Med Surg Exam 1
1. What information is gathered about the patient in the preoperative time period and what
sort of risk factors are you looking for?
a. Health History: Past surgical history and reactions, medications the patient is taking. RED
FLAG medications include: Anticoagulants: Coumadin, Warfarin, Plavix, Aspirin,
Heparin, Herbal Medications that can thin your blood, and corticosteroids because they
delay wound healing.
b. Psychosocial Assessment: You want your patient to feel as good as possible. It is a fact
supported by evidence that patients that enter surgery with poorer attitudes experience
poorer outcomes.
c. Cultural/Spiritual Assessment: “Is there anything about your cultural or spiritual
background that I should know that could affect your surgery and care?”
d. Physical Assessment: This will give us a baseline of information with which to
compare during and after surgery.
e. Labs: Hgb & Hct (H & H), platelets, PTT, aPTT, PT/INR, Blood Type & Cross, BUN, and
CR.
f. Diagnostic Tests
2. What risk factors are associated with older adults and surgery?
a. Decreased:
i. Cardiac Output
ii. Peripheral Circulation
iii. Vital Capacity
iv. Oxygenation
v. Blood Flow to kidneys
vi. GFR
b. Increased:
i. Blood Pressure
ii. Risk for Skin Damage
iii. Risk for Infection
iv. Sensory Deficits
v. Falls Risk
vi. Deformities r/t osteoporosis or arthritis
3. When should you do client teaching about the surgery and why?
a. BEFORE the operation. After surgery, patients are in too much pain to care or be able to
retain and understand.
4. Why is client teaching important?
a. It helps the patient understand what to expect after surgery.
i. Be sure to explain equipment, tubes, drains, vascular access, and the frequent
monitoring for vital signs in great detail.
b. It may help to comfort and prepare patients.
c. It reduces anxiety.
5. When can the patient withdraw consent for surgery?
a. AT ANY TIME
6. When should the informed consent form be signed? Who informs the patient about
the procedure, including its risks and benefits?
a. Before the surgery. The surgeon.
,7. What are the RN duties regarding informed consent?
a. Clarify as needed
b. Verify that the consent form has been signed and is on the chart
c. Witness the signature
8. What medications are commonly used pre-op and why?
a. To reduce anxiety, pain, and the amount of anesthesia needed, i.e. sedatives:
atarax/vistaril (hydroxyzine), hypnotics: Ativan (lorazepam), anxiolytics:
versed(midazolam), analgesics: morphine, Demerol (merperidine), fentanyl, dilaudid
(hydromorphone).
b. To decrease oral and gastric secretions, anticholinergics: atropine (urecholine) and
scopolamine.
c. To reduce nausea & vomiting: Phenergan (promethazine), Zofran (Ondansetron),
Reglan (Metoclopramide).
9. What sort of precautions take precedence after giving pre-op medications?
a. Patient safety
b. Monitor status, i.e. vitals, affect
10. What is the pre-op checklist?
a. A complete list of everything that must be done prior to surgery. Every facility has their
own list.
11. What are the roles of the two nurses working in the OR?
a. Scrub nurse: Does not have to be an LPN or RN, can be a tech. Sterile, assists the team,
hands instruments, counts sponges and needles.
b. Circulating Nurse: MUST be a nurse. Not sterile, moves around. Verifies patient identity,
all pre-op orders have been done, consent is on the chart and signed. Opens sterile
equipment and supplies, documentation, adjusts lights, and coordinates other departments
and personnel, including reporting off to the post-op nurse with the surgeon.
12. What are the different types of anesthesia?
a. General
i. Acts on CNS, produces loss of sensation, reflexes, and consciousness.
ii. Breathing, circulation, and temperature are not regulated psychologically. The
anesthesia provider controls this with a ventilator.
iii. Must be carefully monitored during surgery.
b. Regional
i. Blocks conduction of nerve impulses to a specific area.
ii. Patient experiences a loss of sensation and motor function to that area.
iii. Examples: Spinal, epidural
c. Local
i. Used for minor procedures
ii. Briefly disrupts sensory nerve impulse transmission from specific boy
area/region.
iii. Patient remains conscious, able to follow instructions.
