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Med Surg 1
Med Surg 1
Who Signs:
Preoperative Assessment
‣ Goals
‣ Purpose of bowel or GI prep - To facilitate the administration of any
- For clients undergoing abdominal or pelvic anesthetic
surgery, a cleansing enema or laxative may - To minimize respiratory tract and
be prescribed the evening before surgery, secretions
and maybe repeated the morning of - To relax the client and reduce anxiety
surgery changes in heart rate
Rapid - Metaclopramide
Emptying of (Reglan
Stomach
Bulauitan MEDICAL SURGICAL NURSING 9
‣ Surgeon
‣ Core member of the surgical team
‣ Surgical Assistant
‣ Maintains coordination of all team members
‣ Anesthesiologist
‣ Maintains client advocate role
‣ Circulating Nurse
‣ Managing nursing care and coordinating
‣ Scrub Nurse
needs of surgical team
‣ Oversees physical aspects of the OR,
Surgeon including equipment
‣ Assists in transfer and positioning
‣ Skin prep, ensures no break in the sterile
‣ Perform procedure, head of the surgical
technique
team
‣ Anticipate needs of team
‣ Responsible for all medical actions and
judgments
Scrub Nurse
Surgical Assistant
‣ Technical skills, manual dexterity, in-depth
knowledge of the anatomic and mechanical
‣ Works closely with surgeon in performing
aspects of surgery
operation, can either be a physician, nurse,
‣ Organizes surgical equipment and hands
physician’s assistant or other trained
the surgeon appropriate instruments
personnel
required for operation
‣ Duties:
‣ Prepares and preserves sterile field
- Exposing operative site
- Retracting nearby tissue
- Sponging Behind the Scenes
- Suctioning the wound
- Ligating bleeding vessels
‣ Radiologist Technologist
- Suturing or helping suture the surgical
‣ Anesthesia Technician
wound
‣ Nursing Technician
‣ Transport Team
Anesthesiologist ‣ Environmental Services
- The final responsibility for the positioning 6. Semisitting Position: for surgeries
of the client- shared by the circulating on thyroid and neck areas
nurse, the MD and the anesthesiologist
7. Jackknife: used for proctologic
‣ Factors to Consider when Positioning surgeries (removal of hemorrhoids)
the Client and some spinal surgeries;
1. Site of the operation - 12% decreased vital capacity of
2. Age and size of the client the lungs
3. Type of anesthetic used
4. Pain normally experienced by the
client upon movement Equipment Used for Proper Positioning
5. The ability of the client to move
1. Straps
‣ The Positing of the Client Must Not 2. Wrist Restrains
1. Compromise circulation 3. Arm Boards
2. Cause pressure points from bony 4. Donuts
prominences 5. Sandbags or Rolls
3. Restrict ventilation due to pressure on 6. Stirrups
the upper thorax
4. Cover the operative site
Gowning and Gloving
‣ Subcuticular or Buried
Sterile Draping
‣ Running Closure
‣ Plain: Interrupted
- Single Interrupted Closure
‣ Mattress: Continuous
- Horizontal Mattress
- Vertical Mattress
Bulauitan MEDICAL SURGICAL NURSING 14
✴Nursing Intervention
General Anesthesia
- Prepare for and assist in
treatment of cardiovascular and/
Stages of Anesthesia: or pulmonary arrest
a. Stage I: Onset/Induction - Document in record
‣ Administration of anesthesia to the
time of loss of consciousness General Anesthesia
✴ Nursing Intervention
- Close operating room doors and
‣ Total loss of consciousness and sensation
control traffic in and out of room
‣ Produces amnesia
- Position client securely with
safety belts
‣ Methods of administration
- Maintain minimal discussion in
- Intravenous
the OR
- Inhalation
b. Stage II: Excitement/delirium
- Combination of IV and Inhalation
‣ Loss of consciousness to the time
of loss of lid reflex characterized by
Intravenous Agents
shouting, talking, singing, laughing,
or crying, struggling of the client.
