Health Teaching Topics: Med-Surg 1 & 2

CARDIOVASCULAR SYSTEM

1. Hypertension (High Blood Pressure)

• What is hypertension and why it is dangerous (target organ damage)
• DASH diet: low sodium (<2g/day), high potassium, fruits and vegetables
• Medication adherence (antihypertensives - do NOT stop abruptly)
• Lifestyle changes: weight loss, smoking cessation, limit alcohol, regular exercise
• Home BP monitoring: proper technique, log readings, when to call the doctor
• Signs of hypertensive crisis: severe headache, blurred vision, chest pain

2. Heart Failure (CHF)

• Disease process: heart unable to pump effectively, fluid backs up
• Daily weight monitoring - report gain of >2 lbs in a day or >5 lbs in a week
• Low sodium diet (<2g/day), fluid restriction if ordered
• Signs of worsening: increased dyspnea, orthopnea, edema, fatigue
• Medications: diuretics (take in AM, monitor K+), ACE inhibitors, beta-blockers
• Activity pacing and energy conservation techniques
• When to call the doctor or go to the ER

3. Coronary Artery Disease (CAD) / Post-MI Teaching

• Risk factor modification: smoking, diabetes, cholesterol, hypertension
• Heart-healthy diet: low fat, low cholesterol, Mediterranean-style
• Cardiac medications: aspirin, statins, beta-blockers, nitrates (NTG - when and how to use)
• Signs of angina vs. heart attack - when to call 911
• Activity restrictions and gradual return to activity
• Cardiac rehabilitation program

4. Post-CABG / Cardiac Surgery Discharge Teaching

• Sternal precautions: no lifting >10 lbs, no pushing/pulling for 6-8 weeks
• Wound care: keep incision clean and dry, signs of infection
• Activity progression, driving restrictions
• Medications and follow-up appointments
• Signs of complications: fever, drainage, increasing pain, arrhythmias

RESPIRATORY SYSTEM

5. Asthma

• Difference between controller and rescue inhalers
• Proper inhaler technique (MDI with spacer)
• Identifying and avoiding triggers (allergens, smoke, cold air, exercise)
• Peak flow meter use and action zones (green/yellow/red)
• Asthma action plan
• Signs of acute attack - when to go to ER

6. COPD (Chronic Obstructive Pulmonary Disease)

• Disease process: irreversible airflow limitation
• Pursed-lip breathing and diaphragmatic breathing techniques
• Energy conservation and activity pacing
• Smoking cessation (most important intervention)
• Oxygen therapy at home: safe use, no smoking near O2, target SpO2 88-92%
• Medications: bronchodilators, inhaled steroids - proper technique
• Signs of exacerbation: increased sputum, worsening dyspnea, color change of secretions
• Adequate hydration to thin secretions (unless fluid restricted)
• Flu and pneumonia vaccinations

7. Pneumonia

• Complete antibiotic course (do not stop when feeling better)
• Rest, hydration, nutrition
• Deep breathing exercises and use of incentive spirometer
• Infection control: hand hygiene, covering cough
• Prevention: vaccines (pneumococcal, influenza)
• Signs of worsening: increasing fever, difficulty breathing, confusion (especially in elderly)

8. Post-Thoracic Surgery / Chest Tube Removal

• Incentive spirometer use every 1-2 hours while awake
• Deep breathing and coughing exercises (splinting technique)
• Activity progression
• Signs of complications: increased pain, fever, shortness of breath

GASTROINTESTINAL SYSTEM

9. Peptic Ulcer Disease (PUD)

• Avoid NSAIDs and aspirin (can worsen ulcers)
• H. pylori treatment: importance of completing full antibiotic regimen
• Avoid alcohol and smoking
• Dietary modifications: eat small frequent meals, avoid spicy/acidic foods
• PPIs/H2 blockers: how and when to take them
• Signs of complications: tarry black stools, vomiting blood, severe abdominal pain

