MedSurg

• Cholecystectomy is the surgical removal of the gallbladder.
• Insulin is a hormone that lowers the level of glucose in the blood
• Insulin is made by the beta cells of the pancreas and released into the blood when the glucose level goes up, such as after eating
• Insulin helps glucose enter the body's cells, where it can be used for energy or stored for future use
• The major action of insulin is to lower blood glucose
• • Onset: 2-4 hr
  • Peak: 3-4 hr
  • Duration: 4-12 hr
  • Usually taken after food
  • Long Acting:
  • Agents: Glargine (Lantus), Detemir (Levemir)
  • Onset: 1 hr
  • Peak: Continuous (no peak)
  • Duration: 24 hr
  • Used for basal dose (insulin absorbed very slowly over 24 hrs and can be given once a day)
• Categories of Insulin:

  • Rapid Acting:
  • Agents: Lispro (Humalog), Aspart (Novolog)
  • Onset: 10-15 min
  • Peak: 5-15 min
  • Duration: 1hr
  • Indication: Used for rapid reduction of glucose level to treat postprandial hyperglycemia and to prevent nocturnal hypoglycemia
  • Short Acting:
  • Agent: Regular (Humalog R, Novolin R)
  • Onset: ½ - 1hr
  • Peak: 2-3 hr
  • Duration: 4-6 hr
  • Usually administered 20-30 min before a meal; may be taken alone or in combination with longer-acting insulin
  • Intermediate Acting:
  • Agent: NPH (Neutral protamine, Hagedorn)
• • Lipohypertrophy is the development of fibrofatty masses at the injection site
  • Rotation of injection site is important to prevent complications
• Complications of Insulin Therapy:

  • Local Allergic Reactions:
  • May appear at the injection site 1-2 hours after insulin administration
  • The physician may prescribe antihistamine to be taken 1hr before the injection
  • Severe reactions may lead to anaphylactic shock
  • Systematic Allergic Reaction:
  • Immediate local skin reaction that spreads into generalized urticaria
  • Treatment is desensitization with small doses of insulin administration in gradually increasing amounts using a desensitization kit
  • Insulin Lipodystrophy:
• Morning Hyperglycemia:

  • Insulin Waning: Progressive rise in blood glucose from bedtime to morning
  • Dawn Phenomenon: Normal blood glucose until about 3 am, when the level begins to rise
  • Somogyi Effect: Normal or elevated blood glucose at bedtime then a decrease at 2-3 am to hypoglycemic levels and a subsequent increase caused by the production of counterregulatory hormones
• How to aspirate and mix regular insulin and NPH insulin in a single syringe:

  • Instill air into the NPH vial and withdraw the needle
  • Inject air into the regular insulin vial and withdraw regular insulin
  • Reinsert the needle into the NPH insulin vial and withdraw the ordered amount of NPH insulin
• Sliding Scales:

  • Insulin prescriptions specify fixed amounts of long-acting insulin to be given routinely and fixed amounts of short-acting insulin prior to every meal
  • Different doses based on fingerstick glucose levels
• Injection Sites:

  • Front of thigh/lateral thigh
  • Abdomen
  • Buttocks
  • Lateral aspect of arm
  • Cleaning or disinfection of skin is not necessary unless hygiene is a real problem
  • Rotation of injection site is important to prevent lipodystrophy
• Insulin Injection Rotation:

  • Rotation methods vary, but it's important to rotate injection sites to prevent complications
  • Different methods of rotation include clockwise or side-to-side progression, ensuring all available areas are eventually used
• Professor: 'Dr. Potenciana A. Maroma'
• BSN 3RD YEAR 2ND SEMESTER MIDTERM 2023
• Bachelor of Science in Nursing 3YB
• Exam Week
• Midterm Topics


  • Diabetes
  • DI, SIADH, Thyroid disorders
  • Adrenal and parathyroid gland disorders
  • Introduction to nervous system
  • Increased ICP, Head injury, CVA, SCI and Seizures
• Diabetes Mellitus


  A chronic metabolic disease characterized by hyperglycemia due to disorder of carbohydrate, fat and protein metabolism
• Once you have diabetes, it is a lifetime condition
• Predisposing Factors for Diabetes Mellitus

  • Heredity
  • Obesity
  • Stress
  • Viral infection
  • Autoimmune Disorders
  • Multigravida Women with large babies
• Types of Diabetes Mellitus

  • Type I
  • Type II
  • Gestational Diabetes
  • Diabetes associated with other conditions or syndromes
• Type I Diabetes (IDDM)


  • Juvenile-onset, Brittle DM, Unstable DM
  • Onset is less than 30 years
  • Common in children or in non-obese adults
  • NO insulin production
  • Prone for DKA (Diabetic Ketone Acidosis)
  • Management: Diet, Exercise, Insulin lifetime
• Type II Diabetes (NIDDM)

  • Maturity-onset, Stable DM, Ketosis-resistant DM
  • Onset is 40 years
  • Common in obese adults
  • Inadequate insulin production or cells do not respond to insulin
  • Prone for HHNKS (Hyperosmolar Hyperglycemic Nonketotic Syndrome)
  • Management: Diet, Exercise, OHA (Oral Hypoglycaemic Agents), Insulin in stressful situations
• Pathophysiology of Diabetes


  1. When a patient ingests food, the absorption of nutrients from the food occurs

  2. Pancreas secretes chemicals, including insulin produced by beta cells

  3. Insulin binds to its receptors to decrease glucose levels in the body

  4. Malfunction of the pancreas or receptor problems can lead to glucose staying in the blood, resulting in diabetes type 1 or 2
• Ketones act as CNS depressants

  May decrease brain pH leading to coma
• Hyperglycemia symptoms (3P’s)


  • Polyuria
  • Polydipsia
  • Polyphagia
• If the pancreas malfunctions or has problems
• If the pancreas doesn't produce insulin or the receptors don't function
• This leads to glucose staying in the blood and resulting in diabetes, either type 1 or 2
• Infections related to diabetes

  • Periodontal
  • UTI
  • Vasculitis
  • Cellulitis
  • Vaginitis
  • Furuncles
  • Carbuncles
  • Retarded Wound Healing
• It is a MUST to thoroughly inspect your feet daily and keep them clean and dry
• Complications of diabetes


  • Macroangiopathy (malalaking blood vessels)
  • Microangiopathy (maliliit na blood vessels)
  • Neuropathy
• Macroangiopathy in the brain

  Cerebrovascular accident
• Macroangiopathy in the heart

  Myocardial infarction
• Macroangiopathy in peripheral arteries


  Peripheral vascular disease
• Microangiopathy in the kidneys

  Renal failure due to nephropathy
• Microangiopathy in the eyes

  Cataract due to retinopathy
• Neuropathy in the spinal cord/ANS


  Peripheral neuropathy - Involves damage to the PNS, Affect movement, sensation, and bodily functions (numbness/tingling)