SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
Delegation
If giving to LVN/LPN or other nurse that is floating or not critical care- give
nurse the most STABLE client.
Center of Gravity-
Older individuals’ center of gravity is the upper
torso. Adults- hips
ABC’s
▪ Airway, Breathing, Circulation
▪ (CAB)- compression, airway, breathing
▪ Provide if unwitnessed cardiac arrest occurs.
▪ If unconscious- begin with circulation, airway, breathing; begin CPR.
▪ 30:2 with partner
▪ 15:2 alone
▪ Place hands at lower half of sternum; above xiphoid process
▪ Reposition head to validate proper position to open airway
if chest is not moving
▪ When carotid pulse is felt, there is return of cardiac
function, with return of breathing
▪ Signs of effective tissue perfusion should be noticed
Preoperative-
,SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
• Nurses role is to educate/advocate, reduce anxiety, Ensure consent
has been signed within past 24 hours (valid for 45 days)
• Teaching/Learning- outcome is best when demonstrated and not
only verbalized; returned demonstration is best method.
• KNOW ALLERGIES, OTC, herbal meds
• Know any issues with previous surgical experiences
• Know about person’s culture
• Often no blood transfusions for Jehovah’s Witness
• Often NPO after midnight; clear liquids sometimes allowed up to 6
hrs before surgery
o If client does not follow, surgery will be rescheduled
• Ensure client is both emotionally and physically prepared for surgery
Surgical Risk Factors-
• Age-young and old
• Nutrition- obese and malnutrition
• Fluid/Electrolyte-dehydration/hypovolemia
• Infection
• Cardiac conditions
• Blood coagulation disorders
• URI/COPD- exacerbated by general anesthesia
• Renal disease- impairs F/E balance
• Uncontrolled DM- infection & delayed healing
• Liver disease- inability to detoxify meds
Meds that increase risk:
• Anticoagulants- increases bleeding
,SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
• Tranquilizers- hypotension
• Heroin- decreased CNS response
• Antibiotics- may be incompatible with anesthesia
• Diuretics- may cause electrolyte imbalance
• Steroids
• OTC herbal meds-
o THINK THREE G’s: ginseng, garlic, gingko- increase bleeding
o Fish oil, dong quai, feverfew- increase bleeding
o Prolong anesthesia- kava, Valerian, St. John’s (also interacts
with EVERYTHING)
Postoperative-
Immediate Care:
▪ VS- BP, pulse, respirations
o Especially if client has slurred speech- may indicate neuro deficits
o If SOB, may need to intubate
▪ LOC, skin color & condition
▪ Dressing location and condition
▪ IV fluids
▪ Urine output
o Notify HCP if dark and less than 30mL/hr
▪ Drainage tubes & position
▪ O2 saturation
Monitor for S&S:
▪ Shock/hemorrhage
, SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
o Compensatory mechanism is activation of SNS that will increase
RR & pulse to restore BP; constricts arterioles and causes
oliguria
o Client will show elevated BP as compensatory mechanism
▪ Narrow pulse pressure
▪ Rapid weak pulse
▪ Cold, moist skin
▪ Increased cap refill
Position client on side to prevent aspiration and to allow client to cough out
airway; side rails should be up.
N/V- suction
▪ When getting out of bed for first time, if client had HOB down,
allow client to sit with bed in high fowlers position.
▪ Help client sit and dangle legs on side of bed.
▪ Place chair at a right angle to bedside.
▪ Encourage deep breathing prior to standing.
Most common complications:
▪ Urinary retention- monitor hydration status and I&O;
offer bedpan/commode
▪ Pulmonary problems- assist to turn, cough, deep breath Q1-2 hrs.,
Keep hydrated, early ambulation, incentive spirometry.
▪ Wound-healing- teach splinting when patient coughs, monitor for S&S
of infection, malnutrition, dehydration HIGH PROTEIN DIET
▪ UTI- increase fluids, empty bladder Q4-6 hrs, monitor I&O,
avoid catheterization if possible, remove ASAP
GUIDE
Delegation
If giving to LVN/LPN or other nurse that is floating or not critical care- give
nurse the most STABLE client.
