Medical-Surgical Nursing Lecture 1

I. Perioperative Nursing k. Nephro – kidney h. Itis - inflammation

 This includes a wide variety of nursing functions l. Neuro – nerve
associated with the patient’s surgical experience. m. Oophor – ovary
 Addresses the nursing roles relevant to the 3 phases n. Pneumo – lungs
of the surgical experience - pre-operative, intra o. Pyelo – kidney pelvis
operative and post-operative phase. p. Salphingo – fallopian tube
✓ Informed consent is obtained during the pre-operative q. Thoraco – chest
phase. r. Viscero – organ esp.
✓ Induction of anesthesia happens during the intra- abdomen
operative phase. Classifications of Surgical Procedures
✓ Discharge and a follow-up for 7 days are done According to Purpose
during the post-operative phase. 1. Diagnostic
Surgery  To confirm the presence of a condition (e.g., biopsy)
 Maintain body function 2. Exploratory
 Repair organs and tissues  To determine the extent of a disease condition (e.g.,
 Sterile technique is used exploratory laparotomy)
Operation 3. Curative
 Invasive modality of treatment  Removes/repairs damaged tissues (e.g., craniotomy)
Asepsis 3.1 Ablative involves the removal of an organ.
 The process of removing pathogenic microorganisms 3.2 Constructive involves the repairing of a congenitally-
or protecting against infection by such organisms. defective organ (e.g., cheiloplasty, uranoplasty)
Types of Asepsis 3.3 Reconstructive involves the repair of a damaged organ
maybe d/t adulting or accident (e.g., burn, skin grafting, plastic
surgery)
- This reduces the number - Total absence of
3.4 Palliative involves the relieving the signs and symptoms
of microorganisms microorganisms
but will not totally remove the cause/disease (e.g., colostomy,
- Used in enema - Used in catheterization
gastrostomy)
Sepsis
According to Degree of Risk
 Toxic condition resulting from the spread of bacteria
1. Major
or their toxic products from a focus of infection
 Involves high risk of morbidity and mortality
 This originates from one’s body
 Maybe complicated or prolonged and vital organs are
 Low blood pressure is the no. 1 sign of septic shock
manipulated
Infection
 This involves a large amount of blood loss
 Originates/caught from other people
 Involves great risk of occurrence of complications
Prefixes Suffixes
 Often, patients are under the use of general anesthesia
a. Supra – above; beyond a. Ectomy – removal of an
b. Ortho – joint organ or a gland  Craniotomy, open heart surgery, pneumonectomy,

c. Chole – bile/gall bladder b. Rhapy – suturing or TAHBSO

d. Cysto – bladder stitching of a part or organ 2. Minor

e. Encephalo – brain c. Scopy – looking into  Procedure is not prolonged and has a lesser risk

f. Entero – intestine d. Ostomy – making an  “Day surgery’

g. Hystero – uterus opening or stoma  Does not usually involve greater complication

h. Mast – breast e. Otomy – cutting into According to Urgency

i. Meningo – membrane; f. Plasty – to repair/restore 1. Emergency
meninges g. Cele – tumor; hernia;  Patient requires immediate attention without delay
j. Myo – muscle swelling  Maybe life threatening

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 Medical-Surgical Nursing Lecture 1
 GSW, stab wound, severe bleeding, fractured skull, 4. Planning for discharge & any projected changes in lifestyle d/t
extensive burn surgery
2. Urgent/Imperative Pre-operative Assessment
 Patient requires prompt attention A. Nutritional and Fluid Status
 The surgery can be delayed within 24-30 hours ➢ Optimal nutrition is an essential factor in promoting
 AGI (acute gallbladder infection), kidney or ureteral healing, resisting infection & other surgical
stone complications
3. Required Nutritional Status Danger
 Patient needs to have surgery 1. Obesity a. Increases difficulty in the
 Necessary for survival technical aspects of performing
 Maybe delayed within weeks/months surgery
 Prostatic hyperplasia, thyroid d/o, cataracts, tonsilitis b. Wound dehiscence (separation)
4. Elective is greater
 The procedure is not necessary for survival c. Increases likelihood of the
 Delay or omission will not cause any adverse effects infection