✴ Nursing Intervention ‣ These medications may be given to induce
- Shield client from extra noice or maintain anesthesia. Although they are
and physical stimuli often used in combination with inhalation
- Protect the client’s extremities anesthetic agents, they may be used alone.
- Assist anesthesia personnel as they may also be used to produce
needed. Stay with the client moderate sedation.
c. Stage III: Surgical ‣ Advantage:
‣ Loss of lid reflex to the loss of most ‣ Onset is pleasant, none of the
reflexes surgical procedure is buzzing, roaring, or dizziness known
started to follow administration of an
✴ Nursing Intervention inhalation anesthetic.
- Assist anesthesia personnel with ‣ The duration of action is brief, and
intubation of client in position for the patient awakens with little
surgery nausea or vomiting
- Prep the clients skin in area of ‣ Thiopental sodium (Pentothal) commonly
operative site called “Sodium penthotal” (Class:
d. Stage IV: Medullary/Stage of Barbiturate)
danger ‣ Diprivan (Propofol - Milk of amnesia)
‣ Characterized by cardiac/respiratory • Rapid acting
depression or arrest due to • Monitor vital signs
overdose of anesthesia, • Respirator depression
resuscitation must be done
Bulauitan MEDICAL SURGICAL NURSING 15
‣ Anaphylaxis (allergy)
‣ Incorrect administration technique ‣ Start with Pentothal or Propofol
‣ Systemic absorption of medication ‣ Add in some Nitrous oxide for amnesia
‣ infection ‣ Use inhalation agent such as Halothane
‣ Stir in a little opiate-Morphine, Fentanyl, for
Complication of Local or Regional postop analgesia
Anesthesia ‣ To top if off Pavulon, a neuromuscular
blocker, for additional muscular relaxation
‣ Anaphylaxis
‣ Incorrect Delivery Technique
‣ Systemic Absorption
‣ Overdoseage
‣ Assess for Central Nervous System
stimulation, central nervous system and
cardiac depression, restlessness,
excitement, incoherent speech, headache,
blurred vision, metallic taste, nausea and
Bulauitan MEDICAL SURGICAL NURSING 18
Special Consideration
for the Older Adults
‣ PACU/RECOVER ROOM
‣ BP Monitoring Equipment
- “Post Anesthesia Care Unit”
‣ Cardiac Monitor
- Purpose: is to provide ongoing
‣ IV Equipment
evaluation and stabilization of clients to
‣ Suction Equipment
anticipate, prevent, and treat
‣ Supplies to support respiration - O2
complications after surgery
‣ Medications, such as narcotics,
- usually located close to surgical suite
antihypertensive drugs, etc
- Nurse is skilled in the care of clients
‣ Emesis basin, mouth wipes
with multiple medical and surgical
‣ Urinals and bedpans
problems that can occur following a
‣ Warmed blankets
surgical procedure
‣ Emergency Cart
‣ Standards of PACU
Data bout the Client to be Obtained from
1. All patients who have received
the Anesthesiologist Or Nurse should
general anesthesia, regional
include:
anesthesia, or monitored anesthesia
care should receive post-anesthesia
management ‣ Current medical diagnosis
2. Patient should be transported to the ‣ Surgical Procedure performed - what & why
PACU by a member of the anesthesia ‣ Anesthetic agent administered and other
care team that is knowledgeable medications given in the OR
about the patient’s condition ‣ Complications during surgery, the type, and
3. Upon arrival int the PACU, the patient the treatment done
should be re-evaluated and a verbal ‣ Fluids - EBL (Estimated Blood Loss) and
report should be provided to the nurse total administered; total output
4. The patient shall be evaluated ‣ Pertinent pre-op problems - physical and
continually in the PACU psychologic
5. A physician is responsible for
discharge of the patient Nursing Management in the PACU