9/8/23, 11:53 AM Adult Med Surg Notes
Adult Med- Surg Notes
Role of nurse in preopera琀椀ve care
Pre-op admission assessment
Preopera琀椀ve teaching
Verify consent has been signed- whoever requires the consent should obtain the signature (e.g., the surgeon)
Categories of pa琀椀ents at higher opera琀椀ve risk (ABCDE)
A- Allergies
o Important to document what it is and what the response is
o Higher risk of hypersensi琀椀vity reac琀椀ons to anesthesia and other meds used in surgery and pre op
B- Bleeding (past history or risk)
o E.g., Pts taking ASAs
o Higher risk for surgicals complica琀椀ons and bleeding
C- cor琀椀sone/ steroids
o Increased risk of emboli
o Impacts ability to heal and reac琀椀on to anesthe琀椀cs
D- diabetes
o Important to iden琀椀fy glucose management plan
E- emboli (history or risk)
o Surgery and post- opera琀椀ve immobiliza琀椀on increases risk of embolus
Major complica琀椀ons
Anaphylaxis
o Typically due to hypersensi琀椀vity reac琀椀on or drug- drug interac琀椀on with other meds
Major blood loss
o Coagula琀椀on issues can occur when pa琀椀ent’s circula琀椀on is slowed due to cold or an an琀椀platelet give
reduce clo琀�ng in surgery
o Mechanical hemorrhage can also occur
Malignant hypothermia
o Rare, inherited, gene琀椀c muscle disease, with no symptoms other than during exposure to certain drugs
o GA can trigger hypercatabolic state (uncontrolled increase in metabolism, leading to hyperthermia,
muscle rigidity/ spasms, and tachycardia) which can be fatal if untreated
o Treat with muscle relaxant and physical cooling
Poten琀椀al problems in the post opera琀椀ve period
Neuro Delayed awakening, increased ICP, cerebral hemorrhage (Cerebral vascular accident/ stroke), post-
opera琀椀ve stroke
Resp Airway obstruc琀椀on, hypoxemia, atelectasis, hypoven琀椀la琀椀on, pulmonary edema, pulmonary embolism,
aspira琀椀on, post-op pneumonia and infec琀椀on
Cardiac Hypotension, hemorrhage, hypovolemia, syncope/ arrhythmias (can be due to the previous 3 things), DVT
(must have through assessment of chest or leg/ calf pain bc of DVT risk)
GI N/V/C, abdominal distension, postopera琀椀ve ileus (usually resolves in 2-3 days), paraly琀椀c ileus (lasts more
than 2-3 days, and is more concerning)
GU Oliguria (<30 mls/hr), anuria (no urine), urinary reten琀椀on, UTI
Wounds Infec琀椀on, dehiscence, eviscera琀椀on
Transfusions
Plasma = 55% of blood, blood cells = 45%
Pancytopenia: en琀椀re CBC is suppressed (RBC, WBC, and platelets)
CBC
Hemoglobin Measure of gas carrying capacity of RBCs
LOW: anemia, hemorrhage, hemodilu琀椀on
HIGH: increased O2 carrying requirement due to smoking, living at higher al琀椀tudes, COPD,
1
about:blank 1/10
, 9/8/23, 11:53 AM Adult Med Surg Notes
dehydra琀椀on, emphysema, heart failure, some cancers
Hematocrit Measure of packed cell volume of RBCs expressed as a percentage of total blood volume (high and
low similar to hemoglobin)
WBC count LOW: autoimmune disorders (e.g., lupus, HIV) malnutri琀椀on, vitamin de昀椀ciencies, TB, medica琀椀on,
cancers
HIGH: infec琀椀on, allergies, stress, steroids
Platelet count LOW: infec琀椀ons, anemia, cancers, medica琀椀ons (e.g., an琀椀bio琀椀cs, an琀椀convulsants, chemo)
pregnancy, autoimmune disorders, TTP (Thrombo琀椀c Thrombocytopenic Purpura)
HIGH: bone marrow disorders, acute bleeding, infec琀椀on, in昀氀amma琀椀on, surgery, trauma
INR How long blood takes to clot
LOW: clot too fast- increased vitamin K, estrogen containing medica琀椀ons,
HIGH: blood thinners, NSAIDs, liver failure, bleeding, vitamin K de昀椀ciency
People on warfarin will have INR of 2-3