d. Procedural (Conscious) Sedation
i. Local or regional anesthesia plus IV sedation
ii. Things to monitor:
1. Blood pressure
2. O2 sat
, 3. Heart rate and rhythm
13. What are some possible complications from local and regional anesthesia?
a. Anaphylaxis
b. Incorrect delivery technique
c. Systemic Absorption
d. Overdose
e. Local Complications
14. What are some possible complications from general anesthesia?
a. Overdose
b. Unrecognized hypoventilation
c. Problems with specific anesthetic agents
d. Intubation problems
e. Malignant Hyperthermia
15. Tell me everything I could possible want to know about malignant hyperthermia?
a. It is an inherited disorder.
b. Gathering past medical history and family history regarding this reaction is vital pre-op.
c. Body temp, muscle metabolism, and heat production increase rapidly, progressively, and
uncontrollably in response to stress and some anesthesia meds.
d. Symptoms: Tachycardia, tachypnea, fever, diaphoresis, muscle rigidity, cyanosis, mottled
skin, decreased urine output, hypotension, irregular heart rate, and cardiac arrest.
e. Risk Factors
i. Bulky strong muscles
ii. History of muscle cramps, muscle weakness and unexpected temp elevation
iii. Unexplained death of a family member accompanied by a febrile response after
anesthesia.
16. What are the possible intraoperative complications?
a. Infection
b. Fluid volume deficit or excess
c. Injury r/t positioning
d. Hypothermia
17. What is the most important priority for the nurse in the immediate postop period?
a. Close observation and monitoring of patient during emerging from anesthesia. Initial
and ongoing assessment occurs until patient is transferred.
18. What assessments are most important in the post op period?
a. Respiratory Assessment
i. Use your ABCs. Airway, Breathing, Circulation. A Patent airway is the
number one most important priority. Patent airway ensures adequate gas
exchange.
ii. Check o2 sat, should be between 92-100. If it goes below, apply oxygen.
iii. Monitor rate, pattern, and depth of breathing.
iv. Listen to breath sounds.
v. Monitor for use of accessory muscles.
vi. Snoring, stridor and other adventitious lung sounds can alert you that something
isn’t right.
b. Cardiovascular Assessment
i. Monitor vital sins every 15 minutes.
ii. Listen to heart sounds.
iii. Cardiac monitoring requires interpreting from the nurse.
1. What information is gathered about the patient in the preoperative time period and what
sort of risk factors are you looking for?
a. Health History: Past surgical history and reactions, medications the patient is taking. RED
FLAG medications include: Anticoagulants: Coumadin, Warfarin, Plavix, Aspirin,
Heparin, Herbal Medications that can thin your blood, and corticosteroids because they
delay wound healing.
b. Psychosocial Assessment: You want your patient to feel as good as possible. It is a fact
supported by evidence that patients that enter surgery with poorer attitudes experience
poorer outcomes.
c. Cultural/Spiritual Assessment: “Is there anything about your cultural or spiritual
background that I should know that could affect your surgery and care?”
d. Physical Assessment: This will give us a baseline of information with which to
compare during and after surgery.
e. Labs: Hgb & Hct (H & H), platelets, PTT, aPTT, PT/INR, Blood Type & Cross, BUN, and
CR.
f. Diagnostic Tests
2. What risk factors are associated with older adults and surgery?
a. Decreased:
i. Cardiac Output
ii. Peripheral Circulation
iii. Vital Capacity
iv. Oxygenation
v. Blood Flow to kidneys
vi. GFR
b. Increased:
i. Blood Pressure
ii. Risk for Skin Damage
iii. Risk for Infection
iv. Sensory Deficits
v. Falls Risk
vi. Deformities r/t osteoporosis or arthritis
3. When should you do client teaching about the surgery and why?
a. BEFORE the operation. After surgery, patients are in too much pain to care or be able to
retain and understand.
4. Why is client teaching important?
a. It helps the patient understand what to expect after surgery.
i. Be sure to explain equipment, tubes, drains, vascular access, and the frequent
monitoring for vital signs in great detail.
b. It may help to comfort and prepare patients.
c. It reduces anxiety.
5. When can the patient withdraw consent for surgery?
a. AT ANY TIME
6. When should the informed consent form be signed? Who informs the patient about
the procedure, including its risks and benefits?
a. Before the surgery. The surgeon.
