Med Surg Exam # 2
• Pre-Operative Patient Care • Oxygenation Disturbances
• Post-Operative Patient Care • Sleep Apnea (podcast)
• Wound Care • Sinusitis/Acute Bronchitis (podcast)
• Oncology • Pneumonia (podcast)
Pre-Operative Patient Care
Surgery - art and science of treating disease, injuries, and deformities by operation and
instrumentation.
Classification of Surgery:
- Seriousness
- Major
- Minor
- Urgency
- Elective
- Urgent
- Emergency
Classification of Surgery
Purpose:
- Diagnosis: determine presence and/or extent of disease
- Cure: eliminate or repair pathology
- Palliation: alleviate symptoms without cure
- Prevention
- Exploration: surgical exam to determine nature and extent of disease
- Cosmetic Improvement
Surgical Settings:
Determined by:
- complexity of surgery
- potential complications
- general health status of patient
Inpatient (have surgery and stay overnight in hospital)
- same day admission
- in hospital prior to surgery
Ambulatory (outpatient) Surgery
- majority of surgeries
1 of 49
,- minimally invasive procedures
- sites:
- emergency departments
- endoscopy clinics
- physician’s office
- free standing surgical clinics
- outpatient surgery units in hospitals
Ambulatory Surgery
- can use general, regional, or local anesthesia
- operating time < 2 hours
- less than 24 hour stay postoperative
- benefits:
- generally preferred by patient and physician
- involves minimal lab tests
- requires fewer pre-op and post-op medications
- reduces patient susceptibility to hospital acquired infections
- cost is usually less for patient and insurer
Pre-Operative Interview and Assessment
*Overall Goal: determine risk factors
and determine plan to ensure safety
throughout surgical experience
Goals of Assessment:
- any problems with previous
surgeries / pt or family
- screen for malignant
hyperthermia risk
- determine physiologic risk factors
(PMH)
- establish baseline for comparison
during preoperative period
- identify prescription meds, OTC
meds, herbal supplements, and
recreational drugs used by the patient
- review all pre-op labs and testing that has been done
- identify and document surgical site
- identify any cultural or ethical factors that might affect the surgical experience
- determine psychologic status of patient in order to reinforce use of coping strategies during
surgical experience
- determine is informed consent has been completed
Pre-Operative Nursing Interventions
2 of 49
,Informed Consent:
- active, shared decision-making process between health care provider and the recipient of
care
- 3 conditions must be present:
- adequate disclosure
- clear understanding
- voluntary
- physician responsible for obtaining consent
- nurse may witness pt signature and confirms that pt understands all information
*IF pt says “I don’t want to know about the surgery just do it” What do you ?
- try to explain why it’s important information; if they REALLY don’t wanna know that is their
decision. DOCUMENT this.
Pre-Operative Interview and Assessment
Medications
- need accurate list of all medications being taken
- ask them to bring all medications in for accurate list
Specifics to think about:
- tranquilizers
- antihypertensives
- insulin or oral hypoglycemias
- ASA, NSAIDs, Plavix (any blood thinners bc will cause bleeding problems) TYLENOL can be
alternative!!
- Coumadin
- Specifically ask about herbals*
- ask about use of recreations drugs
*all body systems reviewed for risk factors and baseline*
1 THING THEY ARE ALLOWED TO LEAVE ON IN SURGERY: HEARING AID
Cardiovascular:
- cardiac clearance:
- consult with cardiologist
- coagulation studies
- EKAG, echocardiogram, stress test
- on diuretic, may need K+ checked pre-op
Respiratory:
- conditions likely to compromise respiratory function:
- smoking, sleep apnea, obesity, spinal, chest, airway deformities
- Respiratory clearance may include:
- consult with pulmonologist
- ABGs, CXR, pulmonary function tests
3 of 49
, Neurologic:
- crucial to get baseline cognitive function, especially elderly
- hearing and vision
Genitourinary:
- ability to void, incontinence; BPH may make it difficult to insert foley
- R/O pregnancy in women of childbearing age
- altered renal function can lead to F&E problems
- may need BUN/Creat, electrolytes
Hepatic:
- liver detoxifies many anesthetics and adjunctive meds
- ppl with liver disease may have increased risk for clotting abnormalities
Integumentary:
- condition of skin at potential surgical site
- risk for pressure ulcers
- tattoos and body piercings
Musculoskeletal:
- mobility restrictions may limit positioning and post-op ambulation
- spinal anesthesia may be difficult to person who cannot flex lumbar spine
- if next affected intubation may be difficult
- any mobility aides should be brought to facility with pt
Endocrine:
- diabetes and thyroid disease
Immune:
- allergies
- history of compromised immune status or taking immunosuppressive drugs
- corticosteroids should be tapered before surgery
- delays wound healing and increases risk for post op infection
Fluid and Electrolyte Status:
- S&S of vomiting or diarrhea
- use of diuretics
- pre op bowel preps
- NPO pre op may lead to hypovolemia
Nutritional Status
- dentures and bridges
- overnutrition or undernutrition can be problem
Surgical Events
4 of 49
• Pre-Operative Patient Care • Oxygenation Disturbances
• Post-Operative Patient Care • Sleep Apnea (podcast)
• Wound Care • Sinusitis/Acute Bronchitis (podcast)
• Oncology • Pneumonia (podcast)
Pre-Operative Patient Care
Surgery - art and science of treating disease, injuries, and deformities by operation and
instrumentation.