10. Inflammatory Bowel Disease (Crohn's / Ulcerative Colitis)

• Disease process and difference between Crohn's and UC
• Dietary modifications during flares (low fiber, low residue)
• Medications: mesalamine, steroids, biologics - importance of adherence
• Monitoring for complications: bowel obstruction, fistulas, colorectal cancer
• Stress management
• Regular colonoscopy follow-up

11. Liver Cirrhosis / Hepatic Disease

• Low sodium diet to minimize ascites
• Alcohol abstinence (absolute)
• Protein intake guidance (adequate protein, avoid excess if encephalopathy present)
• Fluid restrictions if ordered
• Medications: lactulose (to reduce ammonia), diuretics
• Signs of hepatic encephalopathy: confusion, asterixis, personality changes
• Avoiding hepatotoxic drugs (acetaminophen, NSAIDs)
• Skin care for jaundice and pruritus

12. Ostomy Care (Colostomy / Ileostomy)

• Pouch application, emptying, and changing technique
• Normal stoma appearance vs. signs of complications (pale, dusky, bleeding)
• Dietary modifications: avoid gas-forming foods initially, chew thoroughly
• Odor and gas management
• Activity restrictions and return to normal activities
• Body image concerns - support groups and resources
• When to call the doctor

URINARY SYSTEM

13. Urinary Tract Infection (UTI) Prevention

• Proper perineal hygiene (front to back for females)
• Adequate fluid intake (at least 2-3 L/day unless contraindicated)
• Void after sexual intercourse
• Avoid holding urine for long periods
• Signs of UTI vs. kidney infection (ascending infection signs)
• Complete antibiotic course

14. Chronic Kidney Disease (CKD) / Renal Diet

• Fluid restriction if applicable
• Dietary restrictions: low potassium, low phosphorus, low sodium, protein restriction based on stage
• Avoid nephrotoxic medications (NSAIDs, contrast dye precautions)
• Medications: phosphate binders (take with meals), erythropoietin, antihypertensives
• Monitoring: weight, BP, edema, urine output
• Dialysis preparation and access care (AV fistula care - no BP/IV on that arm)
• Signs of uremia: nausea, confusion, pruritus, metallic taste

15. Urinary Incontinence

• Pelvic floor (Kegel) exercises
• Bladder training / timed voiding schedule
• Fluid management (avoid bladder irritants: caffeine, alcohol, carbonated drinks)
• Skin care and hygiene to prevent breakdown
• Types of incontinence and management strategies

ENDOCRINE SYSTEM

16. Diabetes Mellitus (Type 1 & 2)

• Blood glucose monitoring: how to use glucometer, target ranges
• Insulin administration technique: rotation of injection sites, storage
• Oral medications: how and when to take metformin and other agents
• Sick day management: do not skip insulin when sick
• Hypoglycemia: signs (shakiness, diaphoresis, confusion), treatment (15-15 rule)
• Hyperglycemia and DKA signs: polydipsia, polyuria, fruity breath, nausea
• Diabetic foot care: daily inspection, proper footwear, nail care, no barefoot walking
• Heart-healthy, carbohydrate-controlled diet
• Regular HbA1c checks, ophthalmology, nephrology, and podiatry referrals

17. Thyroid Disorders

• Hypothyroidism: take levothyroxine on empty stomach in AM, do not skip doses, signs of under/over-replacement
• Hyperthyroidism: antithyroid medications (methimazole, PTU), radioactive iodine precautions, signs of thyroid storm
• Monitoring symptoms: weight, energy, heart rate, temperature tolerance

18. Cushing's Syndrome

• Steroid taper importance if exogenous - never stop abruptly
• Low calorie, low sodium, high calcium/potassium diet
• Fall and fracture prevention (osteoporosis risk)
• Infection precautions (immunosuppressed)
• Skin integrity and wound healing concerns
• Mood changes and coping strategies

MUSCULOSKELETAL SYSTEM

19. Osteoporosis

• Calcium (1000-1200 mg/day) and Vitamin D supplementation
• Weight-bearing exercise
• Fall prevention: home safety, remove rugs, install grab bars
• Smoking cessation and limit alcohol
• Bisphosphonate therapy: take on empty stomach with full glass of water, remain upright 30-60 minutes
• DEXA scan follow-up