,7. What are the RN duties regarding informed consent?
a. Clarify as needed
b. Verify that the consent form has been signed and is on the chart
c. Witness the signature
8. What medications are commonly used pre-op and why?
a. To reduce anxiety, pain, and the amount of anesthesia needed, i.e. sedatives:
atarax/vistaril (hydroxyzine), hypnotics: Ativan (lorazepam), anxiolytics:
versed(midazolam), analgesics: morphine, Demerol (merperidine), fentanyl, dilaudid
(hydromorphone).
b. To decrease oral and gastric secretions, anticholinergics: atropine (urecholine) and
scopolamine.
c. To reduce nausea & vomiting: Phenergan (promethazine), Zofran (Ondansetron),
Reglan (Metoclopramide).
9. What sort of precautions take precedence after giving pre-op medications?
a. Patient safety
b. Monitor status, i.e. vitals, affect
10. What is the pre-op checklist?
a. A complete list of everything that must be done prior to surgery. Every facility has their
own list.
11. What are the roles of the two nurses working in the OR?
a. Scrub nurse: Does not have to be an LPN or RN, can be a tech. Sterile, assists the team,
hands instruments, counts sponges and needles.
b. Circulating Nurse: MUST be a nurse. Not sterile, moves around. Verifies patient identity,
all pre-op orders have been done, consent is on the chart and signed. Opens sterile
equipment and supplies, documentation, adjusts lights, and coordinates other departments
and personnel, including reporting off to the post-op nurse with the surgeon.
12. What are the different types of anesthesia?
a. General
i. Acts on CNS, produces loss of sensation, reflexes, and consciousness.
ii. Breathing, circulation, and temperature are not regulated psychologically. The
anesthesia provider controls this with a ventilator.
iii. Must be carefully monitored during surgery.
b. Regional
i. Blocks conduction of nerve impulses to a specific area.
ii. Patient experiences a loss of sensation and motor function to that area.
iii. Examples: Spinal, epidural
c. Local
i. Used for minor procedures
ii. Briefly disrupts sensory nerve impulse transmission from specific boy
area/region.
iii. Patient remains conscious, able to follow instructions.
d. Procedural (Conscious) Sedation
i. Local or regional anesthesia plus IV sedation
ii. Things to monitor:
1. Blood pressure
2. O2 sat
, 3. Heart rate and rhythm
13. What are some possible complications from local and regional anesthesia?
a. Anaphylaxis
b. Incorrect delivery technique
c. Systemic Absorption
d. Overdose
e. Local Complications
14. What are some possible complications from general anesthesia?
a. Overdose
b. Unrecognized hypoventilation
c. Problems with specific anesthetic agents
d. Intubation problems
e. Malignant Hyperthermia
15. Tell me everything I could possible want to know about malignant hyperthermia?
a. It is an inherited disorder.
b. Gathering past medical history and family history regarding this reaction is vital pre-op.
c. Body temp, muscle metabolism, and heat production increase rapidly, progressively, and
uncontrollably in response to stress and some anesthesia meds.
d. Symptoms: Tachycardia, tachypnea, fever, diaphoresis, muscle rigidity, cyanosis, mottled
skin, decreased urine output, hypotension, irregular heart rate, and cardiac arrest.
e. Risk Factors
i. Bulky strong muscles
ii. History of muscle cramps, muscle weakness and unexpected temp elevation
iii. Unexplained death of a family member accompanied by a febrile response after
anesthesia.
16. What are the possible intraoperative complications?
a. Infection
b. Fluid volume deficit or excess
c. Injury r/t positioning
d. Hypothermia
17. What is the most important priority for the nurse in the immediate postop period?
a. Close observation and monitoring of patient during emerging from anesthesia. Initial
and ongoing assessment occurs until patient is transferred.
18. What assessments are most important in the post op period?
a. Respiratory Assessment
i. Use your ABCs. Airway, Breathing, Circulation. A Patent airway is the
number one most important priority. Patent airway ensures adequate gas
exchange.
ii. Check o2 sat, should be between 92-100. If it goes below, apply oxygen.
iii. Monitor rate, pattern, and depth of breathing.
iv. Listen to breath sounds.
v. Monitor for use of accessory muscles.
vi. Snoring, stridor and other adventitious lung sounds can alert you that something
isn’t right.
b. Cardiovascular Assessment
i. Monitor vital sins every 15 minutes.
ii. Listen to heart sounds.
iii. Cardiac monitoring requires interpreting from the nurse.
