Class notes
Medical surgical 2
- Course
- Institution
Med surg 1: Pre/post operative, endocrine, diabetes, gastrointestinal, liver, musculoskeletal
[Show more]
2 reviews
By: andrewsbrooke559 • 4 months ago
By: cbeler88 • 4 months ago
Content preview
MED SURG 1Perioperative Nursing
Intraoperative: To the O.R through admission to PACU
Perioperative: Entire surgical experience
Postoperative: From PACU to follow up evaluation
Preoperative: Decision for surgery made to O.R
Emergent surgery: Life threatening, ex. Gunshot wound
Urgent surgery: Acute injury/illness, ex. Appendectomy, kidney stones
Elective surgery: Highly suggested but not mandatory, ex. Tonsils out
Optional surgery: Personal preference, ex. Cosmetics, breast augmentation
Required surgery: Needed eventually, ex. Cataracts
INFORMED CONSENT:
Surgeon: obtains consent, does education 30 DAYS PRIOR TO SURGERY
Nurse: WITNESS signature, can CLARIFY what was already taught, BEFORE
PSYCHOACTIVE MEDICATIONS ARE GIVEN
Preoperative:
· Hx/ allergies assessment
· Head to toe assessment
· EKG
· UA, CBC, CMP
· Type/ cross match
*Nurse completes pre-op checklist*
Medication to avoid before surgery:
· Anticoagulants Ex. Coumadin
· NSAIDS Ex. Ibuprofen
· Antihypertensives Ex. Lisinopril
· Tricyclic antidepressants
· Insulin (in some cases, tailored to patient)
,Intraoperative:
Circulating nurse: HAS TO BE AN RN
· Identifies patient, surgical site, consent, allergies
· Monitors patient safety
· Sets up supplies/ materials
· Documents
Scrub nurse: CAN BE LPN, SURGICAL TECH, RN
· Sets up table, remains sterile
· Hands tools to surgeon
· Oversees patients’ status from RN role, COUNTS SUPPLIES AT END
Regional anesthesia: injected around nerves
Epidural: Into epidural space, blocks pain but still little feeling. Sits upright during
procedure
CAN CAUSE HYPOTENSION AND RESPIRATORY DEPRESSION
Spinal: Into subarachnoid space, numbs all lower extremities and abdomen.
Lies on side, knee-chest position
CAN CAUSE A HEADACHE
Moderate sedation: Depresses LOC, for anxiety/ pain control (twilight zone)
Intraoperative complications:
Anesthesia awareness
Anaphylaxis
Hypoxia
Nausea/ vomiting (turn on side)
Malignant hyperthermia
First sign: tachycardia >150 bpm
Hypotension
Hypercapnia (high CO2)
Muscle rigidity (late sign)
High fever, can be over >107 (late sign)
,TREATMENT:
Dantrolene sodium
Post-Operative:
Post-op care:
· Vitals Q5-15 min
· Neurological assessment, LOC (Aldrete score 7 -10 to leave PACU)
· Respiratory assessment
· Assess surgical site
· Assess pain level
· Assess urine output, bowel sounds
· Check all drains/ IV sites
· MAINTAIN PATENT AIRWAY
Post-op complications:
· Pneumonia
· Atelectasis
· DVT
· Hypovolemic shock
· Infection
· Hemorrhage
*REPORT SYSTOLIC <90*
Endocrine Disorders:
Anterior pituitary: TSH, GH
Posterior Pituitary: ADH, oxytocin
Adrenal cortex: aldosterone, cortisol
Adrenal medulla: Epinephrine, non-epinephrine
Thyroid: T3, T4
Parathyroid: Calcium
, Addison’s:
-Hyposecretion of adrenal cortex hormones
DECREASE IN GLUCOCORTICOIDS, MINERALOCORTICOIDS, ANDROGENS
(LOW SALT, SEX, SUGAR)
SIGNS AND SYMPTOMS:
· Hyponatremia, hyperkalemia
· Hypoglycemia
· Fluid volume deficit
· Hypotension
· Hyperpigmentation (Eternal tan)
· Decreased resistance to stress
Treatment & management:
· Add hormones (steroid replacement) TAKE IN MORNING WITH FOOD
· Monitor vitals
· Monitor glucose
· Manage stress (quiet, non-stimulating environment)
· High protein/ high complex carbs
ADDISONIAN CRISIS:
-Acute exacerbation of Addison’s
Severe electrolyte imbalance (Hyperkalemia)
Can lead to:
· Dysrhythmias
· Hypotension (Extremely low=shock)
· Hypoglycemia
· Severe dehydration
· N/V
· Confusion
Treatment:
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller julianareddan18. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $8.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
78134 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 15 years now