20. Total Hip / Knee Replacement (Arthroplasty)

• Hip precautions (posterior approach): avoid flexion >90°, adduction past midline, internal rotation - no crossing legs, use raised toilet seat, no low chairs
• Weight-bearing restrictions as ordered
• DVT prevention: anticoagulants, compression stockings, ankle pumps, early ambulation
• Signs of infection: redness, warmth, drainage, fever
• PT/OT exercises and follow-up
• Signs of dislocation (hip): sudden severe pain, leg shortening, external rotation
• When to call the doctor

21. Fracture / Cast Care

• Neurovascular checks: color, sensation, movement, capillary refill of digits
• Keep cast dry and elevated
• Signs of compartment syndrome: 6 P's - Pain (unrelieved), Pressure, Pallor, Pulselessness, Paresthesia, Paralysis
• No inserting objects under cast
• Weight-bearing restrictions
• Isometric exercises to prevent muscle atrophy

NEUROLOGICAL SYSTEM

22. Stroke (CVA) - Secondary Prevention

• Risk factor modification: BP control, anticoagulation for A-fib, diabetes, cholesterol
• Medication adherence (antiplatelet or anticoagulant therapy)
• Recognize stroke signs: FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911)
• Swallowing precautions if dysphagia present
• Rehabilitation: PT, OT, speech therapy
• Fall prevention strategies

23. Seizure Disorder / Epilepsy

• Medication adherence (antiepileptics) - never skip doses
• Seizure precautions: no bathing alone, no swimming alone, driving restrictions
• Identify and avoid triggers (sleep deprivation, alcohol, stress, flashing lights)
• What to do if seizure occurs: safety, timing, positioning, when to call 911
• Medical alert bracelet

24. Increased Intracranial Pressure (ICP) - Post-op / Head Injury

• Activity restrictions
• Avoid activities that increase ICP: straining, coughing, Valsalva maneuver
• Head of bed positioning (30-45°)
• Signs of increasing ICP: severe headache, projectile vomiting, changes in consciousness, pupil changes (Cushing's triad - late sign)

HEMATOLOGIC / ONCOLOGIC SYSTEM

25. Chemotherapy / Cancer Patient Teaching

• Neutropenia precautions: avoid crowds, sick contacts, raw foods; hand hygiene
• Thrombocytopenia precautions: avoid injury, use soft toothbrush, electric razor, no NSAIDs
• Anemia management: rest, nutrition, report extreme fatigue or dizziness
• Nausea management: antiemetics, small frequent meals, avoid strong odors
• Oral care during chemotherapy (mucositis prevention)
• Central line / port care
• Signs of infection in an immunocompromised patient (neutropenic fever = emergency)

26. Anticoagulation Therapy (Warfarin / Heparin / NOACs)

• Warfarin: consistent vitamin K intake, regular INR monitoring, drug/food interactions
• Signs of bleeding: blood in urine/stool, unusual bruising, prolonged bleeding from cuts
• Avoid contact sports and activities with high injury risk
• Carry medical alert card or bracelet
• Notify all healthcare providers (including dentist) about anticoagulant use

INTEGUMENTARY SYSTEM

27. Wound Care / Pressure Injury Prevention

• Pressure ulcer staging and prevention
• Repositioning every 2 hours (or weight shifts every 15 min in wheelchair)
• Adequate nutrition and hydration for wound healing (protein, Vitamin C, zinc)
• Keep skin clean and dry, use moisture barriers
• Inspect bony prominences daily
• Proper wound dressing technique and signs of infection

28. Burns

• Wound care and dressing changes
• Infection prevention
• Nutritional needs (high protein, high calorie diet)
• Scar management: compression garments, moisturizing
• Pain management strategies
• Psychological support and body image concerns
• Range of motion exercises to prevent contractures

REPRODUCTIVE / GENITOURINARY

29. Benign Prostatic Hyperplasia (BPH) / Post-TURP

• Urinary symptoms to monitor: hesitancy, weak stream, nocturia
• Fluid intake recommendations
• Avoid decongestants and antihistamines (worsen urinary retention)
• Post-TURP: expect pink-tinged urine initially, increase fluid intake, avoid straining
• Medications: alpha-blockers (take at bedtime due to orthostatic hypotension risk)
• Follow-up PSA and prostate screenings

