MEDICAL SURGERY EXAM 1 REVIEW

MEDICAL SURGERY EXAM 1 REVIEW
Med Surg Exam 1 review
Chapters 12, 13, 17, 18, 19, 20, 21, 22, 23, 24, 51, & 52

1. Know how to interpret blood gas analysis:
Normal Arterial Blood gas Values:
PH- 7.35-7.45
Pac02- 35-45 to interpret using tic tac toe method, switch the values (45-35)
Bicarbonate(HC03-)- 21-28
Pa02-80-100
Pyramid Points
In acidosis, the PH is decreased
In alkalosis, the PH is elevated
The respiratory function indicator is the Paco2
The metabolic function indicator is the bicarbonate ion (HC03-)
Pyramid Steps
(1) Look at the PH. If the PH is elevated, it reflects alkalosis. If the PH is decreased, it
reflects acidosis.
(2) Look at the Pac02. You will find an opposite relationship between the PH and the
Pac02; the PH will be elevated with a decreased Pac02 (alkalosis) or the PH will be
decreased with an elevated Pac02 (acidosis). This reflects a respiratory imbalance.
(3) Look at the HC03- there is a corresponding relationship between the PH and the
HC03-; the PH will be elevated and the HC03- will be elevated (alkalosis) or the PH
will be decreased and the HC03- will be decreased (acidosis). Look at the PH and the
HC03- to determine whether the condition is a metabolic problem.
(4) Full compensation has occurred if the PH is in a normal range of 7.35-7.45. If the PH
is not within normal range, look at the respiratory or metabolic function indicators.
If the condition is a respiratory imbalance, look at the HC03- to determine the state
of compensation. Example: respiratory acidosis/alkalosis- HC03- Normal
(uncompensated), metabolic acidosis- HC03- decreased (uncompensated), metabolic
alkalosis- Hc03- elevated (uncompensated).


2. How to control epistaxis:
Sit upright and tilt head forward, pinch soft frontal portion of nose for 5-10 minutes.
3. Nasal decongestant administration and education:
To achieve max benefit instruct pt to blow nose before applying med into nasal cavity.
Teach pt to keep head upright; spray quickly and firmly into each nostril away from
septum; and wait at least 1 min before administering the second spray. The container
should be cleaned after each use and should never be shared to avoid cross
contamination. If case is infectious rhinitis then nurse reviews hand hygiene technique to
prevent transmission of organisms. Should be used with caution. Overuse can cause
rebound rhinitis (rhinitis medicamentosa)
4. How to promote sinus drainage: (In general) Instructs pt about humidification of the air
in the home, use of warm compresses to relieve pressure. Avoid swimming, diving, and

, air travel if acute. Pt using tobacco products are instructed to stop smoking immediately
or using any form of tobacco. Instruct pt on the correct use of nasal sprays if prescribed.
Educate pt on the side effects of prescribed or OTC nasal sprays and about rebound
rhinitis. Appropriate pain relief-Advil, Tylenol, etc. If recurrent rhinitis then start
decongestants at the first sign. (Specifically through chapter with certain conditions)
Depends on cause of sinus congestion. Avoid or reduce exposure to allergens. Saline
spray may help soften crust, soothing mucus membranes. Increase fluids. Instruct pt to
take all medications as instructed or prescribed-antibiotics, OTC decongestants-oral or
nasal, anti-inflammatory, anti-histamines, immune modifiers.
5. Surgical assessment and management:
 Preoperative Phase
Preadmission testing: initiates initial preoperative assessment, education
appropriate to patient’s needs, involves family in interview, verifies completion of
preoperative diagnostic testing, verifies understanding of surgeon- specific
preoperative orders. (e.g., bowel preparation, preoperative shower), discusses
and reviews advance directive document, begins discharge planning by assessing
patient’s need for postoperative transportation and care.
Admission to surgical center: completes preoperative assessment, assesses for
risks for postoperative complications, reports unexpected findings or any
deviations from normal, Verifies that operative consent has been signed,
coordinates patient education and plan of care with Nursing staff and other
health team members, reinforces previous education, explains phases in
perioperative period and expectations, answers patient’s and family’s questions.
In the holding Area: Identifies patient, assesses patient’s status, baseline pain,
and nutritional status, reviews medical record, verifies surgical site and that it has
been marked per institutional policy, establishes IV line, administers medication if
prescribed,( The Nurse in the perioperative area needs to be alert for
appropriate preoperative prescriptions aimed at preventing VTE and SSI.), takes
measures to ensure patient’s comfort, provides psychological support,
communicates patient’s emotional status to other appropriate members of the
health care team.