 Repair of scars, simple hernia, vaginal repair d. Increases potential for post-op
5. Optional pneumonia & other pulmonary

 Procedure is requested by the patient (personal complications

preference) e. Increases possibility of renal,

 Usually cosmetic surgeries biliary, hepatic & endocrine d/o

Conditions Requiring Surgery f. Decreases ability to conserve

1. Obstruction – impairment to the flow of vital fluids heat d/t radiant heat loss
2. Perforation – rupture of an organ g. Has altered response to many
3. Erosion – wearing off a surface membrane drugs and anesthetics
4. Tumors – abnormal new growths h. Decreases likelihood to early

Phases of Perioperative Nursing ambulation

I. Pre-operative Phase 2. Poor nutrition a. Impaired wound healing

 Extends from the time when the decision to proceed b. Increases risk of infection &

with the surgical intervention is made and ends with the shock

transfer of the patient onto the OR table. 3. Fluid and electrolyte a. Dehydration

 Involves establishing a baseline evaluation of the imbalances (Na, K, Ca) b. Hypovolemia

patient before surgery by carrying out a pre-operative c. May affects anesthesia

interview. administration

 Includes the preparation of the patient physically, B. Drug or Alcohol Use

psychologically, psychosocially, spiritually and legally. ➢ Both anesthesia and drug/alcohol cause respiratory

 Nursing activities on the day of the surgery includes depression hence anesthesia may not be administered

pre-operative patient assessment and addressing when a patient is under the influence of drug/alcohol

questions the patient or family may have. ➢ Alcoholism is usually accompanied by problems of
malnutrition which increases surgical risk.
Goals of Care During the Pre-operative Period
₋ Pt. may have an increased tolerance to
1. Assessing and correcting physiologic & psychologic problems
anesthesia (Because acutely intoxicated
that might increase surgical risk
people are susceptible to injury - SURGERY
2. Giving the person & significant others complete
is POSTPONED)
learning/teaching guidelines regarding surgery
₋ In case of an emergency surgery, local, spinal
3. Instructing & demonstrating exercises that will benefit the
or regional block is used to minor surgery
patient during the post-op period

Bachelor of science in nursing 3b 3rd Year: 1st Semester SY. 2022-2023

 Medical-Surgical Nursing Lecture 1
₋ NGT is given for gen. anesthesia to prevent ➢ Identify and document any sensitivity to medications,
vomiting and aspiration past adverse reactions, blood, contrast agents, latex,
➢ Anticipate alcohol withdrawal and food products
➢ Syndrome/Delirium Tremens within 24-72 hours after ➢ Patients who are immunocompromised or
the last alcoholic intake immunosuppressed are highly susceptible to infection;
C. Age great care is taken to ensure strict surgical asepsis
D. Respiratory Status I. Previous Medication Use
➢ A decline in ventilatory function, assessed through ➢ A medication hx is obtained from each patient because
breathing pattern and chest excursion, may indicate a of the possible effects of medication on the
client’s risk for respiratory complications (e.g., COPD) perioperative course, including the possibility of drug
E. Cardiovascular System interactions
➢ The goal of preparing any pt. for surgery is to ensure a ₋ OTC Prep and herbal meds may cause
well-functioning CVS to meet the O2, fluid and bleeding because they may prevent clotting
nutritional needs at the perioperative period ₋ Antibiotics may interrupt nerve transmission
➢ If the pt. has uncontrolled HPN, surgery may be ₋ Diuretics may cause excessive respiratory
postponed until the BP is under control depression associated with electrolyte
➢ Increased surgical risk to pt. suffering from angina, MI, imbalance
and heart failure ₋ Steroids inhibit wound healing
F. Hepatic and Renal Function ₋ Anticoagulant and NSAID may cause
➢ BUN and Creatinine will indicate if the kidney is good unexpected bleeding and should be
enough to wash off the anesthesia discontinued 7-10 days before surgery
➢ The liver is important in the biotransformation of PSYCHOSOCIAL ASSESSMENT OF A CLIENT UNDERGOING SURGERY
anesthetic compounds- any d/o of the liver has an A. Fear of the Unknown
effect on how anesthetic compounds are metabolized ➢ This is the greatest fear of most patients undergoing
➢ The kidneys are involved in excreting anesthetic surgery
medication & their metabolites surgery is ➢ This results from uncertainty of the possible outcome
contraindicated if pt. has acute nephritis, acute renal of the procedure
insufficiency with oliguria/anuria or other acute renal B. Fear of Anesthesia
problems ➢ Pt. feel their vulnerability while unconscious
➢ Assess for voiding patterns, I&O, BUN, and Creatinine C. Fear of Pain
levels ➢ Pts. fear the agony, suffering, or distress that may
G. Endocrine Function result from surgical procedure esp. post-op wound and
➢ Pt. with diabetes who is undergoing surgery is at risk from contraptions
for hypoglycemia and hyperglycemia D. Fear of Death
➢ Hypoglycemia may develop during anesthesia or ➢ This is d/t the risk of complications of anesthesia and
postoperatively from inadequate CHO or excessive the surgical procedure itself
insulin. E. Fear of Body Image Disturbance
➢ Hyperglycemia imposes increased risk for surgical ➢ Distortion of appearance of body part, loss of body part,
wound infection. or loss of function of a body part
➢ Maintain a blood glucose of 200 mg/dL
SIGNS AND SYMPTOMS OF FEAR
₋ Pts. Who received corticosteroids (at risk of
Anxiousness Sadness/tendency to withdraw
adrenal insufficiency) and pts. with
Anger Inability to concentrate/short
uncontrolled thyroid d/o are at increased risk
attention span
of cardiac arrest
H. Immune Function
➢ Determine the presence of allergies