Classification of Surgery:
- Seriousness
- Major
- Minor
- Urgency
- Elective
- Urgent
- Emergency
Classification of Surgery
Purpose:
- Diagnosis: determine presence and/or extent of disease
- Cure: eliminate or repair pathology
- Palliation: alleviate symptoms without cure
- Prevention
- Exploration: surgical exam to determine nature and extent of disease
- Cosmetic Improvement
Surgical Settings:
Determined by:
- complexity of surgery
- potential complications
- general health status of patient
Inpatient (have surgery and stay overnight in hospital)
- same day admission
- in hospital prior to surgery
Ambulatory (outpatient) Surgery
- majority of surgeries
1 of 49
,- minimally invasive procedures
- sites:
- emergency departments
- endoscopy clinics
- physician’s office
- free standing surgical clinics
- outpatient surgery units in hospitals
Ambulatory Surgery
- can use general, regional, or local anesthesia
- operating time < 2 hours
- less than 24 hour stay postoperative
- benefits:
- generally preferred by patient and physician
- involves minimal lab tests
- requires fewer pre-op and post-op medications
- reduces patient susceptibility to hospital acquired infections
- cost is usually less for patient and insurer
Pre-Operative Interview and Assessment
*Overall Goal: determine risk factors
and determine plan to ensure safety
throughout surgical experience
Goals of Assessment:
- any problems with previous
surgeries / pt or family
- screen for malignant
hyperthermia risk
- determine physiologic risk factors
(PMH)
- establish baseline for comparison
during preoperative period
- identify prescription meds, OTC
meds, herbal supplements, and
recreational drugs used by the patient
- review all pre-op labs and testing that has been done
- identify and document surgical site
- identify any cultural or ethical factors that might affect the surgical experience
- determine psychologic status of patient in order to reinforce use of coping strategies during
surgical experience
- determine is informed consent has been completed
Pre-Operative Nursing Interventions
2 of 49
,Informed Consent:
- active, shared decision-making process between health care provider and the recipient of
care
- 3 conditions must be present:
- adequate disclosure
- clear understanding
- voluntary
- physician responsible for obtaining consent
- nurse may witness pt signature and confirms that pt understands all information
*IF pt says “I don’t want to know about the surgery just do it” What do you ?
- try to explain why it’s important information; if they REALLY don’t wanna know that is their
decision. DOCUMENT this.
Pre-Operative Interview and Assessment
Medications
- need accurate list of all medications being taken
- ask them to bring all medications in for accurate list
Specifics to think about:
- tranquilizers
- antihypertensives
- insulin or oral hypoglycemias
- ASA, NSAIDs, Plavix (any blood thinners bc will cause bleeding problems) TYLENOL can be
alternative!!
- Coumadin
- Specifically ask about herbals*
- ask about use of recreations drugs
*all body systems reviewed for risk factors and baseline*
1 THING THEY ARE ALLOWED TO LEAVE ON IN SURGERY: HEARING AID
Cardiovascular:
- cardiac clearance:
- consult with cardiologist
- coagulation studies
- EKAG, echocardiogram, stress test
- on diuretic, may need K+ checked pre-op
Respiratory:
- conditions likely to compromise respiratory function:
- smoking, sleep apnea, obesity, spinal, chest, airway deformities
- Respiratory clearance may include:
- consult with pulmonologist
- ABGs, CXR, pulmonary function tests
3 of 49
, Neurologic:
- crucial to get baseline cognitive function, especially elderly
- hearing and vision
Genitourinary:
- ability to void, incontinence; BPH may make it difficult to insert foley
- R/O pregnancy in women of childbearing age
- altered renal function can lead to F&E problems
- may need BUN/Creat, electrolytes
Hepatic:
- liver detoxifies many anesthetics and adjunctive meds
- ppl with liver disease may have increased risk for clotting abnormalities
Integumentary:
- condition of skin at potential surgical site
- risk for pressure ulcers
- tattoos and body piercings
Musculoskeletal:
- mobility restrictions may limit positioning and post-op ambulation
- spinal anesthesia may be difficult to person who cannot flex lumbar spine
- if next affected intubation may be difficult
- any mobility aides should be brought to facility with pt
Endocrine:
- diabetes and thyroid disease
Immune:
- allergies
- history of compromised immune status or taking immunosuppressive drugs
- corticosteroids should be tapered before surgery
- delays wound healing and increases risk for post op infection
Fluid and Electrolyte Status:
- S&S of vomiting or diarrhea
- use of diuretics
- pre op bowel preps
- NPO pre op may lead to hypovolemia
Nutritional Status
- dentures and bridges
- overnutrition or undernutrition can be problem
Surgical Events
4 of 49