 Intraoperative Phase
Maintenance of safety: maintains aseptic, controlled environment, transfers
patient to operating room bed or table, positions patient based on functional
alignment and exposure of surgical site, applies grounding device to patient,
ensures that the sponge, needle, and instrument counts are correct, completes
intraoperative documentation.
Physiologic Monitoring: calculates effects on patient of excessive fluid loss or
gain, distinguishes normal from abnormal cardiopulmonary data, reports
changes in patient’s vital signs, institutes measures to promote normothermia.
Psychological support( before induction and when patient is conscious):
provides emotional support to patient, stands near or touches patient during
procedures and induction, continues to assess patient’s emotional status.

,  Postoperative Phase
Transfer of patient to postanesthesia care unit (PACU): communication of
intraoperative information, identifies patient by name, states type of surgery
performed, identifies type and amount of anesthetic and analgesic agents used,
reports patient’s vital signs, and response to surgical procedure and anesthesia,
describes intraoperative factors(e.g., insertion of drains or catheters,
administration of blood, medications during surgery, or occurrence of
unexpected events), describes physical limitations, reports patient’s
preoperational level of consciousness, communicates necessary equipment
needs, communicates presence of family or significant others.
Postoperative Assessment Recovery Area: determines patient’s immediate
response to surgical intervention, monitors patient’s vital signs(pulse rate, BP,
and respirations are recorded at least every 15 minutes for the first hour and
every 30 minutes for the next 2 hours, temperature is monitored every 4 hours
for the first 24 hours) and physiologic status, assesses patient’s pain level and
administers appropriate pain-relief measures, maintains patient’s safety
(airway, circulation, prevention of injury), administers medications, fluid, and
blood component therapy if prescribed, provides oral fluids if prescribed for
ambulatory surgery patient, assesses patient’s readiness for transfer to in-
hospital unit or for discharge home based on institutional policy (e.g., Aldrete
score- activity, respiration, circulation, consciousness, o2 saturation. The
Aldrete score is usually between 8 and 10 before discharge from PACU.)
Surgical Nursing Unit: Continues close monitoring of patient’s physical and
psychological response to surgical intervention, assesses patient’s pain level and
administers appropriate pain-relief measures, provides education to patient
during immediate recovery period, assists patient in recovery and preparation for
discharge home, determine patient’s psychological status, assists with discharge
planning.
Home or Clinic: provides follow-up care during office or clinic visit or by
telephone contact, reinforces previous education and answers patient’s and
family’s questions about surgery and follow-up care, assesses patient’s response
to surgery and anesthesia and their effects on body image and function,
determines family’s perception of surgery and its outcome.

6. Neuropathic pain vs nociceptive pain and management: Neuropathic pain results from
abnormal processing of sensory input by the nervous system from damage to the
peripheral and/or central nervous system. The two primary medications to treat
neuropathic pain are Neurontin (gabapentin) and Lyrica (pregabalin), some
antidepressants, anticonvulsants, and local anesthetics have shown varying efficacy in
dealing with neuropathic pain as well. Nociceptive pain is the normal functioning of
physiological symptoms that lead to perception of noxious stimuli as being painful. The
four processes of nociceptive pain are transduction, transmission, perception, and

, modulation. Many different medications are used to treat nociceptive pain including
nonopioids like NSAIDs and salicylates, opioids, and local anesthetics.
7. Know normal lab chemistry values for electrolytes:
Sodium- 135-145mEq/L ; Potassium- 3.5-5mEq/L; Calcium- 8.5-10.5mg/dL; Magnesium-
1.8-2.7mg/dL; Phosphorus- 2.5-4.5mg/dL; Chloride- 96-108mEq/L.
8. Know upper and lower respiratory tract problems and management:
Upper Airway Infections
 Rhinitis
 Viral Rhinitis (Common Cold)
 Rhinosinusitis (Acute or Chronic)
 Pharyngitis (Acute or Chronic)
 Tonsillitis and Adenoiditis
 Peritonsillar Abscess
Upper Respiratory Obstruction and Trauma
 Obstruction During Sleep
 Epitaxis
 Nasal Obstruction
 Fractures of Nose
 Laryngeal Obstruction
 Cancer of Larynx
Lower Respiratory and Chest Problems
 Atelectasis
 Acute Tracheobronchitis
 Pneumonia
 Aspiration
 Severe Acute Respiratory Syndrome
 Pulmonary Tuberculosis
 Pleurisy
 Pleural Effusion
 Empyema
 Acute Respiratory Distress Syndrome
 Pulmonary Hypertension
 Pulmonary Embolism
 Sarcoidosis
 Blunt Trauma
 Penetrating Trauma
 Pneumothorax
 Cardiac Tamponade
 Subcutaneous Emphysema


9. Understand dry and wet chest tube drainage systems and usage: Wet chest tube
drainage systems determine the amount of suction by the amount of water instilled in
suction chamber. The amount of bubbling in the suction chamber indicates the strength