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 Medical-Surgical Nursing Lecture 1
Tendency to exaggerate Repeatedly ask so many 2. Mobility and active body movement
questions even questions were ▪ Turning and positioning
answered previously 3. Pain management

INTERVENTIONS ▪ Acute and chronic pain management

▪ PCA: Morphine
1. Explore client’s feelings
2. Allow pt. to speak openly regarding fears & concerns 4. Cognitive coping strategies

3. Give accurate info regarding symptoms ▪ Imagery

4. Provide emphatic support ▪ Distraction

5. Consider client’s cultural & religious preferences ▪ Optimistic self-recitation

Informed Consent General Preparation of the Patient Before Surgery

1. Correcting dietary deficiencies/managing nutrition and fluid
PURPOSES of informed consent
status
1. To ensure that the client understands the nature of the
2. Preparing the bowel
treatment including potential complication.
3. Preparing the skin
2. To indicate that the client’s decision was made without
II. Intra-operative Phase
pressure.
 Begins from the time the pt. is admitted to the operating
3. To protect the clients against unauthorized procedure.
room, to the time of administration of anesthesia,
4. To protect the surgeon & the hospital against legal action by
surgical procedure is done until the pt. is admitted to
a client who claims that an unauthorized procedure was
RR/PACU
performed.
 The scope of nursing activities includes providing
✓ The surgeon explains the procedure and the nurse
safety, maintaining an aseptic environment, ensuring
will serve as a witness to the patient’s signature.
proper function of equipment, providing the surgeon
informed consent IS NECESSARY IN THE FF. CIRCUMSTANCES
with specific instructions & supplies for the surgical field
1. Invasive procedure - any procedure that involves entry to the
& completing appropriate documentation
body cavity
 Positioning of the pt. at the OR table - acting as scrub
2. Surgical procedure
or circulating nurse
3. Procedures that involve sedation & general anesthesia
Surgical Suite
4. Procedure involving radiation
✓ Controlled environment designed to minimize the
Nursing considerations for informed consent spread of infections & microorganisms & allow a
▪ The patient personally signs the consent if he or she is smooth flow of pts, staff & equipment needed to
of legal age & mentally capable. provide safe pt. care
▪ If the pt. is a minor, neurologically incapacitated or
SURGICAL TEAM
incompetent--- a surrogate (responsible family member
a. Surgeon
preferably next to kin signs the consent).
▪ Performs the surgical procedure
▪ Emancipated minor (Minor who is married,
▪ Licensed physician who is trained and qualified
independently earning & living on his/her own) can sign
b. Anesthesiologist/Anesthetist
a consent.
▪ Anesthesiologist is a physician specifically trained in
▪ In cases of EMERGENCY - the family should be
the art & science of anesthesiology
informed through phone & the physician will document
▪ Anesthetist is a qualified healthcare professional who
the nature of the emergency situation.
administers anesthetics (nurse anesthetist)
▪ The signed consent form is placed in the prominent
▪ They assess the pt. before surgery, select anesthesia,
part of the pts.’ chart & accompanies the pt. to the OR.
administers it, intubates the pt. if necessary, manages
₋ The consent should be signed before the
any problems r/t administration of anesthesia &
client receives pre-op medications.
supervises the pts. condition throughout the surgical
Preoperative Teaching
procedure
1. Deep breathing, coughing, and incentive spirometry

