Med/Surg

This phase begins with the admission of the patient to the perianesthesia care unit (PACU) & continues until the patient's recovery is completed.

Physicians who perform surgical procedures are called_____?

The period when an anesthetic is 1st given until full anesthesia is reached?

This phase begins with the decision to have surgery & ends with transfer of the patient to the operating room

This phase begins when the patient is transferred to the operating room & ends when the patient is admitted to the PACU

An ____ agent is medication (such as narcotics, muscle relaxants, or anti emetics) used with the primary anesthetic agent.

The sudden bursting open of a wound's edges that may be preceded by an increase in serosanguineous drainage is referred to as:

Physicians who administer anesthesia

Causes a loss of sensation hand allows the surgical procedure to be done safely.

Occurs from hypoventilation or mucous obstruction that prevents some alveoli from opening and being fully ventilated.

The removal of necrotic & infected tissue

Body temperature that is below normal range

The viscera spilling out of the abdomen

-Surgery done at request of patient
-Rhinoplasty
-Cosmetic surgery

-Surgery planned & scheduled without immediate time constraints 
-Hernia repairs 
-joint replacements
-skin lesion removal

-Surgery needed within 24-30 hours
-Fracture repair
-Infected gallbladder

-Surgery needed when any delay jeopardizes the patient's life or limb
-Extremity emboli
-Ruptured aorotic aneurysm or appendix
-Traumatic limb amputation, loss of extremity pulse

True or false 


All medications that patients are taking must be reviewed preoperatively.
True False

True or false
Most anticoagulants, such as warfarin (coumadin) do not need to be stopped before surgery
True False

True or False 
Diabetic patients on insulin are told to increase their normal insulin dose the day of surgery
True False

True or False
Blood glucose monitoring for diabetic patients is ordered on admission
True False

True or False
If a patient is on chronic oral steroid therapy it cannot be abruptly stopped when nil per os (NPO)
True False

True or False
Surgery is not a serious stressor for the body.
True False

true or False
Chronic oral steroid therapy should be continued via the parental route if the patient is NPO
True False

True or False 
Circulatory collapse can develop if steroids are not stopped abruptly
True False

Time Frame- Incision to 2nd postoperative day
Wound Healing- Inflammatory response 
Patient Effect- Fever, malaise

Time Frame- 3rd to 14th postop day 
Wound Healing- Granulation tissue forms
Patient Effect- Feeling better

Time Frame- 3rd to 6th postop week
Wound Healing- Collagen deposited 
Patient Effect- Raised scar formed

Time Frame- Months to 1 year 
Wound Healing- Wound contracts & shrinks 
Patient Effect- Flat, thin scar

Its for nursing interview, diagnostic testing, anesthesia interview, & preoperative teaching to ensure patient is in the best possible condition for surgery

Laboratory tests:blood glucose, creatinine, blood urea nitrogen (BUN), electrolytes, complete blood count, prothombin time, partial thrombosplastin time, bleeding time, type & screen & urinalysis are some common test; oxygen saturation, electrocardiogram, chest x-ray

What are the 2 primary responsibilities of the perianesthesia care nurse?

What does deep breathing & coughing prevent?

Leg exercises & activity prevent?

Drains are inserted to prevent____?

When the patient's signature is witnessed by the nurse on the surgical consent, what does that mean?

What is an intraoperative outcome for a patient undergoing an inguinal hernia repair?

What kind of goals:
-Verbalizes goals
-Demonstrates leg exercises
-Explains deep breathing exercises

Discharge criterion from the PACU for a patient following surgery?

Discharge criteria from ambulatory surgery for patients following surgery?

Long term steroid therapy cannot be abruptly stopped because?

Complications that a nurse would correctly explain to a patient can be prevented with early postoperative ambulation

The nurse is caring for a patient with a bowel resection. What would indicate that the patient's gastrointestinal tract is resuming normal function

Bowel is not functioning when:

After surgery, patient's urine is dark amber & concentrated? Why?

The patient develops a low-grade fever 18 hours post-operarively & has diminished breath sounds. What should the nurse do to prevent complications?

