Summary NURS 3628 MedSurg I Exam 1 Review | Complete Latest Solution Guide_2025.

Exam 1 Review:
Perioperative Nursing:
 Preoperative Phase: Starts when the pt decides to have surgery and ends when the
pt is on the OR table.
o Nurses Role:
 Assess and interpret data to make sure the patient is safe for surgery
 Communicate with MDs
 Provide patient education
o Risk Factors:
 Hypovolemia  Cerebrovascular diseases (CAD, MI, HTN,
 Dehydration/Electrolyte imbalances Afib, CHF, bleeding disorders)
 Nutritional deficits  Renal disease (CKD, UTI)
 Very old/very young  Endocrine dysfunctions (DM,
 Infections/sepsis thyroid/adrenal disorders)
 Obesity (harder to intubate,  Liver disease
transport, and needs more meds for  Anxiety (high HR)
sedation)  Recreational drugs
 Pulmonary diseases (COPD, asthma,
smoking)

Medications to Assess:
Medication Examples Hold or Reason
Types Take
Blood Heparin, Plavix, HOLD 1wk Increases bleeding risk
thinners Coumadin, ASA,
Ibuprofen, etc.
Steroids Any TAKE (if May change how the body heals, can mask
long term) sings of infections
Insulin Any TAKE (if May be needed for hyperglycemia
needed)
Vitamins E&G HOLD Increases bleeding risk
1day
OTC Meds Herbs: Ginka, HOLD 2wk Increases bleeding risk
ginger, ginseng,
certain oils
Recreational Weed, Coke, heroin, HOLD Can worsen the hypotensive effects of
Drugs etc sedation
Diuretics Any HOLD Must draw K+ levels

o Priority Assessments:
 Allergies  Bladder voided
 Avocado, kiwi, bananas   Vital signs
Latex allergy  Drugs held (If needed)
 Medications  Blood type
 Recent infections  Health history
 NPO status  Mental status (anxiety)

, Pain

Priority Labs/Diagnostics:
Lab Test Normal Values Abnormal Values
WBC 5,000-10,000 <4,500- pt can’t fight
infection
>11,000- pt has infection
RBC 4.5-6
Platelets 150,000-400,000 <100,000- Don’t go to
surgery
>400,000- pt is at risk for
thromboembolism
(Always check for lovonox)
Hemoglobin (Hgb) F: 12-16 g/dL <9- notify MD
M: 13-18 g/dL
Hematocrit (Hct) F: 36-48 Low values mean pt does not
M: 42-54 have enough circulatory
blood.
BUN 10-20 Checks kidney functions
Creatine 0.6-12 High values mean that kidney
function is compromised
K+ 3.5-5
Na+ 135-145
Ca+ 9-11
PT 11-12.5s Shows how long it takes for
blood to clot
INR 0.8-1.1 2-3s- pt is on warfarin
Shows how long it takes for
blood to clot
ABGs


o Patient Education: Helps prep the pt on what to expect
 Explain:
 Expectations for when they wake up (Pt may have foley, chest tube, etc.)
 Pain and ways that it can be treated (Ex: PCA)
 Ways to prevent complications (TCDB, IS, Early ambulation)
 NPO process and why certain meds need to be held or taken prior to
surgery.
o Informed Consent: Ensures the patient has been given the necessary info about
the surgery/risk.
 Pt cannot be under the influence of any analgesics/anxiety meds during this
process.
 Surgeons are responsible for obtaining consent and explaining procedure.
 Nurses Role: Obtain signature, witness consent, and makes sure the pt
understands procedure

,  Intraoperative Phase: Starts when the pt is transferred to the OR table and ends
when the pt is in PACU.
o Nurses role:
 Ensures TIME OUT (Right pt, procedure, site marked, consent signed,
allergies)
 Monitors pt for hypothermia (Monitor temp, give heated blanket, warm IV
fluids)
 Safety and comfort
 Pt emotional support
 Positioning on OR table (adding padding/pillows on boney prominences
 Counting supplies before and after surgery
o TIME OUT: Double checking the right patient, procedure, and site before the
surgery begins
o Anesthesia:
 Slows down CNS  Decreasing BP, HR, RR, and paralyzes
 When pt comes out of anesthesia, they may have nausea/vomiting (Have
antiemetic ready)
 Stage 1: Beginning anesthesia
 Inhaled agents: Succinylcholine
 Pt becomes drowsy  unconscious but respirations normal
 Stage 2: Excitement
 Ketamine: GIVE IN QUIET ENVIRONMENT, may cause hallucinations
(during and after surgery)
 Muscles tense, irregular breathing, pt may vomit
 Stage 3: Surgical anesthesia
 Breathing regulates, reflexes are lost
 Stage 4: Medullary depression
 Complete respiratory depression, pt is intubated and placed on ventilator
o Complications:
 Nausea/vomiting  Bronchospasm
 Anaphylaxis  Pulmonary edema
 Hypothermia  Aspiration
 Hypoxia  Fluid/electrolyte imbalance
o Malignant Hyperthermia: Reaction to anesthesia (Succinylcholine)
 Risk factors: Family history
 Assessments:
  Co2
 Tachycardia >150bpm (early finding)
 Fever (late finding)
 Rigid muscles
 Tachypnea
 Interventions:
 Dantrolene: Relaxes muscles
 Lidocaine: Calms HR