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 Medical-Surgical Nursing Lecture 1
▪ They visit the pt. before surgery to supply information
& answers questions of pt.
▪ When the pt. arrives in the OR, they assess the pts.
physical condition immediately prior to initiating
anesthesia § during surgery they monitor the pts. BP,
PR, RR as well as ECG, blood O2 saturation, tidal
volume, blood gas levels etc.
c. Registered Nurse First Assistants
▪ Handling tissues and specimens
▪ Providing exposure to the operative side
▪ Maintain hemostasis: carry out principle of surgical
asepsis
d. Scrub Nurse
▪ Performs surgical hand scrub
▪ Set up sterile table
▪ Prepares sutures, needles, and special equipment
▪ Assist the surgeon and surgical assistants during the
procedure by anticipating the instruments & supplies
required such as sponges, drains, cautery & other
equipment
e. Circulating Nurse
▪ Manages the OR & protect the pts. safety & health.
▪ Monitors the activities of the surgical team.
▪ Checks the condition of the OR.
▪ Continuously assess the pt. for signs of injury.
▪ Verify consent.
▪ Ensuring cleanliness, proper temperature, humidity,
lighting, safety functions of equipment & availability of
supplies & materials.
▪ Coordinates with the team.
▪ Monitors aseptic practices.
▪ Documentation.
* As the surgical incision is closed, the scrub nurse and
circulating nurse counts the needles, sponges, and instruments.
Rationale: to be sure that the instruments are counted and not
retained as foreign to the patient.
* If with tissue specimen, the scrub nurse will label the specimen
and the circulating nurse will send it to the laboratory or hand it
to the patient’s family.
Anesthesia
▪ The state of narcosis characterized as severe CNS
depression produced by pharmacologic agents
PURPOSES of anesthesia
1. Promote muscle relaxation
2. Block transmission of nerve impulses
3. Achieve state or reversible unconsciousness
Bachelor of science in nursing 3b
Types of anesthesia and sedation
I. General Anesthesia has four stages:
Stage 1: Beginning Anesthesia/Onset/Induction
✓ The pt. breathes in the anesthetic mixture, warmth,
dizziness & feeling detachment may be experience
✓ The pt. may have ringing, roaring, or buzzing in the
ears, although still conscious
✓ During this stage, noises are exaggerated; even low
voice or minor sounds seem loud & unreal
✓ Unnecessary voice & movement
Stage 2: Excitement/Delirium
✓ From the time of loss of consciousness to the time of
loss of lid reflex
✓ Characterized by struggling, shouting, talking, laughing
or crying
✓ The pupils dilate; PR is rapid; RR is irregular
STAGE 3: Surgical Anesthesia
✓ Loss of lid reflex to loss of most reflexes
✓ The pt. is unconscious & lies quietly on the table
✓ The pupils constrict when exposed to light
✓ RR is regular; PR is normal; skin is pink & slightly
flushed
STAGE 4: Medullary Depression/Danger
✓ This stage is reached when too much anesthesia has
been administered
✓ RR become shallow; PR is weak & thread
✓ Pupils are dilated & does not react to light
✓ Respiratory & cardiac depression § cyanosis develops
✓ Death may rapidly follow
II. Regional Anesthesia
▪ Is a form of local anesthesia in which the anesthetic
agent is injected around nerves so that the area
supplied by these nerves is anesthetized
▪ The pt. receiving regional anesthesia is aware of
his/her surroundings unless medications are given to
produce mild sedation or to relieve anxiety
Types of Regional Anesthesia
a. Epidural
Commonly used conduction block—done by
injecting a local anesthetic into the epidural
space that surrounds the duramater of the
spinal cord
Advantage: Absence of headache
Disadvantage: Greater technical challenge in injecting
the anesthesia
Danger: Hypotension and severe resp. depression
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 Medical-Surgical Nursing Lecture 1
Treatment: Airway support, IVF, Vasopressors ₋ If gagging occurs, the pt. is turned to side, HOB is
b. Spinal Anesthesia lowered & a basin is provided for vomitus
Is an extensive conduction block that is ₋ Administer anti emetics pre- operatively
produced when a local anesthetic is 2. Anaphylaxis

