Medical-Surgical Nursing
What Are the 2017 Hospital National Patient Safety Goals? - ANS - Identify patients correctly
- Improve staff communication
- Use medicines safely
- Use alarms safely
- Identify patient safety risks
- Prevent Infection
- Prevent mistakes in surgery
What Are the Purposes of Surgery? - ANS - Diagnosis (Yes or No)
- Exploration (Find Problem)
- Cure (Remove/Fix)
- Prevention (Early Stages)
- Palliation (Dying, Hospice, Comfort, No Cure)
- Cosmetic Improvement (Burns, Mastectomy, Reconstruction)
What Are the Three Surgical Phases? - ANS 1.) Preoperative (Until the OR)
2.) Intraoperative (Inside OR)
3.) Postoperative (PACU)
What is Elective Surgery? - ANS A planned surgery
Ex: Knee replacement
What is An Emergency Surgery? - ANS Unplanned
Ex: Burst appendix
Inpatient vs. Outpatient - ANS Inpatient
- Same day admission
Outpatient (Ambulatory)
- Leave hospital when recovered and awake
Nursing Management of the Surgical Client - ANS - Knowledge of the nature of the disorder
- Determine the client's response to the stress of surgery
- Assess the results of preoperative diagnostic tests (Look at lab tests)
*What does the patient know, why are they here*
Preoperative:
Client Interview - ANS 1.) Purpose: Where is the patient at mentally, most anxious, take vitals
after a little while, reassurance
2.) Check documented information prior to the interview (Avoids repetition; see how nervous)
3.) Occurs in advance or on day of surgery
Preoperative:
Client Assessment - ANS 1.) Health Hx
2.) Medication Hx (Prescription and OTC)
3.) Diagnostic Testing
4.) Psychosocial Factors (Spiritual/Cultural)
*Stop taking Ibuprofen before, stop smoking, when they last ate, etc*
What Subjective Information is Important from the Preoperative Client Interview? - ANS -
Psychosocial Assessment (Age, Current health)
- Influencing Factors
, Fears: Past experiences, death, complications, disfigurement, disruption of life, disability,
viruses, needles, etc.
Pain: Pain medication and management
Hope: To be cured, do not take away hope
*Stress raises glucose levels; always ask about pain*
*Identify caregivers, also the patient must know what is happening*
Anxiety & Nursing Assessment - ANS Anxiety can arise from:
- Lack of knowledge (More they know the better, use layman's terms)
- Unrealistic expectations (I will have this surgery and be fine)
- Information lessens anxiety
Preoperative Nursing Assessment - ANS - Health Hx
- Family Diseases (Anesthesia problems/malignant hypothermia)
- Previous and Current Diagnoses medical conditions
- Previous surgeries or problems
- Menstrual/Obstetric History (Pregnant?)
- Current Medications
- Drug Intolerance (Allergies/Adverse Rxn)
What Objective Information is Important from the Preoperative Client Interview? - ANS -
Physical Exam
- Lab Diagnostic Testing
- Document Relevant findings and report to the perioperative team
*Always have a CBC; electrolytes, blood sugars, EKG, Chest X-Ray, etc. Know the normal labs,
LOW PLATELETS IS A BIG DEAL*
Cardiovascular System Objective Data - ANS - Heart rate, blood pressure, skin color, sounds,
capillary refill, edema, history of heart attack or cardiac problems, blood clots in legs?
