HESI STUDY GUIDE MEDSURG AND NCLEX-RN HESI STUDY GUIDE MED-SURG AND NCLEX-RN HESI STUDY GUIDE (MED-SURG/NCLEX-RN) Delegation If giving to LVN/LPN or other nurse that is floating or not critical care- give nurse the most STABLE client. Center of Gravi

HESI STUDY GUIDE MEDSURG AND NCLEX-RN HESI STUDY GUIDE MED-SURG AND NCLEX-RN HESI STUDY GUIDE (MED-SURG/NCLEX-RN) Delegation If giving to LVN/LPN or other nurse that is floating or not critical care- give nurse the most STABLE client. Center of GravityOlder individuals’ center of gravity is the upper torso. Adults- hips ABC’s ▪ Airway, Breathing, Circulation ▪ (CAB)- compression, airway, breathing ▪ Provide if unwitnessed cardiac arrest occurs. ▪ If unconscious- begin with circulation, airway, breathing; begin CPR. ▪ 30:2 with partner ▪ 15:2 alone ▪ Place hands at lower half of sternum; above xiphoid process ▪ Reposition head to validate proper position to open airway if chest is not moving ▪ When carotid pulse is felt, there is return of cardiac function, with return of breathing • Signs of effective tissue perfusion should be noticed Preoperative- • Nurses role is to educate/advocate, reduce anxiety, Ensure consent has been signed within past 24 hours (valid for 45 days) • Teaching/Learning- outcome is best when demonstrated and not only verbalized; returned demonstration is best method. • KNOW ALLERGIES, OTC, herbal meds • Know any issues with previous surgical experiences • Know about person’s culture • Often no blood transfusions for Jehovah’s Witness • Often NPO after midnight; clear liquids sometimes allowed up to 6 hrs before surgery o If client does not follow, surgery will be rescheduled • Ensure client is both emotionally and physically prepared for surgery Surgical Risk Factors- • Age-young and old • Nutrition- obese and malnutrition • Fluid/Electrolyte-dehydration/hypovolemia • Infection • Cardiac conditions • Blood coagulation disorders • URI/COPD- exacerbated by general anesthesia • Renal disease- impairs F/E balance • Uncontrolled DM- infection & delayed healing • Liver disease- inability to detoxify meds Meds that increase risk: • Anticoagulants- increases bleeding • Tranquilizers- hypotension • Heroin- decreased CNS response • Antibiotics- may be incompatible with anesthesia • Diuretics- may cause electrolyte imbalance • Steroids • OTC herbal medso THINK THREE G’s: ginseng, garlic, gingko- increase bleeding o Fish oil, dong quai, feverfew- increase bleeding o Prolong anesthesia- kava, Valerian, St. John’s (also interacts with EVERYTHING) PostoperativeImmediate Care: ▪ VS- BP, pulse, respirations o Especially if client has slurred speech- may indicate neuro deficits o If SOB, may need to intubate ▪ LOC, skin color & condition ▪ Dressing location and condition ▪ IV fluids ▪ Urine output o Notify HCP if dark and less than 30mL/hr ▪ Drainage tubes & position ▪ O2 saturation Monitor for S&S: ▪ Shock/hemorrhage o Compensatory mechanism is activation of SNS that will increase RR & pulse to restore BP; constricts arterioles and causes oliguria o Client will show elevated BP as compensatory mechanism ▪ Narrow pulse pressure ▪ Rapid weak pulse ▪ Cold, moist skin ▪ Increased cap refilo HESI STUDY GUIDE (MED-SURG/NCLEX-RN) n If giving to LVN/LPN or other nurse that is floating or not critical care- give nurse the most STABLE client. Center of GravityOlder individuals’ center of gravity is the upper torso. Adults- hips ABC’s ▪ Airway, Breathing, Circulation ▪ (CAB)- compression, airway, breathing ▪ Provide if unwitnessed cardiac arrest occurs. ▪ If unconscious- begin with circulation, airway, breathing; begin CPR. ▪ 30:2 with partner ▪ 15:2 alone ▪ Place hands at lower half of sternum; above xiphoid process ▪ Reposition head to validate proper position to open airway if chest is not moving ▪ When carotid pulse is felt, there is return of cardiac function, with return of breathing • Signs of effective tissue perfusion should be noticed Preoperative- • Nurses role is to educate/advocate, reduce anxiety, Ensure consent has been signed within past 24 hours (valid for 45 days) • Teaching/Learning- outcome is best when demonstrated and not only verbalized; returned demonstration is best method. • KNOW ALLERGIES, OTC, herbal meds • Know any issues with previous surgical experiences • Know about person’s culture • Often no blood transfusions for Jehovah’s Witness • Often NPO after midnight; clear liquids sometimes allowed up to 6 hrs before surgery o If client does not follow, surgery will be rescheduled • Ensure client is both emotionally and physically prepared for surgery Surgical Risk Factors- • Age-young and old • Nutrition- obese and malnutrition • Fluid/Electrolyte-dehydration/hypovolemia • Infection • Cardiac conditions • Blood coagulation disorders • URI/COPD- exacerbated by general anesthesia • Renal disease- impairs F/E balance • Uncontrolled DM- infection & delayed healing • Liver disease- inability to detoxify meds Meds that increase risk: • Anticoagulants- increases bleeding • Tranquilizers- hypotension • Heroin- decreased CNS response • Antibiotics- may be incompatible with anesthesia • Diuretics- may cause electrolyte imbalance • Steroids • OTC herbal medso THINK THREE G’s: ginseng, garlic, gingko- increase bleeding o Fish oil, dong quai, feverfew- increase bleeding o Prolong anesthesia- kava, Valerian, St. John’s (also interacts with EVERYTHING) PostoperativeImmediate Care: ▪ VS- BP, pulse, respirations o Especially if client has slurred speech- may indicate neuro deficits o If SOB, may need to intubate ▪ LOC, skin color & condition ▪ Dressing location and condition ▪ IV fluids ▪ Urine output o Notify HCP if dark and less than 30mL/hr ▪ Drainage tubes & position ▪ O2 saturation Monitor for S&S: ▪ Shock/hemorrhage o Compensatory mechanism is activation of SNS that will increase RR & pulse to restore BP; constricts arterioles and causes oliguria o Client will show elevated BP as compensatory mechanism ▪ Narrow pulse pressure ▪ Rapid weak pulse ▪ Cold, moist skin ▪ Increased cap refil