introduced into the subarachnoid space at the ₋ Anytime the pt. comes in contact with a foreign
lumbar level (b/w L4 &L5) substance, medication or latex there is a potential

It produces anesthesia of the lower anaphylactic reaction

extremities, perineum, & lower abdomen Be aware & alert to the possibility &
Disadvantage: N/V observe the pt. for changes in vital signs & symptoms
Headache is an after effect of spinal anesthesia r/t of anaphylaxis
needle size, leakage of fluid from the sub-arachnoid 3. Hypoxia & Other Respiratory Complication

space, and pts. euhydration ₋ Inadequate ventilation, occlusion of airway, inadvertent

Treatments: intubation of the esophagus & hypoxia is significant

₋ Maintaining a quiet environment potential complication associated to general

₋ Keeping the pt. lying on flat anesthesia

₋ Keeping the pt. well-hydrated ₋ May lead to severe respiratory depression & brain

c. Local Conduction Blocks damage

III. Moderate Sedation Have a ventilator support equipment

▪ Also known as conscious sedation ready and peripheral perfusion should be checked

▪ A form of anesthesia that involves IV administration of through pulse oximeter

sedatives and/or analgesic medications to reduce pts. 4. Hypothermia

anxiety & control pain during diagnostic & therapeutic ₋ BT <36.6°C (98°F)

procedures ₋ Glucose metabolism is reduced: metabolic acidosis

▪ Used during specific short-term surgical procedures in may occur

hospitals & ambulatory care centers - its goal is to Causes: Decrease temperature, Infusion of cold fluids,

depress the pts. level of consciousness to moderate Inhalation of cold gases, Open body cavity, Decrease

level to enable surgical, diagnostic or therapeutic muscle activity, Advanced age & other pharmaceutical

procedures to be performed while ensuring pts. comfort agents

& cooperation 4.1 Intentional Hypothermia

IV. Local Anesthesia Is intentionally decreasing the pts. body temperature in

▪ Is the injection of a solution containing local anesthesia selected surgical procedures to reduce metabolic rate

into the tissues at the planned incision site & reduce energy demands such as cardiac surgery

▪ Often administered in combination with Epinephrine requiring cardiopulmonary bypass

because Epi constricts blood vessels which prevents Minimize/reverse the physiologic process

rapid absorption of the anesthetic agent & thus – return the body temp to normal

prolongs its local action i. Adjust temperature in the OR to 25-26.6°C

Advantages: (78-80°F)

1. Simple, economical & non- explosive. ii. Warm IV & irrigating fluids to 37°C (98.6°F)

2. Equipment needed is minimal. iii. Remove wet gowns & drapes & replace it with

3. Post-op recovery is brief. dry

4. Undesirable effects of general anesthesia are avoided. iv. Monitor temp, urine output, ECG, BP, ABG

5. Ideal for short & superficial surgical procedure. levels & serum electrolytes

Intra-Operative Complications and Discomforts 5. Malignant Hyperthermia

1. Nausea and Vomiting ₋ A rare inherited muscle disorder that is chemically

₋ Common side effect of anesthetic agents induced by anesthetic agents that usually occur 10-20
minutes after induction or 1st 24 hours after surgery