May be elective, urgent or emergency
Purpose: To preserve life, repair or remove body part

-Primarily elective
Purpose: To restore function, remove skin lesion & to correct deformities

May be major or minor. Make or confirm diagnosis
Ex: breast diagnosis

Usually major. Diseased body part removed.
Ex: Appendectomy, Amputation

To restore function to traumatized or malfunctioning tissue
Ex: Scar revision, plastic surgery

To replace organs or structures that are diseased 
Ex: heart, kidney, liver & cornea

Influencing factors of surgery

Vitamin B (Thiamine) is for

Vitamin C is for

Vitamin K is for

Blocks central awareness centers in brains, Administered by IV, inhalation
-Loss of consciousness, sensation, skeletal muscle relax & reduction of reflex

Minimal, can move

Surface/ topical applied directly to skin & mucous membranes

Used in minor procedures like skin biopsy / suturing

Anesthesia in nerve trunk

Via lumbar puncture into subarachnoid space

-Protects the client, physician & the health care institution, legal document
-Description of the procedure /Treatment
-Name & qualification of person performing procedure 
-Explanation of risks involved
-Explains alternatives/ possible effects of not having treatment
-Info. that patient has the right to refuse treatment

Consent forms are not legal if:

Height, weight, VS, general appearance, provides base line data
-status of skin
-Respiration status
*Cardiovascular status 
*Immunologic status:history of allergies, immunosuppression common with radiation & chemo therapy
*Abd status: Bowel sounds, size, shape, last BM
*Endocrine status: in uncontrolled diabetes, hazard in hypoglycemia from anesthesia 
*Neurologic status: Mood, motor & sensory function, follows all commands

The edges of the wound are approximated with staples or sutures. Minimal scarring.
-occurs in a clean wound

The wound is left open & allowed to heal by inside/out. Scarring is usually big w/ longed healing.
-Large, irregular or infected wounds
-Pressure ulcers are or chronic wounds are treated this way.

An infected wound is left open until there is no evidence of infection & the wound is then surgically closed.
-Granulation tissue fills in for some wound healing & then edges are approximated
-Wider scarring occurs

White blood cells, dead & live bacteria, warm, reddened, & tender and may have drainage (pus).

place the patient in low fowlers position with flexed knees. Cover the wound w/ sterile dressings or towels moistened w/ warm sterile normal saline. -Notify Dr. immediately of surgical emergency. 
-Apply gentle pressure over the wound
-Monitor VS for evidence of shock
-Prepare pt for immediate surgery

Mostly clear portion of blood, large #s of RBC's

Composed of fluid & cells escaping from blood vessels

Caused by bacterial invasion

WHat kind of asepsis for dressing changes

Excessive blood loss wither internally or externally
-May occur from a slipped suture, clot or stress on operative site
-Assess for restlessness
Goal: stopping the bleeding, replacing the blood volume 
-Intervention: Pressure dressing to bleeding

Partial or total disruption of wound layers 
-Goal: prevention- good nutritional status promotes wound healing, aseptic technique 
-If superficial, may only need steristrips

Spilling of viscera thru the incision 
-Goal: good nutrition 
-Interventions: Cover wound area w/ a saline soaked sterile towel
-DO NOT TRY TO PUSH ORGANS INSIDE

Provides a sinus tract

For bile drainage after a gall bladder

Decreases dead space by collecting drainage usually after abdominal surgery

Decreases dead space by collecting drainage usually w/ orthopedic surgery

Purpose: Inspect for healing & sign of infection
Advantages: absorbs drainage, protect the wound, used as pressure dressing, splint or immobilize the wound
Supplies: Cleansing agent, Dressing, Tape, / montgomery straps

-Cause: Decreased blood flow, decreased circulation to body part, decreased oxygen called ischemia 
-Risk: bony prominents

Redness (Erythema)

Superficial layer (epidermis/dermis)

Damage or necrosis of subcutaneous tissue

Damage to muscle-bone

Chronic renal disease

For dehisced surgical incisions that resist healing, aids in healing the incision. 
-Applies negative pressure to wound edges

Removal by cutting

Suture of or repair

Looking into

Formation of a permanent artificial opening

Incision or cutting into

Formation or repair

Not smoking increases the action of the lungs defense mechanisms & makes more hemogoblin available to carry oxygen during surgery.

Long term alcohol use causes nutritional & liver damage. It can create bleeding problems, fluid volume imbalances & drug metabolism alterations.

Collapse of the lung caused by hypoventilation or mucous obstruction preventing some alveoli from opening & being fully ventilated

Do this hourly while awake, sets of 5, for 24-48 hours postoperatively

Prevents atelectasis by increasing lung volume, alveoli expansion & venous return 
-For elderly & people w/ respiration problems 
-sit at 45 degrees 
-Take 2 normal breaths 
-Inhale until target is reached 
-hold for 3-5 seconds 
-exhale completely 
Perform 10 sets of breaths each hour

causes the patient to loose sensation, consciousness, & reflexes.
-Acts directly on the central nervous system

Blocks nerve impulses along the nerve where it is injected, resulting in the loss of sensation to a region of the body w/o the loss of consciousness

A localized collection of extravasated blood, usually clotted, in an organ, space or tissue