Center of Gravity-
Older individuals’ center of gravity is the upper
torso. Adults- hips
ABC’s
▪ Airway, Breathing, Circulation
▪ (CAB)- compression, airway, breathing
▪ Provide if unwitnessed cardiac arrest occurs.
▪ If unconscious- begin with circulation, airway, breathing; begin CPR.
▪ 30:2 with partner
▪ 15:2 alone
▪ Place hands at lower half of sternum; above xiphoid process
▪ Reposition head to validate proper position to open airway
if chest is not moving
▪ When carotid pulse is felt, there is return of cardiac
function, with return of breathing
▪ Signs of effective tissue perfusion should be noticed
Preoperative-
,SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
• Nurses role is to educate/advocate, reduce anxiety, Ensure consent
has been signed within past 24 hours (valid for 45 days)
• Teaching/Learning- outcome is best when demonstrated and not
only verbalized; returned demonstration is best method.
• KNOW ALLERGIES, OTC, herbal meds
• Know any issues with previous surgical experiences
• Know about person’s culture
• Often no blood transfusions for Jehovah’s Witness
• Often NPO after midnight; clear liquids sometimes allowed up to 6
hrs before surgery
o If client does not follow, surgery will be rescheduled
• Ensure client is both emotionally and physically prepared for surgery
Surgical Risk Factors-
• Age-young and old
• Nutrition- obese and malnutrition
• Fluid/Electrolyte-dehydration/hypovolemia
• Infection
• Cardiac conditions
• Blood coagulation disorders
• URI/COPD- exacerbated by general anesthesia
• Renal disease- impairs F/E balance
• Uncontrolled DM- infection & delayed healing
• Liver disease- inability to detoxify meds
Meds that increase risk:
• Anticoagulants- increases bleeding
,SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
• Tranquilizers- hypotension
• Heroin- decreased CNS response
• Antibiotics- may be incompatible with anesthesia
• Diuretics- may cause electrolyte imbalance
• Steroids
• OTC herbal meds-
o THINK THREE G’s: ginseng, garlic, gingko- increase bleeding
o Fish oil, dong quai, feverfew- increase bleeding
o Prolong anesthesia- kava, Valerian, St. John’s (also interacts
with EVERYTHING)
Postoperative-
Immediate Care:
▪ VS- BP, pulse, respirations
o Especially if client has slurred speech- may indicate neuro deficits
o If SOB, may need to intubate
▪ LOC, skin color & condition
▪ Dressing location and condition
▪ IV fluids
▪ Urine output
o Notify HCP if dark and less than 30mL/hr
▪ Drainage tubes & position
▪ O2 saturation
Monitor for S&S:
▪ Shock/hemorrhage
, SURGICAL NURSING 2022 UPDATED HESI STUDY
GUIDE
o Compensatory mechanism is activation of SNS that will increase
RR & pulse to restore BP; constricts arterioles and causes
oliguria
o Client will show elevated BP as compensatory mechanism
▪ Narrow pulse pressure
▪ Rapid weak pulse
▪ Cold, moist skin
▪ Increased cap refill
Position client on side to prevent aspiration and to allow client to cough out
airway; side rails should be up.
N/V- suction
▪ When getting out of bed for first time, if client had HOB down,
allow client to sit with bed in high fowlers position.
▪ Help client sit and dangle legs on side of bed.
▪ Place chair at a right angle to bedside.
▪ Encourage deep breathing prior to standing.
Most common complications:
▪ Urinary retention- monitor hydration status and I&O;
offer bedpan/commode
▪ Pulmonary problems- assist to turn, cough, deep breath Q1-2 hrs.,
Keep hydrated, early ambulation, incentive spirometry.
▪ Wound-healing- teach splinting when patient coughs, monitor for S&S
of infection, malnutrition, dehydration HIGH PROTEIN DIET
▪ UTI- increase fluids, empty bladder Q4-6 hrs, monitor I&O,
avoid catheterization if possible, remove ASAP
