Med Surg Exam 1
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33 Terms
Preoperative Checklist
Ensures all preparations are completed before surgery.
o Documentation
o Assessment
o Physical preparation
o Educational needs
Informed Consent (done by surgeon)
Legal agreement for procedure, signed by patient.
o Procedure being performed
o Reason
o Consent for blood products
o Name of surgeon
o Anesthesia consent
Time out/pause
Correct pt, procedure, surgical site, position, equipment, surgeon, and imaging
Patient Assessment
o Pt history
o Allergies
o Vitals
o Medications
o Surgical/anesthesia history
o Social history
o Last oral intake
o Head to toe (all organ syst.)
Malignant Hyperthermia
Severe reaction to certain anesthetics, requires immediate treatment.
o Caused by certain anesthesia
o Increased heart rate > coke colored urine > fever
o Treatment: dantrolene & cold NS
Prior to Transfer
o Complete consent
o Skin/bowel prep
o Preoperative meds
o History & assessment completed
Sterile Members
o Surgeon
o Surgical assistants
o Scrub nurse/surgical tech
Surgical Categories
o Elective (>72 hr delay)
o Urgent (24- 72 hr delay)
o Emergent (ASAP)
Anesthesia
o General: unconscious state
o Regional anesthesia: spinal, epidural, caudal, & nerve block
o Local anesthesia: lidocaine
o Monitored anesthesia care (MAC): pt is conscious and is able to answer
questions. They may not be able to remember what happened after the surgery.
PACU
o Close observation after anesthesia
o Control pain
o Prevent complications
o Assess and monitor
o Reassess patient condition
PACU Priority Assessments
o Airway patency
o Respiratory status
o Vitals/skin color
o Neuro function
o Pain
o Condition of dressings/incisions
o Hydration/nutrition status
PACU Interventions
o Connect to cardia monitor
o Admission assessment
o Vitals
o Hand off from OR
o Continuous monitoring
o Medications
PACU Phases
o Phase 1: close monitoring for complications
o Phase 2: past the point of risk, may be discharged
o Phase 3: boarding
*Increased ICP (signs indicate Cushing's Triad, need immediate intervention)
o HR decreases (45)
o Irregular respirations
o Wide pulse pressure (difference b/t systolic & diastolic 190/45)
o Change in LOC
o Vomiting
o Headache
o Seizures
S/S of Bleeding
o Tachycardia
o Hypotension
Managing Postop Nausea/Vomiting
o Complications: dehydration, electrolyte imbalance, wound dehiscence,
aspiration, readmission
o Treatment: minimize postop opioids, pharmacological interventions, pain
management, & antiemetics.
Postop Ileus
o Prevent this by having pt be NPO until bowel motility returns
Wound Dehiscence
o A surgical incision that opens/separates, apply sterile saline on gauze and place
over opening.
Glasgow Coma Scale
o Measures level of consciousness, 15 is best score and 3 is unresponsive
Romberg Test
o For balance
Seizures
o Clonic: jerking, repetitive
o Tonic: increase in muscle tone can cause injury
o Absence: interruption of activities, spacing out, blank stare
o Focal: symptoms localized to one side
o Myoclonic: involuntary muscle contractions
o Medications: levetiracetam, lamotrigine, benzodiazepines
Status Epilepticus (>5min)
o Seizure longer than 5min= emergency
o Seizure longer than 30min can cause respiratory failure, brain damage, & death
Seizure Assessments
o Airway
o Vitals
o Seizure activity
o Presence of aura
*Seizure Interventions
o Maintain suction at bedside
o Have oxygen available
o Place pad on side rails
o Maintain IV access
o Document seizure
o Teaching: medication compliance and driving restrictions
Meningitis
o S/S:
Multiple Sclerosis
o Chronic disease involving the brain and spinal cord, causing myelin sheath breakdown and plaque buildup.
o Medication: beta interferons and baclofen
Parkingson's
o Cardinal Symptoms: tremors, muscle rigidity, slowness of movement
(bradykinesia), & postural instability
o Medication: carbidopa, levodopa
Herniated Disk
o Disk herniates bulges/extends and presses on spinal cord, lower back pain
o Treatment: Medications and motion exercises
Spinal Cord Injury
o common in males due to high-risk physical activity (DUI)
o Treatment- maintain airway patency/bp, spinal immobilization
o C-spine precautions- don't move the pts head, put c collar, nurse is at HOB, need 5 people to move pt
o Halos: pt shouldn't be able to move their head, clean pins regularly, monitor for s/s of infection
Ischemic Stroke (Blockage)
o Blood flow cut off due to blockage
o Risk factors: HTN, atherosclerosis, uncontrolled DM, obesity
o Treatment: TPA (clot buster)
Hemorrhagic Stroke (Bleeding)
o Can be caused by ruptured artery, aneurysm, HTN
o Sudden severe headache
o Treatment: stop bleeding, prevent/treat ICP, seizure precautions
Stroke S/S
o F- facial droop
o A- arm weakness
o S- slurred speech
o T- time
Autonomic Dysreflexia
o 80% of pts w/ spinal cord injuries above T5- T6, occur after spinal shock, strong sensory input (pain, bladder distension, constipation travels to spinal cord > widespread vasoconstriction > increase bp/decreased HR)
o Treatment: take them to bathroom
Note 
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