REPORT: Any cardiac problems so they can be monitored during the intraoperative period. The
use of cardiac drugs, and the presence of a pacemaker/ICD (Implantable Cardioverter
Defibrillator)
Respiratory System Objective Data: - ANS - Respiratory rate, lung sounds, O2 Saturation
REPORT: History of dyspnea, coughing, or hemoptysis (Blood)
- COPD or Asthma (High risk for atelectasis and hypoxemia)
- Smokers (Encourage to quit)
Nervous System Objective Data: - ANS - Level of Consciousness, can they follow commands,
sight, hearing
- Evaluation of neurological functioning (Vision or hearing loss can influence results)
- Cognitive function (Determine if any deficits are present)
Genitourinary System Objective Data: - ANS - Kidney problems, frequency of urination,
urgency, blood, period
- History of renal diseases
- Assess BUN, Creatinine, Specific Gravity
What Are the 2017 Hospital National Patient Safety Goals? - ANS - Identify patients correctly
- Improve staff communication
- Use medicines safely
- Use alarms safely
- Identify patient safety risks
- Prevent Infection
- Prevent mistakes in surgery
What Are the Purposes of Surgery? - ANS - Diagnosis (Yes or No)
- Exploration (Find Problem)
- Cure (Remove/Fix)
- Prevention (Early Stages)
- Palliation (Dying, Hospice, Comfort, No Cure)
- Cosmetic Improvement (Burns, Mastectomy, Reconstruction)
What Are the Three Surgical Phases? - ANS 1.) Preoperative (Until the OR)
2.) Intraoperative (Inside OR)
3.) Postoperative (PACU)
What is Elective Surgery? - ANS A planned surgery
Ex: Knee replacement
What is An Emergency Surgery? - ANS Unplanned
Ex: Burst appendix
Inpatient vs. Outpatient - ANS Inpatient
- Same day admission
Outpatient (Ambulatory)
- Leave hospital when recovered and awake
Nursing Management of the Surgical Client - ANS - Knowledge of the nature of the disorder
- Determine the client's response to the stress of surgery
- Assess the results of preoperative diagnostic tests (Look at lab tests)
*What does the patient know, why are they here*
Preoperative:
Client Interview - ANS 1.) Purpose: Where is the patient at mentally, most anxious, take vitals
after a little while, reassurance
2.) Check documented information prior to the interview (Avoids repetition; see how nervous)
3.) Occurs in advance or on day of surgery
Preoperative:
Client Assessment - ANS 1.) Health Hx
2.) Medication Hx (Prescription and OTC)
3.) Diagnostic Testing
4.) Psychosocial Factors (Spiritual/Cultural)
*Stop taking Ibuprofen before, stop smoking, when they last ate, etc*
What Subjective Information is Important from the Preoperative Client Interview? - ANS -
Psychosocial Assessment (Age, Current health)
- Influencing Factors
, Fears: Past experiences, death, complications, disfigurement, disruption of life, disability,
viruses, needles, etc.
Pain: Pain medication and management
Hope: To be cured, do not take away hope
*Stress raises glucose levels; always ask about pain*
*Identify caregivers, also the patient must know what is happening*
Anxiety & Nursing Assessment - ANS Anxiety can arise from:
- Lack of knowledge (More they know the better, use layman's terms)
- Unrealistic expectations (I will have this surgery and be fine)
- Information lessens anxiety
Preoperative Nursing Assessment - ANS - Health Hx
- Family Diseases (Anesthesia problems/malignant hypothermia)
- Previous and Current Diagnoses medical conditions
- Previous surgeries or problems
- Menstrual/Obstetric History (Pregnant?)
- Current Medications
- Drug Intolerance (Allergies/Adverse Rxn)
What Objective Information is Important from the Preoperative Client Interview? - ANS -
Physical Exam
- Lab Diagnostic Testing
- Document Relevant findings and report to the perioperative team
*Always have a CBC; electrolytes, blood sugars, EKG, Chest X-Ray, etc. Know the normal labs,
LOW PLATELETS IS A BIG DEAL*
Cardiovascular System Objective Data - ANS - Heart rate, blood pressure, skin color, sounds,
capillary refill, edema, history of heart attack or cardiac problems, blood clots in legs?
REPORT: Any cardiac problems so they can be monitored during the intraoperative period. The
use of cardiac drugs, and the presence of a pacemaker/ICD (Implantable Cardioverter
Defibrillator)
Respiratory System Objective Data: - ANS - Respiratory rate, lung sounds, O2 Saturation
REPORT: History of dyspnea, coughing, or hemoptysis (Blood)
- COPD or Asthma (High risk for atelectasis and hypoxemia)
- Smokers (Encourage to quit)
Nervous System Objective Data: - ANS - Level of Consciousness, can they follow commands,
sight, hearing
- Evaluation of neurological functioning (Vision or hearing loss can influence results)
- Cognitive function (Determine if any deficits are present)
Genitourinary System Objective Data: - ANS - Kidney problems, frequency of urination,
urgency, blood, period
- History of renal diseases
- Assess BUN, Creatinine, Specific Gravity
