MED SURG FINAL EXAM 2023 STUDY GUIDE

MED SURG FINAL EXAM 2023 STUDY GUIDE 1 / 4

• NG tube – Placement and verification (look for more information)

✓ X-ray ✓ Aspirate to collect gastric contents, testing pH (4 or less).

• Wound Evisceration – Nursing actions – what to do if you see evisceration?
• Stay with patient and call for help,

ii. Low Fowler’s position, with hips &knees bent iii. Cover wound with sterile wet normal saline dressing iv. Do not attempt to reinsert organs

• Notify physician

• Pre op teaching, informed consent
• Nursing Care

2.Informed Consent 3.Client Education

Nursing Care • Check for informed consent(nurse as witness) • Enemas, laxatives (bowel surgeries) • Check scheduled medication prescriptions • All pts should receive info about deep breathing, coughing and early ambulation.• Verify NPO status: (to avoid aspiration) for at least: • 6 hr. for solid foods.• 2 hr. (clear liquids) before general anesthesia.• 3 to 4 hr.( clear liquids) before local anesthesia • Chart the last time the client ate or drank.• Skin preparation • Antimicrobial soap 2 / 4

• Electrical clippers or chemical depilation only if needed • Remove jewelry (especially if electrocautery devices will be used), dentures, prostheses, make up, nail polish and glasses • Do not have the client sign the informed consent after giving medications that affects decision-making or judgment (i.e. opioids, benzodiazepines, sedatives) • Once the surgery has been discussed as treatment, it is the responsibility of the physician/provider to get the IC.• The nurse can clarify the information if that remains unclear after the provider has explained the patient, however you CANNOT provide any additional information that provider did not discuss.• Nurse CANNOT take the IC • Nurses role is to ONLY witness the client’s signature/signing the informed consent AFTER the client acknowledges the understanding of the procedure.

• It is the responsibility of the nurse to determine if client is:

• >1
• years or emancipated minor
• M

entally capable of understanding the risks, reason and options for surgery and anesthesia

• Un

der the influence of medication that affects decision making or judgement (e.g benzos, opoids, sedatives)

• D

ONOT HAVE CLIENT SIGN IC IF MEDICATIONS HAVE BEEN ADM.

Teach all patients about (unless contraindicated):

Pain Scale NPO required status Deep breathing Coughing Early ambulation Tubes, drains & monitoring devices/special equipment

Some surgeries may require teaching about:

Incentive spirometer Patient-Controlled analgesia pumps Any surgery-specific information (i.e. immobilizers) Purpose of Antiembolism stockings and pneumatic compression devices to prevent deep-vein thrombosis.Invasive devices (drains, catheters, IV lines).Postoperative diet.Reposition every 2 hr and purpose of early ambulation ( no pillows under the knees or elevate the knee gatch on the bed) Use of the incentive spirometer ( every 1-2 hours while awake).Pain Scale.Nursing Interventions

Preoperative instructions:

• Avoid cigarette smoking for 24 hr. preoperatively,

• Medications to hold:

• Acetylsalicylic acid (Aspirin): Stop 1 week before surgery.

• Herbal medications (G’s: Ginkgo -biloba, Ginseng, Garlic): stop taking 2 to 3 weeks before surgery to prevent hemorrhage.

• Feverfew : Stop taking 2-3 weeks (adverse effects to the anesthetic)

• Regular medications for chronic conditions maybe taken before surgery.• Bowel preparation instructions ( if needed) • Pain Scale 3 / 4

• Cl

ient comfort – post surgery Postoperative Nursing Care ch 96 pp 645 Med. Surg.• Who can transfer a client from OR to PACU?• Anesthesia provider (anesthesiologist or CRNA) • Circulating nurse gives the verbal “hand-off” report to PACU nurse.• Postoperative care is provided initially in the PACU by a ACLS certified RN.

• Initial postoperative care:

• assessments, administering medications, managing client’s pain, preventing complications, and determining when a client is ready to be discharged from the PACU.

• PRIORITIES During the immediate postoperative stage:

• airway patency • ventilation • circulatory status

Level of consciousness ABC Pain Medication ( does the pat need or does not need medication?) Urine output (30 mL x hour)

AIRWAY

• Oxygen saturation (pulse oximeter) • Cough and deep breath Q 2hr (splinting abdominal surgical incision) • Incentive Spirometer Q 2hr (prevent atelectasis) • Reposition q 2 hr. + early ambulation POSITIONING & PAIN • No pillows under the knees. No knee elevation) • Early ambulation with periods of rest (to prevent: CV disorders, DVT, and Pulmonary complications) • Assess pain level frequently • Monitor for adverse effects of pain meds.• Administer 30mins prior to ambulation or painful procedures

FLUID STATUS

Administer ordered IV fluids Offer ice chips Frequent oral hygiene

• / 4