PRE-OP AND POST-OP GENERAL TEACHING

30. Pre-operative Teaching

• NPO instructions (nothing by mouth after midnight or per specific protocol)
• Medication instructions (which to take/hold)
• What to expect: pre-op area, anesthesia, PACU
• Informed consent
• Deep breathing, coughing, splinting technique
• Incentive spirometer use
• Early ambulation importance

31. Post-operative / General Surgical Discharge

• Activity restrictions and progression
• Wound care and signs of surgical site infection (SSI): redness, warmth, swelling, purulent drainage, fever >38.5°C
• Pain management: scheduled vs. PRN medications, avoid driving on opioids
• Diet progression
• DVT prevention at home: hydration, ambulation, compression stockings, anticoagulants if prescribed
• Follow-up appointments

PAIN MANAGEMENT

32. Chronic / Acute Pain Management

• Non-pharmacologic methods: ice/heat, positioning, relaxation, distraction, TENS
• Pharmacologic: WHO pain ladder, around-the-clock vs. PRN dosing
• Opioid safety: constipation prevention, no alcohol, fall risk, naloxone education if applicable
• Pain rating scales and how to use them
• Importance of reporting pain (do not "tough it out")

PSYCHOSOCIAL / GENERAL WELLNESS

33. Stress Management and Coping

• Relaxation techniques: deep breathing, guided imagery, progressive muscle relaxation
• Exercise and its role in stress reduction
• Sleep hygiene
• Social support systems
• When to seek mental health support

QUICK REFERENCE: TOPIC SELECTION BY COMMON EXAM/CARE PLAN USE

• Expand any specific topic into a detailed patient handout or nursing care plan
• Create a presentation or study guide for any of these
• Narrow down to a specific system for deeper content

ER-Relevant Health Teaching Topics

CARDIOVASCULAR EMERGENCIES

1. Chest Pain / Acute Coronary Syndrome (ACS)

• Signs of heart attack: chest pressure, jaw/arm/back pain, diaphoresis, nausea
• Call 911 immediately - do NOT drive yourself
• Aspirin: chew 325 mg at onset (if not allergic)
• Nitroglycerin use: 1 tablet SL every 5 min x3, if no relief call 911
• Post-discharge: medication adherence, activity restrictions, follow-up with cardiologist
• Risk factor reduction: smoking, diet, exercise, BP and cholesterol control

2. Hypertensive Urgency / Emergency

• Why uncontrolled BP is dangerous (stroke, MI, kidney damage)
• Take antihypertensives as prescribed - do NOT skip doses
• Low sodium diet, weight management, no alcohol
• Home BP monitoring: how to measure correctly, keep a log
• When to return to ER: BP >180/120 with symptoms (headache, vision changes, chest pain)

3. Palpitations / Atrial Fibrillation

• What A-fib is and stroke risk
• Anticoagulation teaching (warfarin/NOACs) - importance, bleeding precautions
• Avoid triggers: caffeine, alcohol, stress, stimulants
• Rate vs. rhythm control medications
• When to seek emergency care: syncope, severe dyspnea, chest pain

RESPIRATORY EMERGENCIES

4. Acute Asthma Attack

• Use rescue inhaler (albuterol) first, proper technique
• When to go to the ER: no improvement after 3 puffs, SpO2 dropping, can't complete sentences
• Avoid triggers: allergens, smoke, cold air, aspirin/NSAIDs
• Follow up with primary doctor for controller medication adjustment
• Do NOT rely on rescue inhaler alone as long-term control

5. COPD Exacerbation Discharge Teaching

• Recognize early signs of exacerbation: increased sputum, color change, worsening dyspnea
• Completion of antibiotic and steroid course as prescribed
• Proper inhaler technique and spacing of medications
• Home oxygen: safety (no smoking), target saturation 88-92%
• Smoking cessation resources
• Pulmonologist follow-up