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 Medical-Surgical Nursing Lecture 1
₋ Susceptible pts. are those pts. with strong & bulky
muscles, history of muscle cramps & weakness,
unexplained elevation of temperature & history of
unexplained death of a family member during surgery
accompanied by febrile response
6. Disseminated Intravascular Coagulation
₋ Life threatening condition that is characterized by
thrombus formation in the micro-circulation & depletion
of select coagulation proteins causing hemorrhage
Causes: Massive Trauma, Head Injury, Massive
Transfusion, Liver & Kidney Involvement, Embolic
Events, Shock
III. postoperative phase
 Begins from the time of admission of the client to
recovery room or PACU to the time the pt. is
transported to the surgical unit, discharged from the
hospital until follow-up care
 Follow up may last for 1 week
Focus: Recovery and rehabilitation
Nursing Care Postoperatively
1. Maintaining the pts. airway
2. Monitoring vital signs
3. Assessing the effects of anesthetic agents
4. Assessing the pt. for complications
5. Providing comfort & relief
Post Anesthesia Care Unit (PACU)
₋ Usually located adjacent to OR
₋ Pts. under anesthesia or recovering from anesthesia
are placed in this unit for easy access to experienced
skilled nurses, anesthesiologist/anesthetist, surgeons,
advances hemodynamic & pulmonary monitoring &
support, special equipment & medication
₋ The PACU should be kept quiet, clean & free of
unnecessary equipment; should be well ventilated in
order to decrease anxiety & promote comfort
GENERAL POSTOPERATIVE CARE
▪ The first 24 hours when the pt. is recovering from
anesthesia
▪ V/S monitoring
✓ 1st hour – q15min
✓ Next 2 hours – q30min
✓ Next 4 hours – qh
1. Preventing Respiratory Complications
✓ Encourage to turn frequently & take deep breaths q2h
✓ Encourage coughing exercises
✓ Encourage the pt. to yawn
Bachelor of science in nursing 3b
✓ Instruct use of incentive spirometer - 10 deep breaths
every hour while awake
✓ Encourage early ambulation - pt. is encourage to be out
on bed as soon as possible - not later than 1st post op
day
2. Relieving Pain
✓ The degree & severity of post-op pain & the pts.
tolerance for pain depend on the incision site, nature of
the surgical procedure, extent of surgical trauma, the
type of anesthetic agent
✓ Often the physician prescribed different medications or
dosages to cover various levels of pain - The nurse
assesses the effectiveness of medication beginning 30
mins after administration
2.1 Opioid Analgesic is commonly prescribed for pain and
immediate post-op discomfort.
2.2 Patient-Controlled Analgesia
➢ Pt. recovers more quickly when adequate pain relief
measures are used
➢ Permits pts. to administer their own pain medication
when needed
➢ The amount of medication delivered by IV & the time
span during which the opioid medication is released
are controlled by the PCA device
➢ Self-administration promotes pt. participation in care,
eliminates delayed administration of analgesics &
maintains a therapeutic drug level
➢ 2 requirements for PCA - (1) understanding of the need
to self-dose; (2) physical ability to self-dose to prevent
addiction
➢ Upon sensing pain—the pt. activates the medication
delivering pump with hand held button
Non-Pharmacologic Pain Management
a. Imagery d. Music f. Relaxation
b. Massage e. Distraction
c. Application of heat/cold compress
3. Promoting Cardiac Output
✓ IVF replacement for the 1st 24 hours
✓ Monitor I&O – 30 mL/hr (240mL/8h)
✓ Monitor electrolyte, HgB, Hct
✓ Encourage mobility & early ambulation
4. Encouraging Mobility
✓ Reduce incidence of post-op complications such as
atelectasis, hypostatic pneumonia, GI discomforts &
circulatory d/o
4.1 Bed Exercises
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 Medical-Surgical Nursing Lecture 1
4.1.1 Arm exercises c. Monitor for abdominal distention
4.1.2 Hand and finger exercises d. Encourage proper nutrition: Vit. C and CHON
4.1.3 Foot exercises Post-Operative Discomforts
4.1.4 Leg exercises 1. Nausea and Vomiting

