type 1 & 2
● Hyperthyroidism (Graves’ disease)
● Hypothyroidism (Hashimoto’s disease)
I. Key Labs for Endocrine Disorders
Lab Normal Range Clinical Significance
Fasting Blood
Glucose 70–99 mg/dL Elevated in DM
HbA1C 4–6% ≥6.5% = diabetes
TSH 0.4–4.2 µU/mL ↑ in hypothyroidism, ↓ in hyperthyroidism
Free T4 0.8–2.8 ng/dL ↓ in hypothyroidism, ↑ in hyperthyroidism
Free T3 260–480 pg/dL ↑ in hyperthyroidism
Sodium 135–145 mEq/L ↓ in SIADH, ↑ in DI
Potassium 3.5–5.0 mEq/L Abnormal in DKA, adrenal disorders
II. Pathophysiology & Clinical Manifestations
A. Diabetes Mellitus
● Type 1: Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency.
Usually childhood onset.
● Type 2: Insulin resistance + impaired secretion. Usually adult onset, linked to obesity
and lifestyle.
S/S:
● 3 Ps: Polyuria, Polydipsia, Polyphagia
● Fatigue, blurred vision, slow wound healing, recurrent infections
● DKA (Type 1): Hyperglycemia, ketones, metabolic acidosis, fruity breath
● HHS (Type 2): Severe hyperglycemia, dehydration, no ketones
,B. Hyperthyroidism (Graves’)
● Patho: Excess thyroid hormone → hypermetabolic state.
● S/S: Weight loss despite ↑ appetite, heat intolerance, tachycardia, exophthalmos, tremor,
anxiety, warm/moist skin.
● Thyroid storm: Life-threatening; high fever, tachycardia, agitation, confusion.
C. Hypothyroidism (Hashimoto’s)
● Patho: Autoimmune destruction or iodine deficiency → ↓ thyroid hormone.
● S/S: Fatigue, weight gain, cold intolerance, bradycardia, constipation, dry skin,
depression.
● Myxedema coma: Severe hypothyroidism; decreased LOC, hypothermia, hypotension,
bradycardia, hypoventilation.
III. Diagnostic Studies
● DM: FBG ≥126 mg/dL, HbA1C ≥6.5%, random glucose ≥200 mg/dL with symptoms
● Thyroid: TSH, Free T4, Free T3, radioactive iodine uptake scan
IV. Nursing Process Applications
Assessment
● Monitor vital signs, weight, fluid balance
● Assess for hypo/hyperglycemia
● Check for thyroid storm or myxedema signs
● Evaluate patient’s ability to manage disease (med adherence, diet, monitoring)
Interventions
● DM: Administer insulin/oral hypoglycemics as ordered, monitor blood glucose before
meals/bedtime, treat hypoglycemia (15g carb rule).
● Hyperthyroidism: Administer antithyroid drugs (methimazole, PTU), beta-blockers for
symptom control, prepare for thyroidectomy if indicated.
● Hypothyroidism: Administer levothyroxine in AM on empty stomach, lifelong therapy,
avoid abrupt discontinuation.
Evaluation
● Blood glucose within target range, A1C improvement
● Normalization of TSH/T4 levels
● Absence of hypo/hyper symptoms
1
, V. Medications – Classification, MOA, Adverse Effects, Nursing Considerations
Key Adverse Nursing
Condition Class Example MOA Effects Considerations
Replaces
Rapid-acting endogenous Give within 15 min of
DM insulin Lispro insulin Hypoglycemia meal
Long-acting Basal insulin Do not mix, given
DM insulin Glargine coverage Hypoglycemia (rare) once daily
↓ hepatic
glucose
production, ↑
insulin Lactic acidosis, GI Hold before contrast,
DM Biguanide Metformin sensitivity upset monitor renal function
Inhibits thyroid
hormone Agranulocytosis, Monitor WBC, liver
Hyperthyroidism Thioamides Methimazole synthesis hepatotoxicity enzymes
Hyperthyroidism
Synthetic T4 symptoms if Take AM on empty
Hypothyroidism Thyroid hormone Levothyroxine replacement overdose stomach
VI. NCLEX Priority Cues & Safety
● For insulin: Peak times = highest hypoglycemia risk (e.g., Lispro peaks in 1–2 hrs).
● Never stop levothyroxine abruptly (risk of myxedema coma).
● In thyroid storm → ABCs, reduce fever, prevent cardiovascular collapse.
● In DKA/HHS → priority is fluid replacement before insulin.
VII. Patient Education
● DM: Glucose monitoring, carb counting, exercise safety, foot care, sick day rules (check
glucose q4h).
● Hyperthyroidism: Avoid stimulants, high-calorie high-protein diet, protect eyes in
exophthalmos.
● Hypothyroidism: Lifelong medication, monitor for chest pain/palpitations with dose
changes.
Topic 2, Perioperative Nursing and Fluid and Electrolyte Imbalances
High yield objectives: preop to postop nursing process with safety and consent, central line
care, medication education, self-care teaching, recognition and initial management of fluid
volume excess and deficit, and sodium, potassium, calcium, magnesium, phosphate disorders,
plus IV medication calculations.
2
, A. Rapid preop to postop framework
Preoperative essentials
● Verify identity, allergies, procedure, site, consent is signed by the provider and voluntary,
patient capable, interpreter used when needed.
● Assessment focus: airway history, OSA, difficult intubation, dentures, loose teeth,
recent respiratory infection, cardiac history and devices, meds including anticoagulants,
hypoglycemics, steroids, herbal supplements, last PO intake, pregnancy possibility,
substance use.
● Key labs and tests: CBC, BMP, coagulation panel, type and screen or crossmatch,
pregnancy test when applicable, ECG with cardiac history, chest X-ray if indicated.
● Medication holds:
○ Oral hypoglycemics on day of surgery unless otherwise ordered.
○ Metformin 24 to 48 hours before contrast studies and until renal function is
verified post study.
○ Anticoagulants per protocol, often bridge with heparin if high risk.
○ ACE inhibitors or ARBs morning of surgery are often held if hypotension risk,
follow facility policy.
● Preop teaching: incentive spirometer, cough and deep breathe with splinting, early
ambulation, DVT prevention, pain scale and PCA basics, tubes and drains that may be
present. Teaching reduces anxiety and improves outcomes.
Day of surgery
● NPO status verified, last solids and clear liquids times documented.
● Remove jewelry, piercings, contact lenses, dentures if required.
● Preop meds as ordered, for example antibiotic within 60 minutes of incision, beta blocker
continuation when indicated.
● Safety checks: site marking, time out, warm blankets to prevent hypothermia.
Intraoperative priorities
● Sterile field, positioning injury prevention, temperature management, glucose monitoring
for diabetics, accurate I and O, blood loss tracking.
● Malignant hyperthermia recognition, rapidly rising CO2, rigidity, tachycardia,
hyperthermia late, give dantrolene, apply 100 percent oxygen, active cooling, treat
acidosis and hyperkalemia, call for help.
Postoperative, PACU to floor
● First priorities: airway, breathing, circulation, neuro status, surgical site, drains, urine
output, pain, nausea.
● Criteria to transfer from PACU, stable vitals, adequate ventilation and oxygenation,
minimal nausea, controlled pain, minimal bleeding, level of consciousness appropriate.
● Common early complications and actions:
○ Airway obstruction from tongue or secretions, position head tilt and jaw thrust,
suction, consider oral airway.
○ Hypoventilation from opioids or residual anesthetics, stimulate, apply oxygen,
consider naloxone per protocol.
3
