medsurg quiz

1. Purposes of Surgery: Elective, Urgent, and Emergency

  • Elective Surgery

    • Planned in advance, not essential for survival.

    • Purpose: improve quality of life (e.g., knee replacement, cosmetic surgery).

  • Urgent Surgery

    • Needed soon (within 24–48 hours) to prevent health deterioration.

    • Example: gallbladder removal for gallstones causing inflammation.

  • Emergency Surgery

    • Immediate intervention needed to save life or limb.

    • Example: surgery for a ruptured appendix or major trauma.

2. Considerations for the Older Adult Surgical Patient

Older adults are at higher risk for complications. Consider:

  • Slower healing due to reduced tissue elasticity and circulation.

  • Weaker immune system – increased infection risk.

  • Comorbidities (like diabetes, heart disease) can affect surgery outcome.

  • Changes in drug metabolism – monitor for side effects.

  • Confusion/delirium risk post-op (especially with anesthesia).

  • Skin fragility – careful positioning and dressing changes.

3. Preoperative Checklist & Informed Consent

  • Preoperative Checklist Includes:

    • ID band in place

    • Allergies checked

    • NPO status confirmed

    • Informed consent signed

    • Vital signs taken

    • Pre-op meds given (if ordered)

    • Jewelry, dentures, nail polish removed

  • Informed Consent:

    • Must be obtained before sedation.

    • Explains procedure, risks, benefits, alternatives.

    • Must be signed by competent adult or legal guardian.

    • Nurse’s role: witness signature and clarify basic questions, not explain the surgery itself.

4. Initial Nursing Assessment After PACU Transfer

Once patient arrives on the unit from recovery:

  • Airway and breathing – ensure patency, monitor oxygen levels.

  • Vital signs – check every 15 min initially.

  • Level of consciousness – assess for alertness or sedation.

  • Pain level – treat as needed.

  • Wound/dressing – check for drainage or bleeding.

  • IV fluids – ensure correct rate and patency.

  • Urine output – monitor for kidney function and hydration.

5. Information Needed for Postoperative Discharge

  • How to care for incisions and dressings

  • Medications: what, when, why, side effects

  • Signs of infection or complications

  • Diet and activity restrictions

  • Follow-up appointments

  • How to recognize emergency symptoms (e.g., fever, bleeding)

  • When and how to resume normal activities

6. Stages of Wound Healing

  1. Hemostasis (immediate)

    • Blood clot forms to stop bleeding.

  3. Inflammatory Phase (1–3 days)

    • Body sends white blood cells to prevent infection.

  5. Proliferative Phase (3–21 days)

    • New tissue and blood vessels form.

  7. Maturation/Remodeling (up to 1 year)

    • Scar tissue strengthens over time.

7. Applying Dressings

  • Dry Dressing:

    • Clean wound.

    • Apply sterile gauze directly on wound.

    • Secure with tape or bandage.

    • Used for wounds with little to no drainage.

  • Wet-to-Dry Dressing:

    • Soak gauze in saline.

    • Place wet gauze in wound.

    • Cover with dry gauze.

    • When dry, remove to debride dead tissue.

    • Can be painful and is less commonly used today.

8. Dehiscence vs. Evisceration

  • Dehiscence: Wound edges separate, usually from strain or infection.

    • Nursing care: Cover with moist sterile dressing, notify surgeon, reduce movement.

  • Evisceration: Organs protrude through wound opening.

    • Emergency!

    • Nursing care: Stay with patient, cover with saline-soaked sterile dressing, call surgeon immediately, place patient in low Fowler’s position with knees bent to reduce pressure.

9. Hemoglobin vs. Platelets Before Surgery

  • Both are important, but:

    • Platelets are critical to check before surgery to assess clotting ability and bleeding risk.

    • Hemoglobin is also important, but unless critically low, it doesn’t pose immediate risk like low platelets do.