4.1.5 Abdominal and gluteal exercises Causes

4.1.6 Wound care – wound infection is common in the a. Inhalation anesthetics that may irritate the stomach
surgical incision area lining
Causes b. Accumulation of fluid or food in the stomach after
a. Infection occurs in the areas of poor tissue perfusion peristalsis returns
b. Old age and obesity c. Abdominal distention which follows manipulation of
c. Immunocompromised patients abdominal organs
S/Sx of Wound Infection d. Effect of narcotics
a. Redness, tenderness, and heat in the area of incision
b. Presence of purulent wound drainage i. Encourage pt. to breathe deeply to facilitate elimination

c. Fever of anesthetics

d. Tachycardia ii. Turn head to side to prevent aspiration

e. Increased WBC iii. Mouthwash for mouth care

iv. Offer small sips of carbonated beverages such as
i. Use sterile technique in drainage change ginger ale if tolerated or allowed
ii. Start antibiotic therapy v. Monitor I&O and replace fluid as ordered
iii. Proper handling of wound vi. Detect presence of abdominal distention or hiccups
Wound Dehiscence is the unintentional opening of the vii. Administer anti-emetics as ordered
surgical wound 2. Thirst

Wound Evisceration is the protrusion of the body contents Causes

through the wound a. Inhibition of secretions by pre-op meds
▪ Wound Dehiscence and Wound Evisceration usually b. Fluid loss by way of perspiration, blood loss, and DHN
th th
occur between 5 to 8 day post-op. due to pre-op fluid restrictions
Causes
a. Poor wound healing i. Administer IVF or oral fluids

b. Inadequate wound closure, wound infection, sever ii. Offer sips of hot tea or lemon juice

abd. stretching/abd. distention iii. Apply moistened gauze over lips

Signs and Symptoms iv. Obtain hard candies or chewing gum

a. Discharge of serosanguinous fluid from the wound 3. Constipation and Gas Cramps

b. Increase in pain Causes

a. Trauma and manipulation of the bowel during surgery
c. The edges of the wound may part & intestines may
gradually push out
i. Encourage early ambulation

i. Notify the surgeon immediately ii. Increase fluid intake

ii. If intestines are exposed – cover with sterile moist iii. Advocate proper diet

dressing iv. Manual extraction of fecal impaction

v. Administer enema
iii. Monitor V/S: observe signs of shock
vi. Offer laxatives & suppositories
iv. Bed rest
4. Post-operative Pain
v. Prepare the pt. for surgery and repair of wound
Preventions
a. Apply abdominal binder
b. Splint incision when coughing

