Medsurgexam 1 - exam 1 study guide PDF

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exam 1 study guide
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Perioperative Nursing Perioperative Nursing: care that is provided before, during, and after surgery. Effective teaching and discharge planning prevent or minimize complications and ensure quality outcomes Surgical Setting - Ambulatory surgery: outpatient or same day - Purpose of surgery o Diagnose: determine the presence or extent of a disease (biopsy, paracentesis) o Cure: elimination of a pathologic condition, removal of gallbladder or ruptured appendix o Palliate: alleviation of symptoms without cure (back surgery) (radiation to shrink a tumor) o prevention: removal of a mole before it becomes malignant, removal of breasts for patient with the BRACA gene o explore: surgical examination to determine the nature or extent of a disease (often in the abdomen) o cosmetic improvement

Pre-operative Phase: know what type of surgery, educate to alleviate anxiety The most important aspect: assessment and interview Primary purpose: - obtain health information - provide info regarding surgery - assess patient’s readiness for surgery The Nurses Role - Have knowledge of the nature of the disorder requiring surgery. - Identify the individual patient’s response to the stress of surgery. - Assess the results of appropriate preoperative diagnostic tests.

o Make sure they are prepared for surgery physically, clotting / coagulation - Provide a baseline by identifying potential risks and complications. Metabolic panel (BMP/CMP)

CBC (WBC,RBC,Hgb,Hct)

Blood glucose

PT/INR, PTT, platelets

LFTs (liver function test)

Type and Screen/Crossmatc

Urinalysis

hCG

Chest X-ray

Pulmonary Function Test

Serum albumin

EKG

PT/INR, PTT: is your patient at risk for bleeding? CBC: blood supply, immune defense intactness Liver function tests: how is the liver doing? Type and screen/crossmatch: for surgeries with high risk of bleeding EKG: anything that is going on with conduction system that could affect the surgery and outcome Chest XRay: sometimes not always hCG: to know if they are pregnant pulmonary function test: for those that scmoke, have COPD Nursing Process: Assessment Assessment of patient themselves Knowledge of what is going on Psychological status - Stress level? - History of anxiety or depression?

Emotional Health - Body image alterations - Self concept and self esteem Cultural/ethnic factors - How will it impact a hospital stay? Physiologic factors that may contribute to operative risk factors - Any bleeding disorders? - Vital signs? Establish baseline data - Vital signs? - Lab results? Identify meds or herbs taken that may affect surgical outcome Medication history - Prescription - OTC - Herbs - Street drugs - Supplements - Anything can react with anesthesia!!! Allergies  drugs, latex, food, contact - don’t want an adverse reaction from an allergic medicine Identify, document and share results of lab/diagnostic tests - Ask about occupation (*this will determine how the surgery will effect them returning to work) (*connect patient to social worker or someone else to help them if they need) Support sources - Family - Friends

- Home environment *do they have a ride home?! Smoking - Cigs? - Packs per day? - # of years? - Juul, ecig? - Smoking  increased risk of heart disease, MI - Increased pulmonary problems: COPD, emphysema, poor oxygenation - Increased risk DVT Alcohol ingestion and substance use/abuse - How often? - Per day? - Per week? - Medicinal marijuana? Alcohol: most often malnourished or undernourished, higher risk for liver disease, portal hypertension, withdrawal, etc. Substance Use: may need higher amounts of anesthesia and pain medications Support: - Who is driving you home - What is home like Assessment of patients body systems Allergies...