Medsurg clinicals cheat sheet
normal vital signs
Blood Pressure (bp)
Systolic
Diastolic
Heart Rate (hr)
60 – 100 bpm
Respiratory rate (rr)
Parenteral Administration
120 mmHg
80 mmHg
angle
*
12 – 20 breaths/min
temperature (t)
97.8 – 99°F (36.5 - 37.2°C)
oxygen (o2)
95 – 100% COPD pts are expected
to have lower O2 levels
*
PRO TIP:
Intradermal (ID)
10 - 15°
Subcutaneous (SUBQ)
Normal/overweight: 90°
Thin: 45°
Abdomen • Posterior upper arm • Thigh
Intramuscular (IM)
90°
Deltoid • Vastus lateralis • Ventrogluteal
Intravenous (IV)
25°
Hand • Wrist
Cubital fossa • Foot • Scalp
Electrolytes
<135
NA+
135 – 145
mEq/L
<3.5
Thready, weak, irregular pulse, anxiety
K+
3.5 – 5.0
mEq/L
PHOS
2.5 – 4.5
mg/dL
>5.0
Muscle weakness and cramps
<2.5
Change of LOC, numbness,
weakening of the bones
>4.5
Diarrhea, Muscle weakness, ↓DTR
9 – 11
mg/dL
MG+
1.5 – 2.5
mg/dL
<1.5
Increased everything (↑BP, ↑HR, ↑RR, ↑DTR)
BASIC METABOLIC PANEL
(BMP)
K
3.5 - 5
WBC
4.5 - 11
x103
HCO3
Cr
22 - 26 0.6 - 1.2
Glucose
70 - 100
COAGULATION
PT
10 - 13 sec
INR
1-2
PTT
25 - 35 sec
CBC
LIVER PANEL
Hgb
F: 12 - 16
M: 13 - 18
Total
Bilirubin
0.1 - 1.2
HCT
F: 36% - 48%
M: 39% - 54%
PLT
150 - 450
x103
ARTERIAL BLOOD GAS (ABG)
pH
PCO2 HCO3
PO2
7.35 - 7.45 35 - 45 22 - 26 80 - 100
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Humalog
Novolog
Apidra
Humulin R
Novolin R
Humulin N
Novolin N
Lantus
Levemir
ONSET
5-30 min
30-60 min
1-2 hrs
1-2 hrs
PEAK
30-90 min
2-4 hrs
4-12 hrs
none
1 L = 1,000 mL
DURATION
3-5 hrs
5-7 hrs
18-24 hrs
24+ hrs
1 kg = 2.2 lbs
AST
5 - 40
ALT
7 - 56
ALP
40 - 120
RENAL DIAGRAM
Ca
9 - 11
Mg
1.5 - 2.5
Phos
2.5 - 4.5
0
1+
2+
3+
4+
1+
2+
1 g = 1,000 mg
1 oz = 30 mL
8 oz = 1 cup
1 tsp = 5 mL
1 dram = 5 mL
1 tbsp = 15 mL
1 tbsp = 3 tsp
1 mL = 5 gtts (drops)
1 lb = 16 oz
examples
Hypertonic
Isotonic
Decreased everything (↓BP, ↓HR, ↓RR, ↓DTR, ↓energy)
Common Labs
BUN
7 - 20
brand
names
↑Ca+ = ↓PO4
Bone pain, kidney stones, muscle weakness
Cl
Na
135 - 145 95 - 105
Glargine
Detemir
=
inverse
>11
>2.5
NPH
Calcium/Phosphorus
Tetany, Positive Trousseau’s,
Positive Chvostek’s Signs
1 mg = 1,000 mcg
Regular
Iv Fluids
<9
CA+
Conversions
Lispro
Aspart
Glulisine
Seizures, nausea, lethargy
Change of LOC, agitation, restlessness
Commonly
done in
neonates
generic
names
CLASSIC S&S
>145
Inner forearm
Insulin
After you are done taking a patients HR keep your finger on their pulse while
assessing their respirations. This is easier because when the patients knows you
are taking their respirations, they may breathe differently.
NORMAL
VALUE
USUAL SITES
Hypotonic
pulse chart
Pulse is absent
Diminished
Normal
Full
Bounding, strong
edema
Trace Mild swelling
Mild
3+
Moderate Deep
indentation remains
for a short time
4+
Severe Very deep
indentation that lasts
a long time
used for
5% saline
3% saline
5% dextrose in 0.9% saline (D5NS)
5% dextrose in 0.45% saline (D5 1⁄2 NS)
5% dextrose in LR (D5LR)
10% dextrose in water (D10W)
Cerebral edema
Hyponatremia
Metabolic alkalosis
Maintenance fluid
Hypovolemia
0.9% sodium chloride (NS) (normal saline)
5% dextrose in water (D5W)
Lactated Ringers (LR)
Blood loss
Dehydration
Fluids maintenance
0.45% saline (1/2 NS)
0.33% saline (1/3 NS)
0.225 saline (1/4 NS)
5% dextrose in water (D5W)
Diabetic ketoacidosis (DKA)
Hypernatremia
NORMAL
SALINE
is the only solution
compatible to
use with blood
or blood
products
Charting
5+
4+
3+
2+
1+
0
0
1+
2+
3+
4+
Muscle Strength
Normal Strength
Moves against gravity and light resistance
Moves against gravity but not resistant
Moves with gravity eliminated
Muscle movement w/o joint motion
No muscle movement
Reflexes
No response absent
Present, but sluggish or diminished
Active or expected response normal
More brisk than excited; hyperactive
Brisk, hyperactive, with intermittent or transient clonus
Weeping edema: Areas that have pitting edema can leak fluid out directly from the skin