aPTT LOW: trauma, cancer
HIGH: pregnancy, hemophilia, DIC, vitamin K de昀椀ciencies, leukemia, sepsis, liver disease
Fibrinogen LOW (decreases ability to clot): DIC,
HIGH: in昀氀amma琀椀on from cancer
Rh is based on D an琀椀gen found on RBC membrane
Rh+ has D an琀椀gen
An Rh- person can be exposed to Rh+ blood which
results in forming an an琀椀body (an琀椀-D)
o 2nd exposure to Rh+ blood will cause severe
hemoly琀椀c reac琀椀on
Anemia
Can result from
o Decreased RBC produc琀椀on
o Blood loss/ hypovolemia
o Increased RBC destruc琀椀on
Early/ middle signs: Hgb= 60-100 g/L, fa琀椀gue, SOB,
Late: Hgb< 60 g/L, lethargy, headache, dizziness, tachy, low BP, SOB,
Transfusion reac琀椀ons
Can occur during or up to 6 hours post transfusion
SS: fever, chills, hives, SOB, hypo or hypertension, pink urine, lumbar pain, N/V
Steps to take
o STOP transfusion IV TKVO NS check vitals recheck blood product number, compare to pt ID,
no琀椀fy MD, may restart if mild reac琀椀on no琀椀fy transfusion medicine lab as per hospital policy
Allergic transfusion Mild allergic reac琀椀ons to anaphylaxis
reac琀椀on
Febrile non- hemoly琀椀cFever (more than 1 degree increase in temp)
transfusion reac琀椀on
Bacterial sepsis or From bacteria in blood, can cause rigors, fever, tachycardia, hypotension, N/V, DIC
contamina琀椀on
Acute hemoly琀椀c From blood group incompa琀椀bility resul琀椀ng in hemolysis of incompa琀椀ble RBCs, SS: 39 and
transfusion reac琀椀on chills, hemoglobinuria,
Transfusion- related Acute hypoxemia with evidence of B/L lung in昀椀ltrates on x-ray but no evidence of circulatory
acute lung injury overload
(TRALI) SS: hypoxemia, dyspnea, B/L lung in昀椀ltrates visible on CXR
Transfusion- Circulatory overload from excessivsely rapid transfusion and/or pa琀椀ents at greater risk of
2
about:blank 2/10
Adult Med- Surg Notes
Role of nurse in preopera琀椀ve care
Pre-op admission assessment
Preopera琀椀ve teaching
Verify consent has been signed- whoever requires the consent should obtain the signature (e.g., the surgeon)
Categories of pa琀椀ents at higher opera琀椀ve risk (ABCDE)
A- Allergies
o Important to document what it is and what the response is
o Higher risk of hypersensi琀椀vity reac琀椀ons to anesthesia and other meds used in surgery and pre op
B- Bleeding (past history or risk)
o E.g., Pts taking ASAs
o Higher risk for surgicals complica琀椀ons and bleeding
C- cor琀椀sone/ steroids
o Increased risk of emboli
o Impacts ability to heal and reac琀椀on to anesthe琀椀cs
D- diabetes
o Important to iden琀椀fy glucose management plan
E- emboli (history or risk)
o Surgery and post- opera琀椀ve immobiliza琀椀on increases risk of embolus
Major complica琀椀ons
Anaphylaxis
o Typically due to hypersensi琀椀vity reac琀椀on or drug- drug interac琀椀on with other meds
Major blood loss
o Coagula琀椀on issues can occur when pa琀椀ent’s circula琀椀on is slowed due to cold or an an琀椀platelet give
reduce clo琀�ng in surgery
o Mechanical hemorrhage can also occur
Malignant hypothermia
o Rare, inherited, gene琀椀c muscle disease, with no symptoms other than during exposure to certain drugs
o GA can trigger hypercatabolic state (uncontrolled increase in metabolism, leading to hyperthermia,
muscle rigidity/ spasms, and tachycardia) which can be fatal if untreated
o Treat with muscle relaxant and physical cooling
Poten琀椀al problems in the post opera琀椀ve period
Neuro Delayed awakening, increased ICP, cerebral hemorrhage (Cerebral vascular accident/ stroke), post-
opera琀椀ve stroke
Resp Airway obstruc琀椀on, hypoxemia, atelectasis, hypoven琀椀la琀椀on, pulmonary edema, pulmonary embolism,
