NUR 170 Med Surg Exam 1 Review
Preoperative Care
Basic Concepts of Perioperative Care
Risk factors for complications
- Smoking
- Alcohol
- Heart disease
- Respiratory disease
- Kidney disease
- Age
- Malnutrition
- Obesity
- Previous reactions to anesthesia (malignant hypertension
When does discharge planning begin?
Beginning at admission, the provider will write in progress notes the expected date of discharge.
Does the patient have family to help or should they go to rehab, home health
Pre op instructions
NPO status, consent, skin prep, bowel prep, what meds needed the morning of surgery – insulin,
BP meds , med hx ( anesthesia reaction)
Did the patient stop taking NSAIDS 2 weeks before surgery or stop anticoagulants
Labs:
- CBC
- BMP
- CMP
- XRAY - EKG
- Vitals
CBC
Hemoglobin (Hgb) : M: 14g/dL - 18g/dL F: 12g/dL - 16g/dL
Hematocrit (Hct) : M: 42-52% F: 37-47%
White Blood Cells (WBC) : 5,000 - 10,000
Red Blood Cells (RBC) : M: 4.7-6.1 mm F: 4.2-5.4mm
Platelet count (PLT) : 150,000 - 400,000 mm (clotting)
BMP
Glucose (Glu) : 70-110mg/dL
, Calcium (Ca) : 9-10.5mg/dL
Sodium (Na) : 135-145mEq/L
Chloride (Cl) : 98-106mEq/L
Potassium (K) : 3.5-5mEq/L
Magnesium (Mg) : 1.5-2.5mEq/L
Blood Urea Nitrogen (BUN) : 10-20mg/dL
CMP
Albumin: 3.5-5g/dl
Teaching:
- Early ambulation
- Splinting
- Incentive Spirometer use
- Return demonstration
- Risks : Wound dehiscence (obesity, increased drainage, separation of sutures, diabetes,
steroids, ,malnutrition) , infection (proper dressing change,assess odor, drainage, fever,
wbc) , hemorrhaging (hematoma, low BP, high HR - Hypovolemic shock) DVT (SCD -
meds) Pneumonia( , Constipation, Fluid volume excess/deficit, Paralytic ileus (monitor
bowel sounds, look for increased distention, NPO, might need NG tube)
Consent
MD explains procedure, nurse witness, 2 nurses witness to guide blind patient, if pt can’t write
have them sign with x while 2 nurses witness, , speaks another language get interpreter, pt can
always change their mind,
PreOp Meds
- Atropine - Anticholinergic ; dries up secretions
- Midazolam - Anxiety (Versed)
- PPI - Pantoprazole and omeprazole - reduce stomach acid (Pantoprazole - Protonix and
omeprazole Prilosec)
- Morphine - Pain
- Antibiotics
Don’t allow patient to get out of bed after these meds, safety to prevent falls
Preoperative Care
Basic Concepts of Perioperative Care
Risk factors for complications
- Smoking
- Alcohol
- Heart disease
- Respiratory disease
- Kidney disease
- Age
- Malnutrition
- Obesity
- Previous reactions to anesthesia (malignant hypertension
When does discharge planning begin?
Beginning at admission, the provider will write in progress notes the expected date of discharge.
Does the patient have family to help or should they go to rehab, home health
Pre op instructions
NPO status, consent, skin prep, bowel prep, what meds needed the morning of surgery – insulin,
BP meds , med hx ( anesthesia reaction)
Did the patient stop taking NSAIDS 2 weeks before surgery or stop anticoagulants
Labs:
- CBC
- BMP
- CMP
- XRAY - EKG
- Vitals
CBC
Hemoglobin (Hgb) : M: 14g/dL - 18g/dL F: 12g/dL - 16g/dL
Hematocrit (Hct) : M: 42-52% F: 37-47%
White Blood Cells (WBC) : 5,000 - 10,000
Red Blood Cells (RBC) : M: 4.7-6.1 mm F: 4.2-5.4mm
Platelet count (PLT) : 150,000 - 400,000 mm (clotting)
BMP
Glucose (Glu) : 70-110mg/dL
, Calcium (Ca) : 9-10.5mg/dL
Sodium (Na) : 135-145mEq/L
Chloride (Cl) : 98-106mEq/L
Potassium (K) : 3.5-5mEq/L
Magnesium (Mg) : 1.5-2.5mEq/L
Blood Urea Nitrogen (BUN) : 10-20mg/dL
CMP
Albumin: 3.5-5g/dl
Teaching:
- Early ambulation
- Splinting
- Incentive Spirometer use
- Return demonstration
- Risks : Wound dehiscence (obesity, increased drainage, separation of sutures, diabetes,
steroids, ,malnutrition) , infection (proper dressing change,assess odor, drainage, fever,
wbc) , hemorrhaging (hematoma, low BP, high HR - Hypovolemic shock) DVT (SCD -
meds) Pneumonia( , Constipation, Fluid volume excess/deficit, Paralytic ileus (monitor
bowel sounds, look for increased distention, NPO, might need NG tube)
Consent
MD explains procedure, nurse witness, 2 nurses witness to guide blind patient, if pt can’t write
have them sign with x while 2 nurses witness, , speaks another language get interpreter, pt can
always change their mind,
PreOp Meds
- Atropine - Anticholinergic ; dries up secretions
- Midazolam - Anxiety (Versed)
- PPI - Pantoprazole and omeprazole - reduce stomach acid (Pantoprazole - Protonix and
omeprazole Prilosec)
- Morphine - Pain
- Antibiotics
Don’t allow patient to get out of bed after these meds, safety to prevent falls