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 Medical-Surgical Nursing Lecture 1
Post-Operative Complications d. High risk pts. Obese, Prolonged Immobility, Cancer,
1. Circulatory System Smoking, Estrogen Use, Advancing Age, Varicose
1.1 Shock Veins, Orthopedic Procedure, DHN
₋ Is a response of the body to a decrease circulating Signs and Symptoms
blood volume a. Pain or cramps in the calf (Homan’s sign) to
₋ May lead to impairment of tissue perfusion-hypoxia & progressing swelling of the entire leg
death b. Fever, chills, and perspiration
Managements for Shock c. Mark tenderness of the thigh
i. Have blood available
ii. Measure blood loss and monitor I&O i. Hydrate the pt. post-op to prevent hemoconcentration
iii. Monitor V/S: pulse and BP are important indicators ii. Encourage leg exercises & ambulate the pt. as soon as
1.2 Hemorrhage it is permitted by the surgeon
₋ Bleeding caused by an escape of blood from the blood iii. Avoid restricting devices & clothing that can impair
vessel circulation in the lower extremities
Classifications of Hemorrhage iv. Avoid rubbing & massaging the thigh
A. According to Onset v. Instruct pt. to avoid standing or sitting in one place for
❖ Primary – Occurs at the time of operation prolong periods or crossing legs when seated
❖ Intermediary – Few hours after surgery vi. Assess peripheral pulses, capillary refill & sensation of
❖ Secondary – Occurs sometime after the surgery the lower extremities
B. According to Blood Vessel Involved vii. Check for Homan’s sign
❖ Capillary – Slow, general oozing viii. Prevent use of bed rolls
❖ Venous – Dark, bubbles out ix. Start anticoagulant therapy as ordered
❖ Arterial – Bright red, spurts x. May apply elastic bandage
C. According to Location 2. Respiratory System
❖ Evident/External – Visible bleeding on the surface 2.1 Atelectasis
❖ Concealed/Internal – Bleeding within; cannot be seen ₋ Collapse of a portion of the lungs producing an airless
Signs and Symptoms state of the alveoli
a. Apprehension; restlessness, thirst Causes
b. Cold, moist, pale skin a. Undetected resp. infection
c. Decreased cardiac output and narrowed pulse; b. Aspiration of vomitus
decreased BP, Hct, Hgb c. Increased mucus secretion
d. Hx of chronic lung disease
i. Inspect the wound for bleeding e. Ineffective ventilation post-op
ii. Apply pressure over external bleeding sites Signs and Symptoms
iii. Increase IV infusion rate a. Dyspnea
iv. Administer blood as ordered b. Decreased/absent breath sounds
1.3 Deep Vein Thrombosis (DVT) c. Tachycardia
₋ Occurs in in pelvic veins or in deep vein of the d. Increased anxiety and restlessness
extremities post-op
₋ Most common after hip surgery, proctectomy, thoracic i. Turn, cough, and deep breath q2h
& abdominal surgery ii. Maintain adequate hydration (3000 mL/day unless CI)
Causes iii. Encourage ambulation ASAP
a. Injury to the intimal layer of the vessel wall iv. Stimulate coughing
b. Venous stasis 2.2 Pneumonia
c. Hypercoagulopathy; Polycythemia ₋ An acute inflammatory process of the alveolar spaces
₋ The alveoli are filled with exudate thereby causing
consolidation of the lung tissue

Bachelor of science in nursing 3b 3rd Year: 1st Semester SY. 2022-2023

 Medical-Surgical Nursing Lecture 1
Signs and Symptoms Causes
a. Rapid and shallow respiration a. Irritation of the phrenic nerve
b. Fever b. Distended stomach
c. Rales c. Exposure to cold environment, drinking very hot or very
d. Cough cold beverages
e. Tachycardia Signs and Symptoms
a. Audible hic
i. Position to a semi-high fowler b. Distress and fatigue
ii. Hydrate the patient c. Vomiting
iii. Antibiotics and antipyretic
iv. Turn, cough, and deep breathing i. Have the pt. swallow a large gulp of water
3. Elimination ii. Offer sugar at the back of the pts.’ tongue and let the
3.1 Urinary Retention pt. swallow
₋ Patient is unable to void normally
Causes
a. Depression of urinary reflexes by GA and pre-op meds
b. Swelling of the urinary tract d/t trauma
Signs and Symptoms
a. Unable to void 8-10 hours post-op
b. Palpable bladder
c. Frequent voiding of small amounts
d. Discomfort at the suprapubic area

i. Maintain adequate hydration

ii. Offer bedpan or urinal
iii. Assist client to sit/stand
iv. Let pt. listen to running water
3.2 Intestinal Obstruction
₋ Decreased or absent peristalsis causing accumulation
of gas or feces
Signs and Symptoms
a. Intermittent, sharp, colicky abd. distention
b. N/V
c. Abd. Distention/hiccups
d. Absent BM

i. Monitor return of bowel sounds

ii. Insert NGT to relieve abdominal distention
iii. Replace fluid & electrolyte thru IV
iv. Prepare pt. for surgery
v. Monitor for signs of shock
Hiccups (Singultus)

▪ Intermittent spasms of the diaphragm causing the

sound ‘hic’ that result from the vibration of the vocal
cords as air rushes into the lungs

Bachelor of science in nursing 3b 3rd Year: 1st Semester SY. 2022-2023