호주 간다면 어디로? 지역별 비교해보기 4탄 :: 지역별 대표 병원·중증도·공부 혜택 정리

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NCLEX-RN 이것만이라도 보고 가자! : Internal Medicine │ Nurse Haley

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💊 Internal Medicine by Nurse Haley

Endocrine · Cardiometabolic · Hematologic · Infectious 핵심 간호요약



안녕하세요! 오늘의 간호사 Haley 입니다! 이번에는 Internal Medicine (내과 전반) 핵심 정리예요. 시험 전날 꼭 복습해야 하는 당뇨·고혈압·빈혈·패혈증·전해질 불균형을 한눈에 볼 수 있게 구성했습니다. 이전에도 한번씩 다뤄본 내용이긴 하지만 복습한다는 느낌으로 공부해보세요 :) 

📖 Table of Contents

🍬 Diabetes Mellitus / DKA / HHS

Disorder Key Findings Nursing Focus
1️⃣ Type 1 vs Type 2 DM Type 1: no insulin production → DKA risk
Type 2: insulin resistance → HHS risk 		• Monitor glucose, HbA1c.
• Foot care: inspect daily, no barefoot.
• Rotate insulin sites, avoid massage.
• Sick day: continue insulin + fluids.
2️⃣ DKA (Diabetic Ketoacidosis) Type 1, triggered by infection/stress.
Kussmaul breathing, fruity breath, ketonuria. 		• IV fluids (0.9% NS → D5 ½NS when BG<250).
• IV regular insulin.
• Replace K⁺ when urine output adequate.
• Monitor for hypokalemia as acidosis corrects.
3️⃣ HHS (Hyperosmolar Hyperglycemic State) Type 2, severe dehydration, no ketosis. • IV fluids priority.
• IV insulin drip (lower dose).
• Monitor neuro status and electrolytes.
• Prevent with sick-day teaching.

❤️ Hypertension & Cardiometabolic

Disorder Key Findings Nursing Focus
1️⃣ Hypertension (HTN) Often asymptomatic; long-term → stroke, renal failure. • Monitor BP both arms, same position.
• Lifestyle: low-sodium, DASH diet, exercise.
• Meds: ACEI (dry cough), ARB, β-blocker, CCB.
• Change positions slowly (orthostatic hypotension).
2️⃣ Heart Failure L-sided: crackles, SOB, orthopnea
R-sided: JVD, edema, ascites 		• Daily weight, fluid restriction.
• Meds: ACEI, β-blocker, diuretics, Digoxin.
• Monitor K⁺, Digoxin toxicity (N/V, vision changes).
• Position: high-Fowler with legs dependent.

🩸 Anemia & Hematology

Type Key Signs Nursing Care
Iron-deficiency Anemia Fatigue, pallor, spoon nails, pica. • Oral iron (FeSO₄) with vitamin C.
• Avoid with milk/antacids.
• Use straw (stains teeth).
• Stool may turn dark.
Pernicious Anemia (B₁₂) Glossitis, paresthesia, ataxia. • Lifelong B₁₂ injections (no intrinsic factor).
• Monitor neuro function.
Aplastic / Hemolytic Pancytopenia (↓RBC/WBC/platelets). • Bleeding & infection precautions.
• Possible bone-marrow transplant.
• Avoid IM injections.

🦠 Sepsis & Infection Control

Condition Key Findings Nursing Focus
Sepsis / Septic Shock Fever → hypotension → warm then cool skin.
↑ HR, RR; ↓ BP, urine output. 		• Obtain cultures before antibiotics.
• IV fluids (NS), broad-spectrum antibiotics.
• Vasopressors (norepinephrine) if unresponsive.
• Monitor lactate, perfusion, urine output.
Infection Control Isolation Contact: MRSA, C. diff
Droplet: Influenza, Meningitis
Airborne: TB, Varicella, Measles 		• Contact → gown & gloves.
• Droplet → mask within 3 ft.
• Airborne → N95, negative pressure.
• Hand hygiene before/after gloves!
⚠️ NCLEX 핵심포인트:
- Culture before antibiotics!
- MAP < 65 → shock 진행.
- Early fluids + broad antibiotics = gold standard.
- TB patient → N95 + negative room mandatory.

⚡ Fluid & Electrolyte Balance

Electrolyte High / Low Signs Nursing Management
Sodium (Na⁺) Hyper: thirst, confusion → water deficit.
Hypo: confusion, seizures → water excess. 		• Hyper → hypotonic IV (0.45 % NS).
• Hypo → restrict water, hypertonic saline if severe.
Potassium (K⁺) Hyper: peaked T, dysrhythmia.
Hypo: flat T, muscle weakness. 		• Never IV push!
• Hyper → insulin+D50, Ca gluconate.
• Hypo → KCl with pump, monitor ECG.
Calcium (Ca²⁺) Hypo → Chvostek/Trousseau sign.
Hyper → bone pain, kidney stones. 		• Hypo → calcium gluconate IV.
• Hyper → fluids, loop diuretic.
💡 Exam Tip:
- Always replace fluids first, then electrolytes.
- Monitor ECG changes for K⁺/Ca²⁺ shifts.
- Elderly with infection = confusion first symptom!
- In any “restless + tachycardia” scenario → think early shock.

정리: 오늘의 간호사 Haley

📌 본문 내용은 오늘의 간호사 Haley의 저작물로 무단 복제·배포를 금합니다.

#NCLEX #InternalMedicine #DKA #HHS #Hypertension #Anemia #Sepsis #Electrolyte #RNexam #간호요약