6. Shortness of Breath - General Discharge

• Return precautions: worsening SOB at rest, inability to speak in full sentences, cyanosis, altered consciousness
• Sleep with head elevated if needed
• Medication compliance

NEUROLOGICAL EMERGENCIES

7. Stroke / TIA Discharge Teaching

• FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911
• TIA is a warning stroke - very high risk of full stroke in next 48 hours
• Medication adherence: antiplatelets (aspirin, clopidogrel), anticoagulants
• BP, blood sugar, cholesterol control
• Follow-up MRI/neurology is URGENT (within 24-48 hours for TIA)
• No driving until cleared by physician

8. Seizure Discharge Teaching

• Never miss antiepileptic medication doses
• Seizure first aid for family: side-lying position, time the seizure, do NOT restrain or put anything in mouth, call 911 if >5 minutes
• Driving restrictions (varies by state - usually seizure-free period required)
• No swimming/bathing alone
• Identify and avoid triggers: sleep deprivation, alcohol, stress
• Return to ER: seizure >5 min, repeated seizures, injury, or first-ever seizure

9. Head Injury / Concussion Discharge Teaching

• Concussion symptoms to monitor: headache, nausea, vomiting, confusion, memory problems, light/noise sensitivity
• Return to ER immediately if: repeated vomiting, worsening headache, one pupil larger than other, difficulty waking, weakness, slurred speech, seizure
• Rest is key: physical and cognitive rest initially
• Gradual return to activity (no contact sports until cleared)
• No alcohol or sedatives while recovering
• Responsible adult must observe patient for 24 hours

ABDOMINAL / GI EMERGENCIES

10. Abdominal Pain Discharge (General)

• Return precautions: severe worsening pain, inability to tolerate fluids, fever, rigid abdomen, vomiting blood, black/tarry stools
• Diet as tolerated; start with clear liquids and advance slowly
• Follow-up with GI or primary care as directed

11. Gastroenteritis / Dehydration

• Oral rehydration: small frequent sips of clear fluids, ORS (oral rehydration salts)
• Avoid dairy, fatty, spicy foods until resolved (BRAT diet option)
• Signs of dehydration requiring return: no urine output >8 hours, extreme weakness, dry mouth/eyes, confusion
• Hand hygiene to prevent spread
• Food safety practices

12. GI Bleed Discharge (Minor/Stable)

• Avoid NSAIDs and aspirin unless prescribed
• Avoid alcohol
• Soft, bland diet
• Signs requiring immediate return: vomiting blood, large amounts of bright red blood per rectum, black tarry stools, dizziness/fainting
• Urgent GI follow-up

TRAUMA / MUSCULOSKELETAL

13. Sprain / Strain - RICE Method

• Rest - limit use of injured limb
• Ice - 20 minutes on, 20 minutes off for first 48-72 hours
• Compression - elastic bandage, not too tight
• Elevation - raise above heart level to reduce swelling
• Pain management: ibuprofen/acetaminophen as directed
• When to return: increasing pain, numbness, inability to bear weight, visible deformity

14. Fracture / Splint / Cast Care

• Keep splint/cast dry and clean
• Neurovascular checks: report numbness, tingling, severe pain, pale/blue fingers or toes, inability to move digits
• Elevate extremity
• No weight bearing unless specified
• Orthopedic follow-up within 1 week
• Signs of compartment syndrome: severe unrelieved pain, tightness, paresthesia

15. Minor Wound / Laceration Care

• Keep wound clean and dry for 24 hours
• Dressing change instructions: frequency, materials needed
• Signs of infection: increasing redness, warmth, swelling, purulent drainage, fever, red streaks (cellulitis)
• Suture/staple removal timeline and follow-up
• Tetanus status - return if needed

16. Burns (Minor - Discharge)

• Cool running water for 10-20 minutes - no ice
• Do NOT break blisters
• Cover with clean, non-stick dressing
• Signs of infection to watch for
• Pain management
• Return to ER: burns on face/hands/genitals, circumferential burns, signs of infection, >10% TBSA