aspira琀椀on, post-op pneumonia and infec琀椀on
Cardiac Hypotension, hemorrhage, hypovolemia, syncope/ arrhythmias (can be due to the previous 3 things), DVT
(must have through assessment of chest or leg/ calf pain bc of DVT risk)
GI N/V/C, abdominal distension, postopera琀椀ve ileus (usually resolves in 2-3 days), paraly琀椀c ileus (lasts more
than 2-3 days, and is more concerning)
GU Oliguria (<30 mls/hr), anuria (no urine), urinary reten琀椀on, UTI
Wounds Infec琀椀on, dehiscence, eviscera琀椀on
Transfusions
Plasma = 55% of blood, blood cells = 45%
Pancytopenia: en琀椀re CBC is suppressed (RBC, WBC, and platelets)
CBC
Hemoglobin Measure of gas carrying capacity of RBCs
LOW: anemia, hemorrhage, hemodilu琀椀on
HIGH: increased O2 carrying requirement due to smoking, living at higher al琀椀tudes, COPD,
1
about:blank 1/10
, 9/8/23, 11:53 AM Adult Med Surg Notes
dehydra琀椀on, emphysema, heart failure, some cancers
Hematocrit Measure of packed cell volume of RBCs expressed as a percentage of total blood volume (high and
low similar to hemoglobin)
WBC count LOW: autoimmune disorders (e.g., lupus, HIV) malnutri琀椀on, vitamin de昀椀ciencies, TB, medica琀椀on,
cancers
HIGH: infec琀椀on, allergies, stress, steroids
Platelet count LOW: infec琀椀ons, anemia, cancers, medica琀椀ons (e.g., an琀椀bio琀椀cs, an琀椀convulsants, chemo)
pregnancy, autoimmune disorders, TTP (Thrombo琀椀c Thrombocytopenic Purpura)
HIGH: bone marrow disorders, acute bleeding, infec琀椀on, in昀氀amma琀椀on, surgery, trauma
INR How long blood takes to clot
LOW: clot too fast- increased vitamin K, estrogen containing medica琀椀ons,
HIGH: blood thinners, NSAIDs, liver failure, bleeding, vitamin K de昀椀ciency
People on warfarin will have INR of 2-3
aPTT LOW: trauma, cancer
HIGH: pregnancy, hemophilia, DIC, vitamin K de昀椀ciencies, leukemia, sepsis, liver disease
Fibrinogen LOW (decreases ability to clot): DIC,
HIGH: in昀氀amma琀椀on from cancer
Rh is based on D an琀椀gen found on RBC membrane
Rh+ has D an琀椀gen
An Rh- person can be exposed to Rh+ blood which
results in forming an an琀椀body (an琀椀-D)
o 2nd exposure to Rh+ blood will cause severe
hemoly琀椀c reac琀椀on
Anemia
Can result from
o Decreased RBC produc琀椀on
o Blood loss/ hypovolemia
o Increased RBC destruc琀椀on
Early/ middle signs: Hgb= 60-100 g/L, fa琀椀gue, SOB,
Late: Hgb< 60 g/L, lethargy, headache, dizziness, tachy, low BP, SOB,
Transfusion reac琀椀ons
Can occur during or up to 6 hours post transfusion
SS: fever, chills, hives, SOB, hypo or hypertension, pink urine, lumbar pain, N/V
Steps to take
o STOP transfusion IV TKVO NS check vitals recheck blood product number, compare to pt ID,
no琀椀fy MD, may restart if mild reac琀椀on no琀椀fy transfusion medicine lab as per hospital policy
Allergic transfusion Mild allergic reac琀椀ons to anaphylaxis
reac琀椀on
Febrile non- hemoly琀椀cFever (more than 1 degree increase in temp)
transfusion reac琀椀on
Bacterial sepsis or From bacteria in blood, can cause rigors, fever, tachycardia, hypotension, N/V, DIC
contamina琀椀on
Acute hemoly琀椀c From blood group incompa琀椀bility resul琀椀ng in hemolysis of incompa琀椀ble RBCs, SS: 39 and
transfusion reac琀椀on chills, hemoglobinuria,
Transfusion- related Acute hypoxemia with evidence of B/L lung in昀椀ltrates on x-ray but no evidence of circulatory
acute lung injury overload
(TRALI) SS: hypoxemia, dyspnea, B/L lung in昀椀ltrates visible on CXR
Transfusion- Circulatory overload from excessivsely rapid transfusion and/or pa琀椀ents at greater risk of
2
about:blank 2/10
