Learning Thread: Med/Surg

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I don't know if you guys have read the thread in the learning one in the ER section. I think is cool so I thought maybe we should start one here too. When ever you learn something new in your floor or interestiong that nurses should know post it here. We can all learn something from it. We can make it a triva questions like the ER has done.

Ok I will go first this is an easy one:

You have a pt with type 2 diabetes in the hospital with a serious illness and has been controlling her diabetes with oral meds. Now you are giving this pt Insulin. Family is freaking out. Don't understand why now you have to give their family member insulin. What do you tell them?? Why is the pt on Insulin??

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oh come on guys I know you are reading this:lol2:

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Ok,OK maybe I world this wrong.

You are giving this pt Insulin b/c their glucose (sugar) levels are high.

When someone is seriously Ill there are various hormones in our body that come into play to help the body recover. (cortisol, growth hormone, and epinephrine). As a result they increase the bloods glucose very high that oral med are not enogh to decrase them. THis is why Insulin is used. chances are excellent, when they recover from their illness , there blood glucose will decrease and they can go back to their regular oral meds.

OK I guess this was more a pathophysiology way of looking at it, but This does happen alot and now you know why.

Anyone else have a question??? Come on don't be shy

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Lest you feel your post was neglected, I'm sure lots of people are aware of this but I for one just learned something new! I didn't realize illness caused other hormonal shifts that would raise glucose. Tidbits like this make fun reading for those of us lurking nerds that are impatiently waiting to get into/start our nursing programs!

More of the same would be appreciated if anyone feels the urge....

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ok here is one.

If you suspect your pt has DVT in his/her calf muscle do you do the Homan's sign or not???

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As far as the blood glucose bit, all our post open heart patients go on an insulin drip for the first 48 hours post surgery, and are on a sliding scale for the rest of their stay. Understandably, that freaks a lot of them out. "I'm not diabetic! Why are you giving me insulin?" I just explain that studies show that people heal better when their blood glucose is in a certain range, and that's why we're doing that. Stress can tend to raise blood sugar, being in the hospital and going through a major surgery is stressful, let's give your body the best chance possible to heal. . . .just because they are on insulin after surgery doesn't automatically make them diabetic. I think that is what a lot of patients are afraid of. Of course if their HgbA1C is off the scale. . . . ..

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Specializes in Med Surg/Tele/ER.
ok here is one.

If you suspect your pt has DVT in his/her calf muscle do you do the Homan's sign or not???

No. I was taught never to do this as it could dislodge a clot.

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Excellent! You are so right. I still see nurses do that and Doctor too ahhhhh!

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Specializes in Emergency.

So your patient has a seizure, I am talk about tonic-clonic. As the patient is moving into the post-ictal period, the MD starts yelling "Do you know where your at?" "What year is it?" Can you tell me the time or date?" Why?

Maybe the MD is asking the nurse so we can document it? lol?

Do they understand what is happening during this phase of a seizure?

Post Ictal signs and symptoms

Thought:

Memory loss, Writing difficulty

Emotional:

Confusion, Depression and sadness, Fear

Frustration,Shame/Embarrassment

Physical:

Bruising,

Difficulty talking, Injuries, Sleeping

Exhaustion, Headache, Nausea, Pain

Thirst, Weakness, Urge to urinate/defecate

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As far as the blood glucose bit, all our post open heart patients go on an insulin drip for the first 48 hours post surgery, and are on a sliding scale for the rest of their stay. Understandably, that freaks a lot of them out. "I'm not diabetic! Why are you giving me insulin?" I just explain that studies show that people heal better when their blood glucose is in a certain range, and that's why we're doing that. Stress can tend to raise blood sugar, being in the hospital and going through a major surgery is stressful, let's give your body the best chance possible to heal. . . .just because they are on insulin after surgery doesn't automatically make them diabetic. I think that is what a lot of patients are afraid of. Of course if their HgbA1C is off the scale. . . . ..

On a similar note, I spent the better half of one morning a few weeks ago trying to convince a post-op patient to let me administer SSI. She takes metformin at home, and couldn't understand, no matter how much I tried to explain, that we hold metformin 48 hours post NPO. She just kept saying, "but I don't take insulin at home." Never did let me give her insulin; just documented the h$%& out of that conversation!

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steve great post and real.. this is a good reason why we need to educate our pt about the hormoes in our body that help us recover but as a resulf of that increase the sugar level way up. thanks for posting

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Wow I can't believe this post didn't continue, well here is another.

When taking a pts pulse ox, and it shows a 98% saturation but patient looks blue what do you thing this means?

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