METABOLIC / ENDOCRINE EMERGENCIES

17. Hypoglycemia (Low Blood Sugar)

• 15-15 Rule: 15g fast-acting carbs (4 glucose tabs, 4 oz juice, regular soda), wait 15 min, recheck
• Always carry a fast-acting sugar source
• Identify causes of this episode: skipped meal, too much insulin, extra exercise
• Do NOT skip meals
• Wear medical alert bracelet
• When to call 911: unconscious, unable to swallow, seizure
• Teach family/significant other glucagon kit use

18. Hyperglycemia / DKA Discharge

• Sick day rules: NEVER skip insulin when sick
• Monitor blood glucose and ketones when sick
• Increase fluid intake during illness
• When to return: glucose >300 consistently, vomiting/unable to keep fluids down, fruity breath, deep rapid breathing, confusion
• Review insulin dose and technique
• Identify triggers of this episode

INFECTIOUS DISEASE / SEPSIS PREVENTION

19. Fever / Infection Discharge Teaching

• Antipyretic use: acetaminophen or ibuprofen, proper dosing, alternating if needed
• Adequate fluid intake
• Signs of serious infection/sepsis requiring immediate return: high fever >39.5°C, chills, rapid heart rate, confusion, difficulty breathing, low BP symptoms (dizziness, fainting)
• Complete full antibiotic course if prescribed
• Hand hygiene for infection prevention

20. UTI Discharge

• Complete antibiotic course
• Increase fluid intake (2-3 L/day water unless restricted)
• Void frequently, do not hold urine
• Wipe front to back
• Signs of kidney infection (pyelonephritis): flank pain, high fever, chills, nausea/vomiting - return to ER

TOXICOLOGY / OVERDOSE / SUBSTANCE USE

21. Alcohol Intoxication / Withdrawal

• Signs of alcohol withdrawal requiring ER return: tremors, sweating, seizures, hallucinations (can be life-threatening)
• Alcohol cessation resources, referral to addiction services
• Safe drinking limits or abstinence guidance
• Do not drive until completely sober

22. Medication Overdose Discharge (Accidental)

• Safe medication storage (away from children)
• Do not take more than prescribed dose
• Medication reconciliation - know what you are taking
• Poison Control number: 1-800-222-1222 (US)
• Follow-up with primary care or mental health if intentional

23. Naloxone (Narcan) Teaching for Opioid Users / Family

• How to recognize opioid overdose: slow/no breathing, blue lips, unresponsive, pinpoint pupils
• Intranasal or IM naloxone administration technique
• Call 911 immediately, give Narcan, rescue breathing if trained, recovery position
• Naloxone wears off in 30-90 min - patient must be monitored

ANAPHYLAXIS / ALLERGIC REACTION

24. Anaphylaxis Discharge Teaching

• How to use epinephrine auto-injector (EpiPen): remove cap, press to outer thigh, hold 10 seconds
• Always carry TWO EpiPens at all times
• After EpiPen use: call 911 immediately, even if feeling better (biphasic reaction possible up to 12 hours later)
• Strict allergen avoidance: read all food labels, inform restaurants
• Medical alert bracelet
• Antihistamines (Benadryl) do NOT replace epinephrine in anaphylaxis
• Follow-up with allergist/immunologist

MENTAL HEALTH / PSYCHOSOCIAL

25. Anxiety / Panic Attack Discharge

• Panic attacks are not dangerous but feel severe
• Box breathing technique: inhale 4 counts, hold 4, exhale 4, hold 4
• Identify and reduce triggers
• Avoid caffeine, alcohol, stimulants
• Follow-up with primary care or psychiatry
• Return to ER: chest pain with abnormal ECG, first-ever episode, fainting

26. Suicidal Ideation / Mental Health Crisis Discharge (Safety Planning)

• Safety plan review: warning signs, coping strategies, support contacts
• Remove access to lethal means (firearms, medications - lock up or give to trusted person)
• Crisis resources: 988 Suicide & Crisis Lifeline (call or text 988)
• Scheduled follow-up within 24-48 hours
• Emergency contacts aware and involved in care

UNIVERSAL ER DISCHARGE TEACHING (Every Patient)